Clinical implications of attentional bias in anxiety disorders: An integrative literature review.

Research on information processing biases has been motivated by the hope that it would lead to new and more efficient psychotherapeutic interventions. The literature is abundant with empirical data of attentional biases toward threat stimuli in anxiety disorders. This article aims to review the existing literature on the topic of attentional bias in anxiety disorders and discuss important implications for clinical practice. We adopted an integrative approach to link research data on attentional bias, information processing, and cognitive accounts (automaticity and controllability) with clinical practice in cognitive-behavioral therapy. It is important to develop and apply therapeutic interventions that can effectively reduce negative attentional biases while treating the main problems associated with anxiety disorders. However, it remains to be seen whether cognitive therapy interventions targeting more voluntary, strategic information processing can have a positive impact on automatic, involuntary processing involved in attentional biases. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Beliefs in obsessive-compulsive disorder

Several types of beliefs have been hypothesized to be associated with obsessive-compulsive disorder (OCD), including responsibility for harm, need to control thoughts, overestimates of threat, intolerance of uncertainty, and beliefs about the consequences of anxiety and capacity to cope. The present study compared 62 subjects with OCD, 45 with other anxiety disorders (AD) and 34 controls, using 3 measures of OCD-related beliefs. OCD subjects scored higher than AD and control samples on 2 general belief measures. A closer analysis of specific belief domains indicated that OCD subjects scored higher than AD and control subjects on all 6 specific belief domains (responsibility, control, estimation of threat, tolerance of uncertainty, beliefs about the consequences of anxiety, and the capacity to cope). Four of the 6 domains showed reasonable convergent and discriminant validity with measures of OCD symptoms compared to other psychopathology; anxiety and coping beliefs were the exceptions. In regression analyses, cognitive measures contributed significant explanatory power beyond mood state and worry with uncertainty predicting severity of OCD symptoms above all other belief domains. Further research on OCD-relevant belief domains in etiology, maintenance and treatment is warranted.     

Disentangling the overlap between Tourette's disorder and ADHD

OBJECTIVE: To identify similarities and differences in neuropsychiatric correlates in children with Tourette's syndrome (TS) and those with ADHD. METHOD: The sample consisted of children with Tourette's syndrome with ADHD (N = 79), children with Tourette's syndrome without ADHD (N = 18), children with ADHD (N = 563), psychiatrically referred children (N = 212), and healthy controls (N = 140). RESULTS: Disorders specifically associated with Tourette's syndrome were obsessive compulsive disorder (OCD) and simple phobias. Rates of other disorders, including other disruptive behavioral, mood, and anxiety disorders, neuropsychologic correlates, and social and school functioning were indistinguishable in children with Tourette's and ADHD. However, children with Tourette's syndrome plus ADHD had more additional comorbid disorders overall and lower psychosocial function than children with ADHD. CONCLUSIONS: These findings confirm previously noted associations between Tourette's syndrome and OCD but suggest that disruptive behavioral, mood, and anxiety disorders as well as cognitive dysfunctions may be accounted for by comorbidity with ADHD. However, Tourette's syndrome plus ADHD appears to be a more severe condition than ADHD alone.     

Review of Cognitive therapy of anxiety disorders: Science and practice.

Reviews the book, Cognitive therapy of anxiety disorders: Science and practice edited by David A. Clark and Aaron T. Beck (2009). Drs. Clark and Beck’s book Cognitive therapy of anxiety disorders: Science and practise is a comprehensive review of cognitive therapy for anxiety from its empirical theoretical foundation to its clinical application to disorders. Although the focus of the text is ultimately on the cognitive treatment of anxiety, the rich theoretical background that is interwoven throughout makes this book of interest to academics and graduate students as well as clinicians. The book is divided into three parts, each with several chapters: 1) cognitive theory and research on anxiety; 2) assessment and intervention techniques used in cognitive therapy for anxiety; and 3) the application of cognitive therapy to specific anxiety disorders (e.g., panic disorder, obsessive– compulsive disorder [OCD]). Overall, this book is an excellent resource for researchers and clinicians working in the field of anxiety disorders. The reference section alone makes it a valuable addition to one’s bookshelf, and the authors have done an excellent job of organising a vast, and at time disparate, body of research into a cohesive review of cognitive theory as it applies to anxiety. Although the treatment chapters may be a bit overly ambitious in attempting to review both the research and the application of the cognitive model to the treatment of specific disorders, the book in its entirety is clearly an essential text for those interested in obtaining a comprehensive understanding of cognitive therapy and anxiety. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Pediatric Psychopharmacology for Prepubertal Internalizing Disorders.

