Managing unwanted intrusive thoughts in obsessive-compulsive disorder: Relative effectiveness of suppression, focused distraction, and acceptance

Suppression is one of various mental control techniques that people may use to manage unwanted thoughts. Evidence suggests that it is at best unsustainable and at worst counterproductive. This leads to the question: If suppression is a futile way to respond to unwanted, intrusive thoughts, what is a more effective alternative? In the current study, we evaluated the relative effectiveness of suppression and two alternative mental control techniques—focused distraction and acceptance—on the frequency of intrusions and distress associated with them. Results support the claim that suppression is a counterproductive technique for dealing with unwanted, intrusive thoughts in OCD. However, the harmfulness of suppression was reflected primarily in the magnitude of distress and not in intrusion frequency. Focused distraction and acceptance were the more effective techniques for managing clinically significant intrusive thoughts. We discuss implications for the cognitive treatment for OCD.     

Night-time thoughts in high and low worriers: reaction to caffeine-induced sleeplessness

There is ample evidence for the existence of an association between sleeplessness and worry. Not much is known, however, concerning the nature of this relationship. Therefore, a study was conducted investigating the causal relationship between sleeplessness and nocturnal worry. A 2 x 2 (Worry x Induced sleeplessness) analysis of covariance design was used. The first factor consisted of a subject variable defined by scoring either high or low on a trait measure of worry (the Penn State Worry Questionnaire) and the second factor consisted of 300 mg caffeine or placebo. A total of 96 female undergraduate students participated. The dependent variables comprised measures of nocturnal worry (the Night-Time Thoughts Questionnaire) and subjective and objective sleep parameters. Overall, caffeine caused an increase in nocturnal worry and sleeplessness. A significant interaction effect occurred between Worry and Induced sleeplessness on one of the objective sleep parameters, but no other interaction effects were significant. The results suggest that worry may occur as an epiphenomenon of sleeplessness.     

The thought control questionnaire: A measure of individual differences in the control of unwanted thoughts

Previous research has suggested that unpleasant and unwanted thoughts are a frequent experience in both normal and clinical populations. This paper describes the development and validation of a questionnaire that assesses strategies for controlling such thoughts. Analyses of the Thought Control Questionnaire (TCQ) demonstrated five replicable factors: Distraction; Social Control; Worry; Punishment and Reappraisal. Significant associations were found between the punishment and worry subscales of the TCQ and various measures of emotional vulnerability and perceptions of impaired control over cognition. The implications of these findings are discussed in relation to the literature on thought suppression, worry and mental self-regulation.     

The gravity of unwanted thoughts: Asymmetric priming effects in thought suppression

An unwanted thought appears to be cued easily by reminders in the environment but often the thought itself seems to cue nothing more than the desire to eliminate it from consciousness. This unusual asymmetry in the way unwanted thoughts are linked to other thoughts was the focus of the present research. Participants who were asked to suppress a thought or to concentrate on it completed a task assessing the influence of priming on reaction time (RT) for word/non-word judgments. Results revealed that suppression under cognitive load produced asymmetric priming: Priming with the associate of a suppressed word speeded RT for the suppressed word, but priming with a suppressed word did not speed RT for associated words. These findings suggest that thought suppression induces an unusual form of cognitive accessibility in which movement of activation toward the suppressed thought from associates is facilitated but movement of activation away from the suppressed thought to associates is undermined.     

The management of unwanted pre-sleep thoughts in insomnia: distraction with imagery versus general distraction

Insomniacs commonly complain that they are unable to get to sleep at night due to unwanted thoughts, worries and concerns. The present study investigated whether brief training in identifying and elaborating an interesting and engaging imagery task for use during the pre-sleep period can reduce unwanted pre-sleep cognitive activity and sleep onset latency. Forty one people with insomnia were given one of three instructional sets to follow on the experimental night; instructions to distract using imagery, general instructions to distract, or no instructions. Based on previous findings reported by Salkovskis & Campbell (1994) 'Behaviour Research and Therapy 32 (1994) 1' and ironic control theory (Wegner, 1994) 'Psychological Review 101 (1994) 34', it was predicted that (1) "imagery distraction" would be associated with shorter sleep onset latency and less frequent and distressing pre-sleep cognitive activity compared to the "no instruction" group and that (2) "general distraction" would be associated with longer sleep onset latency and more frequent and distressing pre-sleep cognitive activity compared to the "no instruction" group. Support was found for the first but not the second prediction. The success of the "imagery distraction" task is attributed to it occupying sufficient "cognitive space" to keep the individual from re-engaging with thoughts, worries, and concerns during the pre-sleep period. In addition, "imagery distraction" involved a very specific alternative cognitive task hence the operating process was given a feature positive search, conditions where mental control is likely to be achieved.     

