The Meta-Cognitive Beliefs Questionnaire: development of a measure of obsessional beliefs

A 67 item self-report questionnaire called the Meta-Cognitive Beliefs Questionnaire (MCBQ) was developed to assess endorsement of beliefs about the importance of control and negative consequences associated with unwanted, ego-dystonic intrusive thoughts, images and impulses. The MCBQ and a battery of questionnaires that assessed symptoms and cognitions of worry, obsessive-compulsive disorder, anxiety, and depression were administered to large samples of undergraduate students. Beliefs about control of intrusive thoughts and perceived negative consequences due to uncontrolled mental intrusions had a unique significant relationship with obsessions, and to a lesser extent, worry. These findings are consistent with current cognitive behavioral theories that suggest an important role for meta-cognitive beliefs in the pathogenesis of obsessions.     

Implicit and explicit appraisals of the importance of intrusive thoughts

To evaluate cognitive theories of obsessions, the current study experimentally manipulated appraisals of the importance of intrusive thoughts. Undergraduate students (N = 156) completed measures of obsessive-compulsive disorder (OCD) symptoms and beliefs and were primed with a list of commonly reported unwanted thoughts. Participants were then informed that unwanted thoughts are either (1) significant and indicative of their personal values, or (2) meaningless, or participants (3) received no instructions about unwanted thoughts. Participants then completed implicit and explicit measures of self-evaluation and interpretations of their unwanted thoughts. Results indicated that the manipulation shifted implicit appraisals of unwanted thoughts in the expected direction, but not self-evaluations of morality or dangerousness. Interestingly, explicit self-esteem and beliefs about the significance of unwanted thoughts were associated with measures of OCD beliefs, whereas implicit self-evaluations of dangerousness were better predicted by the interaction of pre-existing OCD beliefs with the manipulation. Results are discussed in terms of divergent predictors of implicit and explicit responses to unwanted thoughts.     

Family dysfunction as a risk factor in the development of antisocial behavior.

Many studies have indicated a positive correlation between family dysfunction and subsequent cognitive and behavioral problems in offspring. The purpose of this study was to compare the family histories of 118 inmates with those of 45 college students and to document differential patterns. The possible social implications of the data are discussed as well as directions for further research.     

Cognitive-behavioural therapy for young children with anxiety disorders: Comparison of a Child + Parent condition versus a Parent Only condition

The present study compared the efficacy of a group-based cognitive-behavioural treatment (GCBT) delivered exclusively to parents of young anxious children (between 4 and 8 years of age) with the same intervention delivered to both children and parents, relative to a Wait-list Control condition. Parents of children in the Parent Only condition (N = 25) received 10 weekly sessions of GCBT whereas children and parents in the Parent + Child condition (N = 24) each received 10 weekly sessions of GCBT. Intent-to-treat analyses indicated that both active treatment conditions were superior to the Wait-list condition (N = 11), with 55.3% of children in the Parent Only condition and 54.8% of children in the Parent + Child condition no longer meeting criteria for their principal diagnosis at post-treatment. These treatment gains were maintained in both treatment conditions at six-month and 12-month follow-up assessments. There were no significant differences between the two active conditions on other outcome measures including parental psychopathology and parenting style. However, an unexpected finding was that parenting satisfaction and to some extent parenting competence reduced significantly from pre- to post-treatment regardless of the active treatment condition. The present results suggest that GCBT delivered exclusively to parents of young anxious children may be a viable treatment alternative for improving accessibility to efficacious treatments for children with anxiety disorders and for reducing costs associated with mental health care delivery.     

The effectiveness of stand-alone cognitive-behavioural therapy for body image: a meta-analysis

This meta-analysis examined the effectiveness of stand-alone body image (BI) cognitive-behavioural therapy (CBT). Nineteen studies met inclusion criteria. The behavioural dimension of BI improves most after BI CBT while the investment dimension improves the least. Individuals with clinical BI disturbances improve more than do college student samples. Treatments addressing the attitudinal, behavioural, and perceptual components of BI are more effective than treatments addressing attitude and behaviour only. Therapist-assisted therapy is more effective than is self-directed therapy. BI variables improve somewhat more than do general psychological variables, while the latter show equivalent improvement. Finally, treatment gains are maintained at follow-up. More research is needed to better understand and treat the investment dimension of BI.     

