Models Of Emotional Disorders Research Articles

Testing times: the association of intolerance of uncertainty and metacognitive beliefs to test anxiety in college students

BackgroundTest anxiety has a detrimental effect on test performance but current interventions for test anxiety have limited efficacy. Therefore, examination of newer psychological models of test anxiety is now required. Two transdiagnostic psychological models of emotional disorders that can account for anxiety are the intolerance of uncertainty model (IUM) and the Self-Regulatory Executive Function (S-REF) model. Intolerance of uncertainty, the stable disposition to find uncertainty distressing, is central to the IUM, while beliefs about thinking, metacognition, are central to the S-REF model. We tested for the first time the role of both intolerance of uncertainty and metacognitive beliefs in test anxiety.MethodsA cross-sectional design was used, with college students (n = 675) completing questionnaires assessing their test anxiety, intolerance of uncertainty, and metacognitive beliefs. Hierarchical linear regressions examined if intolerance of uncertainty and metacognitive beliefs were associated with test anxiety, after controlling for age and gender.ResultsFemales reported significantly more test anxiety than males. Partial correlations, controlling for gender, found intolerance of uncertainty and metacognitive beliefs were significantly and positively correlated with test anxiety. Hierarchical linear regressions found metacognitive beliefs explained an additional 13% of variance in test anxiety, after controlling for intolerance of uncertainty. When the order of entry was reversed, intolerance of uncertainty was only able to explain an additional 2% of variance, after controlling for metacognitive beliefs. In the final regression model, gender, intolerance of uncertainty and the metacognitive belief domains of ‘negative beliefs about the uncontrollability and danger of worry’ and ‘cognitive confidence’ were all significantly associated test anxiety, with ‘negative beliefs about the uncontrollability and danger of worry’ having the largest association.ConclusionsBoth intolerance of uncertainty and metacognitive beliefs are linked to test anxiety, but results suggest metacognitive beliefs have more explanatory utility, providing greater support for the S-REF model. Modification of intolerance of uncertainty and metacognitive beliefs could alleviate test anxiety and help students fulfil their academic potential.

Measuring the Cognitive Attentional Syndrome in Cardiac Patients With Anxiety and Depression Symptoms: Psychometric Properties of the CAS-1R.

Metacognitive Therapy (MCT) is a recent treatment with established efficacy in mental health settings. MCT is grounded in the Self-Regulatory Executive Function (S-REF) model of emotional disorders and treats a negative perseverative style of thinking called the cognitive attentional syndrome (CAS), thought to maintain psychological disorders, such as anxiety and depression. The evaluation of effective psychological therapies for anxiety and depression in chronic physical illness is a priority and research in this area depends on the suitability and validity of measures assessing key psychological constructs. The present study examined the psychometric performance of a ten-item scale measuring the CAS, the CAS-1R, in a sample of cardiac rehabilitation patients experiencing mild to severe symptoms of anxiety and/or depression (N = 440). Participants completed the CAS scale, the Hospital Anxiety and Depression Scale and the Metacognitions Questionnaire 30 (MCQ-30). The latent structure of the CAS-1R was assessed using confirmatory factor analyses (CFA). In addition, the validity of the measure in explaining anxiety and depression was assessed using hierarchical regression. CFA supported a three-factor solution (i.e., coping strategies, negative metacognitive beliefs and positive metacognitive beliefs). CFA demonstrated a good fit, with a CFI = 0.988 and an RMSEA = 0.041 (90% CI = 0.017–0.063). Internal consistency was acceptable for the first two factors but low for the third, though all three demonstrated construct validity and the measure accounted for additional variance in anxiety and depression beyond age and gender. Results support the multi-factorial assessment of the CAS using this instrument, and demonstrate suitability for use in cardiac patients who are psychologically distressed.

Beyond Negative Affectivity: A Hierarchical Model of Global and Transdiagnostic Vulnerabilities for Emotional Disorders

Background: Negative affectivity (NA) has been linked to anxiety and depression (DEP). Identifying the common factors between anxiety and DEP is important when explaining their overlap and comorbidity. However, general factors such as NA tend to have differential relationships with different disorders, suggesting the need to identify mediators in order to explicate these relationships. Methods: The current study tests a theoretically and empirically derived hierarchical model of emotional disorders including both a general factor (NA) and transdiagnostic risk factors [anxiety sensitivity (AS) and intolerance of uncertainty (IoU)] using structural equation modeling. AS was tested as a mid-level factor between NA and panic disorder/agoraphobia, while IoU was tested as a mid-level factor between NA and social phobia, generalized anxiety disorder, obsessive-compulsive disorder, and DEP. Data from 642 clinical outpatients with a heterogeneous presentation of emotional disorders were available for analysis. Results: The hierarchical model fits the data adequately. Moreover, while a simplified model removing AS and IoU fits the data well, it resulted in a significant loss of information for all latent disorder constructs. Limitations: Data were unavailable to estimate post-traumatic stress disorder or specific phobias. Future work will need to extend to other emotional disorders. Conclusions: This study demonstrates the importance of both general factors that link disorders together and semi-specific transdiagnostic factors partially explaining their heterogeneity. Including these mid-level factors in hierarchical models of psychopathology can help account for additional variance and help to clarify the relationship between disorder constructs and NA.

