Health-related Internet habits and health anxiety in university students

Health-related Internet use has grown rapidly, yet little research has considered how health anxious individuals use the Internet for this purpose. Our aim was to examine the relationships between health anxiety and the extent of, reasons for, and consequences of health-related Internet usage in university students (n = 255). Responses on a purpose-made Internet use questionnaire were correlated with health anxiety scores; multiple regression analyses controlling for depression and anxiety were also conducted. Health anxiety positively correlated with (all ps < .01): frequency of health-related searching (r_s = .163), proportion of health-related information sought (r_s = .200), time spent online for health purposes (r_s = .166), and number of searches for both illness (r_s = .453) and wellness (r_s = .208) information. Health anxiety further positively correlated with advantages perceived in health-related Internet use (r_s = .183), heightened tension (r_s = .364) and relief (r_s = .174) post-search, and perceived doctor disadvantages (r_s = .306), yet a greater likelihood to visit a doctor post-search (r_s = .217). Health anxiety also correlated with six measures of possible addiction to using the Internet for health purposes (r_s range = .171 to .366, all ps < .01). Some (including several potentially dysfunctional) aspects of health-related Internet use correlate with health anxiety. Research evaluating the possible role of Internet use in the development and maintenance of health anxiety is warranted.     

Imagining the future in health anxiety: the impact of rumination on the specificity of illness-related memory and future thinking

Individuals with health anxiety experience catastrophic fears relating to future illness. However, little research has explored cognitive processes involved in how health anxious individuals picture the future. Ruminative thinking has been shown to impede the ability to recall specific autobiographical memories, which in turn is related to maladaptive, categoric future thinking processes. This study examined the impact of rumination on memory and future thinking among 60 undergraduate participants with varying health anxiety (35% clinical-level health anxiety). Participants were randomized to experiential/ruminative self-focus conditions, then completed an Autobiographical Memory Test and Future Imaginings Task. Responses were coded for specificity and the presence of illness concerns. Rumination led to more specific illness-concerned memories overall, yet at the same time led to more categoric illness-related future imaginings. Rumination and health anxiety together best predicted overgeneral illness-related future imaginings. Highly specific illness-related memories may be maintained due to their personal salience. However, more overgeneral illness-related future imaginings may reflect cognitive avoidance in response to the threat of future illness. This divergent pattern of results between memory and future imaginings may exacerbate health anxiety, and may also serve to maintain maladaptive responses among individuals with realistic medical concerns, such as individuals living with chronic illness.     

安全依恋对人际信任的影响:依恋焦虑的调节效应

采用两个实验探讨了安全依恋启动对人际信任的影响,并考察了特质依恋风格的调节效应。实验1采用回忆书写任务启动安全依恋,采用3(启动分组:安全依恋启动,积极情绪启动,中性启动)×3(目标词类型:信任相关词,信任无关词,非词)混合实验设计考察了不同启动分组对信任词汇反应时的影响。结果发现,与积极情绪启动组和中性启动组相比,安全依恋启动能显著提高信任的词汇决策反应时,特质依恋焦虑起调节效应。实验2采用被试间设计,考察安全依恋启动对信任博弈任务中信任决策的影响,结果发现,安全依恋启动组被试在信任决策中分配的金额显著高于中性组被试,特质依恋焦虑起调节效应。研究结果验证了安全依恋对人际信任的"拓延–建构环"效应,对于促进社会信任的提升具有积极的现实意义。     

Computerized attention retraining for individuals with elevated health anxiety

Background and Objectives: Current cognitive-behavioral theorists conceptualize hypochondriasis as excessive health anxiety (HA). Growing evidence suggests that elevated HA is associated with attentional bias (AB) toward potential health-threat information. Design: This study aimed to examine the effects of attention retraining among individuals with elevated HA, using the established attention modification programs (AMP) designed to train participants to disengage attention from ideographically chosen health-threat words. Methods: Thirty-six randomly assigned individuals with elevated HA completed eight twice-weekly sessions of the AMP (n = 18) or the attention control condition (ACC; n = 18). Results: Despite using the well-established AMP protocol widely used within the field of anxiety disorders, we did not find evidence for change in AB following training. Further, AMP did not outperform ACC in reducing HA and other relevant emotional symptoms. However, both AMP and ACC evidenced overall significant symptom reduction in most of the outcome measures, including overall HA, anxiety sensitivity, general depression and anxiety, and somatic complaints. Conclusions: Further research is needed to better understand the effects and mechanisms of AMP as a possible cognitive intervention for HA.     

