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.     

Anxiety sensitivity as a specific and unique marker of anxious symptoms in youth psychiatric inpatients

We addressed several questions regarding the relation of anxiety sensitivity to anxious symptoms among 47 youth psychiatric inpatients (18 boys, 29 girls), ages 9–17 (M = 14.23, SD = 1.89). Participants completed measures of anxiety sensitivity, anxious and depressive symptoms, trait anxiety, and positive and negative affect; chart diagnoses were available. Consistent with hypotheses, we found that (a) anxiety sensitivity was associated with anxious symptoms, even controlling for trait anxiety and depressive symptoms; and (b) anxiety sensitivity displayed symptom specificity to anxious versus depressive symptoms (i.e., was associated with anxiety controlling for depression but not with depression controlling for anxiety). Furthermore, regarding factors of anxiety sensitivity, we obtained mixed support for our prediction that phrenophobia would be associated with both depression and anxiety, whereas fear of physical arousal would be associated with anxiety but not depression. Implications for the construct validity of anxiety sensitivity were discussed.     

Social anxiety and the effects of negative self-imagery on emotion, cognition, and post-event processing

Numerous studies have shown that social phobia patients experience negative self-impressions or images during social situations. Clark and Wells (1995) posited that such negative self-images are involved in the maintenance of social phobia. Thus, the present study investigated the effects of negative self-imagery on cognition and emotion during and following a brief social situation. Specifically, high and low socially anxious participants (N = 77) were instructed to hold either a negative or control self-image as they engaged in a brief speech. Participants then rated their anxiety, performance, cognitions, and focus of attention. Twenty-four hours later, they returned to the laboratory and completed questionnaires assessing the amount of post-event processing (PEP) they engaged in. The results showed that, irrespective of the level of social anxiety or depressive symptoms, participants that held the negative self-image experienced higher levels of anxiety, were more self-focused, experienced more negative thoughts, rated their anxiety as more visible, appraised their performance more negatively, and engaged in more negative and less positive PEP than participants that held the control self-image. Collectively the results indicate that negative imagery is causally involved in the maintenance of social phobia, as well as in the generation of social anxiety among non-anxious individuals.     

Frequency as a moderating variable in self-report measures of negative cognition

Based on responses to the Distressing Thoughts Questionnaire, subjects' most frequent depressive and anxious cognitions were selected and compared with representative low frequency thought statements. The high frequency cognitions were more emotionally intense, uncontrollable and unacceptable than the low frequency thoughts. Although high frequency anxious items were rated as more frequent than high frequency depressive statements, no differences were evident in emotional intensity and controllability. Furthermore thoughts of loss and failure were specifically predictive of dysphoria only when high frequency cognitive items were utilized. The implications of these findings for cognitive assessment issues were discussed.     

Anxiety,depression, and the suicidal spectrum: a latent class analysis of overlapping and distinctive features

ABSTRACT

Anxiety and depression diagnoses are associated with suicidal thoughts and behaviours. However, a categorical understanding of these associations limits insight into identifying dimensional mechanisms of suicide risk. This study investigated anxious and depressive features through a lens of suicide risk, independent of diagnosis. Latent class analysis of 97 depression, anxiety, and suicidality-related items among 616 psychiatric outpatients indicated a 3-class solution, specifically: (1) a higher suicide-risk class uniquely differentiated from both other classes by high reported levels of depression and anxious arousal; (2) a lower suicide-risk class that reported levels of anxiety sensitivity and generalised worry comparable to Class 1, but lower levels of depression and anxious arousal; and (3) a low to non-suicidal class that reported relatively low levels across all depression and anxiety measures. Discriminants of the higher suicide-risk class included borderline personality disorder; report of worthlessness, crying, and sadness; higher levels of anxious arousal and negative affect; and lower levels of positive affect. Depression and anxiety diagnoses were not discriminant between higher and lower suicide risk classes. This transdiagnostic and dimensional approach to understanding the suicidal spectrum contrasts with treating it as a depressive symptom, and illustrates the advantages of a tripartite model for conceptualising suicide risk.     

