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Metacognitive Therapy for Depressive Rumination

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  • Asto Clinics (UK) and University of Oslo (Norway)
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Abstract

A Brief Overview of the S-Ref ModelClinical Implications of the S-Ref ModelAn Outline of Metacognitive Therapy for Depressive RuminationSpecific TechniquesSummary and Conclusions References

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... In conjunction, several therapeutic techniques such as Socratic dialogues or attention control training may be used to increase attention flexibility and control (Harris & Hayes, 2019;McEvoy, 2019;Rochat et al., 2018). For example, in metacognitive therapy, individuals develop metacognitive awareness, which might help to increase "top down" executive control over attention allocation and facilitate disengagement from unhelpful material (Wells & Papageorgiou, 2003). ...
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Objective: Using the Emotional Cascade Model as a theoretical framework, this study tested whether the relationship between perfectionism and non-suicidal self-injury (NSSI) operates through rumination and negative affect. Additionally, we tested whether the associations between perfectionism and both rumination and negative affect are moderated by attention control. Methods: Using a correlational cross-sectional design, adults aged 18-25 with (N = 197) and without (N = 271) a history of NSSI completed measures of perfectionism, rumination, negative affect, attention control, and NSSI. Results: Perfectionism was directly associated with increased odds of NSSI, and indirectly associated with odds of NSSI through rumination and negative affect. The relationship between perfectionism and rumination was moderated by attention focusing, such that the relationship was stronger for individuals who were higher in attention focusing. Conclusion: Integrating perfectionism and attention with existing models of NSSI may improve understanding of the factors contributing to NSSI and offers insights into future clinical directions.
... Este modelo postula a existência de uma inter-relação, causal e recíproca, entre vários componentes da cognição, tais como crenças e planos metacognitivos, controlo atencional, processamento contínuo e auto-regulação. A premissa básica do modelo é a de que os distúrbios psicológicos se mantêm devido à existência de um síndrome cognitivo -atencional (Cognitive-Attentional Syndrome – CAS; Wells, 2000; 2007) & Wells, 1997; Wells & Papageorgiou, 1998), incluindo os sintomas de stress traumático (Roussis & Wells, 2006; Wells & Papageorgiou, 1995; Wells & Sembi, 2004), os sintomas obsessivo -compulsivos (Emmelkamp & Aardema, 1999; Fisher & Wells, 2005; Wells & Papageorgiou, 1998), a hipocondria (Bouman & Meijer, 1999), a depressão (Papageorgiou & Wells, 2001a,b; Reynolds & Wells, 1999; Wells & Papageorgiou, 2004), o consumo de álcool (Spada & Wells, 2006 ), a ansiedade a exames (Matthews, Hillyard & Campbell, 1999; Spada, Nikčević, Moneta & Ireson, 2006), a procrastinação (Spada, Hiou & Nikčević, 2006), a psicose (Morrison & Wells, 2003; Morrison, Wells & Nothard, 2002) e as alucinações auditivas (Baker & Morrison, 1998; Morrison, Wells & Nothard, 2000; Morrison et al. 2005). Da teoria genérica do S-REF já derivaram diversos modelos teóricos metacognitivos e protocolos de tratamento específicos para vários distúrbios psicológicos (Clark & Wells, 1995; Wells, 2000; 2007; Wells & Papageorgiou, 2001; Wells & Sembi, 2004). ...
... These findings suggest that while CBT focuses on aspects of cognition and behavioral changes that can result in symptom relief, there may be further domains that would deserve specific attention to treat this disorder more effectively. The main treatment target of CBT has been the cognitive content of depressive thoughts and schemas (Beck et al. 1979; Beck 1987; Ingram et al. 1998; Wells and Pagageorgiou 2004). A more recent theory, Metacognitive Therapy (MCT; Wells 2000 Wells , 2009) offers another approach towards the understanding of depression. ...