Health anxiety and hypochondriasis in the light of DSM-5

Background: In the DSM-5, the diagnosis of hypochondriasis was replaced by two new diagnositic entities: somatic symptom disorder (SSD) and illness anxiety disorder (IAD). Both diagnoses share high health anxiety as a common criterion, but additonal somatic symptoms are only required for SSD but not IAD. Design: Our aim was to provide empirical evidence for the validity of these new diagnoses using data from a case–control study of highly health-anxious (n = 96), depressed (n = 52), and healthy (n = 52) individuals. Results: The individuals originally diagnosed as DSM-IV hypochondriasis predominantly met criteria for SSD (74%) and rarely for IAD (26%). Individuals with SSD were more impaired, had more often comorbid panic and generalized anxiety disorders, and had more medical consultations as those with IAD. Yet, no significant differences were found between SSD and IAD with regard to levels of health anxiety, other hypochondriacial characteristics, illness behavior, somatic symptom attributions, and physical concerns, whereas both groups differed significantly from clinical and healthy controls in all of these variables. Conclusion: These results do not support the proposed splitting of health anxiety/hypochondriasis into two diagnoses. Further validation studies with larger samples and additional control groups are warranted to prove the validity of the new diagnoses.     

A mediation model linking attachment to God,self-compassion,and mental health

Attachment theory posits that insecure attachment is a risk factor for the development of anxiety and depression and ample evidence supports this idea. Research has also demonstrated links between attachment to God and mental health, but little is known about the emotion regulatory mechanism that underlies this relationship. The present study explored the explanatory role of self-compassion in the relation between attachment to God and anxiety, depression, and life satisfaction in a sample of 181 adults who completed an online survey. Elevated attachment anxiety and avoidance were associated with higher depression and anxiety, and lower life satisfaction. Self-compassion mediated these associations (in an inverse direction for anxiety and depression), suggesting that people who feel uncomfortable depending on God, or who fear God's rejection, have difficulty extending kindness to themselves. Possible interventions are discussed in the context of these results.     

Gender differences in health anxiety: An investigation of the interpersonal model of health anxiety

Health anxiety (HA) involves persistent worry about one’s health and beliefs one has an illness or may contract a disease. In the present study, gender differences in Noyes et al.’s (2003) interpersonal model of health anxiety (IMHA) were examined. Using a sample of 950 undergraduates (674 women; 276 men), multigroup confirmatory factor analyses suggested the measurement model for key dimensions of the IMHA (i.e., reassurance-seeking, alienation, worry, and absorption) were invariant across gender. This suggests key dimensions of this model are applicable to and generalizable across women and men. Coefficients alpha for and bivariate correlations between these IMHA dimensions were also roughly comparable across women and men. As hypothesized, mean levels of reassurance-seeking and worry were significantly higher in women compared to men. No gender differences were observed in mean levels of alienation or absorption. Reassurance-seeking and worry appear salient in the interpersonal behavior and emotional life of women with HA. The present study helps to clarify gender differences in the IMHA and other HA models involving similar variables.     

Priced just for me: The role of interpersonal attachment style on consumer responses to customized pricing

Customized pricing is an increasing phenomenon in the marketplace, but little is known about factors influencing consumer responses to customized pricing. The present paper seeks to gain an understanding of how, why, and when this emerging pricing mechanism may offer benefits. Specifically, this research focuses on how consumers respond to customized pricing tactics and, more specifically, on how interpersonal attachment orientations impact consumers' responses to prices offered in the presence of a customized pricing program. The results of 3 studies suggest that customized pricing programs likely create an expectation for a discounted price among securely attached individuals, such that these consumers are dissatisfied paying the shelf price in the presence of a customized pricing program. Overall, the results provide evidence that, although customized pricing programs are often used to enhance consumer evaluations, they may not always be effective. This paper advances prior research by integrating important considerations for both pricing and customization strategies based on individual and situational differences in attachment orientations.     