Depression and mental control: the resurgence of unwanted negative thoughts

In three experiments we examined depressed individuals' mental control abilities and strategies. Experiment 1 revealed that although depressed college students were initially successful in suppressing negative material, they eventually experienced a resurgence of unwanted negative thoughts. Analysis of subjects' stream-of-consciousness reports indicated that this resurgence was associated with the use of negative thoughts as distracters from the unwanted item. In Experiment 2 depressed subjects acknowledged that positive distracters were more effective than negative ones in suppressing negative thoughts. This acknowledgement suggests that depressed subjects in Experiment 1 did not deliberately focus on negative distracters but that those thoughts automatically occurred because they were highly accessible. Experiment 3 demonstrated that depressed subjects' use of positive distracters could be increased somewhat when we provided such distracters and made them easily accessible. Taken together, the findings suggest that depression involves an enhanced accessibility of interconnected negative thoughts that can undermine mental control efforts.     

Perfectionism and negative repetitive thoughts: Examining a multiple mediator model in relation to mindfulness

Perfectionism is known to be associated with various maladaptive outcomes, yet little research has examined mechanisms underlying perfectionism or potential protective factors. This study investigated worry and rumination as mediators between perfectionism and psychological distress in university students (N = 213), and related the multiple mediator model to a five-facet conceptualization of mindfulness. Socially prescribed perfectionism was related to higher levels of distress, including negative affect, depression, anxiety, and stress, while self-oriented perfectionism and other-oriented perfectionism appeared unrelated to distress. Mindfulness facets of acting with awareness, non-judging of inner experience, and to a lesser extent non-reactivity to inner experience, were the strongest independent contributors to perfectionism, negative repetitive thoughts, and distress. Worry and rumination mediated the relationship between socially prescribed perfectionism and negative affect; however, the mediating effect of rumination was absent in those high in mindfulness. These findings suggest that a mindfulness disposition may mitigate distress related to socially prescribed perfectionism by removing the mediating effect of ruminative thought. Future research might explore a mindfulness-training program to target negative repetitive thoughts underlying socially prescribed perfectionism.     

Measurement invariance of the Emotion Regulation Questionnaire (ERQ). A cross-national validity study

The goal of this research was to examine the measurement invariance of the Emotion Regulation Questionnaire (ERQ; Gross & John, 2003) across two European nations. Participants were Italian and German undergraduate students. First, confirmatory factor analysis was used to test for the two-factor structure of the ERQ; subsequently, measurement invariance was analysed. The results showed acceptable fit indices for the German and Italian sample; however, results with regard to the Italian sample showed lower fit indices than results regarding the German one. Measurement invariance of the ERQ across Italy and Germany was confirmed. Despite the fact that we assumed measurement invariance of the ERQ, future research is needed to deal with the lower fit regarding the Italian version.     

A multi-dimensional measure of worry: Development and preliminary validation of the anxious thoughts inventory

This paper reports the development of a dispositional self-report measure of multiple dimensions of generalised worry. Factor analyses demonstrated a replicable three factor structure indicating that this measure of worry comprises three basic dimensions: social worry, health worry, and meta-worry. The first two factors reflect different content dimensions whereas the meta-worry factor consists of both content and process dimensions of worry. Individual differences in subscale scores show moderate stability over time, and the subscales possess good psychometric properties. Significant correlations were found between worry subscales and personality dimensions of self-consciousness and EPI scores. The role of multi-dimensional measurement in the exploration of worry is discussed.     

Perseverative thought: a robust predictor of response to emotional challenge in generalized anxiety disorder and major depressive disorder

Generalized anxiety disorder (GAD) and major depressive disorder (MDD) frequently co-occur, yet the reasons for their comorbidity remain poorly understood. In the present experiment, we tested whether a tendency to engage in negative, repetitive thinking constitutes a common risk process for the two disorders. A mixed sample of adults with comorbid GAD–MDD (n = 50), GAD only (n = 35), MDD only (n = 34), or no lifetime psychopathology (n = 35) was administered noncontingent failure and success feedback on consecutive performance tasks. Perseverative thought (PT), measured by negative thought intrusions during a baseline period of focused breathing, emerged as a powerful prospective predictor of responses to this experimental challenge. Participants reporting more frequent negative thought intrusions at baseline, irrespective of thought content or diagnostic status, exhibited a stronger negative response to failure that persisted even after subsequent success. Higher PT over the course of the experiment was associated with later behavioral avoidance, with negative affect and other traits closely linked to anxiety and depression, and with the presence and severity of GAD and MDD. These findings provide evidence for a broadly-defined PT trait that is shared by GAD and MDD and contributes to adverse outcomes in these disorders.     