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Few studies have explored the importance of worry-related metacognitions and thought control strategies in major depressive disorder. The present study explored how metacognitions and thought control strategies differentiated currently depressed (n = 37), previously depressed (n = 81) and never-depressed individuals (n = 50). Discriminant function analysis was performed to investigate group differences on the Metacognitions Questionnaire-30, Thought Control Questionnaire, and Ruminative Response Scale. The analysis revealed that currently depressed participants scored significantly higher than previously depressed participants and that previously depressed participants scored higher than never-depressed participants on negative metacognitive beliefs, rumination, worry and the use of punishment as a thought control strategy. The discriminant function analysis further showed that previously depressed participants had a higher use of the thought control strategy reappraisal, along with lower dysfunctional metacognitions concerning the need to control their thoughts, higher confidence in their cognitive function and lower levels about the need to worry, compared to both the currently and never-depressed groups. The results indicate that metacognitions and thought control strategies could be promising vulnerability markers for depression.
... Furthermore, as cognitive therapy is developing in new directions by emphasizing metacognitive interventions (which try to change an individual's relationship to the intrusive thought rather than directly challenging the thought content, e.g. Hayes, Strosahl and Wilson, 1999; Hayes, Luoma, Bond, Masuda and Lillis, 2006; Segal, Williams and Teasdale, 2002; Wells, 2000; Wells and Sembi, 2004; Wells and Papageorgiou, 2004) it is of particular importance to identify those different types of unwanted intrusive cognitions. As mentioned above, there are different broad categories of intrusive cognitive activities (Clark and Rhyno, 2005). ...
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Background: Although rumination is a key process in the onset and maintenance of depressive symptoms and a powerful predictor of persistent posttraumatic stress disorder (PTSD), little is known about the differences and similarities of rumination in these conditions. Previous research has not always differentiated between rumination and intrusive images. Aims: We sought to systematically evaluate rumination and to gather more information about the content and associated emotions in three patient groups (PTSD, and depressed with and without trauma; n = 65). Furthermore, we examined the interaction between rumination and another predominant intrusive cognition, intrusive image. Method: A multi-method assessment for rumination, including a rumination questionnaire and a rumination log (kept for one week), was employed. Results: Rumination was found to be complex and composed of subcomponents that are similar across the diagnostic groups. Rumination rarely stopped intrusive images and it made the participants feel worse. There were, however, also important differences: in PTSD, rumination always or often triggered intrusive images and the traumatized individuals (PTSD and depressed with trauma) ruminated more than non-traumatized depressed patients. Conclusions: The results corroborate the assumption of rumination being a transdiagnostic process, with similarities but also with important differences across diagnostic groups. Moreover, the findings support recent research on the intricate relationship between different types of intrusive cognitions.
... Longitudinal trials are scarce; however, some longitudinal data indeed support the notion of metacognitions preceding depression and anxiety (Yılmaz, Gençöz and Wells, 2011). Trials on the effectiveness of metacognitive therapy provide further ex juvantibus evidence for the model's validity (van der Heiden, Muris and van der Molen, 2012; Bennett and Wells, 2010; Roelofs et al., 2007; Wells and Papageorgiou, 2004). While the latter studies provide only indirect evidence for the model, the former studies may be afflicted by substantial biases in terms of the retrospective nature of the self-reports (Schwarz, 2007). ...
Article
Background: Self-regulatory executive function theory (Wells and Matthews, 1994; Wells, 2008) stresses the role of metacognitions in the development of emotional disorders. Within this metacognitive model, positive beliefs about ruminative thinking are thought to be a risk factor for engaging in rumination and subsequently for depression. However, most of the existing research relies on retrospective self-report trait measures. Aims: The aim of the present study was to examine the theory's predictions with an Ecological Momentary Assessment approach capturing rumination as it occurs in daily life. Method: Non-clinical participants (N = 93) were equipped with electronic diaries and completed four signal-contingent momentary self-reports per day for 4 weeks. A multilevel mediation model was computed to examine associations between positive beliefs about rumination and ruminative thinking and negative affect in daily life. Results: Positive beliefs about rumination were significantly associated with ruminative thinking as it occurs in daily life. We further found evidence for a negative association with positive affect that was completely mediated via ruminative thinking in daily life occurring in response to negative emotions. Conclusions: Our results add ecologically valid corroborating evidence for the metacognitive model of emotional disorders within the framework of self-regulatory executive function theory.