Depressive, anxious and intrusive thoughts in psychiatric inpatients and outpatients.

A revised form of the Distressing Thoughts Questionnaire as well as standardized self-report measures of depression, anxiety and obsessionality were administered to a large sample of psychiatric inpatients, outpatients and non-clinical controls. A subsample of the clinical subjects completed the questionnaire battery after 3 months. Factor analysis identified three distinct dimensions of negative thinking which corresponded to anxious, depressive and intrusive thoughts. Further analysis revealed that the intrusive thoughts differed from the anxious and depressive negative automatic thoughts in terms of their reduced association with psychopathology, increased temporal stability and nonspecific association with negative affect in general. These findings suggest that by adopting a more specific focus on obsessive-like ego-dystonic intrusive thoughts, researchers will be in a better position to investigate the role of this phenomena in the development of clinical obsessions.     

Comparison of Cognitive-Behavioral Stress Management Techniques With Adolescent Boys

This study examined the effectiveness of two cognitive-behavioral interventions to help adolescent boys cope with stress and other forms of negative emotional arousal. One group of youths, those receiving cognitive restructuring, learned how to identify and monitor stress-promoting cognitions, restructure these cognitions into more adaptive thoughts, and practice and apply these acquired skills. Another group of youths received anxiety management training, and they were taught to recognize cues that signal the onset of anxiety and to react to these cues using various relaxation skills to reduce the anxiety. The youths who received training were compared with a waiting list control group on measures of anxiety, anger, self-esteem, depression, and reports of anxious self-statements. Both groups that received the intervention showed significant reductions in levels of state and trait anxiety, state anger, anger expression, and depression. These treatment gains were maintained at an 11-week follow-up.     

Cognitive specificity and affective confounding in social anxiety and dysphoria in children

Cognitive features of social anxiety and dysphoria were examined with a design that allowed for evaluation of each state alone and in combination. From a community sample of 211 8 to 12 year olds, four groups of children were defined based on previous researcher's criteria: mixed (high socially anxious-dysphoric;n= 14), socially anxious (high socially anxiousnondysphoric;n= 14), dysphoric (non-socially anxious-dysphoric;n= 13), and control (non-socially anxious-nondysphoric;n= 14). The negative cognitive triad and negative cognitions pertaining to the self were associated with both dysphoria and social anxiety. Both dysphoric and socially anxious groups reported significantly more cognitive distortions than the control group, yet cognitive distortions of overgeneralizing and personalizing were specific to social anxiety and not dysphoria. Both dysphoric and socially anxious groups reported significantly more depressive cognitions than the control group, and evidence of cognitive content-specificity emerged only for anxiety, although there was some evidence for depressive content-specificity in the mother's ratings. The mixed group was the most dysfunctional on all of the cognitive measures. This study provided some evidence of cognitive-specificity as well as the confounding between the affective states of dysphoria and social anxiety. Methodological, theoretical, and treatment implications are highlighted.     

Cognitive behavioral variables mediate the associations of neuroticism and attachment insecurity with Prolonged Grief Disorder severity

Prolonged Grief Disorder (PGD) is a debilitating syndrome of grief. A recent cognitive behavioral model asserts that three processes are critical to this condition: (1) insufficient integration of the loss with autobiographical knowledge about the self and the lost person; (2) negative cognitions; and (3) anxious and depressive avoidance behaviors. These processes are assumed to contribute to PGD symptoms and to mediate the influence of personality-related vulnerabilities on the development and maintenance of these symptoms. The present study examined the mediational role of these three processes in the linkage between neuroticism, attachment anxiety, and attachment avoidance on the one hand and PGD symptom severity on the other hand. Self-reported data from 348 bereaved people were used. The results showed that the three personality variables were significantly associated with PGD symptom severity. Moreover, the results provided support for the mediating effects of indices of insufficient integration, negative cognitions, as well as avoidance behaviors - even after controlling for the shared variance between mediators. Theoretical and clinical implications are discussed.     

