Cognitions related to anxiety: a pilot study of treatment

In general, where anxiety appears to have a specific external focus, such as the situations which are avoided by phobic patients, treatment involving systematic exposure to those situations seems to be effective. This is less appropriate, or even impossible, where anxiety is not dependent on any external circumstance, but is described by the patient as occurring at any time or place, either chronically over long periods, or acutely in the form of ‘panic attacks’. These patients with ‘generalised’ anxiety often describe internal cues for anxiety either in the form of thoughts (e.g. worry over a current problem) or somatic (e.g. chest sensations interpreted as possible heart disease). Beck et al. (1974) has suggested that on interview, all patients diagnosed as suffering from diffuse or generalised anxiety can report specific ideas or other cognitive cues which are associated with anxiety. These usually concern possible traumatic events, such as illness and death, or social rejection. Clearly Beck has in mind the possibility that these cognitions have the effect of inducing anxiety, although even if the validity of the subjective reports were to be accepted, the problem remains of whether the relationship between mood state and cognitions is causal and if so, in which direction it operates. Obviously a causal relationship may also operate in both directions simultaneously, to form a ‘vicious circle’ in which each exacerbates the other. To establish whether there is a sense in which particular cognitions contribute causally to anxious mood, it would be necessary to find a method of manipulating the type or frequency of cognitions thought to be operating in this way.

One obvious possibility is that of ‘thought-stopping’: that is, patients could be taught to identify thoughts which are associated with anxiety and stop them in the usual way (Wolpe, 1973, p. 211) e.g. by' shouting stop, and substituting an alternative thought. The present study was planned as a pilot experiment to determine (i) if appropriate anxiety related cognitions could be elicited from a series of patients with generalised anxiety, (ii) if the reported frequency of such thoughts could be modified by a thought-stopping technique, and (iii) if any changes in thought frequency were associated with improvements in mood.

Clearly there are many ‘non-specific’ features involved in thought-stopping which could also have therapeutic effects on mood. For this reason it was necessary to include an alternative procedure, not directed at reducing thought frequency, but having the same degree of plausibility to patients, and preferably to therapists. The control procedure chosen for this purpose was modelled on desensitisation, in which patients were encouraged to allow the supposedly anxiety-provoking thoughts into their mind and tolerate them, rather than attempt to stop them. In summary, the study employed a relaxation training phase as a base-line, followed by a cross-over design in which the two treatment phases of thought-stopping and ‘cognitive desensitisation’ were given to each patient, in balanced order.     

Treatment of dental fears by imaginal flooding and rehearsal of coping behaviour

All combinations of high versus low arousal imaginal flooding, and coping versus no-coping imaginal rehearsal, were compared in the modification of dental fear. About one half of all subjects seen successfully completed dental treatment, although significant differences were found between groups in anxiety reduction before and during dental examination, which favoured the low arousal flooding groups. Coping rehearsal did not influence anxiety, but interacted with arousal level of flooding to determine subsequent dental attendance. The results suggest that flooding without coping rehearsal had little effect at high levels of arousal, but good results at low levels. Flooding with coping rehearsal on the other hand, had mixed results. At high arousal levels avoidance was reduced but not anxiety, while at low levels anxiety was reduced but not avoidance. The implications for further research on coping rehearsal are discussed.     

The human lateral lemniscus and its nuclei: The human auditory pathways: A quantitative study

Quantification of the human lateral lemniscus and its nuclei in 15 brains of patients without hearing impairment revealed these average values: Cross-sectional surface area of the bundle at the level of the nucleus of cranial nerve IV of 2.5 mm², fiber density of 77,000/mm²; 194,000 total fibers on each side; grouping of the nerve cells in three nuclei (olive remnant, ventral, and dorsal) the largest of which is the ventral; cell density in the olive remnant of 5009/mm³, in the ventral nucleus of 15,184/mm³, and 13,169 cells per mm³ in the dorsal nucleus; total cell populations in all nuclei of 20,063 on the left and 26,137 on the right; glial-neuronal index of 9.2; cell dimensions of 23.6 × 15.4 microns in the olive remnant and 21.2 × 12.2 in the other nuclei; combined nuclear volume of 1.91 mm³. Loss of neurons was not apparent in the aged brains but a significant reduction in counts of axons and in lemniscal bulk appeared in two of the older brains of the series (77 and 91 years).     

Spectral versus temporal features in dichotic listening

Ear advantage for the processing of dichotic speech sounds can be separated into two components. One of these components is an ear advantage for those phonetic features that are based on spectral acoustic cues. This ear advantage follows the direction of a given individual's ear dominance for the processing of spectral information in dichotic sounds, whether speech or nonspeech. The other factor represents a right-ear advantage for the processing of temporal information in dichotic sounds, whether speech or nonspeech. The present experiments were successful in dissociating these two factors. Since the results clearly show that ear advantage for speech is influenced by ear dominance for spectral information, a full understanding of the asymmetry in the perceptual salience of speech sounds in any individual will not be possible without knowing his ear dominance.     

Paralinguistic aspects of auditory comprehension in aphasia.

Eight severe aphasics were given sentences with either emotional or neutral content, presented once directly by the examiner and once via a tape recorder. Sentences with emotional content produced a greater number of responses than their neutral counterparts. Sentences spoken by the examiner also produced a significantly greater number of responses than the same items originating from a tape recorder. These results confirm the view that elements not related to the linguistic aspects of a message (and therefore referred to as paralinguistic) play a significant role in auditory comprehension.     

The relation between gesture and language in aphasic communication

Effective communication in aphasia depends not only on use of preserved linguistic capacities but also (and perhaps primarily) on the capacity to exploit alternative modalities of communication, such as gesture. To ascertain the capacity of aphasic patients to use gesture in their spontaneous communication, informally structured interviews were conducted with two Wernicke's aphasics and two Broca's aphasics, as well as with four normal controls. The performances of the patient groups were compared on the physical parameters of gesture, the points in the communication where gestures occurred, and several facets of the semantics and pragmatics of gesture. Generally speaking, the gestures of the aphasics closely paralleled their speech output: on most indices, the performance of the Wernicke's aphasics more closely resembled that of the normal controls. Wernicke's aphasics differed from normals in the clarity of their language and gestures: While individual linguistic units were often clear, the relation among units was not. In contrast, the Broca's aphasics equaled or surpassed the normal controls in the clarity of their communications. The results offer little support for the view that aphasic patients spontaneously enhance their communicative efficacy through the use of gesture; these findings can, however, be interpreted as evidence in favor of a “central organizer” which controls critical features of communication, irrespective of the modality of expression.