Catastrophic Misinterpretation Research Articles

Catastrophic misinterpretations as a predictor of symptom change during treatment for panic disorder.

Cognitive models of panic disorder suggest that change in catastrophic misinterpretations of bodily sensations will predict symptom reduction. To examine change processes, we used a repeated measures design to evaluate whether the trajectory of change in misinterpretations over the course of 12-week cognitive behavior therapy is related to the trajectory of change in a variety of panic-relevant outcomes. Participants had a primary diagnosis of panic disorder (N = 43; 70% female; mean age = 40.14 years). Race or ethnicity was reported as 91% Caucasian, 5% African American, 2.3% biracial, and 2.3% "other." Change in catastrophic misinterpretations (assessed with the Brief Body Sensations Interpretation Questionnaire; Clark et al., 1997) was used to predict a variety of treatment outcomes, including overall panic symptom severity (assessed with the Panic Disorder Severity Scale [PDSS]; Shear et al., 1997), panic attack frequency (assessed with the relevant PDSS item), panic-related distress/apprehension (assessed by a latent factor, including peak anxiety in response to a panic-relevant stressor-a straw breathing task), and avoidance (assessed by a latent factor, which included the Fear Questionnaire-Agoraphobic Avoidance subscale; Marks & Mathews, 1979). Bivariate latent difference score modeling indicated that, as expected, change in catastrophic misinterpretations predicted subsequent reductions in overall symptom severity, panic attack frequency, distress/apprehension, and avoidance behavior. However, change in the various symptom domains was not typically a significant predictor of later interpretation change (except for the distress/apprehension factor). These results provide considerable support for the cognitive model of panic and speak to the temporal sequence of change processes during therapy.

Supplemental Material for Catastrophic Misinterpretations as a Predictor of Symptom Change During Treatment for Panic Disorder

Supplemental Material for Catastrophic Misinterpretations as a Predictor of Symptom Change During Treatment for Panic Disorder

Cognitive Processes during Acute Psychosis: The Role of Heightened Responsibility and Catastrophic Misinterpretations

This study investigated the role of cognitive mechanisms underlying obsessive compulsive and panic disorders in psychosis, and in particular, their possible contributions to acute psychosis. A total of 90 participants were recruited comprising three equal-size groups, including two clinical groups (acute and stable) and one non-clinical matched control group. Symptom severity and distress was assessed using the PSYRATS, and questionnaire measures of anxiety and obsessive beliefs were administered to all participants. Individuals with a diagnosis of psychosis reported significantly higher levels of obsessional beliefs and anxiety sensitivity than the non-clinical group. Furthermore, acutely psychotic patients reported a significantly higher sense of responsibility and catastrophic misinterpretation than the stable psychiatric controls, and than samples of OCD and GAD patients. Results suggest that these anxiety processes are particularly important during acute psychotic episodes, beyond the reported comorbidity. The theoretical and clinical implications of these findings, the limitations of the methodology employed, and suggestions for future research are discussed.

Cognitive and Behavioral Factors in Fibromyalgia: Mood, Goals, and Task Performance

Objectives: This paper reviews the existing theoretical models explaining task persistence in chronic pain, pointing at its strengths and weaknesses.Findings: For chronic musculoskeletal pain, purely biomedical models appear insufficient. The prevailing Fear-Avoidance model postulates that catastrophic misinterpretations of pain give rise to fear of pain, subsequently leading to a cycle of avoidance of activity, disuse, and disability. For pain disability associated with task persistence and overuse often seen in patients with fibromyalgia syndrome, cognitive behavioral mechanisms have been a neglected area in pain research and are just beginning to be scrutinized. One promising theoretical model is the so-called Mood-as-Input model, which predicts that task performance results from the interaction between current mood and certain stop-rules. The novel feature of the Mood-as-Input model is that the effects of mood on task performance are dependent on motivational context variables [As-Many-As-Can [AMAC] a...

A pilot study of cognitive behaviour therapy for panic disorder augmented by panic surfing

This pilot study reports the outcome of cognitive behaviour therapy for panic disorder augmented by panic surfing. This treatment approach encourages acceptance of feelings rather than control of symptoms and anxiety, at the same time also targeting catastrophic misinterpretations, bodily vigilance and safety-seeking behaviours. Eighteen participants completed a brief group treatment for panic disorder incorporating psychoeducation, panic surfing, interoceptive exposure, graded exposure and cognitive restructuring. Significant improvements occurred over the course of this treatment and were maintained at a 1-month follow-up. Results suggest that cognitive behaviour therapy augmented by panic surfing may be effective in the treatment of panic disorder, but there is a need for controlled studies and investigation of the relative contribution of its various components.

