Automatic classification of dysfunctional thoughts: A feasibility test

The identification of dysfunctional thoughts is a central effort in cognitive therapy. This paper describes the first version of a computer module that classifies dysfunctional thoughts automatically. It is part of COGNO, a system we are developing to give automatic feedback on dysfunctional thoughts. The system uses rules that were developed from language markers identified in a sample of 149 dysfunctional thoughts. The system was tested with an independent set of 112 example thoughts. The system detects the majority of dysfunctional thoughts, but works reliably only for some thought categories. Automatic thought classification may be a first step toward developing natural dialogue systems in cognitive therapy.     

Automatic classification of dysfunctional thoughts: a feasibility test.

The identification of dysfunctional thoughts is a central effort in cognitive therapy. This paper describes the first version of a computer module that classifies dysfunctional thoughts automatically. It is part of COGNO, a system we are developing to give automatic feedback on dysfunctional thoughts. The system uses rules that were developed from language markers identified in a sample of 149 dysfunctional thoughts. The system was tested with an independent set of 112 example thoughts. The system detects the majority of dysfunctional thoughts, but works reliably only for some thought categories. Automatic thought classification may be a first step toward developing natural dialogue systems in cognitive therapy.     

The cognitive mediation of thought-control strategies

Research suggests that people use various strategies to control their normally occurring intrusive thoughts. Strategies that involve worrying about the thought and self punishment appear to be associated with certain forms of psychopathology, such as obsessive-compulsive (OC) symptoms. The present study sought to examine whether dysfunctional beliefs associated with OC symptoms (e.g., beliefs that intrusive thoughts are highly significant) underlie the use of such thought control strategies. Ninety-three non-clinical participants completed self-report questionnaires measuring cognitive variables, thought-control strategies, and OC symptoms. Analyses revealed that overestimates of threat and responsibility, beliefs about the significance and need to control intrusions, the need for perfection and certainty, and scrupulosity were associated with the use of punishment, but not worry thought control strategies. These cognitive phenomena also mediated the relationship between OC symptoms and the use of punishment as a thought-control strategy. Results are discussed in terms of cognitive models of OC symptoms and their implications for cognitive-behavioral therapy.     

The warpy thoughts scale: a new 20-item instrument to measure dysfunctional attitudes

Cognitive theories of psychopathology propose that specific negative cognitive schema held by individuals can increase their likelihood of experiencing depressive episodes. While it has been argued that such dysfunctional attitudes are state measures that occur primarily during periods of depression, a range of research has supported the view that holding dysfunctional attitudes is ongoing, persisting prior to and following depressive episodes. To date, the need for a parsimonious measure of dysfunctional attitudes has not been well addressed. Using data provided by 4545 participants in a free on-line cognitive behavioural therapy program, MoodGYM, we have developed the Warpy Thoughts Scale (WTS), a 20-item instrument measuring dysfunctional attitudes. This scale provides 3 first order factors (Relationships, Achievements and Entitlements) and a higher order factor, Warpy Thoughts, from which a Warpy Thoughts score can be obtained. Confirmatory factor analyses on this model indicated that it provides robust results for men and women and for individuals in a wide range of ages. WTS scores were moderately correlated with levels of depressive and anxiety symptoms (0.39 and 0.40, respectively) and explained up to one-fifth of the variance of these mental health measures. Further validation of the WTS against other measures of dysfunctional thoughts is required.     

Sentence-reversion-based thought record (SRBTR): a new strategy to deal with “yes,but…” dysfunctional thoughts in cognitive therapy

The Dysfunctional Thought Record (DTR) is an effective and useful worksheet, widely used in cognitive therapy (CT), to help patients respond to automatic thoughts (ATs) and to change negative mood states. Some clients, however, seem not to improve with the use of the original DTR proposed by Beck et al. (1979). Padesky and Greenberger (1995) added two evidence columns to the original five-column DTR in order to generate more balanced alternative thoughts. In this paper, I present a case report and propose a modified thought record to deal especially with “yes, but…” dysfunctional thoughts.     

