Suppressing and attending to pain-related thoughts in chronic pain patients

Attempted suppression of pain-related thoughts was investigated in consecutive referrals for pain management (N = 39). Participants monitored their pain-related thoughts for three 5-min periods. In period 1, all participants were instructed to think about anything. For period 2, participants were instructed to either suppress pain-related thoughts, attend to pain-related thoughts, or to continue to think about anything. In period 3, all participants were again instructed to think about anything. Participants instructed to attend to their pain reported more pain-related thoughts than suppressors and controls in both periods 2 and 3. Suppressors experienced reduced pain-related thoughts during period 2. There was no immediate enhancement or delayed increase.     

Self-report may underestimate trauma intrusions

Research examining maladaptive responses to trauma routinely relies on spontaneous self-report to index intrusive thoughts, which assumes people accurately recognize and report their intrusive thoughts. However, “mind-wandering” research reveals people are not always meta-aware of their thought content: they often fail to notice shifts in their attention. In two experiments, we exposed subjects to trauma films, then instructed them to report intrusive thoughts during an unrelated reading task. Intermittently, we asked whether they were thinking about the trauma. As expected, subjects often spontaneously reported intrusive thoughts. However, they were also “caught” engaging in unreported trauma-oriented thoughts. The presence and frequency of intermittent probes did not influence self-caught intrusions. Both self-caught and probe-caught intrusions were related to an existing tendency toward intrusive cognition, film-related distress, and thought suppression attempts. Our data suggest people may lack meta-awareness of trauma-related thoughts, which has implications for theory, research and treatment relating to trauma-related psychopathology.     

Summoning White Bears or Letting Them Free: The Influence of the Content of Control Instructions on Target Thought Frequency

In the clinical literature, thought suppression is considered to play a role in the development of intrusion-related psychiatric syndromes, such as obsessive-compulsive disorder, acute or posttraumatic stress disorder, phobias, and addiction. This assumption goes back to a study by D. M. Wegner, D. J. Schneider, S. R. Carter, and T. L. White (1987) in which participants were asked to suppress thoughts of a white bear, an assignment that proved to be nearly impossible to complete. The present two studies sought to explore the influence of the content of control instructions on intrusion frequency in thought suppression experiments. Notably, during nonsuppression (i.e., control) periods, participants can either be instructed to think about white bears (i.e., expression instruction), or to think of anything including white bears (i.e., liberal instruction). Results indicated that expression instructions resulted in an increased number of target thoughts, while liberal instructions did not. Implications for the interpretation of thought suppression findings are discussed.     

Are Individuals Always Aware of Their Trauma-Related Intrusive Thoughts? A Study of Meta-Awareness

Individuals are not always aware of their mental content. We tested whether lack of awareness occurs in those who have experienced trauma, with and without posttraumatic stress disorder (PTSD). We also examined the role of proposed cognitive mechanisms (working memory and inhibition) in explaining unnoticed intrusions. Individuals with PTSD (n = 44), and varying levels of symptoms (high posttraumatic stress [PTS]: n = 24; low PTS: n = 37) reported on intrusive thoughts throughout a reading task. Intermittently, participants responded to probes about whether their thoughts were trauma related. Participants were “caught” engaging in unreported trauma-related thoughts (unnoticed intrusions) for between 24 and 27% of the probes in the PTSD and high PTS groups, compared with 15% of occasions in the low PTS group. For trauma-related intrusions only, participants lacked meta-awareness for almost 40% of probes in the PTSD group, which was significantly less than that observed in the other groups (～60%). Contrary to predictions, working memory and response inhibition did not predict unnoticed intrusions. The results suggest that individuals who have experienced significant trauma can lack awareness about the frequency of their trauma-related thoughts. Further research is warranted to identify the mechanisms underpinning the occurrence of unnoticed intrusions.     

An experimental investigation of thought suppression

An experiment investigating the hypothesis that trying to suppress a thought will lead to an immediate and/or delayed increase in its occurrence is reported. Normal subjects listened to a taped story and then verbalized their stream of consciousness during two consecutive time periods. During the first period, one group (suppression) were asked not to think about the tape while two other groups (controls) were asked to think about anything or think about anything including the tape. During the second period, all three groups were instructed to think about anything. Results from the first period failed to support the immediate enhancement hypothesis as the suppression group reported less thoughts about the tape than the controls. However, results from the second period supported the delayed (rebound) hypothesis as subjects who had previously suppressed reported more thoughts about the tape than subjects who had not. The theoretical, methodological, and clinical implications of these results are discussed.     