Negative Cognitions in Loss-Related Emotional Distress in Adolescent Girls: A Preliminary Study

Some adolescents confronted with loss develop symptoms of complicated grief, depression, and anxiety. Little is known about mechanisms causing such problems in this group. Cognitive behavioral theories of grief hypothesize that negative cognitions are pivotal in emotional problems after loss. The current preliminary study tested this hypothesis among 30 adolescent girls (13–18 years). Findings showed that different types of negative cognitions were significantly associated with complicated grief and depression severity. Global negative beliefs about life and the self and catastrophic misinterpretations of grief reactions were most strongly linked with symptoms. Findings support cognitive behavioral theories of grief.

Negative cognitions in emotional problems following romantic relationship break‐ups

AbstractThis study examined the role of negative cognitions in emotional problems following relationship dissolution. Seventy‐nine undergraduate students who experienced a relationship break‐up completed measures of break‐up related complicated grief, depression and anxiety, together with an adjusted version of the Grief Cognitions Questionnaire (GCQ) that assesses four types of global negative beliefs, negative cognitions about self‐blame and the responses of others, and three types of negative interpretations of one's own grief reactions. Results showed that all cognitive variables tapped by the GCQ were significantly associated with complicated grief, and—except for global beliefs about life—with depression and anxiety. Most of these associations remained significant when controlling for the influence of initiator status, variables linked with the ended relationship (e.g. duration) and personality factors (e.g. attachment anxiety, neuroticism). Catastrophic misinterpretations about one's own reactions, global negative beliefs about the self and cognitions reflecting self‐blame were the strongest cognitive correlates of break‐up related emotional problems. Overall, the findings are in keeping with cognitive models of trauma and loss, and suggest that changing negative cognitions could be a useful intervention for those who fail to recover from a relationship break‐up. Copyright © 2008 John Wiley & Sons, Ltd.

Specificity of Childhood Learning Experiences in Relation to Anxiety Sensitivity and Illness/Injury Sensitivity: Implications for Health Anxiety and Pain

Health anxiety refers to the preoccupation with and fear of bodily sensations arising from catastrophic misinterpretations about the significance of these sensations (Hadjistavropoulos, Asmundson, & Kowalyk, 2004). Constructs theoretically relevant to the development of both health anxiety and chronic pain are two of the putative “fundamental fears” identified by Reiss (1991)—anxiety sensitivity (AS) and illness/injury sensitivity (IS) (Cox, Borger, & Enns, 1999; Vancleef, Peters, Roelofs, & Asmundson, 2006). The learning history origins of AS have been examined in a series of studies (Stewart et al., 2001; Watt & Stewart, 2000; Watt, Stewart, & Cox, 1998); however, no studies have examined the learning history antecedents of IS. The present retrospective study compared the relative specificity of learning experiences related to the development of AS and IS in a sample of 192 undergraduates (143 women and 49 men). Structural equation modeling supported nonspecific paths from both anxiety-related and aches/pains-related childhood learning experiences to AS and a more specific path from aches/pain-related childhood learning experiences to IS. Results suggest that the developmental antecedents of IS are more specific to learning experiences around aches and pains, whereas the developmental origins of AS are more broadly related to learning experiences around bodily sensations.

The Treatment of Obsessions

The Treatment of Obsessions

Superior perception of phasic physiological arousal and the detrimental consequences of the conviction to be aroused on worrying and metacognitions in GAD.

Although people suffering from generalized anxiety disorder (GAD) often report arousal symptoms, psychophysiological studies show no evidence of autonomic hyperarousal. Hypersensitivity toward and catastrophic interpretation of phasic arousal cues may explain this discrepancy. The authors tested (a) whether GAD sufferers perceive nonspecific skin conductance fluctuations (NSCFs), an indicator of phasic autonomic arousal, better than controls do and (b) whether the conviction to be aroused contributes to the maintenance of worrying and metacognitive beliefs about worrying. Thirty-three GAD sufferers and 34 healthy controls participated in 2 experiments. In Experiment 1, participants were asked to detect their own NSCFs during a signal detection task. GAD sufferers accurately detected more of their NSCFs than did controls, who tended to miss NSCFs. In Experiment 2, participants were instructed to relax following worry induction. While relaxing, they received nonveridical feedback indicating either arousal or relaxation. Arousal feedback conserved negative metacognitive beliefs regarding worrying and also maintained negative mood and worry exclusively in GAD participants. These findings suggest that superior perception of phasic arousal cues and their catastrophic misinterpretation increases worrying, negative metacognitive beliefs about worrying, and anxious mood in GAD.

