Bundle now available! Comprehensive summary of all sources (reference list) of task 5 of the block GGZ2024 Anxiety Disorders. The summary is written in English. Subjects; cognitive theory (appraisal, schemas), attentional bias, interpretational bias, biased intrusive ideation, biased inhibitory con...
WHY NEGATIVE BELIEFS SELF-CORRECT IN SOME, BUT PERSIST IN OTHERS
Source: Clark (1999)
Safety-seeking behavior
Safety-seeking behavior is defined as ‘a behavior which is performed in order to minimise a
feared catastrophe’. Salkovskis (1988) suggested that such behavior often explains why non-
occurrence of feared event fails to change patients’ negative beliefs. Some characteristics:
• Many safety-behaviors are internal mental processes.
• It is common for patients to engage in a large number of different safety behaviors
(as is shown in the table).
• Safety behavior can also create some of the symptoms that social phobics fear; for
example, trying to hide underarm sweating by wearing a jacket generates more
sweating.
• Some safety behaviors can even draw other’s attention to the patient.
• Some safety behaviors influence other people in a way which partially confirms social
phobics’ fears. Safety-behaviors in social anxious individuals can make them appear
distant and preoccupied, which other people can interpret as ‘not liking them’.
Attentional development
Many have suggested that selective attention towards threat cues may play a role in the
maintenance of anxiety disorders by enhancing the perception of threat. Research has
recently started to study attentional bias to stimuli that are more directly related to stimuli that
are likely to be encountered in a real-life feared situation. These studies suggest attention
towards threat cues and attention away from threat cues may both play a role.
,Attention towards threat cues
When subjects are presented with pictures of spiders and other, non-phobic objects, patients
with spider phobia show attentional bias towards the spider pictures. Despite going to the
doctor, patients with panic disorder still are afraid they have a physical illness. One reason
that they are not convinced could be that their fear lead them to focus attention on their
bodies, and then become aware of bodily sensations that other people don’t notice. To
conclude, studies strongly suggest that attention towards threat cues plays an important role
in panic disorder and hypochondriasis.
Attention away from threat cues
In social phobia, studies suggest that attention away from threat cues may play an important
role in the maintenance of this disorder. In social phobia, you would expect enhanced
attention to facial expressions of others. But, studies have shown that SAD patients tend to
avoid looking at other people when in feared social situations. Clark & Wells (1995) already
concluded that SAD is associated with reduced attention to external social cues.
Why is there a difference between attentional bias towards threat cues in spider phobia and
panic disorder, whereas SAD patients have attentional bias away from others’ facial
expressions? If a spider phobic is presented with a spider, looking away does not remove the
threat. Looking away from others’ faces and avoiding eye contact is likely to reduce some
aspects of threat for a social phobic. It provides a psychological escape.
Spontaneously occurring images
Beck suggested that spontaneously occurring mental images in which patients see their fears
are common in anxiety disorders, and play an important role in enhancing the perception of
threat. So, images of physical and mental catastrophes are common in panic disorder patients.
Social phobia provides a stunning demonstration of the
importance of spontaneous imagery. If social phobics
attend less to external cues, what makes them think they
are coming across badly? Partly because of self-
imagery; they see themselves as if viewed from the
outside (observer-perspective). In these images, they see
their fears visualised. The majority of patients with SAD
(77%, see figure) reported spontaneously occurring,
negative, observer-perspective images. Only 10% of
non-patients reported them.
Another aspect of these images is that they are rarely updated. So, the images occur in similar
form in many different social situations.
Emotional reasoning
The hypothesis is that interoceptive, anxiety-related information is used to make inferences
about how one appears to others. Studies suggest that SAD may be partly maintained by
patients using perceived body sensations to make erroneous inferences about how anxious
they appear and how poorly they come across; this is called emotional reasoning.
, Memory processes
At least two types of memory processes may contribute to the maintenance of anxiety
disorders. First is a tendency to selectively retrieve information which appears to confirm
their worst fears. The selective retrieval of negative memories and impressions of the
observable self greatly enhances social phobics’ doubts about their ability to achieve their
desired impression in the social situation and would promote avoidance.
The second memory process is an dissociation between explicit and implicit memory, or,
between recall and priming. This is perhaps most marked in PTSD. Often, PTSD patients
involuntarily re-experience aspects of the trauma in a very emotional way. Besides, PTSD
patients display ‘affect without recollection’; triggering of intense affect by the presence of
stimuli that were associated with the trauma, without recollection of the traumatic event.
Studies suggest that part of the problem in PTSD may be dissociation in memory with poor
initial elaboration leading to weak intentional recall and retrieval being dominated by the
basic memory mechanisms that operate through cue-driven retrieval. This could explain;
1) Nature of intrusions; strong sensory impressions with original emotions and a ‘here
and now’ quality.
2) Easy cuing of intrusions by stimuli that may have been temporarily associated with the
trauma, even if they do not have a strong meaning link.
3) The fragmented nature of recall.
Mathews (2005, see later) concludes there is no robust evidence for memory bias in anxiety.
Nature of perceived threat
In the example of ‘affect without recollection’, it is suggested that the ‘out of the blue’ intense
affect in PTSD may be maintained because the threat cue that triggers the problem is out of
awareness and patients have difficulty recognising the inappropriateness of their reaction.
Why are symptoms in PTSD persistent in some people and not in others? One factor may be
the way you interpret your initial normal intrusive recollections and other symptoms. If you
interpret them negatively, thinking they indicate you are going made, losing control or
becoming a neurotic person, you may engage in thought suppression and other dysfunctional
strategies that could prolong the intrusions and other symptoms.
Intrusions, PTSD symptoms negative interpretations thought suppression (harmful)
Empirically derived treatment
Treatment starts by developing an idiosyncratic
model of the disorder. The therapist aims to show
patients how the specific triggers produce
negative automatic thoughts and how these are
maintained by safety behaviors and other
maintenance processes; see figure for example of
panic disorder patients.
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