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"Intrusive thoughts."
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Shared and Distinct Cognitive/Affective Mechanisms in Intrusive Cognition: An Examination of Worry and Obsessions
Generalized anxiety disorder and obsessive–compulsive disorder are defined by chronic intrusive thoughts. The aim of the present study was to evaluate the relationship between cognitive (attentional control) and motivational (negative urgency) mechanisms potentially underlying worry and obsessions. Participants (
N
= 526) completed an online questionnaire battery consisting of self-report measures of worry, OCD symptoms, attentional control (AC), negative urgency (NU), and trait negative affect. After controlling for trait negative affect, self-reported AC was negatively related to worry, repugnant obsessions, and ordering symptoms. Greater NU was associated with increased worry and repugnant obsessions. Further, self-reported AC and NU interacted such that greater NU was associated with greater worry at high but not low levels of AC. AC and NU were independently associated with repugnant obsessions. Perceived executive functioning impairments may confer risk for intrusive thoughts, particularly worries, whereas distress-driven impulsivity may contribute to the involuntary, ego-dystonic features of intrusions.
Journal Article
Repetitive Thought and Health Anxiety: Tests of Specificity
Researchers suggest that worry, rumination, and unwanted intrusive thoughts are forms of repetitive thought (RT) important to health anxiety. To better understand RT-health anxiety interrelations, four tests of specificity between these three forms of RT and health anxiety were completed in the present research using a large community sample of medically healthy adults (
N
= 410). Results were that worry and rumination shared particularly strong zero-order correlations with health anxiety. In addition, worry, rumination, and unwanted intrusive thoughts each shared statistically stronger zero-order correlations with health anxiety than did another form of RT (i.e., reflection). Moreover, worry, rumination, and unwanted intrusive thoughts each shared unique relations with health anxiety after accounting for negative affect. Finally, these three forms of RT each evidenced incremental validity beyond one another as they relate to health anxiety. The pattern of relations was replicated across three commonly used measures of health anxiety. Implications for the conceptualization, assessment, and treatment of health anxiety are discussed.
Journal Article
The role of guilt in Posttraumatic Stress Disorder
Background: A growing body of evidence supports the notion that the emotional profile of Posttraumatic Stress Disorder (PTSD) may be more diverse than traditional accounts presume. PTSD's image as an anxiety-based disorder is undergoing change as the significance of other emotions in its development becomes more evident. Experimental research is needed in order to expand the understanding of underlying processes driving the development of PTSD.
Objective: Experimentally test the influence of stressor-related guilt on the occurrence of PTSD symptomatology.
Method: A non-clinical student sample faced an analogue trauma, a stressor in the form of a computer crash and related loss of data. We either personally blamed participants for causing the incident (blame group) or told them that it was a technical failure and therefore not their fault (no-blame group). Levels of guilt before and after the incident as well as number and associated distress of incident-related intrusions were assessed using a one-day diary and compared between groups.
Results: The guilt manipulation was successful: feelings of guilt significantly increased in the blame group but not in the no-blame group. Furthermore, the blame group showed a significantly higher number of intrusions and associated distress compared to the no-blame group at one-day follow-up.
Conclusions: These laboratory findings indicate that feelings of guilt may lead to increased PTSD symptomatology, supporting the view that guilt experienced in reaction to a traumatic event may be part of a causal mechanism driving the development of PTSD.
Journal Article
Resilience after trauma
Therapists have discussed for a long time whether attempts to voluntarily suppress the intrusion of trauma memories are helpful to combat the distressing impacts of trauma. Mary et al. studied survivors of the 2015 Paris terrorist attacks who developed posttraumatic stress disorder and those who did not (see the Perspective by Ersche). Using functional magnetic resonance imaging, they investigated the neural networks underlying the control and suppression of memory retrieval. The results suggest that the characteristic symptoms of the disorder are not related to the memory itself but to its maladaptive control. These results offer new insights into the development of post-traumatic stress disorder and potential avenues for treatment. Science , this issue p. eaay8477 ; see also p. 734 A brain imaging study of survivors of the 2015 Paris terror attacks suggests that memory suppression shields against posttraumatic stress disorder. In the aftermath of trauma, little is known about why the unwanted and unbidden recollection of traumatic memories persists in some individuals but not others. We implemented neutral and inoffensive intrusive memories in the laboratory in a group of 102 individuals exposed to the 2015 Paris terrorist attacks and 73 nonexposed individuals, who were not in Paris during the attacks. While reexperiencing these intrusive memories, nonexposed individuals and exposed individuals without posttraumatic stress disorder (PTSD) could adaptively suppress memory activity, but exposed individuals with PTSD could not. These findings suggest that the capacity to suppress memory is central to positive posttraumatic adaptation. A generalized disruption of the memory control system could explain the maladaptive and unsuccessful suppression attempts often seen in PTSD, and this disruption should be targeted by specific treatments.