Evidence-based studies of drug, psychosocial and combined treatments for prepubertal internalizing disorders (depression, obsessive-compulsive disorder [OCD], and non-OCD anxiety) were reviewed. No age effects were found. Although no combined studies met evidence-based criteria, efficacious and possibly efficacious psychosocial and pharmacological treatments were identified, along with safety concerns for drug treatments. Evidentiary support favored psychosocial treatment for non-OCD anxiety disorders and pharmacological treatments for OCD, with mixed results for depression. Cost-benefit considerations suggest psychosocial treatments should be considered the first choice for at least anxiety and depression, except in unusual cases where stabilization may require pharmacological intervention first. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

A cognitive-motivational analysis of anxiety

Evidence of preattentive and attentional biases in anxiety is evaluated from a cognitive-motivational perspective. According to this analysis, vulnerability to anxiety stems mainly from a lower threshold for appraising threat, rather than a bias in the direction of attention deployment. Thus, relatively innocuous stimuli are evaluated as having higher subjective threat value by high than low trait anxious individuals, and it is further assumed that everyone orients to stimuli that are judged to be significantly threatening. This account is contrasted with other recent cognitive models of anxiety, and implications for the etiology, maintenance and treatment of anxiety disorders are discussed.     

Effects of stress and anxiety on the processing of threat stimuli.

Two experiments extended the work of C. MacLeod and A. Mathews (see record 1989-23867-001) and examined whether a cognitive bias for threat information is a function of state or trait anxiety. Color-naming and attention deployment tasks were used to assess the effects of a stress manipulation procedure on attentional responses in high and low trait anxious Ss. Ss under high stress selectively allocated processing resources toward threat stimuli, irrespective of their trait anxiety level. There was no consistent evidence of a cognitive bias associated with trait anxiety, and the effect of the stress manipulation did not apppear to be mediated by state anxiety. It was suggested that trait factors do not modify attentional biases associated with acute stress but may influence such biases when stress is prolonged. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Selective attention to affective stimuli and clinical depression among youths: Role of anxiety and specificity of emotion.

Cognitive models of psychopathology posit that the content or focus of information-processing biases (e.g., attentional biases) is disorder specific: Depression is hypothesized to be characterized by attentional biases specifically for depression-relevant stimuli (e.g., sad facial expressions), whereas anxiety should relate particularly to attentional biases to threat-relevant stimuli (e.g., angry faces). However, little research has investigated this specificity hypothesis and none with a sample of youths. The present study examined attentional biases to emotional faces (sad, angry, and happy compared with neutral) in groups of pure depressed, pure anxious, comorbid depressed and anxious, and control youths (ages 9–17 years; N = 161). Consistent with cognitive models, pure depressed and pure anxious youths exhibited attentional biases specifically to sad and angry faces, respectively, whereas comorbid youths exhibited attentional biases to both facial expressions. In addition, control youths exhibited attentional avoidance of sad faces, and comorbid boys avoided happy faces. Overall, findings suggest that cognitive biases and processing of particular emotional information are specific to pure clinical depression and anxiety, and results inform etiological models of potentially specific processes that are associated with internalizing disorders among youths. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Review of Fear of contamination: Assessment and treatment.

Reviews the book, Fear of Contamination: Assessment and Treatment by Stanley Rachman (2006). As a renowned expert on obsessive compulsive disorder (OCD), Professor Rachman's contributions have shaped current psychological theory, research, and treatment of OCD more than any other contemporary psychologist. The current book, Fear of Contamination, adopts the author's current emphasis on fine-grained analyses of OCD, digging deep into the unique phenomenology of specific obsessional concerns. Based on his prior cognitive formulations for obsessions, Dr. Rachman's present book proposes a new cognitive-behavioural model for another OCD subgroup that has been neglected in recent years, those with fears of contamination. It begins with a convincing argument for taking a fresh look at our understanding and treatment of contamination OCD. Throughout the remainder of the book, the author provides a fascinating and highly innovative analysis of contamination fears. Fear of Contamination is a well-written, authoritative, and innovative treatment manual for disease and contamination fears that is sure to set a new standard for research and treatment of this disorder. It is probably the most important book published in the last few decades on this particular subtype of OCD and it promises to stimulate our research and invigorate our treatment of this rather intransigent fear. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A Comparison of Attentional Biases and Memory Biases in Women With Social Phobia and Major Depression.

