Optimizing Exposure Therapy for Pathological Health Anxiety: Considerations From the Inhibitory Learning Approach

Exposure therapy has demonstrated its efficacy in the treatment of pathological health anxiety—however, psychotherapy research reveals that many patients do not show a clinically significant change. Therefore, improvements are necessary to optimize psychotherapy for pathological health anxiety. Most treatment rationales refer to habituation during exposure as the central mechanism of change. However, there is evidence that extinction learning is mediated by inhibitory learning processes. Targeting these processes may help to improve treatment outcomes in pathological health anxiety. The aim of this review was to adapt, from the inhibitory learning approach and empirical findings, the most promising strategies for the exposure-based treatment of pathological health anxiety. The exposure-optimizing strategies adapted are expectancy violation, combination, variability in contexts and stimuli, affect labeling, and removal of safety signals. A case example illustrates how to implement these methods for patients with pathological health anxiety.     

On the influence of causal beliefs on the feeling of agency

The sense of agency is the experience of being the origin of a sensory consequence. This study investigates whether contextual beliefs modulate low-level sensorimotor processes which contribute to the emergence of the sense of agency. We looked at the influence of causal beliefs on ‘intentional binding’, a phenomenon which accompanies self-agency. Participants judged the onset-time of either an action or a sound which followed the action. They were induced to believe that the tone was either triggered by themselves or by somebody else, although, in reality, the sound was always triggered by the participants. We found that intentional binding was stronger when participants believed that they triggered the tone, compared to when they believed that another person triggered the tone. These results suggest that high-level contextual information influences sensorimotor processes responsible for generating intentional binding.     

Virtual/real transfer of spatial knowledge: benefit from visual fidelity provided in a virtual environment and impact of active navigation

The purpose of this study was to evaluate the effect the visual fidelity of a virtual environment (VE) (undetailed vs. detailed) has on the transfer of spatial knowledge based on the navigation mode (passive vs. active) for three different spatial recall tasks (wayfinding, sketch mapping, and picture sorting). Sixty-four subjects (32 men and 32 women) participated in the experiment. Spatial learning was evaluated by these three tasks in the context of the Bordeaux district. In the wayfinding task, the results indicated that the detailed VE helped subjects to transfer their spatial knowledge from the VE to the real world, irrespective of the navigation mode. In the sketch-mapping task, the detailed VE increased performances compared to the undetailed VE condition, and allowed subjects to benefit from the active navigation. In the sorting task, performances were better in the detailed VE; however, in the undetailed version of the VE, active learning either did not help the subjects or it even deteriorated their performances. These results are discussed in terms of appropriate perceptive-motor and/or spatial representations for each spatial recall task.     

Interaction of task readiness and automatic retrieval in task switching: Negative priming and competitor priming

When subjects switch between tasks, performance is slower after a task switch than after a task repetition, even when preparation time is long. We report two experiments that support the idea that a large part of these residual task shift costs can be due to stimulus-cued retrieval of previous task episodes. We demonstrate that there are two different factors at work: (1) facilitation of response to the current distractor stimulus, appropriate to the previously relevant, competing task (competitor priming), and (2) impaired processing of previously suppressed responses (negative priming). Negative priming was contingent on the size of the stimulus set, suggesting that distractor suppression comes into effect only if the distractors are highly activated. Importantly, both types of interference interacted with task readiness: Whereas in the nondominant task (picture naming), switch and nonswitch trials were equally affected, the dominant task (word reading) showed priming effects on switch trials only. Thus, the retrieval of previous processing episodes has a selective impact on situations in which task competition is high.     

Object-based attentional selection can modulate the Stroop effect

The Stroop (1935) effect is the inability to ignore a color word when the task is to report the ink color of that word (i.e., to say "green" to the word RED in green ink). The present study investigated whether object-based processing contributes to the Stroop effect. According to this view, observers are unable to ignore irrelevant features of an attended object (Kahneman & Henik, 1981). In three experiments, participants had to name the color of one of two superimposed rectangles and to ignore words that appeared in the relevant object, in the irrelevant object, or in the background. The words were congruent, neutral, or incongruent with respect to the correct color response. Words in the irrelevant object and in the background produced significant Stroop effects, consistent with earlier findings. Importantly, however, words in the relevant object produced larger Stroop effects than did the other conditions, suggesting amplified processing of all the features of an attended object. Thus, object-based processing can modulate the Stroop effect.     

Risky decision making and cognitive flexibility among online sports bettors in Nigeria

Online sports betting is a popular recreational activity in Nigeria. Like other forms of gambling, risk of pathological progression exists for gamblers who continue betting despite severe financial and psychosocial consequences. In the present study, we examined whether this population of gamblers shows deficits in decision making and cognitive flexibility that have been documented in Western gambling populations. Thirty-six online sports bettors and 42 non-gambling participants completed a version of the Iowa gambling task (IGT) and an established set-shifting task for the assessment of cognitive flexibility. The two groups did not differ significantly in the selection of disadvantageous decks on the IGT. In contrast, sports bettors committed significantly more errors on the set-shifting task than non-gambling control participants. As this performance deficit was not specific to trials requiring a set shift, it most likely resulted from gambling-related changes in general cognitive or motivational abilities that are required to successfully complete challenging mental tasks. While our results illustrate that findings from Western populations cannot automatically be generalised to other contexts, it should be noted that we focused on only one particular type of gambling and included mostly participants with mild gambling-related problems.     

The anxiety-buffering function of close relationships: evidence that relationship commitment acts as a terror management mechanism

Three studies examined the terror management function of romantic commitment. In Study 1 (N = 94), making mortality salient led to higher reports of romantic commitment on the Dimensions of Commitment Inventory (J. M. Adams & W. H. Jones, 1997) than control conditions. In Study 2 (N = 60), the contextual salience of thoughts about romantic commitment reduced the effects of mortality salience on judgments of social transgressions. In Study 3 (N = 100), the induction of thoughts about problems in romantic relationships led to higher accessibility of death-related thoughts than did the induction of thoughts about either academic problems or a neutral theme. The findings expand terror management theory, emphasizing the anxiety-buffering function of close relationships.     

Attachment security in couple relationships: a systemic model and its implications for family dynamics

Theory and research on adult attachment style emphasize the crucial role that the sense of attachment security plays in the formation and maintenance of couple relationships. In the present article, we review studies that have examined the contribution of adult attachment style to relational cognitions, emotions, and behaviors as well as to the formation, quality, and stability of dating and marital relationships. We discuss some of the measurement and design issues raised by this research. Based on the reviewed findings, we provide an integrative, systemic theoretical model delineating how the links between partners' attachment security and the quality of their couple relationship occurs. Finally, we discuss the implications of this model for the understanding of how attachment style and couple relationships combine to affect the family system in general, and parent-child relationships and children's developmental outcomes, in particular.