Neuroticism,Life Events and Negative Thoughts in the Development of Depression in Adolescent Girls

Theories of depression suggest that cognitive and environmental factors may explain the relationship between personality and depression. This study tested such a model in early adolescence, incorporating neuroticism, stress-generation and negative automatic thoughts in the development of depressive symptoms. Participants (896 girls, mean age 12.3 years) completed measures of personality and depressive symptoms, and 12 months later completed measures of depressive symptoms, recent stressors and negative automatic thoughts. Path analysis supported a model in which neuroticism serves as a distal vulnerability for depression, conferring a risk of experiencing dependent negative events and negative automatic thoughts, which fully mediate the effect of neuroticism on later depression. A second path supported a maintenance model for depression in adolescence, with initial levels of depression predicting dependent negative events, negative automatic thoughts and subsequent depressive symptoms. Unexpectedly, initial depression was also associated with later independent life events. This study establishes potential mechanisms through which personality contributes to the development of depression in adolescent girls.     

Dimensions of Perfectionism and Anxiety Sensitivity

The current study investigated the extent to which dimensions of perfectionism are associated with components of the anxiety sensitivity construct. A sample of 177 undergraduate students completed the Multidimensional Perfectionism Scale, the Perfectionism Cognitions Inventory, the Perfectionistic Self-Presentation Scale, and the Expanded Anxiety Sensitivity Index developed by Taylor and Cox (1998). The results confirmed that automatic thoughts involving perfectionism and the interpersonal aspects of the perfectionism construct are associated with anxiety sensitivity. Examination of the Anxiety Sensitivity Index factors showed that perfectionism cognitions were associated primarily with anxiety sensitivity involving fears of cognitive dyscontrol, while socially prescribed perfectionism and perfectionistic self-presentation were associated primarily with fears of publicly observable anxiety reactions in a manner suggesting that the interpersonal perfectionism dimensions are linked closely with an anxious sensitivity to negative social evaluation and subsequent panic attacks. The theoretical and treatment implications of the link between perfectionism and anxiety sensitivity are discussed.     

Relationships between personality traits and positive/negative sexual cognitions

In this study we examined the relationship between gender, age, religion, neuroticism, extraversion, openness to experience, and obsessiveness on one side and the frequency and content of sexual cognitions experienced as being positive/pleasant or negative/unpleasant on the other. The sample was made up of 1,500 individuals (42.8% men and 57.2% women) aged between 18 and 72 years. Results indicated that all the socio-demographic variables as well as the traits neuroticism, openness to experience, and obsessiveness were important in the prediction of the overall frequency of positive sexual cognitions. Age and neuroticism, openness to experience, and obsessiveness were found to be significant in the prediction of the overall frequency of negative sexual cognitions. When considering the content of sexual cognitions (i.e., intimate, exploratory, sadomasochistic, and impersonal), all the socio-demographic variables and the trait openness to experience were found to be significantly related to all types of positive sexual cognitions. Neither socio-demographic variables nor personality traits were significantly associated with the content of negative sexual cognitions. Overall, this study highlights the weakness of the predictive value of personality traits on sexual cognitions, especially those experienced as being negative. We discuss the usefulness of classic personality traits in predicting sexual aspects.     

