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An Adapted Word-Sentence Association Paradigm for Generalized Anxiety and Worry: Assessing Interpretation Bias
Abstract
Individuals with pathological worry, a common symptom of Generalized Anxiety Disorder (GAD), make threatening interpretations of ambiguous information related to various life domains (e.g., finances, relationships). A word-sentence association paradigm (WSAP) computer task, originally designed for social anxiety, was adapted to assess two threat-related interpretation biases common among individuals with generalized anxiety and pathological worry. The two biases, which have yet to be investigated simultaneously, include: accepting threatening interpretations and rejecting benign interpretations of ambiguous information (for the original WSAP, see Beard & Amir, 2009). It was hypothesized that endorsing threat interpretations on the WSAP would be associated with greater bias for threat on a validated self-report measure of bias, and would predict GAD symptoms and worry after trait anxiety and depression were statistically controlled. Results from a non-clinical sample (N = 148) provided support for the convergent validity of the WSAP. After controlling for trait anxiety and depression, a bias to accept threat interpretations predicted a unique and significant proportion of variance in measures of GAD symptoms and worry. A bias away from non-threat (i.e., rejecting benign interpretations) was unrelated. The WSAP shows evidence of sensitivity and specificity to GAD symptoms and worry, and appears to be a unique and specific measure of two types of threat bias making it theoretically informative and clinically useful.
... For participants with SAD, both threat bias and lack of positive IB (interpreting an ambiguous situation as neutral) have been found (Amir, Prouvost, & Kuckertz, 2012), with the former potentially resulting in avoidance of social situations and the latter in a decreased tendency to experience positive affect in such situations (Kashdan, Weeks, & Savotyanova, 2011). In contrast, a greater severity of GAD symptoms and worry was not found to be associated with a tendency to reject positive interpretations, but was related to endorsement of threat interpretations (Ogniewicz, Dugas, Langlois, Gosselin, & Koerner, 2014). As only the first component has been studied in EDs so far, it remains unclear whether the IB may result in a higher endorsement rate of negative interpretations, in a higher rejection rate of positive interpretations, or in both. ...
... We generated ambiguous sentences and corresponding interpretation words on the basis of treatment manuals for ED, SAD, GAD, and disorderspecific internet platforms and by translating already existing stimuli kindly provided by other research groups (Beard & Amir, 2008;Buhlmann et al., 2002;Martinelli, Holzinger, & Chasson, 2014;Mobius, Tendolkar, Lohner, Baltussen, & Becker, 2015;Ogniewicz et al., 2014). For each disorderspecific ambiguous situation, a negative (disorder-specific) and a positive (non-disorder-specific or neutral) interpretive word were selected (e.g., "You notice that your voice is trembling," followed by either "fear" or "cold" (SAD); "You have three missed calls from your mother," followed by "worry "or "call back" (GAD), and "You calculate your BMI and discover it is in the normal range" followed by "satisfied" or "disappointed" (ED)). ...
... The original version, the Word Sentence Association Paradigm (WSAP), has been used to assess interpretation bias in various mental disorders (e.g., SAD , GAD (Ogniewicz et al., 2014), and in women with body dysphoria (Martinelli et al., 2014). In the current study, we used a modified version, the SWAP, thus presenting an ambiguous (either ED-, SAD-, or GAD-specific) sentence followed by a valent word (disorder-specific negative or non-disorder-specific) in order to minimize priming and anchor effects (Beard & Amir, 2009;Hayes & Hirsch, 2007). ...
Objective:
Cognitive biases, such as memory, attention, and interpretation bias, are thought to play a central role in the development and maintenance of eating disorders (EDs). The aim of the present study was to investigate whether the interpretation bias is ED-specific or can be generalized to comorbid disorder-related threats in women with high levels of ED symptoms.
Method:
In an online study, we measured interpretation bias using the modified Sentence Word Association Paradigm (SWAP), comparing women with (n = 39) and without (sub)threshold eating disorders (n = 56). We assessed endorsement and rejection rates as well as reaction times in response to a positive/neutral or a negative ED-specific, social anxiety-specific (SAD), or generalized anxiety-specific (GAD) interpretive word following an ambiguous sentence.
Results:
In ambiguous situations, women with high ED symptoms selected more negative (p < .001) and fewer positive/neutral ED-related interpretations (p < .001). Negative interpretations were endorsed significantly faster (p < .001), while positive interpretations were rejected faster in this group (p < .001). These women also manifested negative SAD-specific interpretation bias patterns in reaction time measures. Nevertheless, ED severity was best predicted by the endorsement of negative ED-specific stimuli, whereas ED and SAD reaction time measures seemed to have a negligible effect.
Discussion:
The results indicate that the interpretation bias might be ED-specific. The SWAP can be a useful tool for the further investigation of the etiological relevance of the interpretation bias as well as for the development of modification training interventions.
... Étant donné les résultats encourageants rapportés par Beard et Amir (2008), un PMI basé sur le WSAP a été développé pour le TAG (voir Ogniewicz, Dugas, Langlois, Gosselin & Koerner, 2014). Il comprend 120 phrases ambiguës reliées à 10 domaines d'inquiétude communément rapportés par les individus ayant un TAG (Dugas et al., 1998;Hoyer, Becker & Roth, 2001). ...
... Le répondant doit sélectionner le chiffre qui correspond le mieux à son niveau de préoccupation lorsqu'il s'imagine être dans la situation présentée par la vignette. Cet outil de mesure présente une cohérence interne pour le score total, ␣ ϭ 0,96 (Ogniewicz et al., 2014). Dans le cadre de cette étude, les sous-échelles sont considérées séparément. ...
Chez les personnes atteintes du trouble d'anxiété généralisée (TAG), celles ayant une plus forte tendance à interpréter négativement les situations ambiguës bénéficient moins de la thérapie cognitivo-comportementale (TCC). En conséquence, un programme de modification des interprétations (PMI) pourrait améliorer l'efficacité de la TCC pour cette population anxieuse. Cet essai clinique randomisé évalue l'impact de l'ajout d'un PMI à une TCC pour le TAG. Nos hypothèses sont les suivantes : 1) le biais d'interprétation sera corrélé avec la sévérité des symptômes du TAG au prétraitement; 2) l'ajout d'un PMI à la TCC permettra une plus grande amélioration du biais d'interprétation; 3) l'ajout d'un PMI à la TCC mènera à une plus grande diminution des symptômes du TAG et de dépression. Une randomisation aléatoire répartit les participants (N ϭ 71) en 2 groupes (TCC ϩ PMI; TCC ϩ Entraînement placebo). Le biais d'interprétation et la sévérité des symptômes du TAG sont mesurés au prétraitement, au mi-traitement et au post-traitement. Les résultats montrent que le biais d'interprétation est corrélé positivement avec la sévérité des symptômes du TAG au prétraitement, r ϭ 0,46, p Ͻ 0,001. L'ajout du PMI à la TCC permet aussi une plus grande amélioration du biais d'interprétation en situations ambiguës, F(2, 64,77) ϭ 4,22, p ϭ 0,044, f 2 ϭ 0,02. Enfin, les résultats observés ne permettent pas d'appuyer une plus grande diminution des symptômes du TAG pour la condition TCC ϩ PMI, F(2, 126,16) ϭ 0,41, p ϭ 0,67, f 2 Ͻ 0,01. L'ajout d'un PMI à la TCC permet de diminuer davantage le biais d'interprétation de participants, mais pas les symptômes du TAG. Intérêt public Combiner un programme de modification des interprétations (PMI) à la thérapie cognitivo-comportementale (TCC) pourrait améliorer notre capacité à venir en aide aux personnes atteintes du trouble d'anxiété généralisée (TAG). Selon nos résultats, comparativement à la TCC seule, cette thérapie « combinée » mène à une plus grande diminution du biais d'interprétation en situation ambiguë, mais pas à une plus grande diminution des symptômes du TAG et de la dépression. Par conséquent, l'ajout d'un PMI ne semble pas augmenter l'efficacité thérapeutique de la TCC pour les personnes souffrant du TAG. Mots-clés : trouble d'anxiété généralisée, biais d'interprétation, thérapie cognitivo-comportementale, programme de modification des interprétations, essai clinique randomisé. Matériel supplémentaire : http://dx.