Perceived Family Environment and Symptoms of Emotional Disorders: The Role of Perceived Control, Attributional Style, and Attachment

Findings from decades of research suggest that a perceived lack of parental care and overprotection are positively related to later symptoms of emotional disorders in children and adolescents. The present study used a cross-sectional design to evaluate models investigating reported family environment during childhood, current attachments, control-related cognitions, and current symptoms of emotional disorders in adolescence. It was hypothesized the effect of a perceived controlling and rejecting family environment during childhood would influence current depression and anxiety, and that these effects would be partially accounted for by the quality of current attachments, perceived control, and attributional style. A sample of 234 university students was assessed. Regression analyses of variables, including analyses of indirect effects, were conducted. As predicted, current attachment, perceived control, and attributional style helped to account for relationships between some family variables, and depression and anxiety. Findings are discussed with respect to the interplay of family variables and models of emotional disorders.

On the links between self-discrepancies, rumination, metacognitions, and symptoms of depression in undergraduates

The present study aimed to test the central components of Papageorgiou and Wells’ (2003) non-clinical metacognitive model of rumination and depression that is grounded on the Self-Regulatory Executive Function (S-REF) model of emotional disorders [Wells, A., & Matthews, G. (1994). Attention and emotion: A clinical perspective. Hove, UK: Lawrence Erlbaum.]. A second aim of this study was to extend the non-clinical model with the concept of self-discrepancy in line with the S-REF model. Data of the current study were collected in a large sample of non-clinical Dutch undergraduates ( N=196), who completed a battery of questionnaires including measures of rumination, positive and negative metacognitions, depressive symptoms, and self-discrepancy (i.e., actual-ideal, actual-ought, and actual-feared discrepancies). Hypothesized relationships among these variables were tested by means of structural equation modelling. Following some theoretically consistent modifications, the model was an adequate fit to the data. With respect to the second aim of the study, self-discrepancies were directly linked to symptoms of depression as well as indirectly via the cognitive processes involved in the metacognitive model of rumination and depression. Evidence was found for positive beliefs about rumination to partially mediate the relation between self-discrepancy and rumination. Clinical implications of the findings, including implementation of a metacognitive-focused cognitive therapy of depression, and suggestions for future research are discussed.

An interacting cognitive subsystems model of relapse and the course of psychosis

This paper outlines a theoretical analysis of current psychological conceptualizations of psychosis that draws on Teasdale and Barnard's (1993) Interacting Cognitive Subsystems (ICS) model of depression. The ICS model differs from Beck et al.'s (1979) model of emotional disorders in that it specifies two qualitatively different levels of meaning. These different levels of meaning play a different role in the production, maintenance and modification of emotion, and indeed, also recognize the distinction between ‘intellectual' belief and ‘emotional' belief. Intellectual beliefs are at the level of specific propositional meaning: they have a truth value which can be assessed and they are not directly influenced by sensory information such as voice tone, arousal and body state, or visual stimuli. Given this, propositional meaning does not have a direct link to the production of emotion. Rather the link to emotion is an indirect one, through the activation of more generic and holistic affect-related schematic models. These latter schematic models are hypothesized to have implicational meaning, and correspond to schematic models derived from emotive experiences. In consequence they do not have a specific truth-value and they reflect contributions from a wide variety of sources, including multiple patterns of specific meanings, and patterns of direct sensory input. This ICS perspective proposes that integration of these two levels of meaning can facilitate the psychological conceptualization of the initiation, acceleration, and maintenance of positive psychotic symptomatology during relapse. This theoretical analysis is illustrated by the use of a case study, which describes the process and application of ICS to facilitating recovery from acute psychosis. This paper also provides a detailed discussion of the implications of this analysis for future research and psychological therapy. In particular, ICS has relevance for tracing the evolution of schematic beliefs during the early episodes of psychosis, which are hypothesized to have a bearing on the future course of psychosis. This has implications for the further development and expansion of psychological treatments for relapse and recovery from psychosis. Copyright © 1999 John Wiley & Sons, Ltd.