... Treatment Within this range treatment was ended when therapist and patient agreed. Treatment followed the treatment as set out in two sources: a chapter (Wells and Papageorgiou 2004), and a treatment manual (see Wells 2008) which acted as the main session by session manual. In the first treatment session an idiosyncratic case formulation based on the metacognitive model of depression was presented to each patient. ...
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Metacognitive Therapy (MCT) for depression is a formulation-driven treatment grounded in the Wells and Matthews (Attention and emotion: A clinical perspective, 1994) self-regulatory model. Unlike traditional CBT it does not focus on challenging the content of depressive thoughts or on increasing mastery and pleasure. Instead it focuses on reducing unhelpful cognitive processes and facilitates metacognitive modes of processing. MCT enables patients to interrupt rumination, reduce unhelpful self-monitoring tendencies, and establish more adaptive styles of responding to thoughts and feelings. An important component of treatment is modification of positive and negative metacognitive beliefs about rumination. MCT was evaluated in 6–8 sessions of up to 1h each across 4 patients with recurrent and/or chronic major depressive disorder. A non-concurrent multiple-baseline with follow-up at 3 and 6months was used. Patients were randomly allocated to different length baselines and outcomes were assessed via self-report and assessor ratings. Treatment was associated with large and clinically significant improvements in depressive symptoms, rumination and metacognitive beliefs and gains were maintained over follow-up. The small number of cases limits generalisability but continued evaluation of this new brief treatment is clearly indicated.
... Furthermore, as cognitive therapy is developing in new directions by emphasizing metacognitive interventions (which try to change an individual's relationship to the intrusive thought rather than directly challenging the thought content, e.g. Hayes, Strosahl and Wilson, 1999; Hayes, Luoma, Bond, Masuda and Lillis, 2006; Segal, Williams and Teasdale, 2002; Wells, 2000; Wells and Sembi, 2004; Wells and Papageorgiou, 2004) it is of particular importance to identify those different types of unwanted intrusive cognitions. As mentioned above, there are different broad categories of intrusive cognitive activities (Clark and Rhyno, 2005). ...
Article
Full-text available
Although rumination is a key process in the onset and maintenance of depressive symptoms and a powerful predictor of persistent posttraumatic stress disorder (PTSD), little is known about the differences and similarities of rumination in these conditions. Previous research has not always differentiated between rumination and intrusive images. We sought to systematically evaluate rumination and to gather more information about the content and associated emotions in three patient groups (PTSD, and depressed with and without trauma; n = 65). Furthermore, we examined the interaction between rumination and another predominant intrusive cognition, intrusive image. A multi-method assessment for rumination, including a rumination questionnaire and a rumination log (kept for one week), was employed. Rumination was found to be complex and composed of subcomponents that are similar across the diagnostic groups. Rumination rarely stopped intrusive images and it made the participants feel worse. There were, however, also important differences: in PTSD, rumination always or often triggered intrusive images and the traumatized individuals (PTSD and depressed with trauma) ruminated more than non-traumatized depressed patients. The results corroborate the assumption of rumination being a transdiagnostic process, with similarities but also with important differences across diagnostic groups. Moreover, the findings support recent research on the intricate relationship between different types of intrusive cognitions.
... Two therapies have been shown to be effective in reducing rumination: metacognitive therapy (Wells & Papageorgiou, 2004) and behavioral activation (BA; Martell, Addis, & Jacobson, 2001). Metacognitive therapy focuses on teaching patients about rumination, helping them become aware of its real-time occurrence, and implementing anti-rumination strategies. ...
