Abigail L. Wroe

Responsibility attitudes and interpretations are characteristic of obsessive compulsive disorder.

The cognitive-behavioural theory of Obsessive Compulsive Disorder (OCD) proposes that a key factor influencing obsessional behaviour is the way in which the intrusive cognitions are interpreted. The present paper reports an investigation of links between clinical symptoms (of anxiety, depression and obsessionality) and responsibility beliefs. These beliefs include not only measures of general responsibility attitudes (assumptions) but also more specific responsibility appraisals consequent on intrusive cognitions. The characteristics of two new questionnaires specifically designed to measure these beliefs were assessed in patients suffering from Obsessive Compulsive Disorder, in patients suffering from other anxiety disorders and in non-clinical controls. The scales measuring negative beliefs about responsibility were found to have good reliability and internal consistency. Comparisons between criterion groups indicate considerable specificity for both assumptions and appraisals with respect to OCD. There was also good evidence of specificity in the association between responsibility cognitions and obsessional symptoms across groups, and that this association was not a consequence of links with anxiety or depressive symptoms. Although the two measures were correlated, they each made unique contributions to the prediction of obsessional symptoms. Overall, the results are consistent with the hypothesis that responsibility beliefs are important in the experience of obsessional problems.

Understanding and predicting parental decisions about early childhood immunizations.

This research investigated the factors that influence decisions about immunizations. Women in the third trimester of pregnancy (N=195) rated their likelihood of immunizing their child; stated their reasons for and against immunizing; and rated their perceptions of the benefits and risks of immunization, feelings of responsibility, and anticipated regret if harm occurred. Immunization status was determined at follow-up. Stepwise regression analyses demonstrated that immunization decisions are strongly influenced by omission bias factors such as anticipated responsibility and regret variance (which explained more than 50% of variance). It is suggested that parents may benefit from antenatal decision aids that address omission bias and encourage them to assess benefits and risks of immunizations on the basis of scientific evidence.

Evaluation of a decision-making aid for parents regarding childhood immunizations

This intervention study evaluates a decision-making aid for parents considering childhood immunizations. Participants (women in 3rd trimester of pregnancy, n = 100) rated likelihood of immunizing their child, anxiety, and perceptions of risk of the diseases and immunizations. Individuals were allocated to intervention group (received a decision aid) or control group (received standard care). Ratings were then repeated, and further ratings were obtained when the infant was 10 weeks old. The intervention compared with the comparison condition was associated with significant increase in likelihood of immunizing the infant on time, decreased perceptions of risks of immunizations, increased perceptions of risk of the diseases, reduced anxiety, and increased satisfaction. This intervention may form a useful basis for decision aids in health care settings.

Neutralizing increases discomfort associated with obsessional thoughts: An experimental study with obsessional patients

Cognitive-behavioral theories suggest that the development of neutralizing is crucial in the development and persistence of obsessional problems (OCD). Twenty-nine patients with a Diagnostic and Statistical Manual of Mental Disorders (4th ed., American Psychiatric Association, 1994) diagnosis of OCD were randomly allocated to 2 conditions. Both listened to repeated recorded presentations of their intrusive thoughts and either neutralized (experimental group) or distracted themselves (control). Discomfort was rated during this 1st phase and then during a 2nd phase without neutralizing or distraction. The experimental group showed a similar level of discomfort in the 1st phase, which significantly reduced during the period compared with controls. The experimental group experienced significantly more discomfort during the 2nd phase, and significantly stronger urges to neutralize and distract at the end of this phase than controls.

The prospect of predictive testing for personal risk: attitudes and decision making

As predictive tests for medical problems such as genetic disorders become more widely available, it becomes increasingly important to understand the processes involved in the decision whether or not to seek testing. This study investigates the decision to pursue the possibility of testing. Individuals (one group who had already contemplated the possibility of predictive testing and one group who had not) were asked to consider predictive testing for several diseases. They rated the likelihood of opting for testing and specified the reasons which they believed had affected their decision. The ratio of the numbers of reasons stated for testing and the numbers of reasons stated against testing was a good predictor of the stated likelihood of testing, particularly when the reasons were weighted by utility (importance). Those who had previously contemplated testing specified more emotional reasons. It is proposed that the decision process is internally logical although it may seem illogical to others due to there being idiosyncratic premises (or reasons) upon which the decision is based. It is concluded that the Utility Theory is a useful basis for describing how people make decisions related to predictive testing; modifications of the theory are proposed.