... The situation set consisted of 240 sentence-word-combinations extracted from a pre-validated stimulus pool (see Appendix for examples). This stimulus pool was compiled from pre-existing stimulus sets of interpretation bias assessment studies in BDD (Buhlmann et al. 2002), SAD (Beard et al. 2011;Beard and Amir 2008) and GAD (Ogniewicz et al. 2014). Stimulus sets were kindly provided by the authors and translated. ...
... In line with the current concern hypothesis, our results indicate a pronounced negative but no lack of positive interpretation bias for general situations in GAD compared to NC. One WSAP-based study had previously demonstrated this pattern in an unselected sample, showing that explicit threat bias, and not reduced positive bias, was predictive of GAD symptoms (Ogniewicz et al. 2014). The present study extends these findings by demonstrating the identical relationship in a sample meeting self-report DSM-5 GAD criteria. ...
Background
Interpretation biases are suggested to be transdiagnostic phenomena, but have rarely been compared across different disorders and current concerns.
Methods
We investigated explicit, decision-based, and more implicit, reaction time-based interpretation bias in individuals with body dysmorphic disorder (BDD; N = 29), social anxiety disorder (SAD; N = 36), generalized anxiety disorder (GAD; N = 22), and non-clinical controls (NC; N = 32), using an adapted Word Sentence Association Paradigm (WSAP).
Results
Results indicated that interpretation bias occurred transdiagnostically, while content-specific bias patterns varied meaningfully across groups. BDD and SAD shared explicit and, more inconsistently, implicit interpretation biases for appearance-related and social situations. The GAD group exhibited an explicit and implicit negative interpretation bias for general situations, and an additional implicit lack of positive bias. Mechanistic Wiener diffusion model analyses revealed that interpretation bias patterns were mainly driven by speeded information uptake, potentially mirroring disorder-specific associative memory organization.
Conclusions
These findings have important implications for understanding interpretation biases as both etiological and treatment factors.
... Étant donné les résultats encourageants rapportés par Beard et Amir (2008), un PMI basé sur le WSAP a été développé pour le TAG (voir Ogniewicz, Dugas, Langlois, Gosselin & Koerner, 2014). Il comprend 120 phrases ambiguës reliées à 10 domaines d'inquiétude communément rapportés par les individus ayant un TAG (Dugas et al., 1998;Hoyer, Becker & Roth, 2001). ...
... Le répondant doit sélectionner le chiffre qui correspond le mieux à son niveau de préoccupation lorsqu'il s'imagine être dans la situation présentée par la vignette. Cet outil de mesure présente une cohérence interne pour le score total, ␣ ϭ 0,96 (Ogniewicz et al., 2014). Dans le cadre de cette étude, les sous-échelles sont considérées séparément. ...
Chez les personnes atteintes du trouble d’anxiété généralisée (TAG), celles ayant une plus forte tendance à interpréter négativement les situations ambiguës bénéficient moins de la thérapie cognitivo-comportementale (TCC). En conséquence, un programme de modification des interprétations (PMI) pourrait améliorer l’efficacité de la TCC pour cette population anxieuse. Cet essai clinique randomisé évalue l’impact de l’ajout d’un PMI à une TCC pour le TAG. Nos hypothèses sont les suivantes : 1) le biais d’interprétation sera corrélé avec la sévérité des symptômes du TAG au prétraitement; 2) l’ajout d’un PMI à la TCC permettra une plus grande amélioration du biais d’interprétation; 3) l’ajout d’un PMI à la TCC mènera à une plus grande diminution des symptômes du TAG et de dépression. Une randomisation aléatoire répartit les participants (N = 71) en 2 groupes (TCC + PMI; TCC + Entraînement placebo). Le biais d’interprétation et la sévérité des symptômes du TAG sont mesurés au prétraitement, au mi-traitement et au post-traitement. Les résultats montrent que le biais d’interprétation est corrélé positivement avec la sévérité des symptômes du TAG au prétraitement, r = 0,46, p < 0,001. L’ajout du PMI à la TCC permet aussi une plus grande amélioration du biais d’interprétation en situations ambiguës, F(2, 64,77) = 4,22, p = 0,044, f² = 0,02. Enfin, les résultats observés ne permettent pas d’appuyer une plus grande diminution des symptômes du TAG pour la condition TCC + PMI, F(2, 126,16) = 0,41, p = 0,67, f² < 0,01. L’ajout d’un PMI à la TCC permet de diminuer davantage le biais d’interprétation de participants, mais pas les symptômes du TAG.
... Word Sentence Association Test-Negative (WSAP-N; Ogniewicz et al., 2014). We presented 16 ambiguous sentences (e.g., "There has been a change in my salary") from the original 120-item pool presented in association with a positive/benign word (e.g., "increase") and a negative (e.g., "decrease") word. ...
Les biais d’attribution hostiles (hostile attributional biases, HAB) sont impliqués dans plusieurs problèmes interpersonnels et de santé mentale. Il a été démontré que ces problèmes sont également présents dans les régions francophones. Or, les évaluations des HAB validées en français sont peu nombreuses et présentent des limites importantes qui empêchent leur adoption à grande échelle par les chercheurs et les professionnels de la santé. Nous avons donc mis au point une version française du Word Sentence Association Paradigm-Hostility (WSAP-H), qui est une mesure courte, facile à administrer et relativement implicite des HAB. Nous avons ensuite mené une étude psychométrique auprès d’un échantillon communautaire en ligne de 315 personnes. En reproduisant les études de validation précédentes, nous avons constaté que les scores du WSAP-H français présentaient une bonne cohérence interne (α = 0,81; ω = 0,84), et nous avons fourni des preuves factorielles (structure à un facteur), convergentes (corrélations significatives avec une autre mesure des HAB, ainsi qu’avec des construits théoriquement liés, à savoir la colère et l’hostilité) et divergentes (corrélations faibles ou non significatives avec l’humeur négative) soutenant la validité des scores du WSAP-H en tant que mesures des HAB. Au-delà des résultats précédents, nous avons également montré que ces scores HAB (a) présentent une fiabilité test-retest acceptable (r = 0,77) et une stabilité (changements non significatifs et faibles [d = 0,21] au niveau du groupe) à un intervalle de 8 semaines, (b) sont liés aux problèmes interpersonnels autodéclarés, et (c) sont distincts d’une tendance plus générale à faire des attributions négatives. Les scores du WSAP-H français constituent donc une mesure fiable et valide des HAB, ce qui confirme l’utilité de cet outil en contexte de recherche et d’intervention.
... This measure identifies worries from across 5 key domains, including worries about social relationships, academic and occupational performance, financial concerns, disrupted or aimless future goals, and lack of confidence. Items were also generated for two other key areas which are often identified as topics of worry in trait anxiety research, these being worries about physical harm/illness to self and others, and generalised abstract worry (Dugas et al., 1998;Ogniewicz et al., 2014;Roemer et al., 1997). Pandemic-related items were generated for each of these domains by one of the authors (Y.F.) and were discussed with and reviewed by other members of the research team (C.H., J.C., Y-L.W., Y-H.W.). ...
Background
The COVID-19 pandemic has resulted in many individuals experiencing increased symptoms of anxiety. We predict that this increase may be underpinned by pandemic-related worry (PRW), characterised by repetitive negative thinking about pandemic-specific outcomes; and that this relationship is mediated through reduced attentional capacity required to regulate negative affect.
Methods
We developed a novel scale to measure the contents of PRW in an initial sample of 255 participants, and explored its relationship with cognitive functioning and negative affect in a sample of 382 UK-based university students, whilst controlling for recalled pre-pandemic trait anxiety.
