Klaske A. Glashouwer

Child abuse and negative explicit and automatic self-associations: the cognitive scars of emotional maltreatment

Individuals reporting Childhood Abuse (CA) (i.e., emotional neglect, emotional-, physical- and sexual-abuse) are marked by increased explicit (i.e. self-reported) negative self-associations, and an increased risk to develop depression or anxiety disorders. Automatic self-associations might play an important role in the development and maintenance of affective disorders after exposure to CA, since automatic associations are assumed to be involved in uncontrolled (spontaneous) affective behavior. This study examined whether individuals reporting a history of CA show stronger automatic (and explicit) self-depression and/or self-anxiety associations than individuals who report no CA in a large cohort study (Netherlands Study of Depression and Anxiety (NESDA), n = 2981). The Implicit Association Test (IAT) was utilized to assess automatic self-depression and self-anxiety associations. We found that CA was associated with enhanced automatic (and explicit) self-depression and self-anxiety associations. Additionally, when compared to physical- and sexual-abuse, Childhood Emotional Maltreatment (CEM; emotional abuse and emotional neglect) had the strongest link with enhanced automatic (and explicit) self-depression and self-anxiety associations. In addition, automatic and explicit negative self-associations partially mediated the association between CEM and depressive or anxious symptomatology. Implications regarding the importance of CA, and CEM in particular will be discussed.

Disorder-specific automatic self-associations in depression and anxiety: results of The Netherlands Study of Depression and Anxiety.

BACKGROUND Cognitive theory points to the importance of negative self-schemas in the onset and maintenance of depression and anxiety disorders. Hereby, it is important to distinguish between automatic and explicit self-schemas, reflecting different cognitive-motivational systems. This study tested whether patients with a current major depression and/or anxiety disorder are characterized by automatic self-anxious and self-depressive associations and whether these associations are disorder specific. METHOD Patients (n=2329) and non-clinical controls (n=652) were tested as part of The Netherlands Study of Depression and Anxiety, a multi-center, longitudinal, cohort study with patients from different health care settings. Patient groups and non-clinical controls (18-65 years of age) were compared with regard to automatic self-anxious and self-depressive associations measured with the Implicit Association Test. RESULTS Individuals with an anxiety disorder showed enhanced self-anxious associations, whereas individuals with a depression showed enhanced self-depressive associations. Individuals with co-morbid disorders scored high on both automatic self-associations. Although remitted individuals showed weaker automatic self-associations than people with a current disorder, their automatic self-anxious/depressed associations were still significantly stronger than those of the control group. Importantly, automatic self-associations showed predictive validity for the severity of anxious and depressive symptoms over and above explicit self-beliefs. CONCLUSIONS This study represents the first evidence that automatic self-anxious and self-depressive associations are differentially involved in anxiety disorders and depression. This may help to explain the refractoriness of these disorders and points to the potential importance of automatic self-associations in the development of psychopathological symptoms.

Do Automatic Self-Associations Relate to Suicidal Ideation?

Dysfunctional self-schemas are assumed to play an important role in suicidal ideation. According to recent information-processing models, it is important to differentiate between ‘explicit’ beliefs and automatic associations. Explicit beliefs stem from the weighting of propositions and their corresponding ‘truth’ values, while automatic associations reflect more simple associations in memory. Both types of associations are assumed to have different functional properties and both may be involved in suicidal ideation. Thus far, studies into self-schemas and suicidal ideation focused on the more explicit, consciously accessible traces of self-schemas and predominantly relied on self-report questionnaires or interviews. To complement these ‘explicit’ findings and more directly tap into self-schemas, this study investigated automatic self-associations in a large scale community sample that was part of the Netherlands Study of Depression and Anxiety (NESDA). The results showed that automatic self-associations of depression and anxiety were indeed significantly related to suicidal ideation and past suicide attempt. Moreover, the interactions between automatic self-depressive (anxious) associations and explicit self-depressive (anxious) beliefs explained additional variance over and above explicit self-beliefs. Together these results provide an initial insight into one explanation of why suicidal patients might report difficulties in preventing and managing suicidal thoughts.

