The effects of safety behaviors on health anxiety: an experimental investigation

The present study examined the extent to which safety behaviors exacerbate symptoms of hypochondriasis (severe health anxiety). Participants were randomized into a safety behavior (n = 30) or control condition (n = 30). After a baseline period, participants in the safety behavior condition spent one week actively engaging in a clinically representative array of health-related safety behaviors on a daily basis, followed by a second week-long baseline period. Participants in the control condition monitored their normal use of safety behaviors. Compared to control participants, those in the safety behavior condition reported significantly greater increases in health anxiety, hypochondriacal beliefs, contamination fear, and avoidant responses to health-related behavioral tasks after the safety behavior manipulation. In contrast, general anxiety symptoms did not significantly differ between the two groups as a function of the manipulation. Mediational analyses were consistent with the hypothesis that changes in the frequency of health-related thoughts mediated the effects of the experimental manipulation on health anxiety. These findings suggest that safety behaviors are associated with increases in health anxiety, perhaps by fostering catastrophic thoughts about health. The implications of these findings for the conceptualization of hypochondriasis as an anxiety disorder are discussed.     

The feature-positive effect and hypochondriacal concerns

There is evidence to suggest that people have more problems with processing information that is absent (negative information) than with present (positive) information. This bias of overweighing positive and underweighing negative information has been termed the "feature-positive effect" (FPE). Typically, hypochondriasis is characterized by excessive focusing on bodily complaints (cf. positive information), and at the same time discarding negative medical test results (cf. negative information). It was explored whether the FPE is involved in this pattern. Fifty-three undergraduates completed a measure of hypochondriacal concerns and a general, domain-free test of the FPE. As expected, a positive correlation between the FPE and hypochondriacal concerns was observed. Implications for cognitive-behavioural theory are discussed.     

Is the Positive Illusory Bias Illusory? Examining Discrepant Self-Perceptions of Competence in Girls with ADHD

It has been claimed that excessively positive self-perceptions of competence are a key risk factor for concurrent and subsequent impairments in youth with attention-deficit/ hyperactivity disorder (ADHD). We examined whether girls with ADHD demonstrate positive illusory self-perceptions in scholastic competence, social acceptance, and behavioral conduct domains. We then tested, across a five-year longitudinal span, whether (a) such self-perceptions versus (b) the constituent informant ratings or test scores were more strongly predictive of adolescent impairment and positive adjustment. Participants included an ethnically diverse sample of 140 girls with ADHD and 88 comparison girls, aged 6-12 at baseline (M?=?9.0, SD?=?1.7). Girls with ADHD rated themselves as more positive than indicated by external ratings, but these self-reports were still in a negative direction (comparison girls rated themselves as less positive than these indicators). ADHD subtypes were not related to discrepancy scores. Higher rates of depression symptoms were associated with attenuated discrepancy scores. Crucially, measures of actual competence were more strongly associated with adolescent impairment and positive adjustment than were "illusory" self-perceptions for girls with ADHD. Our findings challenge the view that, at least in girls with ADHD, overly positive and "illusory" appraisals of competence are strongly associated with future impairment and adjustment. The key psychometric point is that, in difference or discrepancy scores, the individual components of such scores should be separately examined.     

Managing Hypochondriasis in Elderly Clients

The present paper provides a diagnostic and treatment overview of geriatric hypochondriasis. It is suggested that our current definition of hypochondriasis may be inadequate in describing the complexity of the disorder and its varied manifestations in the general population and especially in our geriatric population. Attempts by researchers to provide greater diagnostic clarity are reviewed, including the concepts of hypochondriasis as a discrete disorder (primary hypochondriasis) and hypochondriasis as part of a comorbid mix of disorders (secondary hypochondriasis). Diagnostic features of geriatric hypochondriasis are discussed, including comorbidity, prevalence, the relationship of medical illness to hypochondriacal symptomatology, and etiology. Treatment considerations which are reviewed include: the importance of respect for the defenses of the client, the importance of venting and expressions of feeling by the client, the creation of a psychological atmosphere of professional and interpersonal support, and reattribution training. It is suggested that hypochondriasis is a social “communication” and that comorbidity itself may be the key to unlocking the unspoken “messages” of hypochondriacal older adults.     

Interpretation of bodily symptoms in hypochondriasis.