Results
A five-factor model of PRW was identified, with factors reflecting worry about decline in quality of life (QoL) and probability of infection correlating with attention and memory-related errors. Importantly, attention-related errors partially mediated the positive relationship between PRW and negative affect, even when controlling for pre-pandemic trait anxiety.
Conclusion
PRW’s relationship with negative affect was partially mediated through attentional function, consistent with models of anxiety and attentional control. In UK-based students PRW may be predominantly focused on the decline in QoL; therefore, interventions targeting worry about the decline in QoL caused by COVID-19 are especially important in this population in the wake of the pandemic.
... In contrast to previous research (Feng et al., 2019;Ogniewicz, Dugas, Langlois, Gosselin, & Koerner, 2014) and our hypotheses, no association was found between online interpretation bias and worry or anxiety in either cross-sectional or prospective timeframes. Furthermore, attention bias was only associated with lower anxiety but not worry (in contrast to Goodwin et al., 2017) in the cross-sectional part of the study. ...
Worry, a stream of negative thoughts about the future, is maintained by the poor attention control, and the tendency to attend to negative information (attention bias), and interpret ambiguity negatively (interpretation bias). Memories that integrate negative interpretations (interpretation-memory) may also contribute to worry, but this remains unexplored. We aimed to investigate how these cognitive processes are associated with worry and anxiety cross-sectionally (Phase 1), and then explore which cognitive processes from Phase 1 predict worry and anxiety during times of high stress, namely prior to examinations (Phase 2), and after the initial onset of the COVID-19 pandemic (Phase 3). Worry, anxiety, and cognitive processes were assessed in an undergraduate sample (n = 64). We found that whilst greater benign interpretation bias and benign interpretation-memory bias were associated with lower levels of concurrent worry and anxiety, only interpretation bias explained unique variance in worry and anxiety. No cognitive predictor explained unique variance of changes in prospective worry and anxiety significantly prior to examinations. In relation to anxiety and worry during the stress of the COVID-19 pandemic, both benign attention bias and benign interpretation-memory bias predicted decreased worry; only benign attention bias predicted decreased anxiety. Findings suggest that cognitive processes can predict changes in worry and anxiety during future stressful contexts.
... Ambiguous scenarios were adapted for relevance to young adults in a university setting from existing materials (Berna et al., 2011;Heathcote et al., 2016;Hertel et al., 2014;Klein et al., 2015;Mathews & Mackintosh, 2000;Ogniewicz et al., 2014;Salemink et al., 2007;Salemink & FIG. 2 Training task sequence. c b m -i a f o r a n x i e t y a n d d e p r e s s i v e s y m p t o m s 5 Wiers, 2011). ...
Anxiety and depression are common, co-occurring and costly mental health disorders. Cognitive bias modification aims to modify biases to reduce associated symptoms. Few studies have targeted multiple biases associated with both anxiety and depression, and those that have lacked a control condition. This study piloted a single-session online cognitive bias modification (known as CBM-IA) designed to target two biases associated with anxiety and depression – interpretation bias and attribution style – in adults with varying levels of anxiety and depressive symptoms. Participants (18-26 years) with at least mild levels of anxiety/stress and depressive symptoms on the DASS-21 were randomly allocated to an intervention (n = 23) or a control (n = 22) condition. The training consisted of a single-session online CBM-IA to encourage positive interpretations and a positive attribution style.
Interpretation bias, attribution style, anxious and depressive mood states, and anxiety, stress and depressive symptoms improved at post-training and at follow-up, irrespective of condition. Changes in interpretation bias from pre- to post-training were significantly associated with changes in anxious mood state. CBM-IA, as implemented in this single-session pilot study, did not significantly reduce targeted biases and symptoms compared to a control condition. This adds to the mixed evidence on the efficacy of single-session CBM-I for altering biases and symptoms.
... This measure identifies worries from across 5 key domains, including worries about social relationships, academic and occupational performance, financial concerns, disrupted or aimless future goals, and lack of confidence. Items were also generated for two other key areas which are often identified as topics of worry in trait anxiety research, these being worries about physical harm/illness to self and others, and generalised abstract worry (Dugas et al., 1998;Ogniewicz et al., 2014;Roemer et al., 1997). Pandemic-related items were generated for each of these domains by one of the authors (Y.F.) and were discussed with and reviewed by other members of the research team (C.H., J.C., Y-L.W., Y-H.W.). ...
Background
The COVID-19 pandemic has resulted in many individuals experiencing increased symptoms of anxiety. We predict that this increase may be underpinned by pandemic-related worry (PRW), characterised by repetitive negative thinking about pandemic-specific outcomes; and that this relationship is mediated through reduced attentional capacity required to regulate negative affect.
Methods
We developed a novel scale to measure the contents of PRW in an initial sample of 255 participants, and explored its relationship with cognitive functioning and negative affect in a sample of 382 UK-based university students, whilst controlling for recalled pre-pandemic trait anxiety.
Results
A five-factor model of PRW was identified, with factors reflecting worry about decline in quality of life (QoL) and probability of infection correlating with attention and memory-related errors. Importantly, attention-related errors partially mediated the positive relationship between PRW and negative affect, even when controlling for pre-pandemic trait anxiety.
Conclusion
PRW’s relationship with negative affect was partially mediated through attentional function, consistent with models of anxiety and attentional control. In UK-based students PRW may be predominantly focused on the decline in QoL; therefore, interventions targeting worry about the decline in QoL caused by COVID-19 are especially important in this population in the wake of the pandemic.
... This measure identifies worries from across 5 key domains, including worries about social relationships, academic and occupational performance, financial concerns, disrupted or aimless future goals, and lack of confidence. Items were also generated for two other key areas which are often identified as topics of worry in trait anxiety research, these being worries about physical harm/illness to self and others, and generalised abstract worry (Dugas et al., 1998;Ogniewicz et al., 2014;Roemer et al., 1997). Pandemic-related items were generated for each of these domains by one of the authors (Y.F.) and were discussed with and reviewed by other members of the research team (C.H., J.C., Y-L.W., Y-H.W.). ...
Background: The COVID-19 pandemic has resulted in many individuals experiencing increased symptoms of anxiety. We predict that this increase may be underpinned by pandemic-related worry (PRW), characterised by repetitive negative thinking about pandemic-specific outcomes; and that this relationship is mediated through reduced attentional capacity required to regulate negative affect.
Methods: We developed a novel scale to measure the contents of PRW in an initial sample of 255 participants; and explored its relationship with cognitive functioning and negative affect in a sample of 382 UK-based university students, whilst controlling for recalled pre-pandemic trait anxiety.
Results: A five-factor model of PRW was identified, with factors reflecting worry about decline in quality of life (QoL) and probability of infection correlating with attention and memory-related errors. Importantly, attention-related errors partially mediated the positive relationship between PRW and negative affect, even when controlling for pre-pandemic trait anxiety.
Conclusion: PRW’s relationship with negative affect was partially mediated through attentional function, consistent with models of anxiety and attentional control. In UK-based students PRW may be predominantly focused on the decline in QoL; therefore, interventions targeting worry about the decline in QoL caused by COVID-19 are especially important in this population in the wake of the pandemic.
... A recent review of studies employing the WSAP indicates acceptable internal consistency (alpha .71 to .85) and good test re-test reliability over 12 administration to .51 at second administration (final visit). There are data on the convergent validity, specificity, and sensitivity of the WSAP assessment task (as developed for worry, for example; Ogniewicz et al., 2014). ...
Background and objectives:
Individuals with high anxiety sensitivity (AS) display negative interpretive biases in response to uncomfortable but nondangerous physical sensations. Research suggests that modifying interpretation biases associated with AS leads to changes in AS. The present study sought to replicate and extend this research by addressing limitations of previous studies, increasing the amount of training and adding a follow-up period.
