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.     

Perceived attachment: relations to anxiety sensitivity, worry, and GAD symptoms

This investigation examined the relation between perceived alienation from parents and peers, anxiety sensitivity (AS), and current worry and generalized anxiety disorder (GAD) symptoms with the goal of expanding the knowledge base on factors that may contribute to the development of AS and its role in worry. The mediating role of AS between perceptions of alienation and current worry and GAD symptoms was also examined. Ninety-four non-clinical worriers completed self-report questionnaires assessing their perceptions of attachment, AS levels, and worry and GAD symptoms. Even after controlling for worry and GAD symptoms, greater perceptions of alienation from mothers and peers were significantly associated with higher AS symptoms. AS as a unitary construct mediated the relation between perceptions of alienation from mothers and peers and worry and GAD symptoms. The facets fear of publicly observable symptoms and fear of cognitive dyscontrol also mediated this relation. The role of alienation in relation to AS, worry, and GAD symptoms is discussed along with directions for future research.     

Appraisals of obsessional thoughts in normal samples

Cognitive theories of obsessive-compulsive disorder (OCD) posit that appraisals about the significance of thoughts are critical in the development and persistence of obsessions. Rachman [(1997). A cognitive theory of obsessions. Behaviour Research and Therapy, 35, 793-802.] proposes that appraisals of unwanted thoughts distinguish clinical obsessions from normal intrusive thoughts; thoughts appraised as important and personally significant are expected to be upsetting and recur. Appraisals are also expected to be related to symptoms of OCD. To explore the features of normal appraisals of obsession-like thoughts, nonclinical participants in two studies rated the personal significance of intrusive thoughts portrayed in vignettes containing prototypical themes associated with primary obsessions: aggressive, sexual, and blasphemous thoughts. Unwanted intrusive thoughts that were described as occurring more frequently were appraised as more personally significant, but participants appraised these socially unacceptable thoughts similarly whether they imagined having personally experienced them or a friend confiding about having experienced them. Appraisals in both studies were related to subclinical OC symptoms and OC beliefs.     

Process characteristics of worry and obsessive intrusive thoughts

One hundred and twenty-five university students were administered a battery of self-report measures to assess worry disposition and content, frequency of obsessive intrusive thoughts, and 10 conceptually derived appraisal dimensions of worry and obsessional intrusions. Process ratings indicated that the worrisome thoughts were considered more disturbing than the ego-dystonic intrusive thoughts. Worry was also distinguished by a focus on the possible consequences of negative events, whereas concern about the personal meaning of the thought was a unique process dimension for obsessive intrusive thoughts. Both content and process variables are important in differentiating worry and obsessive-like intrusive thoughts in a nonclinical population.     

Linking obsessional beliefs to OCD symptoms in older and younger adults

There are many open questions about the phenomenology of obsessive-compulsive disorder (OCD) in the elderly, and theories about the development of OCD have rarely been applied to older populations. The current study uses structural equation models to evaluate the relationship between obsessional beliefs and OCD symptoms across young and older adult age groups in a large community sample (aged 18-93; N=335), and to examine whether subjective concerns about cognitive decline partially mediate this relationship. Results support partial mediation, and follow-up analyses suggest that the pattern of relationships among subjective cognitive concerns, obsessional beliefs and OCD symptoms is invariant for younger and older adults, but older adults report relatively greater levels of subjective cognitive concerns.     

Cognitive variables related to worry among adolescents: avoidance strategies and faulty beliefs about worry

Studies aiming to better understand worry have neglected children and adolescents. This constitutes an important limitation considering that excessive worry is frequent among adolescents and that patients suffering from excessive worries associate the beginning of their disorder with adolescence. This study evaluates the cognitive variables associated with worry in a sample of 777 adolescents. It attempts to determine whether cognitive avoidance and false beliefs about the usefulness of worries are present and associated with worries in adolescence. The results showed that participants with a high level of worry used more avoidance strategies and held more beliefs about worry. The results also revealed that avoidance of stimuli that trigger unpleasant thoughts and thought substitution were the major avoidance strategies related to worry among adolescents. The belief that worry helps to avoid future negative events was also related to worry. These findings may suggest that adolescents' worries are maintained by processes similar to those observed among adults.     

