The effects of safety behaviors on health anxiety: an experimental investigation

The present study examined the extent to which safety behaviors exacerbate symptoms of hypochondriasis (severe health anxiety). Participants were randomized into a safety behavior (n = 30) or control condition (n = 30). After a baseline period, participants in the safety behavior condition spent one week actively engaging in a clinically representative array of health-related safety behaviors on a daily basis, followed by a second week-long baseline period. Participants in the control condition monitored their normal use of safety behaviors. Compared to control participants, those in the safety behavior condition reported significantly greater increases in health anxiety, hypochondriacal beliefs, contamination fear, and avoidant responses to health-related behavioral tasks after the safety behavior manipulation. In contrast, general anxiety symptoms did not significantly differ between the two groups as a function of the manipulation. Mediational analyses were consistent with the hypothesis that changes in the frequency of health-related thoughts mediated the effects of the experimental manipulation on health anxiety. These findings suggest that safety behaviors are associated with increases in health anxiety, perhaps by fostering catastrophic thoughts about health. The implications of these findings for the conceptualization of hypochondriasis as an anxiety disorder are discussed.     

Crying for a Vision: The Native American Sweat Lodge Ceremony as Therapeutic Intervention

The Native American sweat lodge ceremony or sweat therapy is being used increasingly in various medical, mental health, correctional, and substance abuse treatment centers serving both Native and non‐Native clients. This article explores the sweat lodge ceremony's background, elements of Native American spirituality, origin story, cultural symbolism, prayer, and contemporary use. Current evidence of effectiveness and therapeutic benefits is presented, then implications for integrating the sweat lodge ceremony as a complementary counseling approach are discussed.     

Attentional bias toward threat in contamination fear: overt components and behavioral correlates

Recent research suggests that an attentional bias toward threat may play a causal role in obsessive-compulsive disorder (OCD) with contamination concerns. However, the attentional components involved in this bias, as well as its behavioral correlates, remain unclear. In the present study, eye movements were recorded in individuals high and low in contamination fear (HCF, LCF, respectively) during 30-s exposures to stimulus arrays containing contamination threat, general threat, pleasant, and neutral images. HCF individuals oriented gaze toward contamination threat more often than LCF individuals in initial fixations, and this bias mediated group differences in responding to a behavioral challenge in a public restroom. No group differences were found in the maintenance of gaze on contamination threat, both in terms of initial gaze encounters, as well as gaze duration over time. However, the HCF group made shorter fixations on contamination threat relative to other image types. The implications of these findings for further delineating the nature and function of attentional biases in contamination-based OCD are discussed.     

Individual differences in disgust sensitivity and health-related avoidance: Examination of specific associations

This present study examined the specificity of disgust sensitivity in predicting health-related anxiety and behavioral avoidance. Participants (n = 60) completed self-report measures of disgust sensitivity, health anxiety, anxiety, and depression. They then completed three randomly presented health-related behavioral avoidance tasks (BATs) that consisted of potential exposure to the common cold, the flu, and mononucleosis. Results indicated that disgust sensitivity was significantly associated with anxious and avoidant responding to the health-related BATs. This association also remained largely intact after controlling for gender, anxiety, depression, and health anxiety. These findings indicate that disgust sensitivity has a specific and robust association with health-related anxiety and avoidance commonly observed among those with excessive health anxiety and obsessive compulsive disorder. The unique role of disgust sensitivity in relation to health anxiety is discussed in the context of a disease-avoidance model.     

The moderating effects of contamination sensitivity on state affect and information processing: Examination of disgust specificity

Although contamination sensitivity has been implicated in several disorders, there is a paucity of research examining the influence of this trait on various outcomes. Accordingly, the present study examined the extent to which individual differences in contamination sensitivity moderated state affect in response to a mood induction and subsequent information processing biases, as assessed by a lexical decision task (LDT). It was hypothesised that the moderating effects of contamination sensitivity would be specific to disgust responding to a negative but not positive mood induction, and to reaction times to disgust and fear compared to happy words on the LDT. The findings were largely consistent with this hypothesis, as contamination sensitivity predicted increased disgust and arousal to the negative mood induction. Contamination sensitivity was also a better predictor of reaction times to disgust and fear words than happy words. However, the moderating effect of contamination sensitivity on reaction times on the LDT was not mediated by its effects on response to the negative mood induction. Implications of these findings for conceptualising the role of contamination sensitivity and its association with disgust in specific disorders are discussed.     