Method:
Participants high in AS were randomly assigned to four sessions of computerized interpretation bias modification (CBM-I) training or four sessions of computerized "sham" training (control condition) over a 2-week period. The outcomes were AS, interpretive biases, and reactions to induced physical sensations. Assessments occurred at baseline, during training, immediately after the final training session, and 2 weeks after the final training; number of re-assessments varied by outcome.
Results:
The CBM-I condition did not outperform the control condition. At the end of the training period, the CBM-I condition displayed limited reductions in AS and interpretation biases. There were no changes in reactions to induced physical sensations. Similar results were found in the control condition for all outcomes.
Limitations:
The control task and the dose of training may have obscured potential effects of CBM-I.
Conclusions:
When considered within the context of previous research, the experimental effects and therapeutic potential of CBM-I for high AS appear to be minimal. However, methodological questions need to be resolved before such a conclusion can be considered definitive.
... Previous research using the WSAP yielded mixed results regarding changes in reaction time (Amir et al. 1998Hindash and Amir 2012), which might at least partially be explained by the interdependency of reaction time measures and response choices. A higher number of trials could minimize this effect (Mobius et al. 2015;Ogniewicz et al. 2014). Future studies may also include a multi-method approach for the examination of stress, rather than the exclusive reliance on self-report measures (Joormann et al. 2015). ...
The aim of this experimental study was to examine whether interpretation biases are possible mechanisms of genesis of eating disorders (ED). We investigated the induction of an interpretation bias in healthy women using an Interpretation Modification Paradigm for ED (IMP-ED). We employed a modified version of the Word-Sentences Association Paradigm, with feedback reinforcing positive or negative responses to enhance either positive or negative interpretation, respectively. These two training conditions (n = 33 each) were compared to a no-feedback control group (n = 31). Effects on appearance-related self-esteem and body satisfaction as well as emotional vulnerability were measured in a subsequent Cyberball Ostracism Task (COT). Reinforcement of positive responses significantly reduced the endorsement of negative interpretations compared to the control group. Reinforcement of negative responses compared to no-feedback significantly decreased appearance-related self-esteem and reduced body image satisfaction compared to positivity training. The induction did not add to the deterioration in self-esteem, body satisfaction, and emotions experienced due to the COT. The IMP-ED successfully changed initial response tendencies by reducing a threat bias, and influenced core symptoms. Impacts of modifications of interpretation tendencies on emotional vulnerability and symptoms should be further studied in clinical samples, and could eventually inform the development of an efficient and economic online bias modification program.
Interpretation biases are suggested to be transdiagnostic phenomenona, but have rarely been compared across disorders and current concerns. We investigated explicit, decision-based and implicit, reaction time-based interpretation bias in body dysmorphic disorder (BDD; N = 29), social anxiety disorder (SAD; N = 36), generalized anxiety disorder (GAD; N = 22), and non-clinical controls (NC; N = 32). Results indicated that biased interpretation can be found transdiagnostically, while content-specific bias patterns vary with group status. BDD and SAD shared explicit and implicit interpretation biases for appearance-related and social situations, compared to GAD and NC. The GAD group exhibited a negative interpretation bias for general situations, and showed an implicit lack of positive bias. Wiener diffusion model analysis revealed that implicit interpretation biases were driven by potentially stronger associations in associative memory, mirroring current concerns. These findings have vital implications for the understanding of interpretation biases as both etiological and treatment factors.
In this study the authors examined whether increases in children's levels of self-reported trait anxiety would be related to their interpretation of ambiguous stimuli. By using the Revised Children's Manifest Anxiety Scale (C. R. Reynolds & B. O. Richmond, 1985), the authors obtained measurements of anxiety for 40 children ages 7 and 9 years. Interpretation of ambiguous stimuli was measured by using a pictorial homophone task, where homophones could be interpreted as either threatening or neutral. Results showed that children's interpretations of homophones was significantly predicted by level of anxiety. Increases in levels of trait anxiety were positively associated with threatening interpretations of homophones.
Beck's influential cognitive account of anxiety has led to the prediction that individuals vulnerable to anxiety should favor threatening interpretations of ambiguity (e.g., Beck & Clark, 1988; Beck, Emery, & Greenberg, 1986). The current study introduces a novel adaptation of the RSVP technique, previously used in text comprehension research, to evaluate this hypothesis. Results suggest that a group of 24 high trait anxious students did indeed selectively impose threatening interpretations on unconstrained ambiguous sentences. In contrast, a matched group of 24 low trait anxious students appeared to selectively impose non-threatening interpretations on such ambiguous sentences. These findings are fully consistent with the predicted anxiety-linked interpretative bias. Specific testable hypotheses are developed concerning the types of interpretative idiosyncrasies that plausibly may contribute to pathological anxiety.
A principal factor analysis, conducted on a mixed psychiatric outpatient sample (N = 470) , identified both common and specific dimensions underlying anxiety and depression. Although an initial single-factor extraction accounted for a significant proportion of variance in cognitive and symptom measures of anxiety and depression, a two-factor solution, in which anxiety and depression formed separate dimensions, proved to be the better solution. MANOVAS performed on pure depressed, pure anxious, and mixed anxious/depressed subgroups provided evidence of a specific cognitive profile for anxiety and depression. The mixed subsample evidenced greater severity, a mixed cognitive and symptom profile, and character traits that may indicate increased vulnerability to psychological disturbance. Results are discussed in terms of Beck's (1976) cognitive content-specificity hypothesis and the positive-negative affect model (Watson & Tellegen, 1985).
We investigated the degree of content specificity evident in the negative cognitions associated with anxiety and depression in two large samples of general psychiatric outpatients. Standardized measures of affect and cognition were analyzed in a multiple regression design. As predicted by Beck’s (1967, 1976, 1987) cognitive theory of psychopathology, thoughts of loss and failure were specifically associated with depression, whereas cognitions of harm and danger were uniquely predictive of anxiety. In addition, hopelessness was specific to depression and not to anxiety. Dysfunctional beliefs showed no consistent association with either mood state. The implication of these results, as well as related findings, is discussed in terms of a cognitive perspective on the differentiation of emotional disorders. Also discussed are the methodological difficulties encountered in research on cognitive-affective relationships.
In previous studies, we have established that anxiety states are characterized by an attentional bias that favors the processing of threatening stimuli. In the present study we extend this finding to ambiguous stimuli, specifically, homophones with spellings that correspond to either a threatening or a neutral meaning. As predicted, clinically anxious subjects used the threatening spellings relatively more than did controls, whereas recovered subjects were intermediate in this respect. Threatening words were associated with greater skin conductance responses than were neutral words, but the groups did not differ in their electrodermal reactions to homophones. We take these findings as evidence that, although the different meanings of ambiguous stimuli may be processed in parallel by all subjects, an interpretive bias operates such that anxiety-prone individuals tend to become preferentially aware of the more threatening meaning of such events.
This study investigated the possible relationship between negative processing biases and subsequent depression. The Scrambled Sentences Test (SST), a mea- sure of processing bias, was administered to a large sample of under- graduates. Participants also completed self-report measures of thought suppression tendencies, current level of depression, and lifetime worst-depres- sion symptoms. High scores on the SST, reflecting a negative processing bias, predicted depression symptoms measured 4 to 6 weeks later, even after controlling for concurrent and past depression. The SST was administered both with and without cognitive load to all participants. The SST with load pre- dicted subsequent depression for both men and women. The SST without load predicted depression for women only. The SST difference score, a mea- sure of the change in scores between the no-load and load conditions, was a significant predictor of subsequent depression for men but not women. Among men, the combination of high thought suppression with either high SST-load scores or high SST difference scores proved to be a particularly strong indicator of vulnerability to subsequent depression.