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Communication and interpersonal deficits are major stumbling blocks that stand between persons with severe mental illness (SMI) and such recovery goals as quality of life (QoL) and community integration. Not only do these deficts have a direct and negative impact on the QoL and community integration of persons with SMI but they also may reduce these persons' ability to take advantage of major interventions in which communication and interpersonal relationships play a central role (i.e., psychotherapy, recovery programs, illness management and recovery). Recent theories of schizophrenia and other SMI attribute these communication and interpersonal limitations of persons with SMI to impairments of metacognition (i.e., empathy, theory of mind [ToM], mind reading). Within a dialogical framework of metacognition that differentiates between empathy and ToM, this paper reviews two interventions for persons with SMI, Metacognitive Training (MCT) and Social Cognition and Integration Training (SCIT), that were recently developed to improve communication and interpersonal skills of persons with schizophrenia. These interventions are based on the above described theories of schizophrenia and SMI. Although preliminary research has produced favorable results for these interventions, additional investigations using more critical research designs are required to establish their efficacy. Furthermore, this paper suggests that adding dialogical elements to these interventions might improve their effectiveness.
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Rumination has been widely studied and is a crucial component in the study of cognitive vulnerabilities to depression. However, rumination means different things in the context of different theories, and has not been uniformly defined or measured. This article aims to review models of rumination, as well as the various ways in which it is assessed. The models are compared and contrasted with respect to several important dimensions of rumination. Guidelines to consider in the selection of a model and measure of rumination are presented, and suggestions for the conceptualization of rumination are offered. In addition, rumination's relation to other similar constructs is evaluated. Finally, future directions for the study of ruminative phenomena are presented. It is hoped that this article will be a useful guide to those interested in studying the multi-faceted construct of rumination.
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Emotion dysregulation is thought to be critical to the development of negative psychological outcomes. Gross (1998b) conceptualized the timing of regulation strategies as key to this relationship, with response-focused strategies, such as expressive suppression, as less effective and more detrimental compared to antecedent-focused ones, such as cognitive reappraisal. In the current study, we examined the relationship between reappraisal and expressive suppression and measures of psychopathology, particularly for stress-related reactions, in both undergraduate and trauma-exposed community samples of women. Generally, expressive suppression was associated with higher, and reappraisal with lower, self-reported stress-related symptoms. In particular, expressive suppression was associated with PTSD, anxiety, and depression symptoms in the trauma-exposed community sample, with rumination partially mediating this association. Finally, based on factor analysis, expressive suppression and cognitive reappraisal appear to be independent constructs. Overall, expressive suppression, much more so than cognitive reappraisal, may play an important role in the experience of stress-related symptoms. Further, given their independence, there are potentially relevant clinical implications, as interventions that shift one of these emotion regulation strategies may not lead to changes in the other.
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Exposure with ritual prevention (ERP) is the psychotherapeutic treatment of choice for pediatric obsessive-compulsive disorder (OCD). In the present study, a new treatment rationale - metacognitive therapy (MCT) for children - was developed and evaluated. Ten children and adolescents with OCD were randomly assigned to either MCT or ERP therapy condition. Patients were assessed before and after treatment and at the 3-month and 2-year follow-up by means of symptom severity interviews. Depressive symptoms were also assessed. Manualized treatment involved up to 20 sessions on a weekly basis. We found clinically and statistically significant improvements in symptom severity after treatment. At the 3-month and 2-year follow-up, the attained improvements during treatment were retained. Despite some methodological limitations, results showed that MCT proved to be a promising psychotherapeutic alternative to the well-established ERP in the treatment of pediatric OCD. Further investigations into the efficacy of MCT are necessary to answer questions as to the working mechanisms underlying therapy for OCD.
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The present study aimed to test the central components of Papageorgiou and Wells' (2003) non-clinical metacognitive model of rumination and depression that is grounded on the Self-Regulatory Executive Function (S-REF) model of emotional disorders [Wells, A., & Matthews, G. (1994). Attention and emotion: A clinical perspective. Hove, UK: Lawrence Erlbaum.]. A second aim of this study was to extend the non-clinical model with the concept of self-discrepancy in line with the S-REF model. Data of the current study were collected in a large sample of non-clinical Dutch undergraduates (N=196), who completed a battery of questionnaires including measures of rumination, positive and negative metacognitions, depressive symptoms, and self-discrepancy (i.e., actual-ideal, actual-ought, and actual-feared discrepancies). Hypothesized relationships among these variables were tested by means of structural equation modelling. Following some theoretically consistent modifications, the model was an adequate fit to the data. With respect to the second aim of the study, self-discrepancies were directly linked to symptoms of depression as well as indirectly via the cognitive processes involved in the metacognitive model of rumination and depression. Evidence was found for positive beliefs about rumination to partially mediate the relation between self-discrepancy and rumination. Clinical implications of the findings, including implementation of a metacognitive-focused cognitive therapy of depression, and suggestions for future research are discussed.
