Amelia Gangemi

A hyper-emotion theory of psychological illnesses.

A hyper-emotion theory of psychological illnesses is presented. It postulates that these illnesses have an onset in which a cognitive evaluation initiates a sequence of unconscious transitions yielding a basic emotion. This emotion is appropriate for the situation but inappropriate in its intensity. Whenever it recurs, it leads individuals to a focus on the precipitating situation and to characteristic patterns of inference that can bolster the illness. Individuals with a propensity to psychological illness accordingly reason better than more robust individuals, but only on topics relevant to their illness. The theory is assessed in the light of previous research, a small epidemiological study of patients, and 3 empirical studies.

Behavior as information: "If I avoid, then there must be a danger"

BACKGROUND AND OBJECTIVES Cognitive models of anxiety disorders view safety-seeking behaviors (i.e., avoidance, washing, etc.) as playing a crucial role in the maintenance of irrational fear. An explanation of how these behaviors may contribute to the maintenance of unrealistic beliefs is that patients use their safety behaviors as a source of information about the situation (behavior as information): the behavior is clear evidence of the danger. This study investigates whether, relative to non-clinical control participants, anxious participants actually infer danger on the basis of their safety behaviors, rather than on the basis of objective information. METHODS Three groups of individuals affected by anxiety disorders (31 obsessive-compulsive participants, 22 panic participants, and 17 participants with social phobia) and a group (31) of non-clinical controls rated the danger perceived in scripts in which information about objective safety vs. objective danger, and safety behavior vs. no-safety behavior were systematically varied. RESULTS As expected, anxious participants were influenced by both objective danger information and safety behavior information, while the non-clinical controls were mainly influenced by objective danger but not by safety behavior information. The effect was disturbance specific, but only for individuals with social phobia and obsessive-compulsive disorder. CONCLUSIONS The tendency to infer danger on the basis of the use of safety behavior may play a role in the development and maintenance of anxiety disorders.

Feelings of error in reasoning—in search of a phenomenon

Recent research shows that in reasoning tasks, subjects usually produce an initial intuitive answer, accompanied by a metacognitive experience, which has been called feeling of rightness. This paper is aimed at exploring the complimentary experience of feeling of error (FOE), that is, the spontaneous, subtle sensation of cognitive uneasiness arising from conflict detection during thinking. We investigate FOE in two studies with the “bat-and-ball” (B&B) reasoning task, in its standard and isomorphic control versions. Study 1 is a generation study, in which participants are asked to generate their own response. Study 2 is an evaluation study, in which participants are asked to choose between two conflicting answers (normative vs. intuitive). In each study, the FOE is measured by the FOE questionnaire. Results show that the FOE is significantly present in the standard B&B task when participants give a wrong answer, that our questionnaire can measure it, and furthermore, that it is diagnostic of genuine error.

Behavior as information about threat in anxiety disorders : A comparison of patients with anxiety disorders and non-anxious controls

BACKGROUND Gangemi, Mancini, and van den Hout (2012) argued that anxious patients use safety behaviors as information that the situation in which the safety behaviors are displayed is dangerous, even when that situation is objectively safe. This was concluded from a vignette study in which anxious patients and non-clinical controls rated the dangerousness of scripts that were safe or dangerous and in which the protagonist did or did not display safety behaviors. Patients were more likely to take safety behavior as evidence that the situation was dangerous, especially in safe situations. Their non-clinical group may not have been psychologically naïve. We critically replicated the Gangemi et al. study using a psychologically non-informed control group. METHOD The same materials were used and patients (Obsessive Compulsive Disorder, Panic Disorder, Social Phobia; n = 30 per sub-group) were compared to matched non-patients. Using Bayesian statistics, data from the Gangemi et al. samples and the present groups were (re-)analyzed testing the hypothesis relative to non-patients, patients infer threat from safety behaviors, especially if displayed in safe situations. RESULTS The Gangemi et al. data yielded a Bayes factor of 3.31 in support of the hypothesis. The present Bayes Factor was smaller (2.34), but strengthened the support for the hypothesis expressed by an updated Bayes factor of 3.31 × 2.34 = 7.75. CONCLUSIONS The finding that anxious patients infer threat from safety behaviors, in particular in safe contexts, was corroborated, suggesting one way in which safety behaviors are involved in the maintenance of anxiety disorders.

