Changing Beliefs About Emotions in IBS: A Single Case Design.

BACKGROUND: Previous research suggests benefits of targeting beliefs about the unacceptability of emotions in treatment for irritable bowel syndrome (IBS). AIMS: The current study developed and tested an intervention focusing on beliefs and behaviours around emotional expression. METHOD: Four participants with IBS attended five group sessions using cognitive behavioural techniques focusing on beliefs about the unacceptability of expressing emotions. Bi-weekly questionnaires were completed and a group interview was conducted. This study used an AB design with four participants. RESULTS: Averages indicate that participants showed decreases in beliefs about unacceptability of emotions and emotional suppression during the intervention, although this was not reflected in any of the individual trends in Beliefs about Emotions Scale scores and was significant in only one individual case for Courtauld Emotional Control Scale scores. Affective distress and quality of life improved during follow-up, with only one participant not improving with regard to distress. Qualitative data suggest that participants felt that the intervention was beneficial, referencing the value in sharing their emotions. CONCLUSIONS: This study suggests the potential for beliefs about emotions and emotional suppression to be addressed in cognitive behavioural interventions in IBS. That beliefs and behaviours improved before outcomes suggests they may be important processes to investigate in treatment for IBS.

An experimental investigation of factors involved in the decision to undertake genetic testing for schizophrenia.

BACKGROUND: The psychological issues surrounding genetic testing, particularly decision-making processes, are not well understood. Previous studies suggest that apparently "nondirective" strategies intended to help individuals consider the consequences of undergoing predictive testing for physical illness can influence the decision. AIMS: To investigate the influence of selectively focussing on different aspects of previously provided information concerning genetic testing for schizophrenia. METHOD: Community participants (n = 120) rated how likely they would be to arrange to have a genetic test for schizophrenia if it were available, before and after being given detailed information about schizophrenia and the implications of testing. Participants were then randomly allocated to four groups, and were implicitly focused on the negative issues (negative group), the positive issues (positive group), both the negative and positive issues (all-focusing group) or schizophrenia-irrelevant health-related issues (control group). All issues on which the experimental groups focussed were included in the information provided and the form of questioning meets current definitions of nondirectiveness. RESULTS: Hypothetical decisions whether to arrange a genetic test for schizophrenia were influenced by the issues on which participants had focused; the positive group were more likely to say they would be tested relative to the other groups. CONCLUSIONS: Decisions about genetic testing for schizophrenia were influenced by the specific issues on which individuals were encouraged to focus at that time.

Neutralizing increases discomfort associated with obsessional thoughts: an experimental study with obsessional patients.

Cognitive-behavioral theories suggest that the development of neutralizing is crucial in the development and persistence of obsessional problems (OCD). Twenty-nine patients with a Diagnostic and Statistical Manual of Mental Disorders (4th ed., American Psychiatric Association, 1994) diagnosis of OCD were randomly allocated to 2 conditions. Both listened to repeated recorded presentations of their intrusive thoughts and either neutralized (experimental group) or distracted themselves (control). Discomfort was rated during this 1st phase and then during a 2nd phase without neutralizing or distraction. The experimental group showed a similar level of discomfort in the 1st phase, which significantly reduced during the period compared with controls. The experimental group experienced significantly more discomfort during the 2nd phase, and significantly stronger urges to neutralize and distract at the end of this phase than controls.

Causing harm and allowing harm: a study of beliefs in obsessional problems.

This study investigates two factors hypothesised as relevant to obsessional problems because of the way in which they influence decisions whether or not to act to prevent harm. These are (i) the way in which intrusive thoughts increase the internal awareness of harm, and confront the person with the possibility of taking action to prevent such harm and (ii) the extent to which there is some obvious external factor which increases awareness of the possibility of preventing harm. Obsessional patients, anxious and non-clinical controls completed a scale which systematically measured these factors across a wide range of situations. Results across all situations evaluated confirmed previous findings that both obsessionals and nonobsessionals were more likely to report acting to prevent harm when awareness of it is prompted by an intrusion than when it is not. It was also found that participants in all groups acted more 'obsessionally' when a scenario is described in ways which suggest that harm may be by 'commission' than when it is described in terms of an 'omission'. When scenarios about which each individual is most disturbed were analysed, anxious and non-clinical controls continued to differentially rate omission and commission situations; as predicted, this differential was not present for obsessional patients. It is concluded that obsessionals are more sensitive to omission than are nonobsessionals when considering scenarios about which they are concerned, and that this sensitivity is one factor influencing the decision whether to act to prevent harm.

Responsibility attitudes and interpretations are characteristic of obsessive compulsive disorder.