Sensitization of catastrophic cognition in cognitive-behavioral therapy for panic disorder

BackgroundCognitive model of panic disorder have proposed that panic attacks result from the catastrophic misinterpretation of certain bodily sensations. Cognitive-Behavioral Therapy (CBT) for panic disorder aims to change these catastrophic cognitions. CBT intervention successfully caused reduction of catastrophic cognitions and symptomatic improvement in the majority of cases. However there are some patients who fail to modify their catastrophic cognitions or rather experience an increase in them during CBT treatment. It is clinically and theoretically important to understand about cognitive sensitization of panic disorder during CBT sessions. The purpose of the present study is 1) to clarify the baseline characteristics of panic patients who would experience sensitization of their catastrophic cognitions through the CBT treatment, and 2) to examine the course of symptomatic changes for them.MethodsOf ninety-five outpatients with panic disorder started the group CBT program for treatment of panic disorder, seventy-nine completer were classified as "cognitively sensitized (CS)" or "cognitive responding (CR)" or "no-responder" according to the difference of the Agoraphobic Cognitions Questionnaire score across treatment. We compared the CS and CR patients in terms of their baseline clinical characteristics. Then we assessed the symptomatic and functional changes for both groups.ResultsAt the start of the CBT program, despite of the same degree of panic disorder severity, CS scored significantly lower on ACQ score than CR. CS also showed significantly lower score on anticipatory anxiety compared to CR. At the end of treatment CS showed significant improvement in severity of panic disorder, although the degree of improvement was smaller than that for CR. Then CS would progressively reduce their agoraphobic fear and avoidance, and would improve their functional impairment up to three month of follow-up.ConclusionPanic patients who would experience sensitization of their catastrophic cognitions through the CBT treatment could nonetheless gradually improve. They showed a relatively low level of catastrophic cognition and anticipatory anxiety before starting the CBT program. We might conclude that temporary sensitization of catastrophic cognition may be necessary before improvement especially among those with initially low catastrophic body sensation fears and that we need not be concerned too much with temporary increase in catastrophic cognition in the process of CBT for panic disorder.

An Internet-based investigation of the catastrophic misinterpretation model of panic disorder

The catastrophic misinterpretation (CM) model of panic disorder proposes that spontaneous panic attacks are the result of interpretation of harmless autonomic arousal as precursors to physical (e.g., heart attack) or psychological (e.g., insanity) emergency. Mixed research findings to date have provided equivocal support. The body sensations interpretation questionnaire-modified was administered via Internet to investigate core assumptions of the model among 30 people with panic disorder (PD), 28 with social anxiety disorder (SAD), and 30 non-anxious controls. The PD group gave more harm-related interpretations of ambiguous internal stimuli than both other groups, and this tendency to interpret ambiguous stimuli catastrophically was not also apparent for external/general events. Furthermore, people with PD rated harm and anxiety outcomes as more catastrophic than non-anxious controls. Results substantially support the CM model although a modification is proposed.

The Relationship Between Attachment Style, Anxiety Sensitivity and Interpretive Bias Among Adolescent Nonclinical Panickers

AbstractElevated anxiety sensitivity and the tendency to catastrophically misinterpret ambiguous bodily sensations has been demonstrated in people who experience nonclinical levels of panic (Richards, Austin, & Alvarenga, 2001), and anxiety sensitivity has been shown to be associated with insecure attachment in adolescents and young adults (Weems, Berman, Silverman, & Saavedra, 2001). This study investigated the relationship between attachment style, anxiety sensitivity and catastrophic misinterpretation among 11 nonclinical panickers and 58 nonanxious controls aged 18 to 19 years. Participants completed the Brief Bodily Sensations Interpretation Questionnaire (BBSIQ), Anxiety Sensitivity Index (ASI) and an attachment questionnaire. The hypothesis that insecurely attached individuals would demonstrate greater catastrophic misinterpretation and higher anxiety sensitivity than securely attached individuals was not supported; however, nonclinical panickers gave more anxiety-related interpretations of ambiguous internal stimuli than nonanxious controls. Results do not support the notion that attachment style is related to anxiety sensitivity or catastrophic misinterpretation (regardless of panic experience). Results do, however, support the notion that anxiety-related misinterpretation of ambiguous somatic sensations precedes the onset of panic disorder.

