Appraisal Of Intrusive Thoughts Research Articles

Intrusive Thoughts and Images in Health Anxiety: Rates, Characteristics, and Responses

ABSTRACTObjectivesIntrusive thoughts and images in Health Anxiety are poorly understood. The current study aims to explore the rates and nature of health‐related intrusive thoughts and images in people with and without Health Anxiety.DesignWe used a cross‐sectional interview and survey design recruiting 82 participants (Health Anxiety: n = 37; control: n = 45).MethodsParticipants completed a diagnostic and clinical interview, and questionnaires to assess experiences and appraisals of intrusive thoughts and images about health.ResultsExperiencing an intrusive thought or image was common in both groups (Health Anxiety: 89.2%, control: 55.6%). However, the Health Anxiety group reported their intrusive thoughts as more frequent, more distressing, and associated them with more negative emotions than controls. Further, the Health Anxiety group had increased negative appraisals and specific maladaptive behaviours for both intrusive thoughts and intrusive images compared to controls.ConclusionsWe conclude that, relative to controls, individuals with Health Anxiety experience intrusive thoughts and images more intensely and negatively, have more dysfunctional appraisals of them, and are more likely to respond to them with specific maladaptive behaviours. As such, addressing intrusive thoughts and images as part of cognitive behavioural interventions for Health Anxiety is warranted.

The Appraisal of Intrusive Thoughts in Relation to Obsessional–Compulsive Symptoms

Research has shown that although intrusive thoughts occur universally, the majority of individuals do not view intrusive thoughts as being problematic (Freeston, Ladouceur, Thibodeau, & Gagnon, 1991; Rachman & de Silva, 1978; Salkovskis & Harrison, 1984). Thus, it is not the presence of intrusive thoughts that leads to obsessional problems but rather some other factor that plays a role in the development of abnormal obsessions. According to the cognitive model of obsessive–compulsive disorder (OCD) put forth by Salkovskis (1985), the crucial factor that differentiates between individuals with OCD and those without is the individual's appraisal of the naturally occurring intrusive thoughts. This study aimed to test Salkovskis's model by examining the role of cognitive biases (responsibility, thought–action fusion, and thought control) as well as distress in the relationship between intrusive thoughts and obsessive–compulsive symptoms in an undergraduate sample of 326 students. An existing measure of intrusive thoughts (the Revised Obsessional Intrusions Inventory) was modified for this study to include a scale of distress associated with each intrusive thought in addition to the current frequency scale. When the Yale-Brown Obsessive-Compulsive Scale was used as the measure of OCD symptoms, a significant interaction effect of frequency and distress of intrusive thoughts resulted. Additionally, a significant three-way interaction of Frequency × Distress × Responsibility was found when the Obsessive Compulsive Inventory–Revised was used as the measure of OCD symptoms. These results indicate that the appraisal of intrusive thoughts is important in predicting OCD symptoms, thus providing support for Salkovskis's model of OCD.

The manipulation of responsibility in obsessive-compulsive disorder.

It has been suggested that appraisal of intrusive thoughts in terms of responsibility for harm lies at the core of obsessional complaints. Clinical observation, psychometric data and the effects of manipulating responsibility for threat in compulsive checkers and normal samples have supported this formulation. The purpose of the present study was to manipulate responsibility in 36 obsessional participants with varied phenomenology. Responsibility was manipulated indirectly by varying the presence/absence of the experimenter during a behavioural task. The manipulation was successful in influencing reports of perceived responsibility for threat. In the high responsibility condition; estimates of the urge to neutralize, discomfort and probability of threat were all significantly higher than in the low responsibility condition; estimates of responsibility for thoughts and the control over the threat did not change significantly between the conditions. There was no significant interaction between the responsibility manipulation and the type of compulsion. The results are interpreted as providing support for a cognitive-behavioural formulation which emphasizes the role of responsibility appraisal in obsessive-compulsive disorder.