Although it has been suggested that hypochondriasis is caused by the misinterpretation of innocuous bodily sensations, support for this hypothesis rests largely upon uncontrolled self-report. We investigated the interpretation of ambiguous bodily sensations in three experiments using separate samples of non-clinical subjects differing in level of hypochondriacal concern. Results confirmed that subjects with high hypochondriacal concern endorse more thoughts about illness interpretations of bodily sensations, but reported thought content resembled 'catastrophic' rather than the 'non-emergency' thoughts suggested by Warwick and Salkovskis (Hypochondriasis. Behavior Research and Therapy, 28, 105-117, 1990). Presence of an interpretive bias was further supported in a study of recognition bias for disambiguated versions of ambiguously threatening sentences, although this applied as much to social as to illness threats. A final experiment failed to support the hypothesis of an automatic inference bias, but did show that subjects with high hypochondriacal concern were quicker to correctly identify previously exposed illness words. Thus, reported thoughts are consistent with catastrophic interpretations of common bodily sensations, but interpretive bias may not be limited to illness threat. However, high hypochondriacal subjects do show a more specific enhanced perceptual sensitivity to illness cues, which may play a role in maintaining their concern with bodily symptoms.     

Modelling decisions to undergo genetic testing for susceptibility to common health conditions: an ancillary study of the Multiplex Initiative

New genetic tests reveal risks for multiple conditions simultaneously, although little is understood about the psychological factors that affect testing uptake. We assessed a conceptual model called the multiplex genetic testing model (MGTM) using structural equation modelling. The MGTM delineates worry, perceived severity, perceived risk, response efficacy and attitudes towards testing as predictors of intentions and behaviour. Participants were 270 healthy insured adults aged 25-40 from the Multiplex Initiative conducted within a health care system in Detroit, MI, USA. Participants were offered a genetic test that assessed risk for eight common health conditions. Confirmatory factor analysis revealed that worry, perceived risk and severity clustered into two disease domains: cancer or metabolic conditions. Only perceived severity of metabolic conditions was correlated with general response efficacy (β?=?0.13, p<0.05), which predicted general attitudes towards testing (β?=?0.24, p<0.01). Consistent with our hypothesised model, attitudes towards testing were the strongest predictors of intentions to undergo testing (β?=?0.49, p<0.01), which in turn predicted testing uptake (OR 17.7, β?=?0.97, p<0.01). The MGTM explained a striking 48% of the variance in intentions and 94% of the variation in uptake. These findings support use of the MGTM to explain psychological predictors of testing for multiple health conditions.     

青少年抑郁综合认知模型及其性别差异

Beck抑郁认知理论认为功能失调性态度和自动思维对抑郁的形成和发展有着重要的影响, 但是不同水平的认知因素在青少年抑郁中起什么样的作用还有待于进一步的研究。根据Oei和Kwon (2007)综合认知模型(ICM), 我们假设在青少年负性生活事件和抑郁症状间功能失调性态度是调节变量, 而自动思维是中介变量。研究采用开学初和临近期末间隔近四个月两个时间点的纵向数据搜集方式, 对613名初中生施以青少年生活事件量表(ASLEC)、功能失调性态度问卷(DAS)、自动思维问卷(ATQ)以及流调中心用抑郁量表(CES-D), 然后通过路径分析对模型进行了拟合度和性别差异检验, 结果表明：(1)各变量显著相关(p<0.01), 且各变量间隔四个月两个时间点的分数差异显著(p<0.01); (2)修正后的青少年抑郁综合认知模型较好地拟了数据, 且功能失调性态度与负性生活事件的交互作用对自动思维的影响上女生的路径系数显著大于男生。结论：功能失调性态度在负性生活事件和青少年抑郁症状间起调节作用, 而自动思维从中起到了认知中介的作用, 且该模型性别差异显著。     

Clients’ perceptions of personal psychotherapy or counselling for therapists

The purpose of this study was to examine clients’ opinions of therapists’ personal use of psychotherapy or counselling. Participants in this study, a nationwide sample of clients recruited through Amazon’s MTurk system, were asked to complete an online survey assessing their attitudes towards treatment use by therapists as well as their general attitudes towards psychological help-seeking and perceptions of stigma (social and self) with psychological treatments. In this study, we found that clients generally had positive views about therapists’ personal use of psychotherapy or counselling. Although overall positive attitudes were found, the results from repeated measures ANOVAs indicated that attitudes depended somewhat on whether the therapist had sought out treatment as part of a training requirement for self-enrichment, or for the treatment of a psychological problem. In addition, participating clients were less supportive of therapists disclosing a treatment use history with their clients. Regression analyses also indicated that attitudes towards treatment use by therapists were significantly predicted by general help-seeking attitudes and perceptions of stigma (social and self), but attitudes towards disclosure were not. The findings from this study have important implications regarding therapist treatment use and disclosure in practice.     