This study examined the relations between trait anxiety, social problem-solving ability, and two different measures of worry in a sample of 353 college students. The worry measures were the Penn State Worry Questionnaire (PSWQ), which measures worry frequency, uncontrollability, and distress, and the Catastrophic Worry Questionnaire (CWQ), which assesses extreme negative outcome expectancies associated with worry. Results of hierarchical multiple regression analyses showed that social problem-solving ability accounted for a significant amount of variance in both worry measures even after trait anxiety was controlled. Three different dimensions of social problem-solving ability were found to be significantly associated with worry. Negative problem orientation was positively related to both worry measures after controlling for trait anxiety. In addition, rational problem solving and impulsivity/carelessness style were both positively related to the CWQ after controlling for trait anxiety and problem orientation, which suggests that catastrophic worry has both constructive and dysfunctional problem-solving aspects that cannot be accounted for by the person's problem orientation. The implications of these findings for theory, research, and practice were discussed.
Scale discriminability is the ability of a measure to discriminate among individuals ordered along some continuum, such as depressive severity. We used a nonparametric item-response model to examine scale discriminability in the Beck Depression Inventory (BDI) and Center for Epidemiologic Studies Depression Scale (CES-D) in both college and depressed outpatient samples. In the college sample, the CES-D was more discriminating than the BDI, but a standard CES-D cutoff score of 16 overestimated the likely prevalence of depression (45%). The CES-D may be more effective than the BDI in detecting differences in depressive severity in college students but may be less specific. In the depressed outpatient sample, the CES-D was again more discriminating than the BDI. The superior scale discriminability of the CES-D offers one explanation for its poorer specificity in college samples. Endorsing many items that discriminate at low levels of depressive severity can result in scores that exceed a cutoff criterion. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
To date, little research has endeavoured to discriminate between cognitive and somatic dimensions of trait anxiety and, consequently, it remains uncertain whether these anxiety dimensions can be reliably distinguished at the trait level. The four studies presented here support the validity of the distinction between cognitive and somatic anxiety at both state and trait levels. The research involved the development and validation of a self-report questionnaire, the State-Trait Inventory for cognitive and somatic anxiety (STICSA). The nature of the anxiety dimensions assessed by this new measure was then investigated. The results indicate that the state scales of this new measure assess the degree of cognitive and somatic anxiety experienced at a particular point in time. The trait scales of the STICSA predict the situations in which different individuals will display elevations in cognitive and somatic state anxiety. Trait cognitive and somatic anxiety are indeed distinct constructs that can be reliably and validly assessed. Theoretical and applied implications of this finding are discussed.
We present an evidence-based model of pathological worry in which worry arises from an interaction between involuntary (bottom-up) processes, such as habitual biases in attention and interpretation favouring threat content, and voluntary (top-down) processes, such as attentional control. At a pre-conscious level, these processes influence the competition between mental representations when some correspond to the intended focus of attention and others to threat distracters. Processing biases influence the probability of threat representations initially intruding into awareness as negative thoughts. Worry in predominantly verbal form then develops, influenced by conscious processes such as attempts to resolve the perceived threat and the redirection of attentional control resources to worry content, as well as the continuing influence of habitual processing biases. After describing this model, we present evidence for each component process and for their causal role in pathological worry, together with implications for new directions in the treatment of pathological worry.
Numerous studies have indicated that interpretation bias plays a key role in the development and maintenance of panic disorder;
however, whether this bias is specific to the self or more generalized is unknown. This study offers a closer examination
of the nature of interpretation bias among patients with panic disorder in an outpatient hospital-based anxiety clinic. Self-referential
and global versions of the Body Sensation Interpretation Questionnaire (Clark et al. in J Consult Clin Psychol 65:203–213, 1997) were administered to 25 individuals with panic disorder, 25 individuals
with social anxiety disorder and 24 non-anxious controls. Consistent with previous findings, individuals with panic disorder
misinterpreted panic-related body sensations more so than anxious or non-anxious controls. Furthermore, the interpretation
bias was limited to the self and did not extend to beliefs about how others would interpret panic sensations. Implications
of these findings are discussed.
This research investigated whether increasing access to benign outcomes of ambiguous events decreases excessive worry. Participants reporting high levels of worry were assigned either to practice in accessing benign meanings of threat-related homographs and emotionally ambiguous scenarios or to a control condition in which threatening or benign meanings were accessed with equal frequency. Results were assessed by use of a breathing focus task that involved categorizing the valence of thought intrusions before and after an instructed worry period and a test of working memory capacity available to participants while worrying. In comparison with the control group, the benign group reported fewer negative thought intrusions (as rated by both participants and an assessor) and less anxiety during the breathing focus task and showed greater residual working memory capacity while worrying. These findings suggest that enhancing access to benign outcomes is an effective method of reducing both the persistence of worry and its detrimental consequences.
In previous studies, we have established that anxiety states are characterized by an attentional bias that favors the processing of threatening stimuli. In the present study we extend this finding to ambiguous stimuli, specifically, homophones with spellings that correspond to either a threatening or a neutral meaning. As predicted, clinically anxious subjects used the threatening spellings relatively more than did controls, whereas recovered subjects were intermediate in this respect. Threatening words were associated with greater skin conductance responses than were neutral words, but the groups did not differ in their electrodermal reactions to homophones. We take these findings as evidence that, although the different meanings of ambiguous stimuli may be processed in parallel by all subjects, an interpretive bias operates such that anxiety-prone individuals tend to become preferentially aware of the more threatening meaning of such events.
This article describes 6 studies that have used a catastrophizing interview technique to investigate some of the characteristics of catastrophic worrying. The main findings were (a) worriers were willing to catastrophize both a positive aspect of their life and a new hypothetical worry significantly more than nonworriers, (b) worriers were more likely than nonworriers to rate catastrophizing steps for a new worry as containing information relevant to existing worries, (c) worriers displayed a general iterative style that was independent of the valency of the iterative task, and (d) worriers tended to couch their worries in terms of personal inadequacies, and personal inadequacy became a feature of their catastrophizing regardless of the worry topic. Worriers' tendency to couch worries and catastrophizing steps in terms of personal inadequacies and their perseverative iterative style are both important contributors to the unresolved catastrophic thought experienced by chronic worriers.
The current study examined the phenomenon of sudden gains (i.e., rapid symptom reductions between two treatment sessions) in individuals who received cognitive-behavioral treatment for generalized anxiety disorder (GAD). The sample consisted of 59 Francophone adults with a primary diagnosis of GAD who completed a 14-week evidence-based treatment. Throughout treatment, participants completed the Penn State Worry Questionnaire—Past Week on a weekly basis. They also received assessments of GAD symptoms at intake and treatment termination using the Anxiety Disorders Interview Schedule for DSM-IV, the Worry and Anxiety Questionnaire (WAQ), and the Penn State Worry Questionnaire (PSWQ). Clients who experienced at least one sudden gain (20.34 % of the sample) experienced greater symptom reductions from pre-to post-treatment on the WAQ and the PSWQ than clients who did not experience a sudden gain. Our results suggest that the experience of sudden gains predicts positive treatment outcomes during cognitive-behavioral treatment for GAD.
Brief measurement devices can alleviate respondent burden and lower refusal rates in surveys. This article reports on a field test of two shorter forms of the Center for Epidemiological Studies Depression (CES-D) symptoms index in a multisite survey of persons 65 and older. Factor analyses demonstrate that the briefer forms tap the same symptom dimensions as does the original CES-D, and reliability statistics indicate that they sacrifice little precision. Simple transformations are presented to show how scores from the briefer forms can be compared to those of the original.
The CES-D scale is a short self-report scale designed to measure depressive symptomatology in the general population. The items of the scale are symptoms associated with depression which have been used in previously validated longer scales. The new scale was tested in household interview surveys and in psychiatric settings. It was found to have very high internal consistency and adequate test- retest repeatability. Validity was established by pat terns of correlations with other self-report measures, by correlations with clinical ratings of depression, and by relationships with other variables which support its construct validity. Reliability, validity, and factor structure were similar across a wide variety of demographic characteristics in the general population samples tested. The scale should be a useful tool for epidemiologic studies of de pression.