Predictors and consequences of sudden gains in transdiagnostic cognitive-behavioural therapy for anxiety disorders

Sudden gains—substantial stable symptom improvements between consecutive therapy sessions—are a common phenomenon. As condensed points of change, examination of sudden gains can provide insight into mechanisms of therapeutic change. This study investigated the association between sudden gains and cognitive change, therapeutic alliance, and/or client engagement in transdiagnostic group cognitive-behavioural therapy for anxiety disorders. Of 58 treatment initiators, 21% (n = 12) exhibited a sudden gain. Consistent with previous research, sudden gainers demonstrated significantly greater pre- to post-treatment symptom improvement than non-sudden gainers. Observational coding of therapy sessions found that sudden gains were associated with elevated levels of cognitive change and client engagement in the pre-gain session, and elevated levels of cognitive change and therapeutic alliance in the post-gain session. However, these results varied by use of within- and between-subject control comparisons, highlighting the value using a dual control methodology. In context of previous research, the results on cognitive change replicate previous findings in depressive populations, and clarify mixed findings in anxiety populations. The results on therapeutic alliance replicate previous findings for the first time in an anxiety sample, although the between-subject control comparisons revealed complexity previously undetected. This study was also the first to investigate and thus establish the relation between client engagement and sudden gains.     

The relationship between sensory responsiveness profiles,attachment orientations,and anxiety symptoms

Individual variations in the way people respond to sensory stimuli can sometimes lead to maladaptive representations of the world. Indeed, sensory responsiveness profiles were found to be associated with mood symptoms such as depression and anxiety. The goal of the current study was to investigate whether attachment orientations can account for the relationship between sensory responsiveness profiles and anxiety symptoms. Participants (N = 194) completed a battery of questionnaires assessing sensory responsiveness profiles, attachment orientations, and anxiety symptoms. As expected, various associations between sensory responsiveness profiles and anxiety symptoms were accounted for by attachment anxiety and avoidance. We suggest a possible causal path, in which early‐developing sensory responsiveness profiles lead to attachment insecurities, which in turn may lead to mood symptoms such as anxiety.     

Meta-analysis of the efficacy and acceptability of cognitive-behavioural therapy for Arab adult populations experiencing anxiety,depression or post-traumatic stress disorder

A meta-analysis of the literature of cognitive behaviour therapy (CBT) with Arab adult populations experiencing anxiety, depression or post-traumatic stress disorder (PTSD) was conducted. Nine studies (n = 536) met the eligibility criteria. Three of the nine studies (33%) were randomised control trials using waitlist control groups. All studies (100%) reported a statistically significant reduction in psychological symptoms at post-treatment with large effect sizes for anxiety (effect size, 95% confidence interval) (1.44 [1.29, 1.59]), depression (1.26 [1.16, 1.35]) and PTSD (2.08 [1.94, 2.23]). Six out of the nine studies (67%) collated follow-up data and reported that reductions of psychological symptoms were maintained at follow-up. An average dropout rate of 26% indicated good overall acceptability. Five out of nine (55%) of the trials reported diagnostic remission rates and of those trials the mean remission rate was 31%). Five of the nine eligible studies (55%) delivered remotely via Internet or telephone were found to have similar effect sizes as face-to-face CBT. The current meta-analysis indicates the potential of CBT, delivered either face-to-face or via internet, as efficacious and acceptable interventions for the treatment of anxiety, depression and PTSD for Arab adult populations.     

Recommendations for the Treatment of Hypochondriac Patients

Hypochondriasis is a debilitating condition in which patients are persistently preoccupied with the possibility of being seriously ill. Its is a costly problem for the health care system whose treatment has not received systematic attention until recently. Although based on few controlled studies, results indicated that various brief cognitive-behavioral techniques produce significant changes in illness fears and attitudes. A list of therapeutic questions that require further study is presented and some indications for both therapists and patients are given.     