Justice Beliefs,Personal Well-Being and Harsh Social Attitudes: Initial Demonstration of a Polynomial Regression and Response Surface Methodology

Tendencies to believe in justice are multidimensional and include beliefs that the world is fair to one’s self (personal justice beliefs) as well as to others (general justice beliefs). Previous research suggests that personal and general justice beliefs are divergently linked to well-being and harsh social attitudes, respectively. However, whether and how these justice tendencies conjointly affect well-being and harsh social attitudes is less well known. Guided by equity theory, the current study used polynomial regression and surface response methodology to demonstrate how specific discrepancies between justice beliefs for self and others predict personal well-being and harsh social attitudes. Participants (N?=?1079) completed measures of tendencies to believe in personal and general justice, as well as measures of physical symptoms associated with illness and attitudes towards the poor. Results suggested that discrepancy between personal and general justice beliefs had detrimental effects on these outcomes (i.e., higher number of illness symptoms and harsher attitudes towards the poor). Moreover, discrepancy resulting from a strong belief in general justice and a weak belief in personal justice (i.e., other-favorable discrepancy) was more strongly negatively associated with well-being and positively associated with harsh attitudes towards the poor than discrepancy resulting from a strong personal justice belief and a weak general justice belief (i.e., self-favorable discrepancy). The current research highlights the potential for personal and general justice beliefs to conjointly predict well-being and social attitudes, while simultaneously demonstrating the capacity to better understand these interactive relationships through the use of surface response methodology.     

Manipulating the role of cognitive control while taking the implicit association test

The Implicit Association Test (IAT) is one of the most widely used methods for measuring attitudes in the behavioral and social sciences. Recent studies have found that individual differences in cognitive control correlate with IAT scores. However, these studies did not collect independent measures of attitude, which makes it difficult to isolate the construct of attitude separate from cognitive control. Furthermore, no study has examined whether the role of cognitive control can be manipulated, which is necessary to establish a causal link between cognitive control and IAT performance. By collecting independent measures of attitude (explicit attitude ratings and the Affect Misattribution Procedure: AMP), Experiment 1 factored out the role of attitude for two different IATs and still found a relationship between IAT scores and cognitive control (Stroop and stop-signal). Experiments 2 and 3 manipulated the role of cognitive control through instructions and feedback regarding the race IAT's measurement goal. These manipulations increased average IAT scores (i.e., stronger preference for whites), increased the relationship with cognitive control (Stroop), and decreased the relationship with attitude (AMP). These results demonstrate that cognitive control influences IAT performance rather than merely correlating with IAT performance.     

The role of disgust in patients with hypochondriasis

Theoretically, disgust sensitivity and disgust proneness could play an important role in hypochondriasis, since disgust is a defensive emotion widely believed to protect the organism from illness. However, empirical evidence to support this hypothesis has so far been based only on nonclinical samples, so that the importance and specificity of disgust for hypochondriasis remains unclear. In the current study, 36 patients with hypochondriasis, 27 with an anxiety disorder, and 29 healthy controls completed several measures which included the assessment of disgust sensitivity (Scale for the Assessment of Disgust Sensitivity) and disgust proneness (Questionnaire for the Assessment of Disgust Proneness). We found that patients with hypochondriasis and those with an anxiety disorder had higher scores than those of the healthy controls for several measures of disgust proneness. Moreover, measures of hypochondriacal characteristics were associated with those of disgust proneness and disgust sensitivity. However, no differences were found between patients with hypochondriasis and those with anxiety disorders, with respect to disgust proneness and disgust sensitivity. Therefore, it can be assumed that disgust proneness and disgust sensitivity seem to be less specific than previously suggested for the development and maintenance of hypochondriasis.     

Print adverts: Not remembered but memorable

Attempts to measure advertising effectiveness have relied on explicit memory measures based on recall or recognition. However, recent cognitive research has shown that not only is it possible to measure unconscious effects of prior experience through implicit tests of memory, but that such performance is independent of explicit recollection. The present study sought to determine whether it is possible to demonstrate the same pattern of findings using print advertising in an ecologically valid situation. Eighty subjects saw 25 full-page colour magazine adverts in either a deliberate or incidental study condition and subsequently rated (on four salient dimensions) a set of 50 adverts, which included the target adverts. Following the ratings subjects were asked to indicate which of the adverts they recognized as having been in the original set. While the deliberate study group recognized around 60 per cent of the adverts, the incidental study group recognized only 11 per cent. However, both groups showed the same positive bias in attitudes towards the adverts they had been exposed to compared to the ones they had not seen before. Thus, in line with by the cognitive literature, it is possible to show shifts in attitudes that are independent of conscious recollection. This data questions advertisers' reliance one explicit memory tests as measures of advertising effectiveness.     