Obsessive intrusive thoughts in nonclinical subjects. Part I. Content and relation with depressive, anxious and obsessional symptoms

The present study reports on the development and preliminary validation of a 52 item self-report instrument designed to assess intrusive thoughts, images and impulses that are similar to the aggressive, sexual and disease-related thinking characteristic of clinical obsessions. Two hundred and ninety-three students completed the Obsessive Intrusions Inventory (OII) as well as standard self-report measures of negative cognitions and obsessive, anxious and depressive symptoms. Regression analysis revealed that intrusive thinking was a significant and unique predictor of obsessional but not anxious or depressive symptoms. Furthermore, intrusive thinking showed a moderate correlation with anxious but not depressive cognitions. The results indicate that the intrusive thoughts assessed by the OII are distinct from other forms of negative thinking and may, in fact, constitute an analogue form of clinical obsessions in nonclinical populations.     

Cognitive-behavioural factors and the persistence of intrusive thoughts in obsessional problems

Jakes' critique fails to consider (i) the importance of appraisal of responsibility in initiating neutralising activity, and that (ii) obsessional patients negatively evaluate the occurrence as well as the content of intrusive thoughts. These factors are crucial because neutralising is presumed to be central to the development and maintenance of obsessional disorders. The current form of the hypothesis is outlined and recent data reviewed. Possible experimental investigations on the focus of therapeutic interventions are considered.     

Worry and obsessional symptoms: a correlational analysis.

Several studies have suggested that worry and obsessional symptoms are systematically associated. In the present study, the relationship between worry and obsessional symptoms was confirmed. Measures included a worry content measure, a worry visual analogue scale, a modification of the everyday checking behaviours scale, and the MOCI. Worry was found to be more consistently associated with checking and doubting, than washing and slowness. It is suggested that worry and obsessional symptoms both occur in response to stress. In addition, it is suggested that worry and checking are functionally similar, and Generalised Anxiety Disorder may represent a 'cognitive' variant of obsessional checking.     

Cognitive and emotional control and perspective taking and their relations to empathy in 5-year-old children

The experience of empathy has been described as involving both emotional and cognitive components. The primary hypothesis tested in this study is that cognition and emotion are integrated within 2 distinct types of abilities-control and perspective taking-and that interactions between emotional and cognitive control and between affective and cognitive perspective taking would be related to children's empathic responding. We also hypothesized that boys' control and perspective-taking skills would be more strongly related to empathy than would those of girls. Fifty-seven 5-year-olds completed tasks measuring cognitive control, cognitive and affective perspective taking, and empathy, and their mothers completed a measure of children's emotional control. Results indicated that cognitive perspective taking moderated the relation between affective perspective taking and empathy. In addition, the relation between cognitive inhibitory control and empathy was moderated by gender; boys' control was positively related to empathy, but girls' control was marginally negatively related to empathy.     

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.     

Event‐based prospective memory and obsessive–compulsive disorder intrusive obsessional thoughts

Recent studies have found poorer prospective remembering among students selected for elevated obsessive–compulsive disorder (OCD) checking and washing. However, as prospective memory performance also requires retrospective remembering, it is not clear from earlier work whether deficits in prospective memory in samples with OCD symptomatology are due to problems with prospective remembering, or to retrospective memory failures that result in poorer performance on prospective memory tasks. The present study examines performance on matched prospective and retrospective memory tasks among students selected for high (n = 48) and low (n = 44) scores on the Obsessive–Compulsive Inventory‐Revised Obsession subscale. Significant differences between the groups were found in prospective memory (regardless of whether the word was neutral or harm/danger‐related), but not retrospective memory. The findings are consistent with the prediction that obsessional thoughts that occupy working memory capacity would have a deleterious effect on a resource‐demanding prospective memory task. An additional finding was that there were no group differences in self‐reported complaints of problems with prospective memory.     