The cognitive-behavioural theory of Obsessive Compulsive Disorder (OCD) proposes that a key factor influencing obsessional behaviour is the way in which the intrusive cognitions are interpreted. The present paper reports an investigation of links between clinical symptoms (of anxiety, depression and obsessionality) and responsibility beliefs. These beliefs include not only measures of general responsibility attitudes (assumptions) but also more specific responsibility appraisals consequent on intrusive cognitions. The characteristics of two new questionnaires specifically designed to measure these beliefs were assessed in patients suffering from Obsessive Compulsive Disorder, in patients suffering from other anxiety disorders and in non-clinical controls. The scales measuring negative beliefs about responsibility were found to have good reliability and internal consistency. Comparisons between criterion groups indicate considerable specificity for both assumptions and appraisals with respect to OCD. There was also good evidence of specificity in the association between responsibility cognitions and obsessional symptoms across groups, and that this association was not a consequence of links with anxiety or depressive symptoms. Although the two measures were correlated, they each made unique contributions to the prediction of obsessional symptoms. Overall, the results are consistent with the hypothesis that responsibility beliefs are important in the experience of obsessional problems.

The effects of 'non-directive' questioning on an anticipated decision whether to undergo predictive testing for heart disease: an experimental study.

This study investigates how individuals can be helped to make decisions about predictive genetic testing. Participants (n = 120) rated how likely they would be to opt for predictive testing for heart disease if it were available, and other variables such as anxiety about heart disease. They received information on predictive testing for heart disease and ratings were repeated. Participants were then randomly allocated to one of three groups and focused on the personal relevance of positive issues or negative issues which had been mentioned as part of the standardised information previously given. The third group focused on issues irrelevant to testing for heart disease. The form of questioning used in this focusing manipulation was intended to model the processes involved in non-directive questioning. Results showed a significant increase in likelihood of testing in the positive group, and a significant decrease in the negative group. There was also a significant decrease in rated anxiety about heart disease and perceived severity of an increased susceptibility to heart disease of the negative group relative to the positive and control groups. The results may have implications for the ways in which pre-test counselling is carried out.

The effect of nondirective questioning on women's decisions whether to undergo bone density screening: an experimental study.

This study investigated the effects of nondirective counseling on health screening decisions. Ninety women (mean age = 51 years) received information about bone density screening and osteoporosis. They were then randomly allocated to 1 of 4 groups and were encouraged to focus on positive issues about bone density screening (positive group), on negative issues (negative group), on both positive and negative issues (all-focusing group), or on issues relating to the common cold (control group). Women were asked to rate how likely they would be to opt for bone density screening if they saw it available. After being informed that they could have bone density screening, actual uptake was assessed. It was found that the issues on which individuals focused significantly influenced their rate likelihood of opting for the scan. Rated likelihood of testing was significantly associated with whether individuals actually did opt for testing when it was subsequently offered to them.

An experimental study of influences on the perceived likelihood of seeking genetic testing: "nondirectiveness" may be misleading.

It has been suggested that decision making involves the implicit weighing up of those advantages and disadvantages of possible options considered relevant at the time the decision is made. If this is so, the information that people have most readily available at the time of the decision would influence the decision outcome. The study reported here experimentally evaluates the effect of manipulating the issues on which individuals focus as a way of investigating subtle directive influences. Participants (n = 104) were interviewed about their anticipated likelihood of opting for testing for hereditary hemochromatosis. All participants were given standard information about hemochromatosis, including a description of the disorder as causing progressive damage over many years and an explanation that treatment is most effective if begun before the age of 30 years. Individuals were randomly allocated to groups according to age group (30 years and under, or over 30 years) and gender. Those allocated to the positive group were then encouraged to focus on positive aspects of the previously given information by considering the extent to which statements applied to them, whereas the negative group focused on negative aspects. The control group focused on an unrelated disease. Analyses of variance indicated that the focusing manipulation affected the likelihood of opting for testing. This effect interacted with age of respondent: in participants over 30, the positive group ratings of likelihood of testing increased, whereas in the negative group they decreased; in participants 30 and under, both the positive and negative groups showed an increased desire to be tested. The control group did not alter significantly. The relevance of these findings to "nondirective" approaches to genetic counseling is considered.

The prospect of predictive testing for personal risk: attitudes and decision making.

As predictive tests for medical problems such as genetic disorders become more widely available, it becomes increasingly important to understand the processes involved in the decision whether or not to seek testing. This study investigates the decision to pursue the possibility of testing. Individuals (one group who had already contemplated the possibility of predictive testing and one group who had not) were asked to consider predictive testing for several diseases. They rated the likelihood of opting for testing and specified the reasons which they believed had affected their decision. The ratio of the numbers of reasons stated for testing and the numbers of reasons stated against testing was a good predictor of the stated likelihood of testing, particularly when the reasons were weighted by utility (importance). Those who had previously contemplated testing specified more emotional reasons. It is proposed that the decision process is internally logical although it may seem illogical to others due to there being idiosyncratic premises (or reasons) upon which the decision is based. It is concluded that the Utility Theory is a useful basis for describing how people make decisions related to predictive testing; modifications of the theory are proposed.