Information-processing biases of attention toward and interpretation of threat were measured in 29 undergraduates during a period of low academic stress. During a later period of high academic stress, participants were interviewed about their emotional response: anxious and depressive symptoms, and positive and negative affect. Anxiety symptoms at follow-up were predicted by attention to masked threat stimuli, while negative affect at follow-up was predicted by interpretation of ambiguous items as threatening. Results suggest that although attentional processes appears to play a role in the development of anxiety symptoms, the experience of negative affect during stress may be regulated by more interpretive processes.
Studied the psychometric properties of the Worry and Anxiety Questionnaire (M. J. Dugas et al, 2001) in 274 male and female university students (mean age 22.9 yrs), 19 male and female adults with (mean age 37.7 yrs) with generalized anxiety disorder and 19 male and female adults without anxiety symptoms (mean age 34.5 yrs) (controls), and 33 university students (mean age 23.6 yrs). The Diagnostic and Statistical Manual of Mental Disorders-IV (DSM-IV) and Penn State Anxiety questionnaire (T. J. Meyer et al, 1990) were used. The results indicate that the instrument is specific and sensitive for measuring worry in non-clinical samples and that the instrument is valid for distinguishing between Ss with generalized anxiety disorder and controls. The French text of the instrument is provided. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
according to our cognitive taxonomic system, cognition can be divided into its major conceptual elements: (1) cognitive structure, (2) cognitive propositions, (3) cognitive operations, and (4) cognitive products / briefly defining each of these components
a discussion of the relevance of these components for the cognitive assessment of anxiety
cognitive schemata (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Conducted 3 studies of a French translation of the Penn State Worry Questionnaire (T. J. Meyer et al, 1990) in Canada. In Study 1, the psychometric properties of the questionnaire were assessed with 352 male and female university students (mean age 22 yrs). In Study 2, its temporal stability and its convergent and divergent validity were assessed with 95 male and female university students (mean age 23 yrs). In Study 3, its internal consistency, item quality, and convergent and divergent validity were assessed with 77 male and female patients (mean age 40-42 yrs) with generalized anxiety disorder. The combined results indicate that the Penn State Worry Questionnaire has excellent psychometric properties when used with clinical and nonclinical populations. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Interpretations of negative, positive, and ambiguous situations were examined in individuals with generalized anxiety disorder (GAD), other anxiety disorders (ANX), and no psychiatric condition (CTRL). Additionally, relationships between specific beliefs about uncertainty (Uncertainty Has Negative Behavioral and Self-Referent Implications [IUS-NI], and Uncertainty Is Unfair and Spoils Everything [IUS-US]) and interpretations were explored. The first hypothesis (that the clinical groups would report more concern for negative, positive, and ambiguous situations than would the CTRL group) was supported. The second hypothesis (that the GAD group would report more concern for ambiguous situations than would the ANX group) was not supported; both groups reported similar levels of concern for ambiguous situations. Exploratory analyses revealed no differences between the GAD and ANX groups in their interpretations of positive and negative situations. Finally, the IUS-US predicted interpretations of negative and ambiguous situations in the full sample, whereas the IUS-NI did not. Clinical implications are discussed.
This chapter contains section titled:
Three studies investigated the relationship between anxiety, social desirability, and an interpretative bias favoring, threat
in nonclinical subjects. Interpretative bias was assessed with Mathews, Richards, and Eysenck's (1989) homophone task. In
Study 1, and tendency to produce threatening interpretations of ambiguous words was associated with lower social desirability,
rather than anxiety. In Study 2, the interpretative bias measure correlated with trait anxiety, but not with social desirability.
In Study 3, trait anxiety and social desirability had independent effects on interpretative bias, which were different in
the first and second halves of the homophone task. The predicted effect of trait anxiety was only apparent in the first half
of the task. Possible reasons for the discrepant results, and the importance of assessing the influence of social desirability
on cognitive bias measures, are discussed.
Various possible differences in cognitive functioning between those high and low in trait anxiety are considered. Particular emphasis is paid to the hypothesis that individuals high in trait anxiety tend to approach threatening stimuli, whereas those low in trait anxiety tend to avoid such stimuli. The evidence indicates that there are such differences in the processing of threatening stimuli as a function of trait anxiety. However, these differences are found only under certain conditions, for example, when threatening and nonthreatening stimuli are presented concurrently, and when minor rather than major threat is involved.
The differences between those high and low in trait anxiety encompass pre-attentive, attentional, and interpretative mechanisms. As a consequence, any adequate theory of trait anxiety must take proper account of cognitive mechanisms and functioning.
Cognitive products of anxiety related to the automatic questioning style proposed by Kendall and Ingram (1987) were examined in the context of chronic worry using a method modeled after the cognitive therapy technique of decatastrophizing. As chronic worriers generated sequences of possible catastrophic consequences for two worry topics, they generated significantly more catastrophic steps than nonworriers. Also, worriers reported a significant increase in subjective discomfort as catastrophizing progressed while nonworriers' reports revealed no change. With few exceptions, the content of worriers' catastrophic sequences did not differ from that of nonworriers. Despite this, worriers rated the events in their sequences as significantly more likely to actually occur than nonworriers. These results are consistent with the view of Ingram and Kendall (1987) that anxiety is associated with automatic questions of the form what if? It is argued that the differences between the cognitive products of worriers and nonworriers observed during catastrophizing reflect worriers' more ready access to elaborate memory stores of answers to catastrophic what if? questions that have been acquired through frequent repetition.
Trauma victims with posttraumatic stress disorder (PTSD) may interpret ambiguous information as threatening and have difficulties inhibiting this information. To test these hypotheses, we used a modification of Gernsbacher, Varner, and Faust's homograph paradigm in traumatized individuals with and without PTSD (M. A. Gernsbacher, K. R. Varner, & M. E. Faust, 1990). We hypothesized that having PTSD would be related to poor inhibition of the threat-relevant meanings of homographs (words with two meanings, e.g., mug). Consistent with this hypothesis, our results revealed that traumatized individuals with PTSD showed less inhibition of the threat meanings of homographs than did traumatized individuals without PTSD. These findings are consistent with a delayed activation model of information processing bias in PTSD.
Several studies have been conducted to examine whether the construct of intolerance of uncertainty (IU) (Dugas, Gagnon, Ladouceur,
& Freeston, Behaviour Research and Therapy, 36, 215–226, 1998b) meets formal criteria as a cognitive vulnerability for excessive and uncontrollable worry. Cognitive models
of anxiety suggest that vulnerability is manifest in the manner in which individuals process information. As such, cognitive
bias is expected to be observed in individuals characterized by high levels of a putative cognitive vulnerability. In this
study, individuals low (n=110) and high (n=89) on IU were compared on their appraisals of ambiguous, negative, and positive situations. Individuals high on IU appraised
all situation types as more disconcerting relative to the comparison group. However, when controlling for demographics, generalized
anxiety disorder (GAD) symptoms, and mood variables, the groups differed only in their appraisals of ambiguous situations.
Further, in the high-vulnerability group, degree of IU was a stronger predictor of appraisals of ambiguous situations than
were GAD symptoms and mood variables. Tests of mediation showed that appraisals of ambiguous situations partly mediated the
relationship of IU to worry, the main symptom of GAD; however, worry also emerged as a partial mediator of the relation of
IU to appraisals of ambiguous situations. An exploratory analysis revealed that in individuals high on IU, appraisals were
not specific to the content of current worries, whereas they were to some extent in individuals low on IU. The results are
discussed within the context of findings emerging from cognitive models of GAD, in particular the model proposed by Dugas
etal. (1998b).
This series of three studies investigated some of the characteristics of worrying which are independent of related constructs such as trait anxiety. The results from all three studies suggested that worry and anxiety can be considered as separate constructs, each with their own unique sources of variance. Worrying was associated with adaptive problem-focussed coping strategies and an information-seeking cognitive style. Trait anxiety was independently associated with psychological processes that are normally considered to result in poor psychological outcomes, including (i) poor problem-solving confidence, (ii) poor perceived personal control, (iii) responsibility for negative but not positive outcomes, (iv) the tendency to define events as threats and (v) avoidance or emotion-focused coping strategies. The results also suggested ways in which pathological worrying might be generated, especially where adaptive worrying is thwarted or where processes characteristic of adaptive worrying interact with psychological phenomena associated with high levels of anxiety.