Parenting and mother-infant interactions in the context of maternal postpartum obsessive-compulsive disorder: Effects of obsessional symptoms and mood

BackgroundMaternal mental illness is associated with negative effects on the infant and child. Increased attention has been paid to the effects of specific perinatal disorders on parenting and interactions as an important mechanism of influence. OCD can be a debilitating disorder for the sufferer and those around them. Although OCD is a common perinatal illness, no previous studies have characterized parenting and mother infant interactions in detail for mothers with OCD.Methods37 mothers with postpartum OCD and a 6 month old infant were compared with 37 community control dyads on a variety of measures of psychological distress and parenting. Observed mother-infant interactions were assessed independently.ResultsObsessions and compulsions were reported in both groups, although they did not cause interference in the control group. Mothers with OCD were troubled by their symptoms for a mean of 9.6 hours/day. Mothers with OCD were less confident, reported more marital distress and less social support than healthy peers and were less likely to be breastfeeding. Infant temperament ratings did not differ. Mothers with OCD were rated as less sensitive in interactions than the comparison group, partly attributable to levels of concurrent depression.ConclusionsMaternal postpartum OCD is a disorder that can affect experiences of parenting and mother-infant interactions although this may not be driven by OCD symptoms. Longitudinal studies are required to assess the trajectory and impact of maternal difficulties as the infant develops.     

Psychoeducation for hypochondriasis: a comparison of a cognitive-behavioural approach and a problem-solving approach

In this study, two 6-week psychoeducational courses for hypochondriasis are compared, one based on the cognitive-behavioural approach, and the other on the problem-solving approach. Effects of both courses on hypochondriacal complaints, depression, trait anxiety, and number of problems encountered in daily life, are measured pre-treatment, post-treatment, and at 1- and 6-month follow-up. Participants (N=48, of whom 4 dropped out), suffering from DSM-IV hypochondriasis, were randomized into one of the two course conditions. Results showed beneficial effects of both courses. Few differential treatment effects were found: in both conditions all effect measures decreased significantly over time (p<0.01). However, between- and inter-individual variability in decrease-patterns was of considerable size, leading to large deviations from the mean pattern. Acceptability and feasibility of both courses were rated highly by their respective participants. It is concluded that both courses can be considered equally beneficial and effective over time, with the effects evident immediately after treatment and maintained over the follow-up period.     

Memory of the traumatic event as a risk factor for the development of PTSD: lessons from the study of traumatic brain injury

Traumatic memories, and the mechanisms by which they operate, continue to occupy a central role in the scientific investigation of risk factors for the development of posttraumatic stress disorder (PTSD). However, empirically based studies are constrained by practical and ethical considerations and are limited to naturalistic models. Consequently, the paradigms most appropriate for the exploration of the relationship between traumatic memories and PTSD have been identified in conditions involving traumatic events where memories may be compromised. Indeed, traumatic brain injury, a condition that is commonly associated with memory impairment, has often been utilized as a naturally occurring model for the study of traumatic memory and its contribution to the development of PTSD. This article presents a critical review of these research efforts and discusses their theoretical and clinical implications.     

Shyness as a risk factor for second language acquisition of immigrant preschoolers

The aim of this study was to examine whether shyness is a risk factor for second language acquisition in immigrant preschoolers. Results from studies on first language acquisition indicate that shy children show less favorable language development; however, it remains unclear how shyness affects second language acquisition. As second language skills are often acquired in interactions outside the family where shyness is more evident, we postulate that shyness has a strong negative effect on second language acquisition. This hypothesis was examined using standardized tests and parental ratings in a sample of 330 immigrant preschoolers cross-sectionally and with 130 immigrant preschoolers longitudinally. The analyses revealed lower second language competence as well as slower language development in shy immigrant children compared to their non-shy counterparts. The present study highlights that not only contextual but also personality factors need to be considered for a comprehensive understanding of second language acquisition in immigrant children.     