The nature of worry in generalized anxiety disorder: a predominance of thought activity

Indirect evidence suggests that worry primarily involves thought, rather than imaginal, activity, a distinction within cognitive process that is potentially crucial to some theories of anxiety maintenance and modification. The present study contrasted the frequencies of reporting the presence of thoughts and images among generalized anxiety disorder clients and matched, nonanxious control subjects during a self-relaxation period and a worry period. Repetition of the assessment was conducted with clients after they completed 12 sessions of therapy. Sampling of mentation during these periods revealed that (a) during relaxation, nonanxious subjects reported a predominance of imagery whereas clients show equal amounts of thought and imagery, (b) nonanxious subjects shifted to a predominance of thought during worry, and (c) clients showed a normalization of thought and image frequencies after successful therapy. This combination of results suggests that worry is principally thought-like in content. The speculation is offered that worry may function as motivated avoidance of emotional imagery and its attendant somatic sensations.     

The Warpy Thoughts Scale: a New 20‐Item Instrument to Measure Dysfunctional Attitudes

Cognitive theories of psychopathology propose that specific negative cognitive schema held by individuals can increase their likelihood of experiencing depressive episodes. While it has been argued that such dysfunctional attitudes are state measures that occur primarily during periods of depression, a range of research has supported the view that holding dysfunctional attitudes is ongoing, persisting prior to and following depressive episodes. To date, the need for a parsimonious measure of dysfunctional attitudes has not been well addressed. Using data provided by 4545 participants in a free on‐line cognitive behavioural therapy program, MoodGYM, we have developed the Warpy Thoughts Scale (WTS), a 20‐item instrument measuring dysfunctional attitudes. This scale provides 3 first order factors (Relationships, Achievements and Entitlements) and a higher order factor, Warpy Thoughts, from which a Warpy Thoughts score can be obtained. Confirmatory factor analyses on this model indicated that it provides robust results for men and women and for individuals in a wide range of ages. WTS scores were moderately correlated with levels of depressive and anxiety symptoms (0.39 and 0.40, respectively) and explained up to one‐fifth of the variance of these mental health measures. Further validation of the WTS against other measures of dysfunctional thoughts is required.     

BRIEF REPORT: Intrusive Thoughts and Intrusive Memories in a Nonclinical Sample

We investigated the relative frequency and aversiveness of intrusive thoughts and memories by eliciting the five most common of each in a mixed-sex nonclinical sample. Intrusive memories were a common phenomenon, although not as common as intrusive thoughts. When memories were elicited first, memories and thoughts were rated as equally pleasant, but thoughts were related as more unpleasant when they were elicited first. The most intrusive memory was associated more often with sadness and happiness, whereas the most intrusive thought was associated more often with fear.     

The process of change in cognitive therapy for depression: Predictors of early inter-session symptom gains

Although cognitive therapy for depression is an efficacious treatment, questions about the aspects of the therapy that are most critical to successful implementation remain. In a sample of 60 cognitive therapy patients with moderate to severe depression, we examined three aspects of therapists’ adherence to cognitive therapy techniques, the patients’ facilitation or inhibition of these techniques, and the therapeutic alliance as predictors of session-to-session symptom improvement across the first five therapy sessions. Two elements of therapist adherence (viz., cognitive methods and negotiating content/structuring sessions) emerged as the strongest predictors of symptom improvement. Patient facilitation or inhibition of therapist adherence also predicted subsequent symptom change. Neither adherence to behavioral methods/homework nor the therapeutic alliance was a significant predictor in parallel analyses. Although alliance scores did not predict subsequent symptom change, they were significantly predicted by prior symptom change. These findings support the model of change that motivates cognitive therapy for depression, and they highlight the potential role of patient facilitation of therapists’ adherence in treatment response.     