Over the past decade, researchers have attempted to measure worry themes. Some have used free-recall measures (e.g., Craske, Rapee, Jackel & Barlow, Behaviour Research and Therapy, 27, 397–402, 1989) whereas others have constructed structured questionnaires (e.g. Tallis, Eysenck & Mathews, Personality and Individual Differences, 13, 161–168, 1992). This study investigates worry themes in a sample of university students using a free-recall measure (Generalized Anxiety Disorder Questionnaire—Modified) and a structured questionnaire (Worry Domains Questionnaire). Overall, results show that worries were closely related to situational characteristics, as worries about studies, finances, work and intimate relationships were most frequent. Comparison of both measures reveals that major worry themes were ranked similarly but correlations between reported themes were weak. Further, stability of number of worries and specific worry themes was moderately to highly stable over a 4 week test-retest period. The advantages and disadvantages of both types of instruments are discussed and the authors suggest that population-specific structured instruments (using free-recall measures to develop them) would be advantageous for researchers and clinicians alike.
It has been suggested that social phobia may be characterized by two interpretation biases. First, a tendency to interpret ambiguous social events in a negative fashion. Second, a tendency to interpret unambiguous but mildly negative social events in a catastrophic fashion. To assess this possibility, patients with generalized social phobia, equally anxious patients with another anxiety disorder, and non-patient controls were presented with ambiguous scenarios depicting social and non-social events, and with unambiguous scenarios depicting mildly negative social events. Interpretations were assessed by participants' answers to open-ended questions and by their rankings and belief ratings for experimenter-provided, alternative explanations. Compared to both control groups, patients with generalized social phobia were more likely to interpret ambiguous social events in a negative fashion and to catastrophize in response to unambiguous, mildly negative social events.
We investigated the degree of content specificity evident in the negative cognitions associated with anxiety and depression in two large samples of general psychiatric outpatients. Standardized measures of affect and cognition were analyzed in a multiple regression design. As predicted by Beck's (1967, 1976, 1987) cognitive theory of psychopathology, thoughts of loss and failure were specifically associated with depression, whereas cognitions of harm and danger were uniquely predictive of anxiety. In addition, hopelessness was specific to depression and not to anxiety. Dysfunctional beliefs showed no consistent association with either mood state. The implication of these results, as well as related findings, is discussed in terms of a cognitive perspective on the differentiation of emotional disorders. Also discussed are the methodological difficulties encountered in research on cognitive-affective relationships.
Background:
Previous research on the Center for Epidemiologic Studies Depression Scale (CES-D) has five main limitations. First, no study provided evidence of the factorial equivalence of this instrument across samples of depressive and community participants. Second, only one study included systematic tests of measurement invariance based on confirmatory factor analyses (CFA), and this study did not consider the higher-order factor structure of depression, although it is the CES-D global scale score that is most often used in the context of epidemiological studies. Third, few studies investigated the screening properties of the CES-D in non-English-language samples and their results were inconsistent. Fourth, although the French version of the CES-D has been used in several previous studies, it has never been systematically validated among community and/or depressed adults. Finally, very few studies have taken into account the ordered-categorical nature of the CES-D answer scale. The purpose of the study reported herein was therefore to examine the construct validity (i.e., factorial, reliability, measurement invariance, latent mean invariance, convergence, and screening properties) of the CES-D in a French sample of depressed patients and community adults.
Methods:
A total sample of 469 participants, comprising 163 clinically depressed patients and 306 community adults, was involved in this study. The factorial validity, and the measurement and latent mean invariance of the CES-D across gender and clinical status, were verified through CFAs based on ordered-categorical items. Correlation and receiver operator characteristic curves were also used to test the convergent validity and screening properties of the CES-D.
Results:
The present results: (i) provided support for the factor validity and reliability of a second-order measurement model of depression based on responses to the CES-D items; (ii) revealed the full measurement invariance of the first- and second-order measurement models across gender; (iii) showed the partial strict measurement invariance (four uniquenesses had to be freely estimated, but the factor variance-covariance matrix also proved fully invariant) of the first-order factor model and the complete measurement invariance of the second-order model across patients and community adults; (iv) revealed a lack of latent mean invariance across gender and across clinical and community subsamples (with women and patients reporting higher scores on all subscales and on the full scale); (v) confirmed the convergent validity of the CES-D with measures of depression, self-esteem, anxiety, and hopelessness; and (vi) demonstrated the efficacy of the screening properties of this instrument among clinical and nonclinical adults.
Conclusion:
This instrument may be useful for assessing depressive symptoms or for the screening of depressive disorders in the context of epidemiological studies targeting French patients and community men and women with a background similar to those from the present study.
Cognitive models of anxiety posit that negative beliefs influence socially anxious individuals' interpretation of ambiguous social cues. However, paradigms used to assess interpretation bias in social anxiety have not addressed such beliefs. Furthermore, studies have assessed interpretation with either self-report or reaction time paradigms, rather than using both methods. In the current study, socially anxious and non-anxious participants completed the Word Sentence Association Paradigm (WSAP). In the WSAP, participants decide whether or not a word (implying a threat or benign interpretation) is related to an ambiguous sentence. Threat or benign meanings preceded the ambiguity in order to examine the influence of positive and negative beliefs on interpretation of ambiguous information. The WSAP results in two types of interpretation indices: (1) response latency to make relatedness decisions for threat and benign interpretations, and (2) endorsement rates of the relatedness of threat and benign interpretations to ambiguous sentences. Results revealed a threat interpretation bias and a lack of a benign interpretation bias in both reaction time and self-report data. Threat and benign biases were not strongly correlated. These findings support the distinction between threat and benign interpretation biases.
Initiated as part of the ongoing deliberation about the nosological structure of DSM, this review aims to evaluate whether the anxiety disorders share features of responding that define them and make them distinct from depressive disorders, and/or that differentiate fear disorders from anxious-misery disorders. The review covers symptom self-report as well as on-line indices of behavioral, physiological, cognitive, and neural responding in the presence of aversive stimuli. The data indicate that the anxiety disorders share self-reported symptoms of anxiety and fear; heightened anxiety and fear responding to cues that signal threat, cues that signal no threat, cues that formerly signaled threat, and contexts associated with threat; elevated stress reactivity to aversive stimuli; attentional biases to threat-relevant stimuli and threat-based appraisals of ambiguous stimuli; and elevated amygdala responses to threat-relevant stimuli. Some differences exist among anxiety disorders, and between anxiety disorders and depressive disorders. However, the differences are not fully consistent with proposed subdivisions of fear disorders vs. anxious misery disorders, and comparative data in large part are lacking. Given the high rates of co-morbidity, advances in our understanding of the features of responding that are shared across vs. unique to anxiety and depressive disorders will require dimensional approaches. In summary, the extant data help to define the features of responding that are shared across anxiety disorders, but are insufficient to justify revisions to the DSM nosology at this time.
This study investigated whether facilitating a benign interpretive bias decreases negative thought intrusions in generalized anxiety disorder (GAD). Clients were randomly allocated to an interpretation modification condition in which they repeatedly accessed benign meanings of emotionally ambiguous homographs and scenarios, or to a control condition in which they accessed threat and benign meanings with equal frequency. Worry frequency was assessed using a breathing focus task that involved categorising the valence of thought intrusions before and after an instructed worry period. Interpretation bias was assessed during the modification tasks, and on a different measure of interpretation bias (sentence completion) following a period of worry. The experimental procedure modified interpretations made during training, and in the later sentence completion task. Furthermore, compared to the control group, the benign group showed fewer negative thought intrusions during breathing focus (as rated by both participants and an assessor). These findings show that it is possible to induce a more benign interpretive bias in GAD clients and that this reduces negative thought intrusions.