Poor social skills are a vulnerability factor in the development of psychosocial problems

This 2‐wave panel study sought to test a social skills deficit vulnerability model of psychosocial problems. According to this model, poor social skills are thought to make people vulnerable to psychosocial problems pursuant to the experience of stressful life events. This model was tested in a sample of 118 students who were moving at least 200 miles away from their home town and making the transition to their first semester of college. At the end of their high school career, participants completed measures of social skills and the following psychosocial problems: depression, loneliness, and social anxiety. Toward the end of their first semester of college, they again completed measures of the psychosocial problems and a measure of stressful life events. Results indicated that lower social skills scores at T1 were predictive of a worsening of psychosocial problems over the course of the study. Furthermore, social skills interacted with stressful life events to predict changes in depression and loneliness. In each case, those with lower social skills at T1 appeared more vulnerable to the development of psychosocial problems by T2 than those with better social skills at T1.     

Childhood experience of illness as a risk factor for medically unexplained symptoms

Clinical experience suggests that a high proportion of patients with medically unexplained symptoms or somatoform disorders give histories of adverse childhood experiences. Previous work has reported that both personal and family experience of illness may be associated with later unexplained symptoms in the individual. Most of this research is subject to recall bias. This review explores data from the UK Medical Research Council National Survey of Health and Development, a population-based birth cohort study. The main finding of this work is that childhood experience of illness in parents is an independent risk factor for later unexplained symptoms. Personal experience of illness has a more complicated relationship. There is no evidence that severe physical disease in childhood is associated with later unexplained symptoms, but common childhood unexplained symptoms are predictors of symptoms in adulthood.     

Follow-up results of a cognitive-behavioural treatment for chronic pain in a primary care setting

Abstract

An outpatient cognitive-behavioural treatment programme for pain control was administered to chronic pain patients in three primary care practices with a medical psychologist as a group therapist. The patients suffered from headaches, migraines, cervical pain, shoulder-arm pain, and low back pain. A matched sample of patients with the same disorders served as a waiting-list control group. The programme consisted of training in progressive muscle relaxation, several attention related techniques, and cognitive restructuring as well as reinforcing non-pain behaviour, and aimed at an improvement of self-control strategies. At the six month follow-up, the treated subjects showed improvements in their average scores of anxiety, depression and bodily symptoms compared with the untreated controls. Pain intensity was reduced by 34% in those subjects (9 out of 25) who were most adherent to the treatment regimen. Our results indicate a long-term improvement in well-being as a consequence of the treatment. This was confirmed by the ratings of the physicians and by the reduced number of patient-physician contacts three months post treatment as compared to the controls. Treatment adherence seems to be a most important agent in maintaining long-term reductions of pain intensity.     

Media violence use as a risk factor for aggressive behaviour in adolescence

Whether exposure to violence in the virtual reality of the media has an impact on users’ aggressive behaviour has been a controversial issue in academic as well as public debate. This article summarises a programme of research conducted with adolescents in Germany that presents cross-sectional and longitudinal evidence for the association between violent media use and aggression. It provides experimental evidence in support of mediating variables, such as hostile attributional style, increased normative acceptance of aggression, and emotional desensitisation, which might explain the pathways from media violence use to aggression. In addition it presents the development and experimental evaluation of a theory-based intervention designed to reduce media violence use and decrease its link with aggressive behaviour. The findings are discussed in the context of a large international body of research that points to the causal role of violent media use as a risk factor for aggressive behaviour.     

Preschool boys' development of emotional self-regulation strategies in a sample at risk for behavior problems

Little longitudinal research has been conducted on changes in children's emotional self-regulation strategy (SRS) use after infancy, particularly for children at risk. In this study, the authors examined changes in boys' emotional SRS from toddlerhood through preschool. Repeated observational assessments using delay of gratification tasks at ages 2, 3, and 4 years were examined with both variable- and person-oriented analyses in a low-income sample of boys (N = 117) at risk for early problem behavior. Results were consistent with theory on emotional SRS development in young children. Children initially used more emotion-focused SRS (e.g., comfort seeking) and transitioned to greater use of planful SRS (e.g., distraction) by 4 years of age. Person-oriented analysis using trajectory analysis found similar patterns from 2 to 4 years, with small groups of boys showing delayed movement away from emotion-focused strategies or delay in the onset of regular use of distraction. The results provide a foundation for future researchers to examine the development of SRS in low-income young children.     