Ignorance May Be Bliss, But Thought Suppression Promotes Superficial Cognitive Processing

This study examined the impact of thought suppression on the quality of cognitive processing and self-reported mood. While completing a stream-of-consciousness task about two topics sequentially, participants were either instructed to suppress negative thoughts or were given no suppression instructions. Computer-based content analyses indicated that thought suppression led to significantly less causal reasoning and discrepancy seeking. However, the suppression of negative thoughts also resulted in a more positive mood. Results suggest that thought suppression can improve mood but it comes with the cognitive cost of superficial processing.     

Directed forgetting in acute stress disorder

The rationale underpinning the diagnosis of acute stress disorder is that cognitive mechanisms result in avoidant processing of aversive experiences. This study investigated acutely traumatized participants with either acute stress disorder (ASD; n = 15) or no ASD (n = 14) and nontraumatized comparison participants (n = 16). Participants were administered intermixed presentations on a computer screen of positive, neutral, and trauma-related words that were followed by instructions to either remember or forget each word. On a subsequent recall test, ASD participants displayed poorer recall of to-be-forgotten trauma-related words than did non-ASD participants. Severity of psychopathology was negatively correlated with to-be-remembered positive words. These findings are consistent with the proposal that people who develop ASD display an aptitude for superior forgetting of aversive material.     

Cognitive control of obsessional thoughts

A defining characteristic of obsessive-compulsive disorder (OCD) is unsuccessful suppression of unwanted thoughts. Recent evidence of individual differences in ability to control intrusive thoughts may inform our understanding of failures of cognitive control associated with OCD symptomatology. The current study investigated characteristics of cognitive style that are potentially associated with OCD symptoms and may influence response to unwanted thoughts, including perceived ability to control thoughts and tendency to ruminate. Undergraduate students (N = 166) completed self-report measures of OCD symptoms, perceived thought control, and ruminative thinking. They were then presented with a distressing target thought and completed a standard thought suppression paradigm. Correlational results indicated that, controlling for anxiety and depression, OCD symptoms were positively associated with rumination and inversely associated with perceived thought control ability. In addition, OCD symptoms were associated with higher levels of distress and greater spontaneous efforts to suppress the target thought during a baseline period, while perceived thought control ability predicted frequency of target thoughts during suppression. Finally, results of the experimental manipulation confirmed that participants instructed to suppress experienced more intrusions during the recovery period. Clinical implications and future directions are discussed.     

The tendency to suppress, inhibiting thoughts, and dream rebound

Ironic control theory proposes that suppressing thoughts leads to increased occurrence of the suppressed thought because monitoring for the unwanted thought leads to intrusions. This study investigated the influence of suppressing unwanted thoughts on dream content. One hundred participants who had high or low levels of tendency to suppress unwanted thoughts nominated an intrusive thought, and half of the participants were instructed to suppress that thought for 5 min prior to sleeping. Participants completed a dream diary upon waking, which was subsequently rated by independent raters for dream content. In terms of the 79 participants who reported dreaming, more high suppressors who were instructed to suppress dreamt about the intrusive thought than high suppressors in the control condition. There was no difference between low suppressors in the suppression and control conditions. These results suggest that dream content can be influenced by attempted suppression prior to sleep, and this is particularly apparent in people with a tendency to suppress unwanted thoughts.     

Suppressing unwanted memories: where there is a will,there is a way?

Research suggests that suppressing unwanted thoughts, generally, is an ineffective thought control strategy, because suppression attempts oftentimes fail, and, furthermore, result in a paradoxical increase of unwanted thoughts, later on. The present study sought to investigate whether manipulated expectations about suppression efficacy determine actual effects of suppression attempts. To test this hypothesis, participants listened to an audiotaped story, and were subsequently appointed to one of four conditions: a no-instruction-control (n = 20), suppression (n = 20), suppression-works (n = 20; participants were told that suppression generally is a fruitful strategy), or suppression-does-not-work (n = 25; participants were told that suppression primarily has paradoxical effects) condition. Two hours later, participants' memories of the story were tested, and several metamemory questions were answered. Induced expectations actually determined the perceived efficacy of suppression attempts, as well as thought frequency, although perceived or actual accuracy of recollections was not affected by the instructions.     