Although worry is considered to be the key feature of generalised anxiety disorder, it has its own unique properties. The study aimed to investigate the extent to which intolerance of uncertainty, poor problem solving confidence, positive beliefs about worry and negative thinking style, predicted worry, both individually and in combination, once the effects of trait anxiety were removed. Ninety-six university students participated in the study by completing a battery of questionnaires. Results, showed trait anxiety to be the strongest predictor. Further, negative thinking, intolerance of uncertainty and positive beliefs about worry contributed to the prediction of worry individually, beyond the effects of trait anxiety. However, when examined collectively, intolerance of uncertainty and a negative thinking were shown to be superior predictors of worry. The findings support the cognitive processing models of worry and generalised anxiety. The implications of these findings are discussed with reference to future research.
Previous research suggests that socially anxious individuals interpret ambiguous social information in a more threatening manner compared to non-anxious individuals. Recently, studies have experimentally modified interpretation and shown that this subsequently affected anxiety in non-anxious individuals. If similar procedures can modify interpretation biases in socially anxious individuals, they may lead to a reduction in social anxiety symptoms. In the current study, we examined the effect of a computerized Interpretation Modification Program (IMP) on interpretation bias and social anxiety symptoms. Twenty-seven socially anxious individuals were randomly assigned to the IMP or a control condition. Participants completed eight computer sessions over four weeks. The IMP modified interpretation by providing positive feedback when participants made benign interpretations and negative feedback in response to threat interpretations. The IMP successfully decreased threat interpretations, increased benign interpretations, and decreased social anxiety symptoms compared to the control condition. Moreover, changes in benign interpretation mediated IMP's effect on social anxiety. This initial trial suggests that interpretation modification may have clinical utility when applied as a multi-session intervention.
The present report describes the development of the Penn State Worry Questionnaire to measure the trait of worry. The 16-item instrument emerged from factor analysis of a large number of items and was found to possess high internal consistency and good test-retest reliability. The questionnaire correlates predictably with several psychological measures reasonably related to worry, and does not correlate with other measures more remote to the construct. Responses to the questionnaire are not influenced by social desirability. The measure was found to significantly discriminate college samples (a) who met all, some, or none of the DSM-III-R diagnostic criteria for generalized anxiety disorder and (b) who met criteria for GAD vs posttraumatic stress disorder. Among 34 GAD-diagnosed clinical subjects, the worry questionnaire was found not to correlate with other measures of anxiety or depression, indicating that it is tapping an independent construct with severely anxious individuals, and coping desensitization plus cognitive therapy was found to produce significantly greater reductions in the measure than did a nondirective therapy condition.
It was postulated that generalized anxiety states are associated with selective processing of threat cues arising from the activity of cognitive structures concerned with processing information related to personal danger (danger schemata). Selective processing was investigated using a modification of the Stroop Colour-naming Task, in which some of the target words were related to physical or social threat, while others were completely unrelated to danger. Anxious Ss were generally slower than controls in colour-naming all words, but were particularly slow with threat words. In the case of physical (but not social) threat words, there was also evidence that interference was most marked in those Ss reporting worries within the relevant domain. Taken together with correlational findings that degree of slowing was associated with mood state, the results were interpreted as evidence that the individual content of danger schemata determine the type of material that is selectively processed, while the extent of interference observed depends on current anxiety level.
The authors gave the CES-D, a self-report depression symptom scale, to 515 people drawn from a longitudinal community survey. The subjects were also interviewed using the Schedule for Affective Disorders and Schizophrenia (SADS). From the information collected on the SADS, the subjects were given diagnoses based on Research Diagnostic Criteria. The results indicate a modest relationship between self-reported symptoms of depression and the diagnosis of a major or minor depression. However, the groups defined as "cases" by such reports also include many people with other diagnoses or with no diagnoses at all. Thus, symptom scales are useful for the screening of depressed persons in research studies but are only rough indicators of clinical depression in the community.
Patients with generalized anxiety disorder (GAD) without concurrent depression (n = 11) and normal controls (n = 17) were tested twice, about 2 months apart, on a modified Stroop colour-naming task, which presented anxiety-related, depression-related and neutral words in masked and unmasked exposure conditions. GAD patients received cognitive behaviour therapy in the test-retest interval, and were also retested at follow-up, about 20 months after initial testing. GAD patients showed interference in colour-naming negative words across both masked and unmasked conditions before treatment, but not post-treatment, compared with controls. Reduced interference effects of masked threat words over time correlated with reduced ratings of anxious thoughts at post-treatment, and at follow-up, in GAD patients. Thus, the preconscious bias for threat information in GAD appears to vary over time in association with changes in anxious thoughts and worries.
Despite evidence for a broad range of processing biases for threat-related material associated with anxiety, there is relatively little research which demonstrates such biases in memory in anxious individuals. The present paper reports two methodologies which demonstrate selective processing of threat-related stimuli in anxious subjects. These are a homophone spelling task and an anagram solution task. Both paradigms require subjects to somehow 'generate' the threat-related material. Despite such selective processing, subsequent recall and recognition memory tests for the same material revealed no evidence of a memory bias. The clinical and theoretical implications of the data are discussed.
Nationally representative general population data are presented on the current, 12-month, and lifetime prevalence of DSM-III-R generalized anxiety disorder (GAD) as well as on risk factors, comorbidity, and related impairments.
The data are from the National Comorbidity Survey, a large general population survey of persons aged 15 to 54 years in the noninstitutionalized civilian population of the United States. DSM-III-R GAD was assessed by lay interviewers using a revised version of the Composite International Diagnostic Interview.
Generalized anxiety disorder was found to be a relatively rare current disorder with a current prevalence of 1.6% but was found to be a more frequent lifetime disorder affecting 5.1% of the US population aged 15 to 45 years. Generalized anxiety disorder was twice as common among women as among men. Multivariate logistic regression analysis showed that being older than 24 years, separated, widowed, divorced, unemployed, and a homemaker are significant correlates of GAD. Consistent with studies in treatment samples, we found that GAD was frequently associated with a wide spectrum of other mental disorders, with a lifetime comorbidity among 90.4% of the people who had a history of GAD.
Contrary to the traditional view that GAD is a mild disorder, we found that the majority of people with GAD, whether they were comorbid or not, reported substantial interference with their life, a high degree of professional help seeking, and a high use of medication because of their GAD symptoms. Although lifetime GAD is highly comorbid, the proportion of current GAD that is not accompanied by any other current diagnosis is high enough to indicate that GAD should be considered an independent disorder rather than exclusively a residual or prodrome of other disorders.
Beck's influential cognitive account of anxiety has led to the prediction that individuals vulnerable to anxiety should favor threatening interpretations of ambiguity (e.g., Beck & Clark, 1988; Beck, Emery, & Greenberg, 1986). The current study introduces a novel adaptation of the RSVP technique, previously used in text comprehension research, to evaluate this hypothesis. Results suggest that a group of 24 high trait anxious students did indeed selectively impose threatening interpretations on unconstrained ambiguous sentences. In contrast, a matched group of 24 low trait anxious students appeared to selectively impose non-threatening interpretations on such ambiguous sentences. These findings are fully consistent with the predicted anxiety-linked interpretative bias. Specific testable hypotheses are developed concerning the types of interpretative idiosyncrasies that plausibly may contribute to pathological anxiety.
This paper describes a study comparing three worry questionnaires; The Worry Domains Questionnaire (WDQ), The Penn State Worry Questionnaire (PSWQ), and The Student Worry Scale (SWS). The results suggested that (i) scores on two out of the three questionnaires exhibited sources of variance that were independent of trait anxiety, (ii) content-based questionnaires (the WDQ and SWS) appeared to capture features of task-oriented constructive worrying, whereas the PSWQ did not, and (iii) all three questionnaires indicated that worriers were characterized by an information-seeking, monitoring cognitive style and a tendency to indulge in avoidance coping behaviours. The implications of these findings for the development of a clinically useful diagnostic instrument are discussed.