The Cruelest Cure? Ethical Issues in the Implementation of Exposure-Based Treatments

Numerous studies have provided supportive evidence for the efficacy of exposure-based treatments for many psychological disorders. However, surprisingly few therapists use exposure therapy in the clinical setting. Although the limited use of exposure-based treatments may be partially attributable to a shortage of suitably trained therapists, exposure therapy also suffers from a “public relations problem” predicated upon concerns that it is cruel and at odds with some ethical considerations (e.g., first do no harm). This article provides an overview of ethical issues and considerations relevant to the use of exposure therapy. It is argued that the degree to which ethical issues become problematic in implementing exposure-based treatments is largely dependent upon the therapist's ability to create an adequately safe and professional context. Specific strategies that may be employed for avoiding potential ethical conflicts in the use of exposure-based treatments are discussed.     

The Disgust Scale: item analysis, factor structure, and suggestions for refinement

In the 4 studies presented (N = 1,939), a converging set of analyses was conducted to evaluate the item adequacy, factor structure, reliability, and validity of the Disgust Scale (DS; J. Haidt, C. McCauley, & P. Rozin, 1994). The results suggest that 7 items (i.e., Items 2, 7, 8, 21, 23, 24, and 25) should be considered for removal from the DS. Secondary to removing the items, exploratory and confirmatory factor analyses revealed that the DS taps 3 dimensions of disgust: Core Disgust, Animal Reminder Disgust, and Contamination-Based Disgust. Women scored higher than men on the 3 disgust dimensions. Structural modeling provided support for the specificity of the 3-factor model, as Core Disgust and Contamination-Based Disgust were significantly predictive of obsessive- compulsive disorder (OCD) concerns, whereas Animal Reminder Disgust was not. Results from a clinical sample indicated that patients with OCD washing concerns scored significantly higher than patients with OCD without washing concerns on both Core Disgust and Contamination-Based Disgust, but not on Animal Reminder Disgust. These findings are discussed in the context of the refinement of the DS to promote a more psychometrically sound assessment of disgust sensitivity.     

The Use of the Racial/Cultural Identity Development Model to Understand a Vietnamese American: A Research Case Study

This article presents the sociohistorical experiences of Vietnamese Americans that contextualize the therapeutic relationship. Using a case study approach, researchers illustrate the use of the Racial/Cultural Identity Development model (D. W. Sue & D. Sue, 2003) in the analysis of an interview with a young, adult, Vietnamese immigrant. Este artículo muestra las experiencias histórico‐sociales de Americanos Vietnamitas que contextualizan la relación terapéutica. Empleando la aproximación de un estudio de caso, investigadores ilustran el uso del modelo de Desarrollo de Identidad Racial/Cultural por sus siglas en inglés, de D.W. Sue & D. Sue, 2003, en el análisis de una entrevista con un inmigrante Vietnamita adulto y joven.     

Enhancing Inhibitory Learning: The Utility of Variability in Exposure

Exposure therapy has strong empirical support as a treatment for anxiety and related disorders, yet not all participants see clinically meaningful reduction in symptoms, and some experience return of fear. In this review, we examine the theoretical models of exposure therapy, from early precursors to the contemporary inhibitory learning model. The inhibitory learning model is applied to examine one potential method of improving outcomes in exposure therapy: increasing variability in the progression of the exposure hierarchy. We explore mechanisms that support the use of variability in exposure, including the violation of expectancies to enhance learning. In addition, the role of intolerance of uncertainty in anxiety is examined; variable exposure therapy could target this transdiagnostic mechanism in anxiety and related disorders. Suggestions for future research are then offered.     

Linking attentional control and PTSD symptom severity: the role of rumination

Although deficits in attentional control have been linked to posttraumatic stress disorder (PTSD), the mechanism that may account for this association has not been fully elucidated. The present study examined rumination as a mediator of the relationship between attentional control and PTSD symptoms. Veterans with PTSD and trauma-exposed veterans without PTSD completed measures of attentional control, rumination, and PTSD symptom severity. As predicted, the findings showed that veterans with PTSD reported significantly lower levels of attentional control than veterans without PTSD. Veterans with PTSD also reported significantly higher levels of rumination than veterans without PTSD. Subsequent analysis of the total sample revealed that the relationship between attentional control and PTSD symptom severity was accounted for by excessive rumination. Attentional control may contribute to PTSD symptoms through excessive rumination. Attentional control and rumination may be important targets for PTSD interventions.