On bad mood and white bears: The effects of mood state on ability to suppress unwanted thoughts

Does temporary mood influence people's ability to engage in effective thought suppression? Based on past research on mental control and recent work on affective influences on social cognition, this experiment predicted and found that negative mood improved and positive mood impaired people's ability to suppress their thoughts when instructed not to think of a neutral concept, white bears. We also found clear evidence for ironic rebound effects: on a subsequent generative task, intrusions of the suppressed thought were greater in the negative than in the positive mood group. Participants received positive or negative feedback about performance on a supposed creativity task to induce positive or negative moods, and then engaged in two consecutive generative writing tasks, the first accompanied by instructions to suppress thoughts of white bears. Those in a negative group reported fewer “white bear” intrusions when attempting to suppress, but more “white bear” intrusions (an ironic rebound effect) in the subsequent task when the suppression instruction was lifted. The implications of these results for everyday tasks of mental control, and for recent affect–cognition theories are discussed.     

A comparison of the effects of thought suppression, distraction and concentration

This study compared the effects of suppression, focused-distraction, and concentration on controlling unwanted distressing thoughts, and examined how anxiety levels were associated with the use of each thought-control technique. In the study, college students were told to suppress thoughts about a distressing story, to suppress the same thoughts by focusing on an alternative distraction task, to simply concentrate on that alternative task, or to think about anything without restrictions for 6 minutes. This initial period was followed by a “free-thinking” period to assess the delayed effect of thought-control techniques. The results indicated that focused-distraction and concentration led to fewer intrusions of target thoughts than suppression, and concentration in turn resulted in fewer target intrusions than focused-distraction during the initial period. Participants in the focused-distraction and concentration condition also tended to report lower anxiety during the initial period than those who were told to suppress thoughts.     

Cognitive Load Undermines Thought Suppression in Acute Stress Disorder

Thought suppression studies demonstrate that attempts to suppress can be undermined by cognitive load. We report the first instance in which this has been tested experimentally in a sample of recently traumatized individuals. Individuals with and without acute stress disorder (ASD) were recruited following recent trauma and randomized to load or no load conditions (N = 56). They monitored intrusive memories during baseline, suppression, and think anything phases. The impact of suppression and load on self-reported intrusions, attention bias (dot-probe), and memory priming (word-stem task) was assessed. The ASD load group were less able to suppress memories (d = 0.32, CI₉₅ [− 0.15, 0.83], p = .088) than the ASD no load group (d = 0.63, CI₉₅ [0.08, 1.24], p < .001). In the think anything phase, the ASD load group reported more intrusions than the ASD no load or non-ASD groups (with and without load). No consistent findings were observed in relation to attentional bias. ASD load individuals exhibited stronger priming responses for motor vehicle accident and assault words than all other groups (ds between 0.35–0.73). Working memory did not moderate any outcomes of interest. The findings indicate that cognitive load interferes with suppression and may enhance access to trauma memories and associated material. The study extends previous research by demonstrating these effects for the first time in a clinical sample of recent survivors of trauma.     

The contribution of thought-action fusion and thought suppression in the development of obsession-like intrusions in normal participants

Both thought-action fusion (TAF: i.e., a cognitive bias implying an inflated sense of responsibility for one's own thoughts) and thought suppression have been claimed to contribute to the development of obsession-like intrusions. Therefore, it seems plausible that conjunction of these phenomena results in highly intense intrusions. However, possible interactions between TAF and thought suppression have not yet been investigated experimentally. In the current study, healthy volunteers were exposed to a TAF-like intrusion. They were, then, randomly assigned to a suppression (n=21) or non-suppression condition (n=19). Next, visual analogue scales (VASs) were completed measuring anxiety, feelings of responsibility and guilt, urge to neutralise and so on. Contrary to expectation, several VAS scores were lower for participants in the suppression group than for those in the non-suppression group. Hence, it is concluded that thought suppression may, at least in the short term, alleviate discomfort caused by TAF-like intrusions.     

False Memories for an Analogue Trauma: Does Thought Suppression Help or Hinder Memory Accuracy?

In the current study, we investigated whether suppression can produce an amplified memory for a traumatic experience. Participants viewed a distressing film depicting a multi‐fatality car accident. We broke the film down into several short clips, some of which were removed. After viewing the film, we instructed participants to (i) suppress and monitor film‐related thoughts, (ii) think freely and monitor film‐related thoughts or (iii) just think freely. Twenty‐four hours later, participants completed a recognition test. Memory distortion was comparable across conditions; however, suppression and monitoring of trauma‐related thoughts removed the typical bias to falsely remember the most critical and traumatic clips of the film over the least critical clips. Our data suggest that suppression may be effective in reducing trauma‐related cognitions and, therefore, does not predict a more ‘amplified’ memory for trauma. Instead, suppression and thought monitoring encourage an unbiased, although inaccurate, memory for trauma.Copyright © 2016 John Wiley & Sons, Ltd.     

