The simulation heuristic, paranoia, and social anxiety in a non-clinical sample.

BACKGROUND AND OBJECTIVES: Quality of reasoning within non-clinical paranoia and mental simulation of future paranoia themed events was investigated by use of a simulation task to determine whether paranoid individuals would be restricted or more adept at reasoning about paranoia relevant material in comparison to a social anxiety group and a group with low paranoia and social anxiety. METHOD: Participants (N = 63) were divided into the three groups based on paranoia and social anxiety scores. They were presented with the beginning and end of an imaginary situation and were asked to describe, step-by-step, what they imagined would happen between those two points. They were also administered a beads task to evaluate the jumping to conclusion decision making bias. RESULTS: The prediction of more adept reasoning was not supported for paranoia. However, the social anxiety comparison group on average better simulated a scenario with congruent (socially anxious) thematic content compared to ones with non-congruent content. Further, in an exploratory analysis, jumping to conclusions bias was found to be positively related to goodness of simulation for paranoia themed scenarios within the paranoia group. LIMITATIONS: Study groups were relatively small and so power was an issue. CONCLUSION: The results are discussed in the context of the sometimes paradoxical findings in the area of cognitive biases and paranoia.

The Anxiety Attitude and Belief Scale-2: Development, Measurement Model, and Initial Validity.

UNLABELLED: There is a notable lack of measures of enduring beliefs, which are key etiological factors in Beck's cognitive model of anxiety. The Anxiety Attitude and Belief Scale-2 was developed to address this need. Items from the original AABS were reviewed and revised, and additional items were added to cover the range of constructs identified as reflecting anxiety related expectancies while avoiding the confounding of cognition and affect. Suitability of items was examined using cognitive interviewing (Willis, 2004). The resulting set of 48 items was administered to an index sample of individuals reporting anxiety symptoms and a cross-validation sample of undergraduate students in order to derive a measurement model describing its internal structure. The final, 33-item AABS-2 had a bifactor structure of one general and four specific factors, good fit to the data, common factor content across groups, acceptable precision in measurement, and evidence of construct validity. KEY PRACTITIONER MESSAGE: Measures of enduring beliefs related to anxiety disorders are needed to assess etiological factors within cognitive therapy; while there are numerous measures of automatic thoughts, there are few measures of beliefs. The present study sought to address this gap. The items that originally appeared on ten rationally derived scales drawn from clinical phenomenology of anxiety disorders were eventually grouped into four group factors and one general factor in the course of psychometric analyses. The group factors included ones expected to distinguish groups reporting panic, OCD, and social anxiety symptoms from other anxiety symptom groups, and this prediction was supported. The majority of predictions regarding patterns or correlations were also supported. Further validation research is needed to evaluate the validity of the AABS and its subscales in predicting course and outcome of psychotherapy.

Construct validity and vulnerability to anxiety: a cognitive interviewing study of the revised Anxiety Sensitivity Index.

The Anxiety Sensitivity Index (ASI; Reiss, S., Peterson, R. A., Gursky, D. M., & McNally, R. J. (1986). Anxiety sensitivity, anxiety frequency and the prediction of fearfulness. Behaviour Research and Therapy, 24, 1-8) is probably the most widely used measure of cognitive vulnerability to anxiety. However, there have been periodic doubts expressed about whether it measures beliefs about the negative consequences of anxiety symptoms, as it purports to, or actual anxiety experiences. The present study investigated the construct validity of the revised ASI using a cognitive interviewing approach. Sixteen outpatients with anxiety problems responded to ASI-R items and items from another measure of vulnerability to anxiety, the Anxiety Attitude and Belief Scale, while thinking aloud. The resulting verbal protocols were coded according to the apparent cognitive processes respondents engaged in when answering the items. Responses to the revised ASI-R more often entailed retrieval of past episodes of anxiety, and participants more frequently formulated their responses based on judgments of the occurrence or intensity of feelings rather than on the appraisal of anticipated consequences of what was described in the items. These findings potentially have significant implications for interpretation of results from the large body of literature using the different versions of the ASI.

Obsessive compulsive symptoms and the simulation of future negative events.

OBJECTIVES: To explore whether Kahneman and Tversky's (1982) simulation heuristic might help account for why the obsessions of people with obsessive compulsive disorder (OCD) are so compelling to them. It was predicted that participants would be better able to simulate a scenario relevant to a central OCD fear than they would scenarios related to other OCD and non-OCD fears and that how well participants simulated feared scenarios would be associated with higher ratings of subjective probability for that outcome and consequently greater worry. DESIGN: Individuals with obsessive compulsive symptoms mentally simulated hypothetical scenarios so as to enable comparison of a personally relevant to less relevant scenarios. METHODS: Thirty participants recruited from OCD support groups simulated four scenarios each and completed symptom and relevant construct measures. RESULTS: Personally relevant scenarios were better simulated than less relevant scenarios. 'Goodness of simulation' (GOS) was related to worry about the feared outcome, but this was not mediated by raised subjective probabilities. GOS correlated with OCD symptomatology, anxiety, and depression but not with cognitive variables thought to be related to OCD phenomenology. CONCLUSION: The overall findings converge with recent literature (O'Connor, 2002) emphasizing the importance of imagination and imaginary narratives in fuelling OCD symptoms.

A preliminary evaluation of cognitive-behaviour therapy for clinical perfectionism: a case series.

OBJECTIVE: The construct of 'clinical perfectionism' has been developed in response to criticisms that other approaches have failed to yield advances in the treatment of the type of self-oriented perfectionism that poses a clinical problem. The primary aim of this study was to conduct a preliminary investigation into the efficacy of a theory-driven, cognitive-behavioural intervention for 'clinical perfectionism'. DESIGN: A multiple baseline single case series design was used. METHOD: A specific, 10-session cognitive-behavioural intervention to address clinical perfectionism in eating disorders was adapted to allow its use in nine patients referred with a range of axis I disorders and clinical perfectionism. RESULTS: The intervention led to clinically significant improvements in self-referential perfectionism from pretreatment to follow-up for six of the nine participants on two perfectionism measures and for three of the nine participants on the measure of clinical perfectionism. Statistically significant improvements from pre- to post-intervention for the group as a whole were found on all three measures. The improvements were maintained at follow-up. CONCLUSIONS: The finding that clinical perfectionism is improved in the majority of participants is particularly encouraging given that perfectionism has traditionally been viewed as a personality characteristic resistant to change. These preliminary findings warrant replication in a larger study.

Counterfactual thinking and posttraumatic stress reactions.

Preoccupation with alternative outcomes (counterfactual thinking) is a central component of the ruminations of trauma victims. The questions investigated were whether such thinking should be distinguished from general rumination and whether elements of counterfactual thinking might relate to the process of adjustment. A sample of assault victims was interviewed. They completed a battery of self-report scales and thought-listing procedures. Frequency of counterfactual thinking was closely associated with continuing levels of posttraumatic distress. However, high availability of counterfactuals (as indexed by verbal fluency) was related to potentially adaptive outcomes, such as the generation of behavioral plans. In addition, as expected, levels of different aspects of counterfactual thinking were moderated by metacognitive control strategies as a function of time since the trauma.