Mark H. Freeston

Generalized anxiety disorder: a preliminary test of a conceptual model

This study presents a preliminary test of a conceptual model of Generalized Anxiety Disorder (GAD) which is theoretically driven and has clear clinical implications. The models main features are intolerance of uncertainty, beliefs about worry, poor problem orientation and cognitive avoidance, Subjects were 24 GAD patients and 20 non clinical control subjects. The results show that all main components of the model were highly related to the discriminant function and that intolerance of uncertainty was pivotal in distinguishing GAD patients from non clinical subjects. Further, the discriminant function derived from these four process variables was very effective for classifying GAD patients and non clinical subjects into their respective groups. Overall, 82% of subjects were correctly classified as 18 of 24 subjects in the GAD group and 18 of 20 subjects in the non clinical group were properly identified. The results are discussed in terms of the proposed model of GAD and its clinical implications.

Intolerance of Uncertainty and Problem Orientation in Worry

Worry, which is the central feature of generalized anxiety disorder (GAD), is now recognized as a truly important clinical phenomenon. The present study examines the relationship between intolerance of uncertainty and problem orientation in nonclinical worry. Subjects were 285 French-Canadian university students who completed a battery of questionnaires on a voluntary basis. The results indicate that intolerance of uncertainty and emotional problem orientation are strong predictors of trait worry, even when personal variables (age, sex) and mood state (level of anxiety, depression) have been partialed out. The findings also show that intolerance of uncertainty and emotional problem orientation both make common as well as a unique contributions to the prediction of worry. Implications for the treatment of worry are discussed and specific guidelines for reducing intolerance of uncertainty and intolerance of emotional arousal for different types of worries are suggested.

Correcting faulty appraisals of obsessional thoughts

Cognitive techniques are becoming more widely established in the treatment of obsessive-compulsive disorder (OCD). This paper extends previous work by van Oppen and Arntz (1994, Behaviour Research and Therapy, 33, 79-87) on overestimation of threat and excessive responsibility by discussing other types of appraisals that may be involved in OCD, particularly when overt compulsions are absent. Examples are given of types of intervention that may be useful to correct faulty appraisals concerning the overestimation of the importance of thoughts such as thought-action fusion, excessive responsibility, perfectionistic concerns such as the need for absolute certainty, and expectations about anxiety and its consequences.

Perfectionism, responsibility and Obsessive-Compulsive symptoms

Although both perfectionism and responsibility have been associated with OCD at a theoretical level, responsibility has been the focus of a number of recent articles. This study was conducted in order to empirically test the relative importance of perfectionism and responsibility in Obsessive-Compulsive symptoms. Perfectionism and two measures of responsibility showed moderate correlations with Obsessive-Compulsive symptoms. A hierarchical regression analysis revealed that although responsibility accounted for more variance, perfectionism was still a significant predictor of Obsessive-Compulsive symptoms, once responsibility had been partialled out. These results suggest that although responsibility is related to OC symptoms, perfectionism is also independently associated. While responsibility has received much attention lately from OCD theorists and clinicians, perfectionism may also play a significant if underestimated role in some OC patients. The results are discussed in terms of their implications for current cognitive models and treatment procedures that give responsibility a central role in OCD. A new definition of perfectionism is also proposed.

Experimental manipulations of responsibility: An analogue test for models of Obsessive-Compulsive Disorder

Several authors attribute excessive responsibility a predominant role in Obsessive-Compulsive Disorder (OCD) [Salkovskis, P. M. (1985) Behaviour Research and Therapy, 23, 571-583; Rachman, S. (1993) Behaviour Research and Therapy, 31, 149-154; van Oppen, P. & Arntz, A. (1994) Behaviour Research and Therapy, 32, 79-87]. The present studies aimed at demonstrating the link between different levels of perceived responsibility and checking behaviors by experimentally manipulating responsibility in non-clinical Ss. In the first study, a sound recognition task was used to compare checking behaviors in Ss with high (HR) and low (LR) perceived responsibility. Only one variable was significantly different, Ss from the HR group reporting more anxiety during the task than Ss from the LR group. Results did not support a link between responsibility and checking behavior. In a second study HR and LR Ss were compared on a manual classification task. Subjects from the HR group hesitated and checked more, and reported more preoccupation with errors and anxiety during the task than Ss from the LR group. Since perceived severity of the outcome was the most variable affected by the manipulation, the implications for current models of OCD are discussed and an alternative explanation is attempted. Finally, clinical implications are examined and suggestions are made for future directions of research.