Clinical obsessions in obsessive-compulsive patients and obsession-relevant intrusive thoughts in non-clinical, depressed and anxious subjects: where are the differences?

Contemporary cognitive models of obsessive-compulsive disorder (OCD) assume that clinical obsessions evolve from some modalities of intrusive thoughts (ITs) that are experienced by the vast majority of the population. These approaches also consider that the differences between "abnormal" obsessions and "normal" ITs rely on quantitative parameters rather than qualitative. The present paper examines the frequency, contents, emotional impact, consequences, cognitive appraisals and control strategies associated with clinical obsessions in a group of 31 OCD patients compared with the obsession-relevant ITs in three control groups: 22 depressed patients, 31 non-obsessive anxious patients, and 30 non-clinical community subjects. Between-group differences indicated that the ITs frequency, the unpleasantness and uncontrollability of having the IT, and the avoidance of thought triggers obtained the highest effect sizes, and they were specific to OCD patients. Moreover, two dysfunctional appraisals (worry that the thought will come true, and the importance of controlling thoughts) were specific to OCD patients. The OCD and depressed patients shared some dysfunctional appraisals about their most disturbing obsession or IT (guilt, unacceptability, likelihood thought would come true, danger, and responsibility for having the IT), whereas the non-obsessive anxious were nearer to the non-clinical participants than to the other two groups of patients. The OCD patients showed an increased use of thought control strategies, with overt neutralizing, thought suppression, and searching for reassurance being highly specific to this group.     

Cognitive reactivity, dysfunctional attitudes, and depressive relapse and recurrence in cognitive therapy responders

Dysfunctional attitudes can foreshadow depressive relapse/recurrence. Priming mood, through induction paradigms, is hypothesized to activate dysfunctional attitudes. Cognitive reactivity (CR) refers to mood-linked increases in dysfunctional attitudes after priming. Here we explored the extent to which CR as well as residual, unprimed, dysfunctional attitudes predicted depressive relapse/recurrence among depressed patients who responded to acute phase cognitive therapy (CT). Consenting adults, aged 18–70, with recurrent major depressive disorder (n = 523) participated in a two-site randomized controlled trial examining the durability of continuation phase treatments. Patients received 16–20 sessions of CT. Among the 245 incompletely remitted responders, 213 agreed to undergo a mood induction paradigm. After 8 months of continuation phase treatments, participants were followed an additional 24 months. Although the mood induction significantly lowered mood in 80% of responders, the expected CR was not evident. By contrast, higher unprimed dysfunctional attitudes following CT did predict relapse/recurrence over 20 and 32 months post-randomization. The findings of this large longitudinal study of incompletely remitted CT responders challenge the notion that it is necessary to prime mood in order to maximize dysfunctional attitudes’ prediction of relapse and/or recurrence. While findings cannot be generalized beyond CT responders, they emphasize the clinical importance of reducing dysfunctional attitudes in preventing depression.     

Cognitive behaviour therapy approach to assessing dysfunctional thoughts

Research shows that the client who is emotionally distressed will have many negative or dysfunctional thoughts. Some of these thoughts are irrelevant or less important to the patient's problem. This means that some thoughts are more central to the client's problem than the others. Among these relevant central thoughts, one thought is hypothesed to be the most central to the client's problem. This is known as a critical thought and should be the most appropriate cognitive target for intervention. In addition, this paper suggests that the therapist/nurse should treat each of the expressed emotions relating to a negative event as a separate entity for assessment. Rationale and clinical strategies for the assessment, particularly on the identification of the critical thought, are discussed.     

Acceptance and Commitment Therapy for Treatment-Resistant Posttraumatic Stress Disorder: A Case Study

An adult woman with chronic posttraumatic stress disorder (PTSD) and major depressive disorder who was nonresponsive to 20 sessions of cognitive behavior therapy (CBT) is presented in this case study. Two months after her CBT trial, she was treated with 21 sessions of Acceptance and Commitment Therapy (ACT) for PTSD. Measurements of PTSD severity, depression, anxiety, psychological flexibility and trauma-related thoughts and beliefs were taken at pretreatment, after Sessions 8 and 16, and at posttreatment. Results showed significant reduction on all measures throughout treatment, except for trauma-related thoughts and beliefs, which did not decrease until near the end of treatment. Strengths, limitations, and future directions are discussed.     