Models and cognitive change in psychopathology

The hyper-emotion theory attributes psychological illnesses to emotions of aberrant intensity, which in turn prompt better reasoning about their causes. Two experiments in which participants drew their own conclusions from syllogistic premises tested this prediction. Individuals from the same populations as the experimental participants rated the believability of likely conclusions. One experiment compared patients with depression with controls, and the other experiment compared students scoring high on anxiety with controls. Controls tended to draw believable conclusions and not to draw unbelievable conclusions, and this belief bias was greater for invalid inferences. The clinical groups were better reasoners than the controls, and did not show belief bias. As our hypothesis predicted, they drew many more valid conclusions concerning their illness than controls drew valid believable conclusions. But, contrary to the hypothesis, they refrained from drawing invalid conclusions about neutral topics more than controls refrained from drawing invalid unbelievable conclusions.

Erratum to "Behavior as information about threat in anxiety disorders: A comparison of patients with anxiety disorders and non-anxious controls [Journal of Behavior, Therapy and Experimental Psychiatry, 45, 489–495]

In 2014 we published a paper in this Journal: Hout, M. A. van den, Gangemi, A., Mancini, F., Engelhard, I.M., Rijkeboer, M.M., van Dam, M.,& Klugkist, I. (2014): Behavior as information about threat in anxiety disorders: A comparison of patients with anxiety disorders and non-anxious controls. Journal of Behavior, Therapy and Experimental Psychiatry, 45, 489e495. In that paper we reported a replication of an experiment by Gangemi et al. (2012): Behavior as information: “If I avoid, then there must be a danger”. Journal of Behavior Therapy and Experimental Psychiatry, 43, 1032e1038. The van den Hout et al. (2014) findings were in line with the Gangemi results but, using traditional null hypothesis testing (NHT), our findings were not significant (p > 0.05). There are several problems with NHTand one of themwas encountered here: it would be irrational and misleading to argue that a study where the crucial interaction was significant (e.g.: p 1⁄4 0.04) is contradicted by a replication study showing the same pattern of interaction but with a p value of, say, 0.06. Replication is crucial to sound science, and in our 2014 paper we introduced and reported a novel analysis in this area: Bayesian analysis of constrained hypotheses. We calculated the Bayes factor (BF) for the Gangemi experiment (BF1⁄4 3.31) and for our replication (BF 1⁄4 2.34), multiplied the two BF’s and reported the product (BF 1⁄4 7.75) as the best estimate of the empirical support for the hypothesis after both experiments. We recently foundout that thismultiplication, simple as it is,was inappropriate. In the context of testing constrained hypotheses, the error can be explained as follows. The BF is a model selection criterion that combines a measure of fit (‘howwell do the data fit with the constraints of the hypotheses’) and a penalty for model size (to prevent overfitting). By multiplying two BFs of two replication studies, the correction formodel size is incorrectly applied twice. As a result, the support for smaller models is overestimated. In the general context of hypothesis testing with Bayes factors,

Obsessive Patients and Deontological Guilt: A Review

In line with the Appraisal Theories of Obsessive–Compulsive Disorder (OCD), in this review we present some experiments aimed at demonstrating the role of fear of guilt in OCD. What kind of guilt do OC patients want to prevent? Several studies suggest the existence of two different types of guilt emotions, namely deontological guilt and altruistic guilt. This research suggests that the former, more than the latter, is involved in OCD. Moreover, it demonstrates that the deontological guilt is related to disgust, and that this relationship could explain why both fear of contamination and fear of guilt are often co-present in obsessive patients. Finally, research shows that the Not Just Right Experience (NJRE) in OCD can be influenced by the deontological guilt. Future research should further verify the actual role of deontological guilt in OCD, and its therapeutical implications.