Cognitive processes play an important role in the etiology and maintenance of anxiety and depression. Current theories differ, however, in their predictions regarding the occurrence of attentional biases and memory biases in depression and anxiety. To allow for a systematic comparison of disorders and cognitive processes, 117 women (35 with generalized social phobia, 27 with major depression, and 55 healthy controls) participated in a test of visual attention (visual search), an explicit memory test (free recall), and an implicit memory test (anagram solving). Both clinical groups exhibited attentional biases for disorder-related words, whereas only depressed participants showed clear evidence of explicit and implicit memory biases. The implications of these results for competing theories are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Adult head-banging and stereotypic movement disorders

Stereotypic movement disorders (SMD) such as head-banging, which are common among children with mental retardation or pervasive developmental disorders, may also occur in intellectually normal adults. We report a 27-year history of daily head-banging with self-injury in a 49-year-old man with normal cognition. The patient had no personal or family history of Tourette's syndrome, tic disorder, obsessive-compulsive disorder (OCD), or mental retardation. The frequency of his stereotypical head-banging increased with anxiety, loud noises with startle, and boredom. He reported a sense of pleasure from his head-banging, and the frequency of this behavior decreased when he was treated with the opioid antagonist naltrexone. Although not diagnostic, the self-stimulatory or pleasurable component of head-banging, body-rocking, thumb-sucking, and other SMD may help distinguish them from tics, Tourette's syndrome, OCD, and deliberate self-harming behavior. This report reviews the disorders associated with SMD and discusses the potential mechanisms for these behaviors. The treatment of SMD includes drugs that work through opioid, serotonergic, or dopaminergic systems.     

Issues in the monopharmacotherapy and polypharmacotherapy of obsessive-compulsive disorder

Polypharmacotherapy is again becoming common place in clinical practice. Obsessive-compulsive disorder (OCD) as a single primary diagnosis is responsive exclusively to the serotonin reuptake inhibitors (SRIs) and this fact forms the major evidence supporting a central role for 5-HT (serotonin) in the pathogenesis of the disorder. Presently, the highly potent serotonin reuptake inhibitors clomipramine, fluoxetine, fluvoxamine, and paroxetine are the only agents approved by the Food and Drug Administration (FDA) for OCD, but there is evidence that other SRIs, such as sertraline, are also effective. Because OCD is often treatment refractory and highly comorbid with other psychiatric disorders, the use of polypharmacotherapy can be justified. Other serotonergic medications such as lithium, buspirone, trazodone, or fenfluramine may be useful as adjuvant treatments in treatment-refractory OCD and adjuvant antipsychotics are useful in tic disorders, personality disorders, and psychotic disorders. The usefulness of polypharmacotherapy should be tempered by adverse effects including the serotonin syndrome, withdrawal phenomena, extrapyramidal side effects, and drug-drug interactions.     

Comparison of clinical characteristics in obsessive-compulsive disorder and body dysmorphic disorder

Recent research has suggested that body dysmorphic disorder (BDD) is part of the spectrum of obsessive-compulsive disorders. In order to determine the extent of similarity for psychopathology measures, patients diagnosed with BDD were compared to a group of patients diagnosed with obsessive-compulsive disorder (OCD) on obsessionality, compulsivity, overvalued ideas, depression, and anxiety. Results indicate that BDD patients are similar to OCD patients for measures of obsessionality and compulsivity when BDD symptoms are assessed as such. BDD and OCD patients were also similar for measures of depression, and state and trait anxiety. OCD patients had higher levels of anxiety when measuring common physical symptoms associated with this affective reaction. BDD patients had higher levels of overvalued ideas, but fewer obsessive and compulsive symptoms. Overall, the results suggest that BDD is a variant of OCD, with special considerations given to degree of belief conviction (overvalued ideas.     

Memory bias in clinical anxiety.

Predictions from a cognitive schema model of anxiety were tested by comparing generally anxious patients and normal controls on their incidental recall of positive and negative, threatening and nonthreatening, self- and other-referenced words. There was no evidence of a self-referent recall bias favoring negative or threatening words in anxiety. Contrary to expectation, the results indicated relatively poorer memory for threatening material in anxious patients. We argue that the cognitive schema model could not adequately account for these and other recent research findings and suggest an alternative formulation of information-processing biases in anxiety. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Course of psychiatric and substance abuse syndromes co-occurring with bipolar disorder after a first psychiatric hospitalization

BACKGROUND: Patients with bipolar disorder frequently meet criteria for other psychiatric and substance abuse diagnoses. To clarify relationships among these disorders, the authors examined the course of syndromes co-occurring with bipolar disorder for 12 months after a first hospitalization. METHOD: Seventy-seven patients were recruited from consecutive inpatient admissions who met DSM-III-R criteria for bipolar disorder, manic or mixed with psychosis. The 12-month syndromal course of co-occurring DSM-III-R alcohol and drug abuse disorders, posttraumatic stress disorder (PTSD), obsessive-compulsive disorder (OCD), and other anxiety disorders were longitudinally recorded. RESULTS: The rates of all syndromes, except other anxiety disorders, were elevated. OCD demonstrated an interval course that frequently mirrored the course of the bipolar disorder. The courses of PTSD and substance abuse syndromes were separate from that of the bipolar disorder in many of those with both syndromes. Alcohol and drug abuse syndromes were strongly correlated. CONCLUSION: The obsessive-compulsive syndrome may represent an alternative expression of bipolar disorder in some patients. In contrast, PTSD appears to represent a truly separate disorder, which is possibly more prevalent in bipolar patients due to a shared risk factor. Substance abuse does not appear to simply result from attempts at self-medication or from the impulsivity of mania. These results suggest that future studies examining the course of syndromes co-occurring with bipolar disorder are warranted.     