Sleep locus of control and computerized cognitive-behavioral therapy (cCBT)

This study investigated the relationship between sleep locus of control and sleep in a secondary data analysis. Participants were 100 adults with chronic insomnia previously involved in a randomized controlled trial of 5 weeks of computerized cognitive-behavioral therapy (cCBT). Additionally, a sample of 46 completers of an in-person group for insomnia were utilized as a comparison group. At pre-treatment, participants completed the Sleep Locus of Control Scale, the Insomnia Severity Index, the Pre-Sleep Arousal Scale, 7 days of sleep diaries, and participated in structured interviews to assess for psychiatric and medical conditions. Measures were re-administered at post-treatment and at a 4 week follow-up. Results showed that sleep locus of control mediated the impact of cCBT on insomnia severity at follow-up. cCBT more than waiting list control or a convenience sample of individuals treated with in-person CBT, enhanced an internal sleep locus of control. Implications are that sleep locus of control may be an important variable to assess in the internet context and that internet programs for insomnia may want to consider amplifying or giving priority to interventions which enhance an internal sleep locus.     

Miller (1944) revisited: Movement times in relation to approach and avoidance conflicts

Three experiments (total N = 291) sought to provide support for the idea that avoidance conflicts, relative to approach conflicts, are more difficult to motorically resolve. Conflicts were instantiated by asking individuals to approach desirable stimuli and avoid undesirable stimuli under conditions in which there was no objectively-correct direction of movement. To control for baseline movement speeds, non-conflict trials presented desirable (e.g., reward) and undesirable (e.g., threat) stimuli in the absence of any spatial conflict. In addition, movement times were isolated through the use of a joystick movement paradigm in which movement speeds were quantified subsequent to some initial tendency to move in one direction or the other. Consistent with hypotheses, all experiments found that movement times were slowed in the context of avoidance conflicts relative to approach conflicts. Results are discussed in terms of theories of motivation, affective processing, conflict, and anxiety.     

The development of stimulus control over tics: A potential explanation for contextually-based variability in the symptoms of Tourette syndrome

Research has demonstrated that providing reinforcement for tic-free intervals can decrease tic frequency in controlled analogue settings. The aim of the current study was to determine whether reinforcement could be used to create stimulus control over tic expression. Ten children with chronic tic disorders (including Tourette syndrome) completed four discrimination training sessions. Each session consisted of three exposures to each of three, 5 min conditions presented in a random order. In one condition, participants were reinforced for tic absence on a 10-s fixed interval schedule in the presence of a purple light. In a second condition, participants were instructed to suppress their tics, but were not reinforced for doing so in the presence of an orange light. In a third condition, participants were instructed not to suppress their tics in the presence of two non-illuminated lights. Confirming findings from other studies, results showed that reinforcing tic suppression reduced tic frequency to a greater extent than only providing instructions to suppress. To test for stimulus control, a fifth session was conducted following the aforementioned discrimination training sessions. The fifth session consisted of three exposures to each of three 5 min conditions presented in a random order. In one condition, a purple light was illuminated. In a second condition, an orange light was illuminated. In a third condition, neither light was illuminated. Across all three conditions, instructions to suppress (or not suppress) tics were not provided, and reinforcers for successful suppression were not delivered. Results indicated that in the presence of the purple light, tics were significantly lower than when neither light was illuminated. These findings provide preliminary support for the idea that a history of differential reinforcement in various contexts may play a role explaining variability in tic symptom expression.     

Interactive learning in the paradise fish (Macropodus opercularis): an ethological interpretation of the second-order conditioning paradigm