Thoughts, images, worry, and anxiety

Recent models suggest that worry is primarily a verbal-linguistic process that enables images to be avoided and reduces somatic activation. Five-hundred and two subjects completed a questionnaire that assessed variables related to generalized anxiety disorder (GAD) criteria and also asked subjects to indicate the percentage of thoughts and images while worrying. Subjects were divided into excessive worriers (worry excessively about two or more topics more days than not for at least the last 6 months) and ordinary worriers (those who did not meet the previous criteria). As predicted, worry was reported as being composed predominantly of thoughts rather than images, and excessive worriers reported a significantly higher percentage of thoughts compared to ordinary worriers. The number of somatic symptoms was positively correlated with the percentage of images. This relationship was stronger among excessive worriers than ordinary worriers, specifically for autonomic hyperactivity symptoms. Further, in the excessive worry group only there was a significant negative correlation between the number of autonomic hyperactivity symptoms and the percentage of thoughts.

Beliefs about obsessional thoughts

Recent cognitive-behavioral formulations of obsessive-compulsive disorder postulate that intrusive or obsessional thoughts are subject to appraisal. Extreme beliefs about the occurrence and meaning of intrusive thoughts direct appraisal, thus causing marked distress and subjective responsibility which may lead to neutralizing activity. A brief self-report belief inventory was developed from a 92-item pool to assess extreme beliefs concerning intrusive thoughts and responsibility, the control of such thoughts and their possible consequences, and the appropriateness of guilt and neutralizing behavior as a response. The inventory was developed sequentially on two nonclinical samples (N=125, N=265) to distinguish between neutralizing and nonneutralizing subjects. Initial psychometric data for the final instrument were obtained for two further nonclinical samples (N=61, N=50) along with a sample of OCD patients and a matched control group. The instrument showed satisfactory reliability and evidence of criterion, convergent, discriminant, and factorial validity. Finally, data from a heterogeneous outpatient medical sample (N=299) was used to test the relationship among obsessive-compulsive symptoms, mood state, and beliefs. The implications of these results for contemporary models of obsessive-compulsive disorder are discussed.

Self-report of obsessions and worry

The relationships between self-reported worry and obsessional-compulsive symptoms were examined among 145 hospital outpatients. Subjects completed the Penn State Worry Questionnaire and the Padua Inventory. Despite moderately strong correlations, the scales measured distinct constructs. Eliminating five items from the Padua Inventory may improve its discriminant validity. Correlations with the Padua Inventory subscales showed that obsessional loss of mental control was moderately correlated to both worry and checking, whereas worry and checking were only weakly correlated. The results are discussed in terms of possible relationships between worry and obsessions.

Reconsideration of the Locke-Wallace Marital Adjustment Test: Is it Still Relevant for the 1990S?:

The Locke-Wallace Marital Adjustment Test has been in use for over thirty years despite the development of other scales. The role of the test is discussed in terms of theoretical and practical concerns in the measurement of marital satisfaction. Major criticisms are briefly reviewed and empirical questions are identified. These questions are addressed using archival data on four samples totalling 281 couples. The test possesses adequate reliability and good criterion-related validity. A single factor was identified for both men and women. Ten items discriminated in all analyses. Minor changes in the scoring procedure were suggested for two items in response to some criticisms. These changes did not affect the psychometric properties. The alternative scoring system proposed by Hunt was also evaluated and a cut-score was identified. Continued use of the test is justified in general contexts where the broadly based definition of adjustment is appropriate. More comprehensive measures of adjustment and satisfaction and simpler measures of marital quality still leave a role for this 15-item rapid assessment measure of marital adjustment.

Psychological factors associated with emergency room visits among asthmatic patients

This study was designed to investigate physiological and psychological characteristics of subjects with high-frequency emergency room (ER) visits. Asthma status, psychological functioning and predispositions, psychosocial adaptation to asthma, and health behaviors were measured for 30 patients who had two or more ER visits during the last 2 years. These subjects were matched for age, sex, and corticosteroid use with 30 subjects who had no unscheduled ER visits for the same period. No significant differences were found for measures of asthma status. Among the asthma-specific variables, the number of hyperventilation-bronchoconstriction symptoms did not distinguish between the groups. High attenders reported more panic-fear symptoms, lower self-efficacy, and more perceived interference. There were no differences for measures of anxiety/depression, self-focused attention, or health locus of control. However, these variables were found to be significant predictors of panic-fear symptoms, lower selfefficacy, and more perceived interference.