Thought control strategies in acute stress disorder

Intrusive trauma-related thoughts and the means to manage them are a central dynamic in posttraumatic stress. Thought control strategies were investigated in survivors of motor vehicle accidents with either acute stress disorder (ASD; n=20) or no ASD (n=20). Participants completed the Acute Stress Disorder Interview, the Beck Depression Inventory, the Beck Anxiety Inventory, the Impact of Event Scale, and the Thought Control Questionnaire (TCQ) within four weeks of their accident. Although distraction, social control, and reappraisal were the most common strategies in both groups, ASD participants engaged in punishment and worry more than non-ASD participants. Worry and punishment were also strongly associated with severity of intrusive, avoidance, arousal, and depressive symptoms. Findings are discussed in terms of the role of cognitive strategies in resolving posttraumatic stress.     

Thought suppression and its effects on thought frequency, appraisal and mood state in individuals with obsessive-compulsive disorder

Leading models of obsessive-compulsive disorder (OCD) implicate thought suppression as a key factor in the escalation and persistence of the disorder. This experiment examined the effects of suppression on the frequency of obsessional thoughts in 50 individuals with a primary diagnosis of OCD, and also investigated the effects of participants' appraisals regarding their failures in thought control on distress about intrusive thoughts and on mood. Participants' most upsetting obsessional thought was primed and they then monitored its occurrence over two 4-min intervals. In the first interval, half of the participants were instructed to suppress their obsessional thought and half were instructed not to suppress any thoughts. In the second interval, all participants were given the 'Do Not Suppress' instructions. Participants rated their suppression effort and discomfort over thought occurrences after each interval and recorded their appraisals of thought recurrences during the first interval. Mood state was then reassessed. No ironic effect of suppression on frequency was noted. However, negative appraisals of thought recurrences were associated with more discomfort over thought occurrences and more negative mood at Time 2. These findings suggest that interpretations regarding failures in thought control may be of central importance in understanding obsessional problems.     

Suppressing and focusing on a negative memory in social anxiety: effects on unwanted thoughts and mood

Researchers have hypothesized that thought suppression contributes to the large volume of unwanted thoughts in anxiety disorders. However, comparisons to both non-suppression and non-anxious groups are necessary for studies on thought suppression in high anxiety. Participants completed a series of thought verbalization periods and a social interaction. During one period, participants were randomly assigned to focus upon a negative social memory, suppress it, or think freely while monitoring the memory. Results indicated that thought suppression and focusing caused a greater rise and subsequent decline in unwanted thoughts than monitoring instructions for both high and low social anxiety groups. Importantly, highly socially anxious participants had more unwanted thoughts overall, but did not respond significantly differently to thinking instructions when compared to the less anxious group. Interestingly, highly socially anxious participants did report more thought suppression attempts in their everyday life. They also appeared to benefit by experiencing less shyness after suppression when compared to focusing, a pattern not evident for the low social anxiety group.     

The Influence of Thought Suppression and Cognitive Load on Intrusions and Memory Processes Following an Analogue Stressor

Ironic Process Theory and the role of thought suppression have been used in part to explain the phenomenon of intrusive memories in various disorders, including posttraumatic stress disorder. How thought suppression interacts with other cognitive processes believed to be instrumental in the development of traumatic intrusive memory is unclear. In an analogue study, thought suppression and cognitive processing was manipulated in 4 experimental groups after participants (n = 80) viewed a trauma film. The impact of suppression was examined in relation to self-reported intrusive experiences as well as via more objective methods (word stem and dot probe tasks) to assess potential preferential encoding of negative material. Cognitive load appeared to undermine thought suppression ability, with these participants experiencing more intrusions over the week relative to participants in all other conditions. This group also showed greater priming to negative film-related words, and both suppression groups demonstrated enhanced memory for film-related content on recognition testing. Thought suppression mediated the relationship between negative interpretations of initial intrusions and later intrusions experienced over the week. The findings are discussed in the context of ironic process theory and cognitive models of posttraumatic stress.     

The effects of analytical rumination, reappraisal, and distraction on anger experience

The manner in which individuals recall negative life events has important affective consequences. The present experiment investigated the effects of emotion regulation strategies on anger experience. One hundred and twenty-one undergraduates recalled an anger-inducing memory and were instructed to engage in either analytical rumination, cognitive reappraisal, or distraction for 20 minutes. In the remaining (control) condition, participants were instructed to write about their thoughts but were not given any emotion regulation instructions. Rumination maintained anger, whereas participants in the remaining conditions reported decreased anger following the writing task. Our results suggest that reappraisal facilitates adaptive processing of anger-inducing memories and distraction facilitates rapid reductions in anger experience. These findings have implications for the management of clinical populations that commonly experience difficulty with anger regulation.