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This study explores the phenomenological experience of rumination in a sample of 22 chronically depressed people and looks at the extent to which it is consistent with theoretical ideas. The findings indicate that, on average, depressed people ruminate about at least two different topics, and that there is wide variability in how long each episode lasts. Rumination is a complex process frequently involving imagery as well as verbal thoughts and is almost invariably associated with multiple emotions. Although there was some evidence for stop rules being involved, most individuals attributed ending a period of rumination to distraction, whether external or internally generated.
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This study evaluated mindfulness-based cognitive therapy (MBCT), a group intervention designed to train recovered recurrently depressed patients to disengage from dysphoria-activated depressogenic thinking that may mediate relapse/recurrence. Recovered recurrently depressed patients (n = 145) were randomized to continue with treatment as usual or, in addition, to receive MBCT. Relapse/recurrence to major depression was assessed over a 60-week study period. For patients with 3 or more previous episodes of depression (77% of the sample), MBCT significantly reduced risk of relapse/recurrence. For patients with only 2 previous episodes, MBCT did not reduce relapse/recurrence. MBCT offers a promising cost-efficient psychological approach to preventing relapse/recurrence in recovered recurrently depressed patients.
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I propose that the ways people respond to their own symptoms of depression influence the duration of these symptoms. People who engage in ruminative responses to depression, focusing on their symptoms and the possible causes and consequences of their symptoms, will show longer depressions than people who take action to distract themselves from their symptoms. Ruminative responses prolong depression because they allow the depressed mood to negatively bias thinking and interfere with instrumental behavior and problem-solving. Laboratory and field studies directly testing this theory have supported its predictions. I discuss how response styles can explain the greater likelihood of depression in women than men. Then I intergrate this response styles theory with studies of coping with discrete events. The response styles theory is compared to other theories of the duration of depression. Finally, I suggest what may help a depressed person to stop engaging in ruminative responses and how response styles for depression may develop.
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Cognitive therapy techniques are applied to an ever-increasing range of psychological disorders. However, both basic methods and general theory of therapy have evolved more slowly. Although cognitive therapy is based on experimentally testable concepts derived from cognitive psychology, an integration of these areas capable of explaining cognitive-attentional phenomena and offering treatment Implications remains to be achieved. In this paper, we outline the Self-Regulatory Executive Function (S-REF) model of emotional disorder, which integrates information processing research with Beck's schema theory. The model advances understanding of the roles of stimulus-driven and voluntary control of cognition, procedural knowledge (beliefs), and of the interactions between different levels of information-processing. It also accounts for cognitive bias effects demonstrated in the experimental psychopathology literature. The model presents implications concerning not only what should be done in cognitive therapy, but how cognitive change may be most effectively accomplished.
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Measures of emotional health and styles of responding to negative moods were obtained for 137 students 14 days before the Loma Prieta earthquake. A follow-up was done 10 days again 7 weeks after the earthquake to test predictions about which of the students would show the most enduring symptoms of depression and posttraumatic stress. Regression analysis showed that students who, before the earthquake, already had elevated levels of depression and stress symptoms and a ruminative style of responding to their symptoms had more depression and stress symptoms for both follow-ups. Students who were exposed to more dangerous or difficult circumstances because of the earthquake also had elevated symptom levels 10 days after the earthquake. Similarly, students who, during the 10 days after the earthquake, had more ruminations about the earthquake were still more likely to have high levels of depressive and stress symptoms 7 weeks after the earthquake.
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Wells and Matthews (1994, 1996) proposed that perseverative negative thinking, such as depressive rumination and anxious worry, is supported by metacognitive beliefs concerning the functions and consequences of these styles of thinking. However, to date no studies have investigated metacognitive beliefs about rumination. This study examined the presence and content of metacognitive beliefs about rumination in patients with recurrent major depression. To achieve this aim, a semistructured interview was conducted with each patient. The results showed that all patients held positive and negative beliefs about rumination. Positive beliefs appear to reflect themes concerning rumination as a coping strategy. Negative beliefs seem to reflect themes concerning uncontrollability and harm, and interpersonal and social consequences of rumination. The conceptual and clinical implications of the results are discussed.