Thought-action fusion as a causal factor in the development of intrusions

Thought-action fusion refers to the tendency to treat thoughts and actions as equivalents. Some authors (e.g., Rachman, 1997; Behaviour Research and Therapy, 35, 793-802) have suggested that thought-action fusion plays a role in the etiology of obsessive intrusions. The present study sought to test this idea. Subjects (n = 19) in the experimental condition underwent a bogus EEG recording session. They were informed that the apparatus was able to pick up the word 'apple' and that thoughts of that word could result in the administration of electrical shocks to another person. After having spent 15 minutes in the EEG laboratory, experimental subjects and controls (n = 26) completed a short questionnaire containing items about characteristics of the target thought (e.g., frequency, aversiveness). Results indicate that thought-action fusion, indeed, promotes intrusive thinking in that it results in a higher frequency of target thoughts, more discomfort, and more resistance. Thus, the current findings support the idea that thought-action fusion may contribute to the development of obsessive intrusions.     

Maladaptive appraisals as a risk factor for posttraumatic stress: a study of trainee firefighters

This study tested the proposal that catastrophic appraisals are a risk factor for developing stress reactions after trauma. Trainee firefighters (N = 82) were assessed during training (and before trauma exposure), and 68 firefighters were subsequently reassessed 6 months after commencing firefighter duty (after trauma exposure). Initial assessment included the Clinician Administered PTSD Scale, the Traumatic Events Questionnaire, and the Posttraumatic Cognitions Inventory. The Clinician Administered PTSD Scale was again administered approximately 20 months after initial assessment and after trauma exposure. Posttraumatic stress at follow-up was predicted by pre*trauma catastrophic thinking (24% of variance). These findings accord with cognitive models predicting that a tendency to catastrophize about negative events is a risk factor for developing posttraumatic stress symptoms.     

Impaired specific autobiographical memory as a risk factor for posttraumatic stress after trauma

This study tested the proposal that impaired retrieval of specific autobiographical memories is a risk factor for psychological disturbance after trauma exposure. Trainee firefighters (N = 60) were assessed during training (before trauma exposure) on the Autobiographical Memory Test, Clinician Administered PTSD Scale, Beck Depression Inventory (BDI-II), and Traumatic Events Questionnaire. Participants were reassessed 4 years later (N = 46) on the Posttraumatic Diagnostic Scale and BDI-II. All participants had been exposed to multiple traumatic events, and 15% met criteria for posttraumatic stress disorder. Impaired retrieval of specific memories in response to positive cues prior to trauma exposure significantly predicted posttraumatic stress severity after trauma exposure. These findings provide initial evidence that impaired specific retrieval of memories may be a risk factor for posttraumatic stress.     

Childhood abuse as a risk factor for suicidal behavior in borderline personality disorder

A childhood history of sexual or physical abuse is highly prevalent in borderline personality disorder (BPD) and is associated with self-destructive behavior in clinical and nonclinical samples. Viewing BPD as a "high risk" disorder, we asked if childhood abuse was a risk factor for adult suicidal behavior or if it was related to other known risk factors for suicide in BPD. A semistructured Abuse History was obtained in 61 criteria-defined BPD patients, who were characterized by structured interviews and self-reports for Axis I disorders, Suicide History, BPD severity, hopelessness, impulsivity, impulsive-aggression, and antisocial traits. Occurrence and severity of childhood sexual abuse, but not physical abuse, predicted adult suicidal behavior independent of other known risk factors. The odds of a sexually abused patient attempting suicide in adulthood was over 10 times that of a patient who was never sexually abused. Given a history of childhood sexual abuse, the risk of adult suicidal behavior in BPD was increased by antisocial traits, severity of BPD, hopelessness, or comorbid major depressive episode (MDE).     

Peer victimization as a risk factor for schizotypal personality in childhood and adolescence

There has been no prior research on peer victimization and child or adolescent schizotypal personality. This study tests the hypothesis that increased peer victimization is associated with increased schizotypal personality. Schizotypy was assessed using the SPQ-C (Schizotypal Personality Questionnaire-Child) in 3,508 male and female schoolchildren aged 8 to 16 years. All forms of peer victimization (physical, verbal, social manipulation, attack on property) were associated with schizotypal personality in both males and females across all age groups. Significant victimization more than doubled schizotypy scores. It is hypothesized that peer victimization may predispose to paranoid ideation, social anxiety, and lack of close friends, and consequently heightened schizotypal personality.