Perceptual consequences of an illness-concern induction and its relation to hypochondriacal tendencies.

This article examines the perceptual consequences of activating illness concern as a function of hypochondriacal tendencies. In 2 independent samples, hypochondriacal tendencies were associated with slower reaction times on a modified emotional Stroop task when the stimulus words were illness related, but only when illness concern was activated. Moreover, these findings emerged when hypochondriacal tendencies were defined as a sensitivity to bodily sensations. When defined as illness preoccupation and fear, hypochondriacal tendencies were associated with a generalized pattern of perseveration to all stimuli when health concern was activated. Finally, the results persisted even after statistically controlling for state anxiety. Findings are discussed within the context of an activation hypothesis and highlight the importance of the operational definition and assessment of hypochondriacal tendencies when examining perceptual biases. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Lower limb revascularization in diabetics

Pure cognition and hence pure cognitive dysfunction might be expected to have no direct relation to any specific emotion. Changes in cognitive processing will change the assessment of stimuli and thus could change emotional responses nonspecifically. However, neurology suggests a more direct relation between at least some aspects of cognition and emotion. The limbic system in general and the hippocampus in particular have been suggested at different times to be crucial for both memory and emotion. Even recently, O'Keefe and Nadel (The hippocampus as a cognitive map, Oxford University Press, 1978) proposed that the hippocampus is a spatial, or cognitive, map, while Gray (The neuropsychology of anxiety: An enquiry into the functions of the septo-hippocampal system. Oxford University Press, 1982) proposed that it is central to anxiety. This apparent incongruity can be resolved by combining recent developments in the psychology of anxiety (which emphasise changed processing biases), recent extensions of Gray's theory (which bring it closer to cognitive views), and recent theories of the role of the hippocampus in memory (which see it as controlling rather than storing information). This paper proposes that at least some instances of clinical anxiety could result from hyperactivity of the septo-hippocampal system, which would produce cognitive dysfunction in the form of increased negative association of stimuli with a consequential increase in anxiety when the stimuli are subsequently presented.     

A meta-analysis of the effect of cognitive bias modification on anxiety and depression.

Cognitive biases have been theorized to play a critical role in the onset and maintenance of anxiety and depression. Cognitive bias modification (CBM), an experimental paradigm that uses training to induce maladaptive or adaptive cognitive biases, was developed to test these causal models. Although CBM has generated considerable interest in the past decade, both as an experimental paradigm and as a form of treatment, there have been no quantitative reviews of the effect of CBM on anxiety and depression. This meta-analysis of 45 studies (2,591 participants) assessed the effect of CBM on cognitive biases and on anxiety and depression. CBM had a medium effect on biases (g = 0.49) that was stronger for interpretation (g = 0.81) than for attention (g = 0.29) biases. CBM further had a small effect on anxiety and depression (g = 0.13), although this effect was reliable only when symptoms were assessed after participants experienced a stressor (g = 0.23). When anxiety and depression were examined separately, CBM significantly modified anxiety but not depression. There was a nonsignificant trend toward a larger effect for studies including multiple training sessions. These findings are broadly consistent with cognitive theories of anxiety and depression that propose an interactive effect of cognitive biases and stressors on these symptoms. However, the small effect sizes observed here suggest that this effect may be more modest than previously believed. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Review of Anxiety disorders and phobias: A cognitive perspective.

Reviews the book, Anxiety disorders and phobias: A cognitive perspective by Aaron T. Beck, Gary Emery, and Ruth L. Greenberg (see record 2006-01301-000). Aaron Beck and colleagues have done an excellent job in their attempt to present a comprehensive cognitive model for understanding and treating anxiety disorders and phobias. The authors set out to present a comprehensive cognitive model for the understanding and treating of anxiety disorders and phobias. What they covered is presented with scholarly thoroughness and depth. What seems to be lacking in their presentation is an attempt to address the impact of interpersonal context. Thus, while the cognitive model promises to be an extremely helpful component to the understanding and treatment of anxiety disorders and phobias, a comprehensive treatment regimen will often require attention to additional aspects. The book is well written and richly illustrated with case histories and examples. It provides important perspectives in the understanding and treatment of anxiety disorders and phobias. (PsycINFO Database Record (c) 2010 APA, all rights reserved)