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This study evaluated the effectiveness of Attention Training (ATT; Wells, 1990) in the treatment of recurrent major depression. This technique is based on an information processing model of emotional disorders (Wells & Matthews, 1994) in which self-focused attention and metacognition maintain dysfunction. ATT was evaluated in a consecutive single-case series of patients referred for treatment of recurrent major depression. Patients were assigned to no-treatment baselines of 3 to 5 weeks, administered five to eight weekly sessions of ATT, and followed up at 3, 6, and 12 months posttreatment. The effects of ATT on depression, anxiety, negative automatic thoughts, rumination, self-focused attention, and metacognition were assessed. Following ATT, all patients showed clinically significant reductions in depression and anxiety. Reductions in negative automatic thoughts, rumination, and attentional and metacognitive factors showed similar improvements. All scores fell within the normal range on completion of ATT. Treatment gains were maintained at the 12-month follow-up assessments. However, randomized controlled trials of ATT are required before firm conclusions can be drawn.
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[This book] is written for students of cognitive psychology, and also for clinicians and researchers in the areas of cognition, stress and emotional disorders. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
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Traces the development of the cognitive approach to psychopathology and psy hotherapy from common-sense observations and folk wisdom, to a more sophisticated understanding of the emotional disorders, and finally to the application of rational techniques to correct the misconceptions and conceptual distortions that form the matrix of the neuroses. The importance of engaging the patient in exploration of his inner world and of obtaining a sharp delineation of specific thoughts and underlying assumptions is emphasized. (91/4 p ref) (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Article
proposed that panic attacks result from the catastrophic misinterpretation of certain bodily sensations . . . involved in normal anxiety responses (e.g., palpitations, breathlessness and dizziness) perceiving these sensations as much more dangerous than they really are / indicative of an immediate, impending disaster types of panic attack / nonconscious processes / state or trait characteristic / fear of fear / hypochondriasis review the literature on panic to determine the extent to which it is consistent with the proposed model / ideational components / perceived sequence of events / role of hyperventilation / lactate-induced / biological factors / pharmacological treatment (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Article
This study tested the effectiveness of a new cognitive technique involving attention training. A single case systematic replication series (Sidman, 1960) was used to replicate and extend previous findings. In particular the effects of attention training on panic frequency, general anxiety, and beliefs was investigated across two panic disorder cases and one social phobia case, and across different therapists, and settings. A true reversal design was used in one of the cases. In this case attention training was followed by an attentional manipulation incompatible with the hypothesized effects of attention training so that the effects of attention training on target problems could be clearly evaluated on its re-introduction. The results are consistent with those of a previous study (Wells, 1990) and provide preliminary evidence that panic attacks, anxiety and beliefs can be effectively and lastingly reduced by cognitive techniques which do not directly target the content of negative appraisal. © 1997 John Wiley & Sons, Ltd.
Article
Cognitive theorists have argued that different types of thinking characterize different emotional states. Recently, in an information-processing model of emotional disorder, Wells and Matthews (1994, 1996) argue that it is not only the content of thought but also the process and meta-cognitive dimensions of particular types of thinking that may be implicated in problem maintenance. However, little is known about how different types of thinking overlap and differ. This study compared the process and meta-cognitive characteristics of naturally occurring depressive and anxious thoughts in a non-clinical sample. We also investigated relationships between thought dimensions and intensity of emotional responses for each type of thought. Subjects were provided with a diary for recording and rating the content of their first and second depressive and anxious thoughts occurring during a two-week period. The results showed that although depressive and anxious thoughts were rated similarly on a number of dimensions, significant differences emerged, and particular dimensions of thought, other than belief level, were associated with emotional intensity. The conceptual and clinical implications of these findings are briefly discussed. Copyright © 1999 John Wiley & Sons, Ltd.