An interacting cognitive subsystems model of relapse and the course of psychosis

This paper outlines a theoretical analysis of current psychological conceptualizations of psychosis that draws on Teasdale and Barnard's (1993) Interacting Cognitive Subsystems (ICS) model of depression. The ICS model differs from Beck et al.'s (1979) model of emotional disorders in that it specifies two qualitatively different levels of meaning. These different levels of meaning play a different role in the production, maintenance and modification of emotion, and indeed, also recognize the distinction between ‘intellectual' belief and ‘emotional' belief. Intellectual beliefs are at the level of specific propositional meaning: they have a truth value which can be assessed and they are not directly influenced by sensory information such as voice tone, arousal and body state, or visual stimuli. Given this, propositional meaning does not have a direct link to the production of emotion. Rather the link to emotion is an indirect one, through the activation of more generic and holistic affect-related schematic models. These latter schematic models are hypothesized to have implicational meaning, and correspond to schematic models derived from emotive experiences. In consequence they do not have a specific truth-value and they reflect contributions from a wide variety of sources, including multiple patterns of specific meanings, and patterns of direct sensory input. This ICS perspective proposes that integration of these two levels of meaning can facilitate the psychological conceptualization of the initiation, acceleration, and maintenance of positive psychotic symptomatology during relapse. This theoretical analysis is illustrated by the use of a case study, which describes the process and application of ICS to facilitating recovery from acute psychosis. This paper also provides a detailed discussion of the implications of this analysis for future research and psychological therapy. In particular, ICS has relevance for tracing the evolution of schematic beliefs during the early episodes of psychosis, which are hypothesized to have a bearing on the future course of psychosis. This has implications for the further development and expansion of psychological treatments for relapse and recovery from psychosis. Copyright © 1999 John Wiley & Sons, Ltd.

The Concept of Uncontrollability

The capacity to integrate different perspectives of complex phenomena and formulate researchable models is David Barlow's great strength. The current article lays out such a model of emotional disorders (for a more complete elaboration of his ideas, see his recent book, Anxiety and Its Disorders; Barlow, 1988). Barlow's model of the genesis of emotional disorders is ethologically based, with a role for learning, and acknowledgment of the contribution of neurophysiologic processes. Barlow focuses on the role of learned processes and automatic behavioral reactivity, placing particular emphasis on an ongoing sense of uncontrollability as a core psychological disturbance, underlying the development of pathological states of anxiety and depression. Barlow presents empirical evidence from clinical, human experimental, and animal work to support his theory. As usual, his points are tightly argued and well supported. My commentary focuses on an exploration of the concept of sense of control, including thoughts about its definition, its relationship to aggression, and the role interpersonal relationships play in its development and stability. Panic disorder is used to illustrate some potential implications of including the dimension of controllability in clinical and research models.

Depression and Anxiety: Disorders of Emotion or Cognition?

Based on developments in emotion theory, Barlow presents a model of psychopathological disorders that is both exciting and broad in its theoretical scope. He suggests that disorders of anxiety and depression (as well as anger and mania) are fundamentally disorders and that they have their origins in the inappropriate and spontaneous firing of certain primitive, basic, negative emotions such as fear (panic in its clinical manifestation) and sadness, respectively, in individuals who are biologically overreactive to stressful life events. These spontaneously firing negative emotions or false alarms occur unpredictably; when they do, they may become the focus of perceptions of uncontrollability among individuals who are also psychologically vulnerable to the development of anxiety and depressive disorders. Thus, those persons who possess an overreactive neurobiological response to stressful life events as well as early experiences with lack of control will be likely to develop clinically significant episodes of anxiety or depression when triggered by unexpected bouts of these negative emotions. In Barlow's view, then, anxiety and depressive disorders share common biological and psychological diatheses as well as a common mediating mechanism, perceptions of uncontrollability over bouts of panic or sadness and the development of anxious apprehension about one's ability to cope with future threats. What determines whether a person becomes anxious and remains so, or also develops depression, is the degree of his or her psychological vulnerability, the severity of current stressors, and the availability of coping mechanisms. According to Barlow, whereas the anxious individual continues to try to cope, the depressed individual has given up. In this commentary, I question Barlow's assumption that anxiety and depressive disorders are fundamentally disorders. In addition, I evaluate Barlow's model of emotional disorders with specific reference to the model's ability to account for the relationship between anxiety and depression. In so doing, I compare Barlow's model to another, more fundamentally cognitive, theory of the relationship between some anxiety and depressive disorders (Alloy, Kelly, Mineka, & Clements, 1990).