A Test of Core Assumptions of the Catastrophic Misinterpretation Model of Panic Disorder

The catastrophic misinterpretation model of panic disorder proposes that spontaneous panic attacks are the result of misinterpretation of harmless autonomic arousal as precursors to physical (e.g. heart attack) or psychological (e.g. insanity) emergency. Mixed research findings to date have provided equivocal support. A modified form of the Body Sensations Interpretation Questionnaire was used to investigate core assumptions of the model amongst 38 people with panic disorder (PD), 20 with non-clinical panic, 21 with social anxiety disorder, and 34 non-anxious controls. The PD group gave more harm-related interpretations of ambiguous internal stimuli than all other groups only when anxiety-related responses (e.g. “I'm going to panic”) were scored as harm, however there was no evidence that anxiety-related interpretations were masking perceived catastrophic physical or psychological outcomes. Despite this, people with PD rated harm and anxiety outcomes as more negative than non-anxious controls. Results failed to unequivocally support core assumptions of the model.

Cognitive Mediation of Panic Severity: The Role of Catastrophic Misinterpretation of Bodily Sensations and Panic Self-Efficacy

This study examined the differential role of negative and positive cognitions in mediating treatment outcome in CBT for Panic Disorder through comparison of a Standard CBT (n = 36) versus a Waitlist Condition (n = 24). Regression analyses indicated that, relative to the Waitlist Condition, patients in the Standard CBT condition reported significantly greater shifts both towards higher panic self-efficacy and lower catastrophic misinterpretation of bodily sensations during treatment, as well as a significantly lower level of panic severity at posttreatment. Changes in catastrophic misinterpretation of bodily sensations and panic self-efficacy contributed significantly more to prediction of panic severity than did assignment to either Standard CBT or a Waitlist Condition. Results are discussed in terms of the importance of including both negative and positive cognitions in demonstrating cognitive mediation.

Modification of the Body Sensations Interpretation Questionnaire (BSIQ-M): validity and reliability

The catastrophic misinterpretation model [Behav. Res. Ther. 24 (1986) 461–470] proposes that panic attacks result from misinterpretation of interoceptive stimuli as precursors to physical or psychological emergency. Inconclusive evidence for the model may be partly explained by limitations of the questionnaires developed to measure catastrophic misinterpretation. For example, the Body Sensations Interpretation Questionnaire (BSIQ) is unable to clarify whether anxiety-related interpretations of ambiguous interoceptive stimuli represent catastrophic misinterpretations or responses masking feared outcomes (e.g., heart failure). Additionally, it lacks items relating to several DSM-IV criteria for panic, thereby limiting content validity. Reliability is also potentially compromised due to experimenter-coding of participant-generated responses. A modified form of the BSIQ was developed to address these limitations and evaluated with non-anxious controls ( n = 34) and people with panic disorder ( n = 38). The revised questionnaire demonstrated good to excellent internal consistency, inter-rater reliability, and construct validity and is a useful development of the BSIQ.

Looking beyond the negatives: A time period analysis of positive cognitions, negative cognitions, and working alliance in cognitive–behavior therapy for panic disorder

Time period analysis was used in an international sample of clients (N=106) to demonstrate that cognitive–behavioral therapy (CBT) for panic disorder is associated with specific changes in both negative and positive cognitions during the treatment period. In the first 6 weeks of the treatment phase, working alliance failed to predict changes in panic severity, whereas changes in panic self-efficacy and catastrophic misinterpretation of bodily sensations predicted rapid symptom relief. In the last 6 weeks of treatment, higher doses of CBT were associated with further changes in positive and negative cognitions. The findings can be interpreted as suggesting that the role of the working alliance in CBT for panic disorder is to facilitate cognitive change. Ein Blick uber negative Indikatoren hinaus: Eine zeitbezogene Analyse positiver und negativer Kognitionen und der therapeutischen Arbeitsbeziehung bei kognitiv-verhaltensorientierter Therapie bei Panikstorungen Um zu zeigen, dass kognitiv-verhaltensorientie...

An integrated cognitive model of panic disorder: The role of positive and negative cognitions

One reason for the neglect of the role of positive factors in cognitive–behavioural therapy (CBT) may relate to a failure to develop cognitive models that integrate positive and negative cognitions. Bandura [Psychol. Rev. 84 (1977) 191; Anxiety Res. 1 (1988) 77] proposed that self-efficacy beliefs mediate a range of emotional and behavioural outcomes. However, in panic disorder, cognitively based research to date has largely focused on catastrophic misinterpretation of bodily sensations. Although a number of studies support each of the predictions associated with the account of panic disorder that is based on the role of negative cognitions, a review of the literature indicated that a cognitively based explanation of the disorder may be considerably strengthened by inclusion of positive cognitions that emphasize control or coping. Evidence to support an Integrated Cognitive Model (ICM) of panic disorder was examined and the theoretical implications of this model were discussed in terms of both schema change and compensatory skills accounts of change processes in CBT.

