New Research on Cognitive Processes in Anxiety

• Report from AABT by Jim Pretzer, 11/30/96
  
  

David Clark (the one from Canada, not the one from England) and colleagues have been investigating worry, intrusive thoughts and the control of anxious thoughts. Worry and intrusive thoughts are an important aspect of OCD and GAD and are reported widely in non-clinical populations as well. These investigators find that both patients and non-patients report the same thought content but that patients report greater frequency and intensity of these thoughts and that patients appraise the thoughts differently (as uncontrollable, dangerous, and beyond my ability to cope). These researchers focused on the ways in which non-clinical individuals responded to worries and intrusive thoughts (i.e. how much did they worry about their worries or intrusive thoughts, how much did they try to control or suppress them). With worries, a focus on the negative consequences of worrying predicted an increased amount of worry while with intrusive thoughts, a view that the intrusive thoughts implied something negative about the individual predicted an an increased amount of intrusive thoughts.

In an investigation of the effects of attempts of thought suppression, they did not find a general tendency for attempts at thought suppression to result in an increased frequency of intrusive thoughts. But, for individuals who held a conviction that one should control/suppress intrusive thoughts, attempts at suppressing thoughts resulted in a dramatic increase in the frequency of intrusive thoughts. It was suggested that this may be because, for individuals who believe that they must control their thoughts, failure at attempts to rigidly control thoughts may result in increased concern ofer the thoughts and inadvertantly result in additional intrusive thoughts.

John Riskin has been investigating whether a looming cognitive style predisposes one to anxiety. The Looming Cognitive Style is a tendency to view threat as rapidly growing, rapidly advancing. A number of studies with subjects ranging from spider phobics to persons who fear contamination or who fear social evaluation have found that phobics have a sense that whatever they fear is rapidly approaching. In other words, spider phobics do not simply think of spiders as a static threat but think of spiders as rapidly approaching them. Individuals who fear weight gain think of calories as almost magically pursuing them. John presented evidence that the Looming Cognitive Style predicts anxiety better that ordinary threat appraisals do, that it is related to anxiety but not depression, and that it predicts increasing anxiety over the course of the subsequent week.

Another line of investigation into worry and the treatment of generalized anxiety disorder was reported by Adrian Wells. He presented a new model of worry which ditinguishes between two types of worry. Type 1 worry (worry about future events) and Type 2 worry (worry about worry). He argued that individuals with GAD believe that worry is an effective means for dealing with threat and reflects positive personal characteristics and thus actively engage in worry as an attempt at coping. However, as they notice the negative consequences, they begin to worry that their worries will lead to disaster (going crazy, losing control, being unable to function, etc.). His research so far supports this model and among other things it shows that Type 1 worries do not differentiate between GAD patients and non-GAD individuals but that Type 2 worries do differentiate. It appears that both positive beliefs about worry and worry about worry may be important targets in the treatment of GAD. He suggests educating patients about the impact of their beliefs and fears about worry, then to work to decrease Type 2 worries, next to work to reduce positive beliefs about worry, and finally to work on non-worry ways of coping with threat.

Roz Shafran presented recent research that she, Rachman and colleagues have conducted on guilty thoughts and their role in anxiety disorders. Clients with anxiety disorders often report considerable guilt but guilt is also prominent in depression. Exploratory research is investigating the differences between obsessive guilt and depressive guilt. Thus far they have found that obsessive community volunteers show higher levels of guilt than control subjects but they did not find a clear distinction between obsessive guilt and depressive guilt. With a clinical sample, they found some differences in the content of guilt in OCD and Depression but, since it is hard to find individuals with OCD who are not also depressed, it is hard to distinguish between obsessive and depressive guilt. At this point, CBT has not developed effective techniques for reducing guilt and this is an area that needs further investigation.

• Dealing with Guilt by David Alexander, 3/31/97