Lars-Gunnar Lundh

Insomnia as an interaction between sleep-interfering and sleep-interpreting processes

The present paper reviews theories and empirical research concerning the role of psychological processes in insomnia. It is argued that two kinds of psychological processes are involved in insomnia: sleep-interfering processes and sleep-interpreting processes. A theoretical model is sketched, where it is argued that psychological vulnerability factors may predispose the individual to (1) respond with sleep-interfering processes to stressful life events, and to (2) engage in dysfunctional sleep-interpreting processes. Examples of the first kind of variables are arousability, slow recuperation after stress, worrying, and emotional conflicts in relation to significant others; examples of the latter are sleep-related beliefs, attitudes, and perfectionistic standards.

Alexithymia, Emotion, and Somatic Complaints

Alexithymia, by definition, involves difficulties in identifying and describing emotions and has been assumed to be associated with somatization (i.e., a tendency to express psychological distress in somatic rather than emotional form). Empirical research so far, however, has produced no convincing evidence that alexithymia is more associated with somatic complaints than with emotional complaints or that alexithymia correlates with somatic complaints when negative affect is controlled for. In the present study, alexithymia, as measured by the TAS-20, showed no association with somatic complaints in a community sample of 137 individuals when trait anxiety and depression were controlled. Alexithymia did correlate negatively with positive affect, and positively with negative affect. The former association, however, was much more robust, whereas the latter association was found mainly on subjective trait measures of negative affect (as distinct from state measures and more objective trait measures derived from daily recordings during an 8-week period). It is suggested that the association between alexithymia and lack of positive affect deserves more attention in future research.

PERFECTIONISM, SELF-CONSCIOUSNESS AND ANXIETY

The relation between perfectionism, anxiety, and self-consciousness was studied in a normal sample. The perfectionism dimensions of Concern over Mistakes, Doubts about Action, and Socially Prescribed Perfectionism showed a pattern of correlations not only with measures of social anxiety, but also with measures of agoraphobic fears, and fears of bodily injury, death and illness. Public self-consciousness also correlated with various measures of anxiety, but these correlations disappeared when the relevant dimensions of perfectionism were controlled for. It is concluded that perfectionism is a more relevant construct in the study of anxiety than is public self-consciousness. The results are discussed in terms of possible causal relationships between perfectionism and anxiety.

Perfectionism and self-consciousness in social phobia and panic disorder with agoraphobia

Social phobics were compared to patients with panic disorder with agoraphobia and normal controls on perfectionism and self-consciousness. On concern over mistakes and doubts about action, social phobics scored higher than patients with panic disorder. Social phobics also demonstrated a higher level of public self-consciousness than patients with panic disorder and when this difference was controlled for the significant differences on perfectionism disappeared. Within each patient group, however, perfectionism was more robustly related to social anxiety than was public self-consciousness, which replicates the findings of Saboonchi and Lundh [Saboonchi, F. & Lundh, L. G. (1997). Perfectionism, self-consciousness and anxiety. Personality and Individual Differences, 22, 921-928.] from a non-clinical sample. The results are discussed in terms of public self-consciousness being a differentiating characteristic of the more severe kind of social anxiety which is typical of social phobia.

Attentional Bias, Self-consciousness and Perfectionism in Social Phobia Before and After Cognitive-Behaviour Therapy

Attentional bias for threat words (as measured by the emotional Stroop task), selfconsciousness and perfectionism was studied in 24 patients with social phobia before and after cognitive-behaviour treatment. A total of 18 (75%) of the patients were classified as treatment responders on the basis of reduced scores for social anxiety. The treatment responders showed a significant reduction in attentional bias for social threat words, in public self-consciousness and in perfectionism. The non-responders showed an equal reduction in perfectionism; as they had a much higher level of perfectionism before treatment, however, their change only amounted to a lowering of their level of perfectionism to the level that characterized the treatment responders before treatment. The treatment responders, on the other hand, reduced their level of perfectionism to that of non-clinical samples.