Do increases in physical activity encourage positive beliefs about further change in the ProActive cohort?

Effects of behaviour change on cognitions are rarely examined within the Theory of Planned Behaviour. We tested whether increases in physical activity resulted in more positive beliefs about further change among a cohort of sedentary adults participating in a behavioural intervention trial (ProActive). At baseline, 6 and 12 months, 365 adults completed questionnaires assessing physical activity and cognitions about becoming more active over the coming year. Objective activity was assessed at baseline and 12 months. Participants reporting larger increases in activity were no more positive about making further increases than those reporting less behaviour change (p-values > 0.05). Participants with larger increases in objective activity reported weaker perceived control (β?=??0.342; p?=?0.001) and more negative instrumental attitudes (β?=??0.230; p?=?0.017) at 12 months. Participants may have felt that they had changed enough or measures of perceived success may be more sensitive to behaviour change. Alternatively, long measurement intervals may have missed immediate cognitive and affective consequences of behaviour change, or such effects may require participants to consistently self-monitor or receive feedback on performance. Future studies could test the effect of such techniques on physical activity and a wider range of cognitive, affective and physiological consequences, using more frequent measurement intervals.     

Are Reports of Life Event Stress among Suicidal Youth Subject to Cognitive Bias?

Severity of depressive symptoms, hopelessness, and suicidal ideation were examined to determine whether they were significantly associated with the accuracy of suicidal adolescents' ratings of stressful life events. The sample included 130 inpatient adolescents who endorsed suicide‐related behaviors. Stress interviews were administered, and the severity of stressful events was rated separately by adolescents and an independent team. A residualized cognitive bias score was created by regressing adolescents' severity ratings to the independent team's severity ratings of the same events. Depressive symptoms, but not hopelessness or suicidal ideation, were significantly associated with cognitive bias scores. A negative cognitive bias in adolescents' reports of life stress may be present at higher levels of depression relative to minimal levels of depression. Further research on the relations between stress and suicide‐related behaviors is encouraged to include independent ratings of stress severity.     

Socio-ecological influences of attitudes toward disability among Kenyan undergraduate students

This study examined personal and contextual variables as predictors of attitudes toward disability at a Kenyan higher education setting. Participants were a convenience sample of 309 undergraduate students at a Kenyan university enrolled in Sociology, Social Work, Psychology, Political Science, and Public Administration majors. Data on attitudes were collected using the Attitudes Towards Disabled Persons scale (ATDP: Antonac & Livneh, 1988). A cross-sectional survey design was employed for data collection, and a multiple regression analysis was used for data analysis. Results revealed that the model was significant: F (9, 250)?=?2.784, p?=?0.004. However, only age (β?=?0.173, p?=?0.044) significantly predicted attitudes towards disability, indicating older students held more positive attitudes than their younger counterparts. Older students had a more favourable attitude towards people with disabilities than younger students. Seniority, by age, is highly valued in Africa than perhaps anywhere in the world. Kenyan older adults may be key to enhancing favourable attitudes toward individuals with disabilities in Kenya as well as interventions aimed at changing negative attitudes towards people with disabilities.     

‘We are the good guys but they are not bad’. In‐group positivity and cognitive performance in preschoolers

The general purpose of this study was to analyse the developmental relations between the early forms of ethnic attitudes, and the classification abilities of the young child. We designed new cognitive tasks within a detection paradigm adapted to preschoolers and attitudinal tasks that were presented as games in a computer screen. Participants were 75 majority‐group children of 3, 4, and 5 years of age. Children's preferences and positive/negative attitudes towards the in‐group (Spaniards) and three out‐groups (Latin‐Americans, Africans, and Asians) were measured. The results showed a remarkable preference and positivity for the in‐group, but not out‐group derogation. Children's cognitive performance, to a greater extent than their age, was positively associated with in‐group favouritism and positivity. On the other hand, we found some interesting differences and developmental changes in children's positive orientation to the out‐groups that are discussed in the last section.     