Article
In this paper a cognitive model of Generalized Anxiety Disorder (GAD) is described. Evidence for the model is briefly reviewed and the specific form of cognitive therapy (metacognitive therapy) derived from the model is outlined. The model accounts for the disappointing effects of existing cognitive-behavioural treatments of GAD in terms of a failure to focus on key beliefs concerning worry itself. The model asserts that pathological worry in GAD is maintained by positive and negative metacognitive beliefs concerning the advantages and the dangers of worrying. Individuals with GAD tend to use internal information such as a felt sense that they will be able to cope as a signal to terminate worrying. Although worrying is used as a means of coping with anticipated threats, it becomes the object of negative beliefs and appraisals. Several feedback cycles maintain the problem. When worrying is appraised as dangerous anxiety increases and it is difficult for the individual to obtain an internal state signalling that it is safe to stop worrying. Unhelpful behavioural strategies such as avoidance of situations that trigger worry, thought control strategies characterized by a lack of attempts to interrupt ongoing worry sequences, and attempts to suppress thoughts that trigger worrying maintain maladaptive metacognitions and anxiety. Specific strategies for conceptualizing GAD cases, and for modifying key metacognitions are presented. Copyright © 1999 John Wiley & Sons, Ltd.
Article
Rumination has attracted increasing theoretical and empirical interest in the past 15 years. Previous research has demonstrated significant relationships between rumination, depression, and metacognition. Two studies were conducted to further investigate these relationships and test the fit of a clinical metacognitive model of rumination and depression in samples of both depressed and nondepressed participants. In these studies, we collected cross-sectional data of rumination, depression, and metacognition. The relationships among variables were examined by testing the fit of structural equation models. In the study on depressed participants, a good model fit was obtained consistent with predictions. There were similarities and differences between the depressed and nondepressed samples in terms of relationships among metacognition, rumination, and depression. In each case, theoretically consistent paths between positive metacognitive beliefs, rumination, negative metacognitive beliefs, and depression were evident. The conceptual and clinical implications of these data are discussed.
Article
A cognitive model of panic is described. Within this model panic attacks are said to result from the catastrophic misinterpretation of certain bodily sensations. The sensations which are misinterpreted are mainly those involved in normal anxiety responses (e.g. palpitations, breathlessness, dizziness etc.) but also include some other sensations. The catastrophic misinterpretation involves perceiving these sensations as much more dangerous than they really are (e.g. perceiving palpitations as evidence of an impending heart attack). A review of the literature indicates that the proposed model is consistent with the major features of panic. In particular, it is consistent with the nature of the cognitive disturbance in panic patients, the perceived sequence of events in an attack, the occurrence of ‘spontaneous’ attacks, the role of hyperventilation in attacks, the effects of sodium lactate and the literature on psychological and pharmacological treatments. Finally, a series of direct tests of the model are proposed.
Article
There is evidence consistent with the suggestion of the cognitive model of depression that certain negative cognitions can produce and maintain the state of depression. There is also good evidence that depressed mood affects the relative accessibility of positive and negative cognitions. Thus, negative cognitions appear to produce depression, and, conversely, depression increases the probability of just those cognitions which will cause further depression. This reciprocal relationship between depression and cognition may form the basis of a vicious cycle which will perpetuate and intensify depression.Bower has proposed an associative network theory to account for the effects of mood on memory. The implications of this model for cognitive models of depression are developed. It is suggested that an important dimension of cognitive vulnerability to depression may be the nature of the cognitions that become accessible in depressed mood.
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The authors review the existing models for understanding agoraphobia and suggest a more complex behavioral model which includes a combination of necessary and sufficient factors for its formation. This model is presented as a framework allowing classification of agoraphobic-like symptoms with implications for treatment planning and research efforts.