Low implicit self-esteem and dysfunctional automatic associations in social anxiety disorder

BACKGROUND AND OBJECTIVES Negative automatic associations towards the self and social cues are assumed to play an important role in social anxiety disorder. We tested whether social anxiety disorder patients (n = 45) showed stronger dysfunctional automatic associations than non-clinical controls (n = 45) and panic disorder patients (n = 24) and whether there existed gender differences in this respect. METHODS We used a single-target Implicit Association Test and an Implicit Association Test to measure dysfunctional automatic associations with social cues and implicit self-esteem, respectively. RESULTS Results showed that automatic associations with social cues were more dysfunctional in socially anxious patients than in both control groups, suggesting this might be a specific characteristic of social anxiety disorder. Socially anxious patients showed relatively low implicit self-esteem compared to non-clinical controls, whereas panic disorder patients scored in between both groups. Unexpectedly, we found that lower implicit self-esteem was related to higher severity of social anxiety symptoms in men, whereas no such relationship was found in women. CONCLUSIONS These findings support the view that automatic negative associations with social cues and lowered implicit self-esteem may both help to enhance our understanding of the cognitive processes that underlie social anxiety disorder.

Cognitive Reactivity, Implicit Associations, and the Incidence of Depression: A Two-Year Prospective Study

Background Cognitive reactivity to sad mood is a vulnerability marker of depression. Implicit self-depressed associations are related to depression status and reduced remission probability. It is unknown whether these cognitive vulnerabilities precede the first onset of depression. Aim To test the predictive value of cognitive reactivity and implicit self-depressed associations for the incidence of depressive disorders. Methods Prospective cohort study of 834 never-depressed individuals, followed over a two-year period. The predictive value of cognitive reactivity and implicit self-depressed associations for the onset of depressive disorders was assessed using binomial logistic regression. The multivariate model corrected for baseline levels of subclinical depressive symptoms, neuroticism, for the presence of a history of anxiety disorders, for family history of depressive or anxiety disorders, and for the incidence of negative life events. Results As single predictors, both cognitive reactivity and implicit self-depressed associations were significantly associated with depression incidence. In the multivariate model, cognitive reactivity was significantly associated with depression incidence, together with baseline depressive symptoms and the number of negative life events, whereas implicit self-depressed associations were not. Conclusion Cognitive reactivity to sad mood is associated with the incidence of depressive disorders, also when various other depression-related variables are controlled for. Implicit self-depressed associations predicted depression incidence in a bivariate test, but not when controlling for other predictors.

Heightened sensitivity to punishment and reward in anorexia nervosa.

OBJECTIVE The aim of this study was to investigate reinforcement sensitivity in anorexia nervosa (AN). It was tested whether self-reported punishment (PS) and reward sensitivity (RS) differed between adolescents with AN and healthy controls, and/or between AN-subtypes. In addition, the predictive validity of PS and RS was examined for AN symptoms one year later. METHOD In total, 165 female adolescents admitted for treatment of AN or eating disorder not otherwise specified resembling AN and 72 controls participated in the study. Participants completed measurements for eating disorder severity and the Sensitivity to Punishment/Sensitivity to Reward Questionnaire (SPSRQ). Percentage of underweight and severity of AN symptoms were measured again after one year in individuals with AN. RESULTS Individuals with AN scored higher on PS and RS than controls. In addition, the AN purging type showed higher PS than the AN restrictive type, whereas there were no differences in RS between AN-subtypes. Regression analyses indicated that PS and RS were independently associated with the degree of eating disorder symptoms, whereas only PS was related to percentage underweight. Yet, neither RS nor PS were related to percentage of underweight and AN symptoms after one year. DISCUSSION Although the present study clearly demonstrated that heightened punishment and reward sensitivity are both linked to AN, there was no evidence that these characteristics are also involved in the course of AN symptoms.