Journal Article
Ego-Syntonicity and Ego-Dystonicity Associated with Upsetting Intrusive Cognitions
Ego-dystonicity and ego-syntonicity are usually considered opposite ends of the same dimension, and they are used to define both obsessions and eating disorder-related symptoms. This study aims to examine the characteristics of ego-dystonicity/syntonicity, their relationships with symptom contents, and with the emotions, behaviours, and evaluative appraisals provoked by these symptoms. A sample of 349 community individuals rated the ego-dystonicity and ego-syntonicity associated with their most upsetting obsessional intrusive thought (OIT) and eating disorder-related intrusive thought (EDIT). Three dimensions, Undesirability/Desirability, Immorality/Morality/, and Irrationality/Rationality explained ego-dystonicity and ego-syntonicity. The size of the relationships among these dimensions was medium, and no correlation exists between morality/immorality concerning the OIT. Since the OIT was rated as more egodystonic and less egosyntonic than the EDIT, both thought modalities were egosyntonic, as they were considered rational/coherent with the personality, but at the same time egodystonic, as they were undesirable. The ego-dystonicity of both the OIT and EDIT was associated with negative emotions, dysfunctional appraisals, and interference in on-going activities, with Immorality being the most noteworthy dimension of ego-dystonicity. Both subclinical OCD and ED subjects scored higher than non-clinical participants on the ego-dystonicity caused by their most upsetting intrusive thought.
Journal Article
Can visiting the site of death be beneficial for bereaved families after terror? A qualitative study of parents' and siblings' experiences of visiting Utøya Island after the 2011 Norway terror attack
Background. After the 2011 terror attack on Utøya Island, a collective visit was organized for bereaved families. There is limited knowledge whether bereaved families can benefit from such visits after terror.
Objective. This study aims to explore how bereaved families experienced visiting the site of death after the 2011 terror attack.
Method. As part of in-depth interviews, 22 parents and 16 siblings were asked whether they had visited Utøya and, if so, how they experienced the visit. Participants' responses were analysed using thematic analysis.
Results. The results showed that for the majority of the bereaved, visiting Utøya had been important in processing their loss. Three key themes emerged as to what they considered important with the visit: 'seeing the actual place of death', 'seeking factual information', and 'learning to know the island'. These factors were associated both with beneficial reactions (e.g. accepting the reality of the loss increased cognitive clarity) and with distressing reactions (e.g. intrusive thoughts, re-enactment images), but the benefits had outweighed the distress. Having the opportunity for multiple visits seemed to optimize the benefits.
Conclusion. Bereaved families should be offered the opportunity to visit the site of death after terror.
Journal Article
The Unbidden Past: Involuntary Autobiographical Memories as a Basic Mode of Remembering
Involuntary autobiographical memories are memories of personal experiences that come to mind spontaneously—that is, with no preceding attempt at retrieval. They were one of Ebbinghaus's (1885/1964) three basic kinds of memory but have been ignored by modern cognitive psychology. Recent work suggests that involuntary memories are a basic mode of remembering that operates on the same episodic memory system as voluntary (strategic) remembering and thus follows the same rules of encoding and maintenance. Due to their associative and unplanned retrieval, involuntary memories differ from voluntary memories by being more specific, by being less relevant to one's life story and identity, and by involving more emotional reaction at the time of recall. Research on involuntary autobiographical memories has important implications for the understanding of intrusive memories in posttraumatic stress disorder (PTSD).
Journal Article
Symptom structure of PTSD and co-morbid depressive symptoms – a network analysis of combat veteran patients
Despite extensive research, symptom structure of posttraumatic stress disorder (PTSD) is highly debated. The network approach to psychopathology offers a novel method for understanding and conceptualizing PTSD. However, extant studies have mainly used small samples and self-report measures among sub-clinical populations, while also overlooking co-morbid depressive symptoms.
PTSD symptom network topology was estimated in a sample of 1489 treatment-seeking veteran patients based on a clinician-rated PTSD measure. Next, clinician-rated depressive symptoms were incorporated into the network to assess their influence on PTSD network structure. The PTSD-symptom network was then contrasted with the network of 306 trauma-exposed (TE) treatment-seeking patients not meeting full criteria for PTSD to assess corresponding network differences. Finally, a directed acyclic graph (DAG) was computed to estimate potential directionality among symptoms, including depressive symptoms and daily functioning.
The PTSD symptom network evidenced robust reliability. Flashbacks and getting emotionally upset by trauma reminders emerged as the most central nodes in the PTSD network, regardless of the inclusion of depressive symptoms. Distinct clustering emerged for PTSD and depressive symptoms within the comorbidity network. DAG analysis suggested a key triggering role for re-experiencing symptoms. Network topology in the PTSD sample was significantly distinct from that of the TE sample.
Flashbacks and psychological reactions to trauma reminders, along with their strong connections to other re-experiencing symptoms, have a pivotal role in the clinical presentation of combat-related PTSD among veterans. Depressive and posttraumatic symptoms constitute two separate diagnostic entities, but with meaningful between-disorder connections, suggesting two mutually-influential systems.
Journal Article