Article
Despite the negative consequences of depressive rumination, little is known about the factors that may be linked to a predisposition to ruminate. Wells and Matthews (1994) suggested that rumination is associated with underlying metacognitive beliefs. Papageorgiou and Wells (in press) provided evidence for the presence of positive and negative metacognitive beliefs about rumination in recurrent major depression. A series of studies concerned with the development and validation of a measure of positive beliefs about rumination, the Positive Beliefs About Rumination Scale (PBRS), is reported. Factor analyses of the scale demonstrated a single factor. The PBRS showed high internal consistency and test-retest reliability, and good psychometric properties of concurrent, convergent, and discriminant validity. The scale was used to test relations between positive beliefs, rumination, and depression. The results were consistent with path models in which rumination mediated the effects of positive beliefs about rumination on state and trait depression.
Article
A case of relaxation induced anxiety in a patient with Panic Disorder is reported. The study reports the use of an attentional training procedure which was effective in eliminating panic and facilitated tension reduction without producing anxiety. A two treatment (ABCB) design revealed that a procedure evoking external attentional focus eliminated panic attacks, whereas autogenic training increased the frequency of panic attacks and the intensity of anxiety. The possible roles of self-focus in mediating panic and the effects of relaxation are briefly discussed.
Book
The first part of this book examines the problem of depression, evidence about it and answers previously offered in the literature. The second part describes the Interacting Cognitive Subsystems model (ICS), its advocacy of two levels of meaning and the way it addresses emotion. The third part examines how the model handles mood and memory effects. The fourth part of the book discusses ICS, negative thinking and the maintenance of depression. Part five deals with ICS, depression and psychological treatment and the concluding part raises some broader issues concerning the application of psychology theories in real world contexts.
Article
This article reviews the cognitive therapy of depression. The psychotherapy based on this theory consists of behavioral and verbal techniques to change cognitions, beliefs, and errors in logic in the patient's thinking. A few of the various techniques are described and a case example is provided. Finally, the outcome studies testing the efficacy of this approach are reviewed.
Article
This study investigated the effects of post-event processing on intrusive images following exposure to stress. It was hypothesized that ruminative activity, especially verbal worry about a stressor leads to an incubation of intrusions. Five groups which differed in the use of post-event processing strategies were used to test for a hypothesized co-joint mechanism underlying the effect. Worrying about a stressor for a period of 4 min after exposure led to significantly more intrusions in the next 3 days than a settle-down control condition. The strategies of imaging about the stressor, distraction, and worrying about usual concerns, produced a significant incremental linear pattern of intrusions across these groups. The pattern of results was as predicted by a co-joint model in which incubation results from 'tagging' of memories and blocked emotional processing. The clinical implications of these findings are briefly discussed.
Article
Empirical evidence indicates that manipulations of attention may facilitate changes in cognition and stress symptoms in emotional disorder. The present study reports the effects of Attention Training (ATT) in a brief case series of three patients with primary hypochondriasis using an A-B-A design. ATT produced clinically significant improvements in self-reported measures of affect, and illness-related behaviour and cognition. Treatment gains were maintained at 6 months follow-up assessments. Measures of body-focused attention indicated that the ATT procedure acted on attentional processes as intended. The present case series extends the effects of ATT to problems of hypochondriasis. A number of studies now suggest that ATT is associated with a reduction in anxiety and negative beliefs across disorders of panic, social phobia and hypochondriasis. Controlled clinical trials are now required to establish firmly the effects of ATT as a component of cognitive therapy.
Article
The Rumination on Sadness Scale (RSS), an individual-difference measure of rumination on sadness, was developed as an alternative to the Ruminative Responses scale of the Response Styles Questionnaire (RRRSQ; Nolen-Hoeksema & Morrow, 1991). Research has shown the RRRSQ to consist of multiple, not highly intercorrelated factors; only I factor explicitly addresses rumination. In Study 1, a 1-factor solution to a principal components analysis was shown to hold for responses to the RSS. The RSS was also shown to be reliable. In Study 2, convergent and discriminant validity of the RSS were assessed. In Study 3, individuals with high RSS scores exhibited more distress regarding current concerns with the introduction of a delay period (to allow them to ruminate) after a sad mood induction.
Attention training and hypochondriasis: Preliminary results of a controlled treatment trial
  • M J Cavanagh
Dimensions of depressive rumination and anxious worry: a comparative study
  • C. Papageorgiou
  • A. Wells
Worrying:Perspectives on Theory, Assessment, and Treatment
  • A. Wells