Predictive Validity of Automatic Self-Associations for the Onset of Anxiety Disorders

Negative self-cognitions are assumed to play an important role in the onset of anxiety disorders. Current dual-process models emphasize the relevance of differentiating between more automatic and more deliberate self-cognitions in this respect. Therefore, this study was designed to test the prognostic value of both deliberate and automatic self-anxious associations as a generic vulnerability factor for the onset of anxiety disorders between baseline and 2-year follow-up. To test the disorder specificity of negative self-associations, we also measured self-depressed associations. Self-report measures of depressive symptoms, anxiety symptoms, neuroticism, and fearful avoidance were included as covariates. Healthy controls (n=593), individuals who had depression (n=238), and individuals remitted from an anxiety disorder (n=448) were tested as part of the Netherlands Study of Depression and Anxiety. Deliberate self-anxious associations predicted the onset of anxiety disorders in all groups. Automatic self-anxious associations showed predictive validity only in individuals remitted from an anxiety disorder or in currently depressed individuals. Although deliberate self-depressed associations were related to the onset of anxiety disorders as well, automatic self-depressed associations were not. In the (remitted) patient groups, only deliberate self-anxious associations showed independent predictive value for the onset of anxiety disorders together with self-reported fearful avoidance behavior. In the healthy controls, only a composite index of negative emotionality (depressive or anxiety symptoms and neuroticism) showed independent predictive validity. This study provides the first evidence that automatic and deliberate self-anxious associations have predictive value for the future onset of anxiety disorders.

Reward and punishment sensitivity and alcohol use: The moderating role of executive control

Reward sensitivity and to a lesser extent punishment sensitivity have been found to explain individual differences in alcohol use. Furthermore, many studies showed that addictive behaviors are characterized by impaired self-regulatory processes, and that individual differences related to alcohol use are moderated by executive control. This is the first study that explores the potential moderating role of executive control in the relation between reward and punishment sensitivity and alcohol use. Participants were 76 university students, selected on earlier given information about their alcohol use. Half of the participants indicated to drink little alcohol and half indicated to drink substantial amounts of alcohol. As expected, correlational analyses showed a positive relationship between reward sensitivity and alcohol use and a negative relation between punishment sensitivity and alcohol use. Regression analysis confirmed that reward sensitivity was a significant independent predictor of alcohol use. Executive control moderated the relation between punishment sensitivity and alcohol use, but not the relation between reward sensitivity and alcohol use. Only in individuals with weak executive control punishment sensitivity and alcohol use were negatively related. The results suggest that for individuals with weak executive control, punishment sensitivity might be a protective factor working against substantial alcohol use.

Individuals with Fear of Blushing Explicitly and Automatically Associate Blushing with Social Costs

To explain fear of blushing, it has been proposed that individuals with fear of blushing overestimate the social costs of their blushing. Current information-processing models emphasize the relevance of differentiating between more automatic and more explicit cognitions, as both types of cognitions may independently influence behavior. The present study tested whether individuals with fear of blushing expect blushing to have more negative social consequences than controls, both on an explicit level and on a more automatic level. Automatic associations between blushing and social costs were assessed in a treatment-seeking sample of individuals with fear of blushing who met DSM-IV criteria for social anxiety disorder (n = 49) and a non-anxious control group (n = 27) using a single-target Implicit Association Test (stIAT). In addition, participants’ explicit expectations about the social costs of their blushing were assessed. Individuals with fear of blushing showed stronger associations between blushing and negative outcomes, as indicated by both stIAT and self-report. The findings support the view that automatic and explicit associations between blushing and social costs may both help to enhance our understanding of the cognitive processes that underlie fear of blushing.

Attentional Bias for Reward and Punishment in Overweight and Obesity: The TRAILS Study

More than 80% of obese adolescents will become obese adults, and it is therefore important to enhance insight into characteristics that underlie the development and maintenance of overweight and obesity at a young age. The current study is the first to focus on attentional biases towards rewarding and punishing cues as potentially important factors. Participants were young adolescents (N = 607) who were followed from the age of 13 until the age of 19, and completed a motivational game indexing the attentional bias to general cues of reward and punishment. Additionally, self-reported reward and punishment sensitivity was measured. This study showed that attentional biases to cues that signal reward or punishment and self-reported reward and punishment sensitivity were not related to body mass index or the change in body mass index over six years in adolescents. Thus, attentional bias to cues of reward and cues of punishment, and self-reported reward and punishment sensitivity, do not seem to be crucial factors in the development and maintenance of overweight and obesity in adolescents. Exploratory analyses of the current study suggest that the amount of effort to gain reward and to avoid punishment may play a role in the development and maintenance of overweight and obesity. However, since the effort measure was a construct based on face validity and has not been properly validated, more studies are necessary before firm conclusions can be drawn.