Factors influencing anticipated decisions about genetic testing: Experimental studies

Objectives. Increasing availability of predictive testing highlights the importance of understanding the decision-making process when people are confronted with the option to have testing. The present study aimed to demonstrate experimentally the impact of (i) providing relatively positive versus relatively negative information, and (ii) focusing on positive or negative issues, on anticipated decisions regarding genetic testing. Method. Two experimental studies were carried out in order to investigate what influences the anticipated decision, one relating to breast cancer and the other heart disease. In each study, participants were randomly allocated to either the positive, the negative or the control group. There were two consecutive experimental manipulations. Firstly, participants were given further information on detecting and preventing the disease (positive group) and on the limitations of these methods (negative group). The control group received information about the common cold. Secondly, participants were encouraged to focus on positive (positive group) or negative (negative group) issues of predictive testing. The control group focused on statements referring to the common cold. Participants made pre-experimental and post-information and post-focusing ratings including how likely they would be to opt for the test. Results. Both information and the focusing manipulations separately modified the rating of anticipated likelihood of being tested in the expected direction. There was also a significant decrease of rated anxiety in the negative group. Conclusion. It appears that anticipated decisions are strongly influenced not only by the information received by the decision maker, but also by the factors on which the decision maker focuses at the time of the decision. This second result in particular has implications for the way in which pre-test counselling is carried out; counsellors may believe that they are being non-directive in their questioning when they are in fact directly and systematically influencing the decision whether or not to be tested.

The effect of nondirective questioning on women's decisions whether to undergo bone density screening: an experimental study.

This study investigated the effects of nondirective counseling on health screening decisions. Ninety women (mean age = 51 years) received information about bone density screening and osteoporosis. They were then randomly allocated to 1 of 4 groups and were encouraged to focus on positive issues about bone density screening (positive group), on negative issues (negative group), on both positive and negative issues (all-focusing group), or on issues relating to the common cold (control group). Women were asked to rate how likely they would be to opt for bone density screening if they saw it available. After being informed that they could have bone density screening, actual uptake was assessed. It was found that the issues on which individuals focused significantly influenced their rate likelihood of opting for the scan. Rated likelihood of testing was significantly associated with whether individuals actually did opt for testing when it was subsequently offered to them.

The effects of 'non-directive' questioning on an anticipated decision whether to undergo predictive testing for heart disease: an experimental study

This study investigates how individuals can be helped to make decisions about predictive genetic testing. Participants (n = 120) rated how likely they would be to opt for predictive testing for heart disease if it were available, and other variables such as anxiety about heart disease. They received information on predictive testing for heart disease and ratings were repeated. Participants were then randomly allocated to one of three groups and focused on the personal relevance of positive issues or negative issues which had been mentioned as part of the standardised information previously given. The third group focused on issues irrelevant to testing for heart disease. The form of questioning used in this focusing manipulation was intended to model the processes involved in non-directive questioning. Results showed a significant increase in likelihood of testing in the positive group, and a significant decrease in the negative group. There was also a significant decrease in rated anxiety about heart disease and perceived severity of an increased susceptibility to heart disease of the negative group relative to the positive and control groups. The results may have implications for the ways in which pre-test counselling is carried out.

Shared decision-making, health choices and the menopause.

Summary The growing influence of the mass media on public understanding of health care matters has increased both information and misinformation in patients seeking help with menopausal symptoms. The use of shared decision-making strategies provides the opportunity to engage the patient in taking some responsibility for their own treatment. It also allows the identification and correction of any distortions in the perceived balance of evidence for and against any particular treatment. Shared decision-making balances the need to respect patients’ values and autonomy with the drive towards evidence-based medicine and clinical cost-effectiveness. Although ways of achieving such a balance are much discussed, the current need is for research which can identify effective strategies that allow the principles of “shared decision-making” and “evidence-based patient choice” to be validated and applied in clinical practice. Previous research focused on hormone replacement therapy indicates that the patients decision is the outcome of the way they balance the pros and cons of taking (or not taking) it, and that their satisfaction with the decision is strongly associated with the perception that they have been given information about the full range of treatment available. It therefore seems likely that patients will respond more positively to consultations which include discussion of hormone replacement therapy alongside alternative strategies such as natural remedies and dietary/lifestyle changes. Psychological factors influencing treatment choice and the decision making process are discussed, and clinical and research implications for clinical practice in the menopause clinic examined.

IAPT and Long Term Medical Conditions: What Can We Offer?

BACKGROUND The proposal of a 4-year plan to integrate treatment of people with long term medical conditions (LTCs) into the IAPT service (Department of Health, 2011) seeks for research to understand the effectiveness of IAPT interventions for this patient group. AIM The aim of this service development pilot work was to develop an intervention that is effective for people with Type 2 Diabetes Mellitus (T2DM). It was hypothesized that the standard IAPT intervention would not be effective, but that it can be adapted so that it is effective both in terms of mood and self-management of T2DM. METHOD Clients (n = 95) who experienced mild to moderate depression and/or anxiety and had a diagnosis of T2DM opted to attend. The intervention was adapted over a series of cohorts from a standard Step 2 intervention. A team of Psychological Wellbeing Practitioners (PWPs), a Clinical Health Psychologist and a General Practitioner worked in collaboration, using outcomes measures and feedback from service users and facilitators. RESULTS The standard IAPT Step 2 intervention met with challenges when specifically targeting this client group. Using paired t-tests, the modified Step 2 intervention demonstrated significant improvements from pre- to postintervention measures both in terms of psychological (n = 17) and physical (n = 9) outcomes. CONCLUSION It is concluded that it may be possible to modify a generic Step 2 IAPT intervention to demonstrate improvements both in terms of psychological wellbeing and self-management of T2DM. The main adaptations were related to more targeted recruitment and linking of diabetes specifically into the CBT model.