This study was aimed at the examination of ‘mental construction’ in paradise fish by interactive learning, which is suggested as an alternative hypothesis for backward or second-order conditioning. Avoidance of goldfish was established in paradise fish by presenting a harmless goldfish (a novel stimulus) after an aversive event (mild electric shocks) in the dark compartment of a shuttle tank. It was found that this avoidance depended on context pre-exposure. Experiment 1 was designed to study the effect of mild shocks on shuttling activity in a familiar context. Experiment 2 aimed at establishing fear-conditioning to the goldfish in a higher-order conditioning paradigm. In the course of training, unpaired stimuli were presented in the dark compartment of the shuttle tank in such a manner that the presentation of mild shocks (20 mA) preceded the encounter with a harmless fish (goldfish). Experiment 3 demonstrated the role of context pre-exposure in interactive learning. Results indicate that (1) while 60 mA shocks resulted in avoidance of the dark compartment, the 20 mA mild shocks affected exploratory behaviour; (2) after pre-exposure to the training environment, paradise fish avoided the dark compartment containing goldfish provided that subjects had previously encountered mild, explorative shocks there; (3) this conditioned fear, a ‘mental construction’ of a potential danger, was proved to be transferable to another context and was consequently aimed specifically at the goldfish, a living being, rather than the training context; (4) the pre-exposure to the shuttle tank was an important part of this training procedure, that is, only subjects habituated to the shuttle tank avoided the goldfish. Results are discussed in the framework of the Interactive Learning Hypothesis, which has been developed as an ethological approach to a higher-order conditioning paradigm. Received: 15 January 1999 / Accepted after revision: 18 August 1999     

Last night I had the strangest dream: Varieties of rational thought processes in dream reports

From the neurophysiological perspective, thinking in dreaming and the quality of dream thought have been considered hallucinatory, bizarre, illogical, improbable, or even impossible. This empirical phenomenological research concentrates on testing whether dream thought can be defined as rational in the sense of an intervening mental process between sensory perception and the creation of meaning, leading to a conclusion or to taking action. From 10 individual dream journals of male participants aged 22–59 years and female participants aged 25–49 years, we delimited four dreams per journal and randomly selected five thought units from each dream for scoring. The units provided a base for testing a hypothesis that the thought processes of dream construction are rational. The results support the hypothesis and demonstrate that eight fundamental rational thought processes can be applied to the dreaming process.     

A comparison of thought suppression to an acceptance-based technique in the management of personal intrusive thoughts: a controlled evaluation

Research suggests that suppressing unwanted thoughts is not possible, leads to a subsequent increase in frequency of the suppressed thoughts, and results in higher levels of distress. Because thought suppression may have negative effects, an alternative, acceptance-based approach has been proposed. The current paper reports the outcomes of two studies. Study I examined the relationships between two naturally occurring strategies of thought management (thought suppression and acceptance), symptoms of psychopathology, and experiences with personally relevant intrusive thoughts. Results showed that those who naturally suppress personally relevant intrusive thoughts have more, are more distressed by, and have a greater "urge to do something" about the thoughts, while those who are naturally more accepting of their intrusive thoughts are less obsessional, have lower levels of depression, and are less anxious. Study II compared three groups (thought suppression, acceptance, and monitor-only groups) on the frequency and distress associated with experiencing personally relevant intrusive thoughts. Results revealed that those instructed to suppress their personal intrusive thoughts were unable to do so and experienced an increased level of distress after suppression, whereas those instructed to use an acceptance-based strategy experienced a decrease in discomfort level (but not thought frequency) after having used such a strategy. These data offer initial evidence that acceptance may be a useful alternative to the suppression of personally relevant intrusive thoughts.     

Attention to phobic stimuli during exposure: the effect of distraction on anxiety reduction, self-efficacy and perceived control

To replicate and extend the finding that distraction facilitates between session anxiety reduction (), 27 spider phobics underwent three 10-min sessions of in vivo exposure followed by one 10-min exposure session at a 4-week follow-up, while having either stimulus-relevant focused conversation or stimulus-irrelevant distracting conversation with the experimenter. Physiological arousal and subjective anxiety were measured during exposure, and self-efficacy, perceived control and performance on a behavioural task were measured at pre-treatment, post session-3, and follow-up. Monitoring and blunting coping styles were also measured at pre-treatment to assess their impact on treatment outcome. Despite equal physiological activation between the groups, those who underwent distracted exposure showed greater reductions in subjective fear within and between sessions, and showed greater increases in self-efficacy ratings, internal perceived control and performance on a behavioural task. Coping style did not interact with the effect of distraction or focusing during exposure, however blunters had less subjective anxiety reduction overall, particularly when they underwent focused exposure. Results are discussed in terms of the emotional processing model and self-efficacy theory.     

Executive control of thought and action: in search of the wild homunculus

Executive control is studied in many areas of psychological research using a wide variety of procedures. This article focuses on studies of the executive processes involved in switching between tasks. The experiments discussed were designed to isolate and measure the duration of the executive processes required to switch from one task to another. However, the research is open to alternative interpretations that do not hypothesize executive processes, suggesting that task-switching procedures may not measure the duration of executive control. Further research is required to determine whether or not behavioral effects reflect the involvement of executive processes.