Emotional inertia contributes to depressive symptoms beyond perseverative thinking

The autocorrelation or inertia of negative affect reflects how much negative emotions carry over from moment to moment and has been associated with increased depressive symptoms. In this study, we posed three challenges to this association by examining: (1) whether emotional inertia is relevant for depressive symptoms when assessed on a longer timescale than usual; (2) whether inertia is uniquely related to depressive symptoms after controlling for perseverative thoughts; and (3) whether inertia is related to depressive symptoms over and above the within-person association between affect and perseverative thoughts. Participants (N = 101) provided ratings of affect and perseverative thoughts for 100 days; depressive symptoms were reported before and after the study, and again after 2.5 years. Day-to-day emotional inertia was related to depressive symptoms over and above trait and state perseverative thoughts. Moreover, inertia predicted depressive symptoms when adjusting for its association with perseverative thoughts. These findings establish the relevance of emotional inertia in depressive symptoms independent of perseverative thoughts.     

Factor Structure and Incremental Utility of the Multidimensional Cognitive Attentional Syndrome Scale (MCASS): A Bifactor Analysis

The Multidimensional Cognitive Attentional Syndrome Scale (MCASS) was developed to assess the seven maladaptive forms of self-regulation that make up the cognitive attentional syndrome (CAS). Both theory and empirical evidence highlight important distinctions among the seven forms of self-regulation underlying the CAS. The primary purpose of the present study was to determine whether the MCASS item scores are sufficiently multidimensional to warrant the use of subscale scores. A secondary aim was to examine the incremental utility of the MCASS domain-specific factors. A battery of self-report measures was administered to adults recruited through a crowd-sourcing website (N?=?359). Bifactor analysis was used to examine the multidimensionality of MCASS item scores. This analytic approach allowed for the quantification of variance captured by each domain-specific item score independent of the general factor. Results from the bifactor analysis suggest that the MCASS is a multidimensional measure, consisting of a strong general factor and domain-specific factors that are sufficiently distinct. Additionally, the majority of domain-specific factors provided incremental utility in predicting two criterion variables (i.e., general distress, happiness emotion goals) after accounting for the general factor. Taken together, results support continued use of the MCASS total scale and subscale scores and suggest that researchers may want to consider using a bifactor model when examining structural models that include the MCASS.

     

Do increases in physical activity encourage positive beliefs about further change in the ProActive cohort?

Effects of behaviour change on cognitions are rarely examined within the Theory of Planned Behaviour. We tested whether increases in physical activity resulted in more positive beliefs about further change among a cohort of sedentary adults participating in a behavioural intervention trial (ProActive). At baseline, 6 and 12 months, 365 adults completed questionnaires assessing physical activity and cognitions about becoming more active over the coming year. Objective activity was assessed at baseline and 12 months. Participants reporting larger increases in activity were no more positive about making further increases than those reporting less behaviour change (p-values>0.05). Participants with larger increases in objective activity reported weaker perceived control (β=-0.342; p=0.001) and more negative instrumental attitudes (β=-0.230; p=0.017) at 12 months. Participants may have felt that they had changed enough or measures of perceived success may be more sensitive to behaviour change. Alternatively, long measurement intervals may have missed immediate cognitive and affective consequences of behaviour change, or such effects may require participants to consistently self-monitor or receive feedback on performance. Future studies could test the effect of such techniques on physical activity and a wider range of cognitive, affective and physiological consequences, using more frequent measurement intervals.     

Hypochondriacs' estimation of negative outcomes: domain-specificity and responsiveness to reassuring and alarming information

Based on hypochondriacal patients' tendency to overestimate the seriousness of bodily sensations and health risks [Barsky, A. J., Wyshak, G. & Klerman, G. L. (1990). The Somatosensory Amplification Scale and its relationship to hypochondriasis. Journal of Psychiatric Research, 24, 323-334; Warwick, H. M. C., & Salkovskis, P. M. (1990). Hypochondriasis. Behaviour Research and Therapy, 28, 105-117], we investigated whether hypochondriacal individuals (n = 20) are inclined to report higher estimates of negative outcomes than healthy controls (n = 20) when interpreting ambiguous health-related and nonhealth-related events. In addition, we explored the influence of additional reassuring and alarming information on hypochondriacs' estimates of negative outcomes. Following the cognitive-behavioural model of hypochondriasis [Warwick, H. M. C. & Salkovskis, P. M. (1989). Hypochondriasis. In J. Scott, J. M. G. Williams & A. T. Beck (Eds.), Cognitive therapy in clinical practice: an illustrative casebook. (pp. 78-102). London: Routledge] we hypothesized that hypochondriacal individuals would be more responsive to alarming information and less responsive to reassuring information than healthy controls. Yet, hypochondriacs were neither found to be immune for reassuring information, nor to be hypersensitive to alarming information. Meanwhile, irrespective of the additional alarming or reassuring information, hypochondriacs clearly showed a domain-specific bias towards higher estimates of negative outcomes in ambiguous health-related situations.