Why did the white bear return? Obsessive-compulsive symptoms and attributions for unsuccessful thought suppression

The current study examined the nature and consequences of attributions about unsuccessful thought suppression. Undergraduate students with either high (n=67) or low (n=59) levels of obsessive–compulsive symptoms rated attributions to explain their unsuccessful thought suppression attempts. We expected that self-blaming attributions and attributions ascribing importance to unwanted thoughts would predict more distress and greater recurrence of thoughts during time spent monitoring or suppressing unwanted thoughts. Further, we expected that these attributions would mediate the relationship between obsessive–compulsive symptom levels and the negative thought suppression outcomes (distress and thought recurrence). Structural equation models largely confirmed the hypotheses, suggesting that attributions may be an important factor in explaining the consequences of thought suppression. Implications are discussed for cognitive theories of obsessive–compulsive disorder and thought suppression.     

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。     

Cognitive-behavioural approaches in the treatment of hypochondriasis: six single case cross-over studies.

This study evaluates a cognitive and a behavioural treatment protocol for hypochondrical complaints. In a cross-over design, six patients with a primary diagnosis of hypochondriasis were treated. Three of them first received a block of behavioural therapy (exposure in vivo and response prevention), followed by a block of cognitive therapy. The other three patients were first treated with cognitive therapy followed by behavioural therapy. The results were promising: four patients made significant improvements. The behavioural therapy sessions appeared to account more often for improvement than did the cognitive sessions. The sequence of behavioural therapy followed by cognitive therapy tended to be more successful than the other way around. The results of these six case studies suggest that exposure in vivo with response prevention and cognitive therapy may both be useful in the treatment of hypochondriasis. A journal controlled study is recommended.     

Therapist-controlled exposure in vivo versus self-controlled exposure in vivo: A comparison with obsessive-compulsive patients

Fourteen obsessive-compulsive clients were given treatment consisting of ten sessions of gradual exposure in vivo With half the clients, the exposure in vivo was therapist-controlled; with the other half, the exposure in vivo was self-controlled.

The results of the posttest showed that both versions of the treatment resulted in a significant improvement on the in vivo measurement, anxiety and avoidance scales, Leyton Obsessional Inventory, Self-Rating Depression Scale and anxious mood. Neither the posttest nor the follow-ups one month and 3.5 months later indicated a difference between the effects of the two conditions. Self-controlled exposure in vivo proved to be as effective as therapist-controlled exposure in vivo, in spite of the fact that in the latter condition each treatment session lasted twice as long as in the former condition.     

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.     

Adaptive Inferential Feedback Partner Training for Depression: A Pilot Study

Adaptive inferential feedback (AIF) partner training is a cognitive technique that teaches the friends and family members of depressed patients to respond to the patients’ dysfunctional thoughts in a targeted manner. These dysfunctional attributions, which AIF addresses, are a common residual feature of depression amongst remitted patients, and are associated with poor long-term consequences. Thus, an AIF partner training intervention, as a supplement to individual cognitive-behavioral therapy (CBT), may help to improve clinical outcomes through the continuing reinforcement of the cognitive restructuring that takes place in the context of the patient’s individual treatment. This 10-patient pilot study examines the feasibility and outcome of the augmentation of standard CBT with 4 sessions of AIF partner training. The patients’ depression, anxiety, negative inferences, and perception of social support, and their partners’ knowledge and provision of AIF significantly improved over the course of the study, with gains maintained at 2-month follow-up. Further research is needed to investigate any incremental value of this intervention beyond standard CBT. A detailed case example, illustrating the application of AIF partner training techniques, is included.