Stroop interference, self-focus and perfectionism in social phobics

Abstract Stroop interference was studied in a group of social phobics under two conditions: presence or absence of a mirror. The mirror was used with the purpose of inducing a higher level of self-focus during testing; this was expected to activate dysfunctional self structures that would increase Stroop interference on socially threatening words. The social phobics showed a Stroop interference effect on socially threatening words, but not on physically threatening words or colour words, relative to the control group. The hypothesis that the presence of the mirror would increase the Stroop interference on socially threatening words, however, was not supported by the data. On the other hand, the social phobics scored significantly higher than the controls on trait measures of self-consciousness and perfectionism. There was a correlation between perfectionism (concern over mistakes) and Stroop interference on socially threatening words. Self-consciousness also correlated with Stroop interference, but this effect was unexpectedly seen most clearly on physically threatening words.

Social Anxiety and the Post-Event Processing of Socially Distressing Events

The correlation between social anxiety, as measured by the Social Phobia Scale, and negative post-event processing of socially distressing events, as measured by a diary record, was studied in a sample of 62 undergraduate students during a 1-week period. Of the participants, 55 individuals reported the experience of at least 1 socially distressing event during this time; only 24 of the participants, however, reported distressing events of a negative-evaluational character during the recording week. Although the Social Phobia Scale did not correlate with post-event processing of socially distressing events in general, it showed moderate to strong correlations with post-event processing of negative-evaluational events both on the same day and on the following day. Furthermore, the degree of negative post-event processing that was reported the same day was strongly predictive of the degree of such processing that was reported the following day. The results confirm that negative post-event processing is a real phenomenon with regard to socially distressing situations, and that high social anxiety is associated with higher degrees of such post-event processing of negative-evaluational events. The results also suggest that social anxiety is only one of several forms of interpersonal distress that are characterized by such negative post-event processing; other forms of such distress involve other fears (fears of separation or loneliness, fears of hurting others, etc.) or other kinds of feelings (e.g. guilt and anger).

Alexithymia, memory of emotion, emotional awareness, and perfectionism.

The Toronto Alexithymia Scale (TAS-20; R. M. Bagby, J. D. A. Parker, & G. J. Taylor, 1994) is a self-assessment instrument designed to measure deficits in meta-emotional functioning (e.g., difficulties in identifying and describing emotions). Four studies were carried out to examine the association between the TAS-20 and (a) performance measures of meta-emotional functioning (memory of emotion and emotional awareness; Studies 1-2) and (b) measures of perfectionistic standards that may possibly be involved in the self-assessment of abilities-difficulties (Studies 3-4). The TAS-20 failed to correlate in the predicted direction with the performance measures but showed sizable correlations with measures of perfectionism. Moreover, perfectionism was found to predict TAS-20 scores independent of depression, anxiety, and somatic complaints. The results are discussed in terms of the TAS-20 measuring primarily certain aspects of meta-emotional self-efficacy.

A Swedish translation of the 20-item Toronto Alexithymia Scale: Cross-validation of the factor structure.

The purpose of this study was to develop a new Swedish translation of the twenty-item Toronto Alexithymia Scale (TAS-20) and to examine if the theoretical structure that underlies the factor structure of the English version of the TAS-20 could be recovered in this Swedish translation of the instrument. A sample of 157 undergraduate students of psychology was tested. Using confirmatory factor analysis, the previously established three-factor TAS-20 model was found to be replicable in this sample. In addition, the Swedish translation of the TAS-20 showed adequate internal reliability. The present study also illustrates the importance of using back translation methodology when transposing psychometric instruments from one language to another.

The enhancement of video feedback by cognitive preparation in the treatment of social anxiety. A single-session experiment.

The present study replicates and extends Harvey, Clark, Ehlers and Rapees (Behav. Res. Therapy 38 (2000) 1183-1192) single-session experiment of video feedback with cognitive preparation in individuals with high social anxiety. Forty participants high on social anxiety were asked to present a speech before a video camera and then received video feedback of their speech. Half of the participants received cognitive preparation prior to the video feedback, whereas the other half only received video feedback. The cognitive preparation procedure asked the participants to (1) predict in detail what they would see in the video, (b) form an image of themselves giving the speech, and (3) watch the video as though they were watching a stranger. All the participants were asked to present a second speech 30 min after the first speech to index generalisation effects. Cognitive preparation enhanced the therapeutic effect of video feedback after the first speech, and also showed a robust generalisation effect on the evaluation of the second speech. Before the second speech, the participants underwent an emotional Stroop task with masked and unmasked words; the results showed that Stroop interference for both masked and unmasked social threat words correlated consistently with measures of social anxiety, but not with the preceding or ensuing speech evaluations.