Effects of worry and somatic anxiety induction on thoughts, emotion and physiological activity

Thirty-six Ss received Velten (1968) emotion inductions designed to produce either worrisome, somatically anxious, or neutral states. A breathing-focus task assessed the frequency of negative thought intrusions before and after the emotion induction. Worry induction produced the greatest increase in negative intrusions, significantly greater than the neutral condition. Somatic anxiety induction produced some increase in intrusions, nonsignificantly between worry and neutral inductions. Both worry and somatic anxiety inductions generated significant increases in cardiovascular activity relative to the neutral condition, while no effect was observed on gastric myoelectric activity. Worry was characterized by emotions on the Multiple Affect Adjective Checklist that overlap with those of depression and somatic anxiety.     

Depressed mood: The role of negative thoughts,self-consciousness,and sex role stereotypes

Research typically finds that depression is twice as common among women as among men. This may relate to differences in socialization that result in different emotions, cognitions, and coping reactions. Sex-role stereotypes, employment and marital status, and differential social pressures may also be significant in making women more vulnerable to the development of depression. Women may have less decision-making power, face more adverse life events, and have limited access to resources, which may lead to feelings of helplessness and low self-esteem. Low self-esteem and negative cognitions about the self in turn may be proximal factors predictive of negative mood. Additionally, women may be more prone to ruminative self-focus rather than active coping, a significant risk factor for depression. This study examined individual predictors of depressed mood for each sex, including coping, self-esteem, negative thoughts, self-consciousness (rumination), as well as social factors such as the endorsement of sex-role stereotypes and decision-making power in the family. Results indicated that social factors were not related to depressed mood in either sex, but were related to coping styles and self-esteem. Depressed mood was associated with individual characteristics, such as avoidant coping styles, social anxiety for women, and ruminative self-focus for men. Regression analysis showed that coping through denial and negative thoughts explained depressed mood, and the latter was particularly true for men. These results point to the significance of examining both individual and social factors when attempting to understand depression in men and women.     

Components of generalized anxiety: the role of intrusive thoughts vs worry

This study explored possible mechanisms involved with the maintenance of generalized anxiety. While several general anxiety-related variables were investigated, the relationship between worry and intrusive thoughts was of primary interest. We postulated that anxious persons continue to worry in order to avoid recollections of distressing life events. Accordingly, we hypothesized that worry can be distinguished from intrusive thoughts and that the experience of worry would be preferred to intrusive thoughts. Results of a factor analysis indicated that worry and intrusive thought items loaded on separate factors, which supports the hypothesis that worry can be distinguished from intrusive thoughts. The study also examined whether different patterns of worry and intrusive thoughts distinguish between high-anxious, panic, and low-anxious persons and how anxiety sensitivity and self-consciousness are related to generalized anxiety and panic. Finally, we discussed the implications of our results for understanding the psychopathology base of Generalized Anxiety Disorder.     

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.     

Contribution of concrete cognition to emotion: neutral symptoms as elicitors of worry about cancer

The relationship between worry about cancer and judged cancer risk was examined among 54 expatients who had been cured of breast cancer and 81 women with no history of cancer. Worry required both a perception of substantial risk and the presence of concrete perceptual cues. Worry promoters include visits to a physician and concrete, noncancerlike symptoms (e.g., fever, pain). Supporting analyses indicate that the symptom effects are not due to self-report biases or attributions of symptoms to cancer but are the result of a reminder process whereby vulnerability beliefs are aroused by somatic cues. Judged cancer risk was unrelated to affective cues, suggesting that across-time variation in worry about cancer reflects the onset and offset of symptom episodes rather than a shift in risk appraisals. Expatients were more worried overall than nonpatient controls. The results have implications for controlling disease worry and initiating preventive behaviors.