Cognitive behavioral variables mediate the associations of neuroticism and attachment insecurity with Prolonged Grief Disorder severity

Abstract

Prolonged Grief Disorder (PGD) is a debilitating syndrome of grief. A recent cognitive behavioral model asserts that three processes are critical to this condition: (1) insufficient integration of the loss with autobiographical knowledge about the self and the lost person; (2) negative cognitions; and (3) anxious and depressive avoidance behaviors. These processes are assumed to contribute to PGD symptoms and to mediate the influence of personality-related vulnerabilities on the development and maintenance of these symptoms. The present study examined the mediational role of these three processes in the linkage between neuroticism, attachment anxiety, and attachment avoidance on the one hand and PGD symptom severity on the other hand. Self-reported data from 348 bereaved people were used. The results showed that the three personality variables were significantly associated with PGD symptom severity. Moreover, the results provided support for the mediating effects of indices of insufficient integration, negative cognitions, as well as avoidance behaviors – even after controlling for the shared variance between mediators. Theoretical and clinical implications are discussed.     

Individual differences in self-reported thought control: the role of the repressive coping sytle

The purpose of the present research is to assess differences between repressors and non repressors in some aspects associated with conscious thought control. Thus, Sixty-three Spanish university students with different combinations of trait anxiety and defensiveness completed the Thought Control Ability Questionnaire (TCAQ) and the White Bear Suppression Inventory (WBSI). Data analysis showed that subjects with low anxiety (repressors and low anxious) reported higher perceived ability to control unpleasant thoughts and less tendency to suppress than did subjects with high anxiety (high anxious and defensive high anxious). Implications of these results are discussed in relation to recent researches that have explored the association between repression and thought suppression.     

A longitudinal analysis of anxiety and depressive symptoms

The authors modeled depressive and anxiety symptom data from 1,391 participants in a longitudinal study of middle-aged and older Swedish twins (M age = 60.9 years, SD = 13.3). Although anxiety and depression were highly correlated, a model with distinct Anxiety and Depression factors fit the data better than models with Positive and Negative Affect factors or a single Mental Health factor. Lack of well-being was associated with anxiety rather than depression. Over two 3-year intervals, anxiety symptoms led to depressive symptoms, but the relationship was not reciprocal. Anxiety symptoms were more stable than depression. These findings provide additional support for the idea that anxiety symptoms may reflect a personality trait such as neuroticism more than do depressive symptoms and suggest that low positive affect may not be as specific to depression among older adults as in younger people.     

Ruminative coping and post-event processing in social anxiety

Cognitive models of social anxiety implicate various factors in the initiation and maintenance of socially anxious states, including anticipatory processing, self-focused attention and post-event processing. The present study focused on post-event processing, which is a post-mortem analysis following a social event that is described as ruminative in nature and serves to maintain social anxiety. Participants (N=112; 64 women, 48 men) were presented with vignettes that involved making mistakes in public and were instructed to record their thoughts to allow for the examination of the content of post-event processing. Ruminative coping and distraction were assessed via self-report. Results indicated that participants high in social anxiety (n=55) were more likely to ruminate and less likely to distract when faced with socially anxious stressors compared to those low in social anxiety (n=57). Further, as hypothesized, participants high in social anxiety recorded more negative thoughts and more upward counterfactual thoughts ('if only' type thoughts on how things could have been better; associated with negative affect) compared to those low in social anxiety. These results are discussed in terms of cognitive models of social anxiety.     

Automatic thoughts and meta‐cognition as predictors of depressive or anxious symptoms: A prospective study of two trajectories

The purpose of this prospective study was to explore the Automatic Thought Questionnaire Negative (ATQ‐30‐N) and the Meta‐cognitions Questionnaire (MCQ‐30) as predictors in the development of depressive or anxious symptoms. A sample (N = 201) completed the ATQ‐30‐N, MCQ‐30, and the Hopkins Symptom Checklist‐25 (HSCL‐25) twice with a three month interval. The HSCL‐25 measures both depressive and anxiety symptoms. Separate multiple hierarchical regression analyses indicated that the ATQ‐30‐N was a positive predictor for levels of depressive symptoms, while the MCQ‐30 was a predictor of both levels of anxiety and depressive symptoms, at follow‐up, when controlling for gender, age and pre‐test levels of symptoms. However, the MCQ‐30 did not predict future levels of depressive symptoms, when levels of automatic negative thoughts measured by the ATQ‐30‐N were statistically controlled for. The findings suggested that the ATQ‐30‐N predicts future levels of depressive symptoms, while the MCQ‐30 primarily predicts future levels of anxiety.     