Anxiety reactivity and anxiety perseveration represent dissociable dimensions of anxiety vulnerability: A replication and extension

Trait anxiety is a unitary construct reflecting individual differences in the tendency to experience anxious symptomatology, typically measured with questionnaires such as the Spielberger Trait Anxiety Inventory (STAI‐T). Recent research by Rudaizky, Page, and MacLeod has found evidence that two different dimensions of trait anxiety account for independent variance in trait anxiety scores. These dimensions are anxiety reactivity (AR), reflecting the probability of experiencing an anxious reaction, and anxiety perseveration (AP), reflecting the persistence of anxious symptoms once elicited. There are two key issues addressed in this study: first, the replicability of Rudaizky et al.'s findings and second, the ability of the measures of AR and AP developed by Rudaizky et al. to predict independent variance in STAI‐T scores after statistically controlling for variance shared with a measure of depression. Regression analysis determined that AR and AP do account for independent variance in STAI‐T trait anxiety scores even after statistically controlling for depression. The implications of these findings for the understanding of anxiety vulnerability are discussed.     

Fear of death mediates ostracism distress and the moderating role of attachment internal working models

Ostracism is known to cause psychological distress; however, it remains unclear why ostracism evokes this response. Two experiments tested empirically whether fear of death mediates ostracism effects and whether attachment internal working models moderate this role. A total of 288 participants played Cyberball with two other ostensible players. After the game the accessibility of their death-related thoughts was assessed by a word completion task, and the Needs Satisfaction Scale was used to measure their distress. Participants’ attachment orientation was measured using the Experiences in Close Relationship scale. Death anxiety fully mediated ostracism distress. However, this effect was stronger in low-anxiety individuals. These studies contribute to the ostracism literature by providing further empirical support that death anxiety mediates ostracism distress, and to the attachment literature by documenting the moderation effect of attachment anxiety.     

Anxiety reactivity and anxiety perseveration represent independent dimensions of anxiety vulnerability: an in vivo study

Trait anxiety is a relatively stable disposition reflecting an individual's tendency to experience anxious symptomatology, typically measured using questionnaires such as the Spielberger Trait Anxiety Inventory (STAI-T). While trait anxiety commonly is considered a unitary construct, recent questionnaire research suggests that two different dimensions of anxiety vulnerability account for independent variance in trait anxiety scores. These dimensions are anxiety reactivity (AR), reflecting the intensity of anxiety reactions to stressors, and anxiety perseveration (AP), reflecting the persistence of anxiety symptoms. This study investigated whether in vivo measures of these two facets independently contribute to anxiety vulnerability. Seventy-two participants were exposed to a novel stress task designed to yield measures of AR and AP. Regression analysis determined that these in vivo measures were unrelated to each other, and each accounted for independent variance in trait anxiety scores. The implications of these findings for the assessment and understanding of anxiety vulnerability are discussed.     

Specific and differential prediction of health anxiety by disgust sensitivity and propensity

Current models of health anxiety suggest that fear resulting from false alarms to perceived threats to one's health results in the development of hypochondriasis and related disorders. Disgust has been proposed as an affective response that may function as an etiological and maintenance mechanism in health anxiety. Moreover, the way in which an individual perceives the disgust response (disgust sensitivity) may affect health anxiety, separately from their likelihood of experiencing disgust (disgust propensity). The present study utilized multiple hierarchical regression analysis to investigate the degree to which self-reported disgust sensitivity and disgust propensity differentially predict elevated health anxiety in a sample of 620 non-treatment-seeking undergraduates. Further, this effect is tested in comparison to that of anxiety sensitivity, a construct demonstrated to be strongly related to health anxiety. Analyses indicate that disgust sensitivity, rather than disgust propensity, is primarily responsible for this relation. An additional analysis tested the specificity of disgust sensitivity relative to anxiety sensitivity. Disgust sensitivity was no longer significant after including anxiety sensitivity in the model. Suggestions for further evaluation of this relation are provided. These results suggest that although disgust sensitivity may appear related to health anxiety, this relation may be confounded by anxiety sensitivity.