Treatment of health anxiety

Health anxiety is usually transient or easily dealt with by appropriate medical reassurance and/or treatment (Figure 1). In some cases, even though no physical illness has been detected, the patient is not reassured and their health anxiety continues. This may occur because of the patient's cognitions (Figure 2), the doctor's failure to provide adequate reassurance, or both. In extreme cases the patient may fulfil the diagnostic criteria of one of the somatoform disorders, primary hypochondriasis. Over the past 20 years, hypochondriasis has been accepted as a disorder in which the central feature is a persistent tendency to make catastrophic misinterpretations of innocuous physical symptoms and signs as evidence of physical illness (Figure 2). More recently it has been suggested that hypochondriasis may be more appropriately classified as an anxiety disorder (Warwick and Salkovskis, 1990) – severe health anxiety. The psychopathology of severe health anxiety is discussed in detail on pages 76–9. It used to be accepted that there was no treatment for severe health anxiety; however, there are now published reports of successful cognitive-behavioural treatment (CBT) for this distressing condition (Warwick et al., 1996; Clark et al., 1998), which will provide the focus for this contribution.

The Treatment of Obsessions.

STANLEY RACHMAN The Treatment of Obsessions New York: Oxford University Press, 2003, 160 pages (ISBN 0-19-851537-5, US$36.95 Paperback) Reviewed by SHERRYH. STEWART This treatment manual is part of Oxford's Cognitive Behavior Therapy: Science and Practice series edited by David Clark, Christopher Fairburn, and Steven Holion. The goals of the book are to provide background theory and research, and to describe treatment techniques for a new cognitive-behavioural treatment for patients whose major or sole problem is obsessions (i.e., recurrent, unwanted thoughts, impulses, or images that the person finds unacceptable or disgusting). As Rachman describes at the outset, until recently, progress in treating obsessions in obsessive-compulsive disorder (OCD) lagged far behind the progress made by cognitive-behavioural therapists in treating compulsions (i.e., repetitive, Stereotypie behaviour). We have known since the early 1980s that we can successfully treat compulsive behaviors like compulsive checking and cleaning - through exposure and response prevention (ERP). However, ERP was not designed to treat the cognitive symptom of obsessions, even though obsessions are the primary problem for nearly one-third of OCD patients. Rachman reviews the prior lack of success of procedures intended to treat obsessions (e.g., thoughtstopping). Given the frequency of obsessions as the primary or only problem in OCD patients and the absence of effective prior treatments for obsessions, this manual is a welcome addition to the literature. In the first two chapters, Rachman describes the nature of obsessions and background cognitive theory and rationale for his novel treatment. He acknowledges that he draws heavily on the work of David Clark (cognitive theory and therapy for panic disorder) and Paul Salkovskis (cognitive theory of obsessions). Rachman clearly describes the three types of classical obsessions - (a) Aggressive/harm obsessions, such as thoughts of harming children or elderly people; (b) Sexual obsessions, such as fears of sexually molesting a child; and (c) Blasphemous obsessions, such as fears of making sacrilegious gestures in a church. he reviews considerable data that indicate intrusive thoughts are a common and normal experience. he then clearly presents the cognitive theory of obsessions, which asserts that catastrophic misinterpretation of the meaning and significance of unwanted thoughts is the factor responsible for turning a nonclinical intrusive thought into a recurrent and troubling obsession. For example, a woman who has an intrusive thought of harming her child develops a harm obsession when she misinterprets her original unwanted thought as evidence that she is a dangerous and evil person. Rachman reviews the accumulating clinical and psychometric evidence for this cognitive theory gathered by his own team and by research groups worldwide. I found this section of the book to be clear, comprehensive, and current, while still managing to remain appropriately brief. In the third chapter, Rachman reviews the importance of proper assessment of the obsessional problem for use in treatment planning, tracking progress (also covered in Chapter 8), and evaluating outcome. he recommends a specific set of tools (structured interviews, questionnaires, behavioral tests, and clinician ratings) for conducting a thorough assessment and suggests when they should be employed at various points in the therapy process. The specific set of tools allows the clinician to gather information about the frequency and specific content of the obsessions, the antecedents, safety behaviours (e.g., avoidance, neutralizing, concealing the thoughts from others), and maintaining factors, as well as associated emotional states (e.g., depression). Since this is a cognitive treatment, Rachman places particular emphasis on evaluating the personal significance or meaning the patient is attaching to obsessive thoughts via tools developed by his research team. …