Is positive thinking in anticipation of a performance situation better than distraction? An experimental study in preadolescents

The current study compares the effects of experimentally induced positive anticipatory thinking and distraction in preadolescents aged 12–13. Eighty‐seven participants were instructed to either engage in positive anticipatory thoughts or perform a distraction task while preparing to perform a sporting activity in front of their peers. Results revealed that trait social anxiety was associated with more negative estimates of sport performance and catastrophic thoughts relating to the impending sport activity. Additionally, compared to children who distracted, children in the positive anticipation condition showed significantly increased anxiety levels, more catastrophic thoughts and more negative predictions of sport performance and appearance, although these effects did not appear to interact with trait social anxiety. Finally, no significant manipulation effect on participants’ observable behavior was found. The findings further highlight the utility of distracting from an impending, anxiety‐provoking situation to keep anxious feelings to a low level.     

The impact of maternal control on children’s anxious cognitions, behaviours and affect: An experimental study

Controlling parenting is associated with child anxiety however the direction of effects remains unclear. The present study implemented a Latin-square experimental design to assess the impact of parental control on children’s anxious affect, cognitions and behaviour. A non-clinical sample of 24 mothers of children aged 4-5 years were trained to engage in (a) controlling and (b) autonomy-granting behaviours in interaction with their child during the preparation of a speech. When mothers engaged in controlling parenting behaviours, children made more negative predictions about their performance prior to delivering their speech and reported feeling less happy about the task, and this was moderated by child trait anxiety. In addition, children with higher trait anxiety displayed a significant increase in observed child anxiety in the controlling condition. The pattern of results was maintained when differences in mothers’ levels of negativity and habitual levels of control were accounted for. These findings are consistent with theories that suggest that controlling parenting is a risk factor in the development of childhood anxiety.     

The symptom perception hypothesis revised: depression and anxiety play different roles in concurrent and retrospective physical symptom reporting

According to the classic symptom perception hypothesis (Costa & McCrae, 1987; Watson & Pennebaker, 1989), the global predisposition to frequently experience a variety of negative emotions-that is, neuroticism (N) or trait negative affectivity (NA)-is associated with inflated physical symptom reporting. We tested a revision of this hypothesis, which posits distinctive roles for depression and anxiety in the physical symptom experience. Three studies tested predictions from the revised symptom perception hypothesis: (a) that depressive affect should be related to inflated retrospective physical symptom reports and (b) that anxious affect should be related to inflated concurrent, or momentary, physical symptom reports. Study 1 assessed the relations among N/NA, depressive affect, and recall of physical symptoms experienced in the previous 3 weeks. Depressive affect was uniquely and positively associated with recalling more symptoms. When entered with depressive affect in multiple regression analyses, neuroticism was not associated with level of symptoms recalled. In Study 2, participants were randomly assigned to anxious, depressed, angry, happy, or neutral mood inductions and then reported about concurrent symptom experience. Participants in the anxious mood condition reported significantly more concurrent physical symptoms than did those in the other 4 conditions. In Study 3, anxious, depressed, or neutral mood was induced, followed by assessment of both concurrent and retrospective physical symptoms. Those assigned to the anxious mood induction reported more concurrent symptoms, while those in the depressed mood condition reported having experienced more symptoms in the past. These findings are consistent with the idea that encoding and retrieval processes, which are differentially associated with anxious versus depressed affect, influence different aspects of physical symptom reporting. The results have implications for self-diagnosis, medical treatment-seeking, and care, and potential insights about other complex social and interpersonal behaviors are discussed.