Anxiety Disorders: Mathews A

Mathews A, MacLeod C. · Medical Research Council, Cognition & Brain Sciences Unit, Cambridge, United Kingdom. · Annu Rev Clin Psychol. · Pubmed #17716086 No free full text.

Abstract: A review of recent research on cognitive processing indicates that biases in attention, memory, and interpretation, as well as repetitive negative thoughts, are common across emotional disorders, although they vary in form according to type of disorder. Current cognitive models emphasize specific forms of biased processing, such as variations in the focus of attention or habitual interpretative styles that contribute to the risk of developing particular disorders. As well as predicting risk of emotional disorders, new studies have provided evidence of a causal relationship between processing bias and vulnerability. Beyond merely demonstrating the existence of biased processing, research is thus beginning to explore the cognitive causes of emotional vulnerability, and their modification.

Hirsch CR, Clark DM, Mathews A. · Institute of Psychiatry, King's College, University of London, De Crespigny Park, UK. · Behav Ther. · Pubmed #16942974 No free full text.

Abstract: Cognitive-behavioral models of clinical problems typically postulate a role for the combined effects of different cognitive biases in the maintenance of a given disorder. It is striking therefore that research has tended to examine cognitive biases in isolation rather than assessing how they work together to maintain psychological dysfunction. The combined cognitive biases hypothesis presented here suggests that cognitive biases influence each another and can interact to maintain a given disorder. Furthermore, it is proposed that the combined effects of cognitive biases may have a greater impact on sustaining a given disorder than if the biases operated in isolation. The combined cognitive biases hypothesis is examined in relation to imagery and interpretation in social phobia. Individuals with social phobia experience negative images of themselves performing poorly in social situations, and they also interpret external social information in a less positive way than those without social anxiety. Evidence of a reciprocal relationship between imagery and interpretations is presented, and the mechanisms underlying the combined effects are discussed. Clinical implications and the potential utility of examining the combined influence of other cognitive biases are highlighted.

Holmes EA, Mathews A, Dalgleish T, Mackintosh B. · MRC Cognition and Brain Sciences Unit, Cambridge, UK. · Behav Ther. · Pubmed #16942975 No free full text.

Abstract: Therapists often assume a special association between mental imagery and emotion, though empirical evidence has been lacking. Using an interpretation training paradigm, we previously found that imagery had a greater impact on anxiety than did verbal processing of the same material (Holmes & Mathews, 2005). Although the finding of a differential impact of imagery versus verbal processing of negative material was replicated, findings did not extend to benign material. Results therefore left open the question of whether there may be a special association between imagery and positive emotion. The current experiment examined positive interpretation training. Numerous scenarios were presented with initial ambiguity as to positive outcome or not, with final information then yielding consistently positive resolutions. Participants were asked to either imagine these positive events or to listen to the same descriptions while thinking about their verbal meaning. Those participants in the imagery condition reported greater increases in positive affect and rated new descriptions as being more positive than did those in the verbal condition. Results suggest that positive training can be enhanced through imagery as opposed to verbal processing. This study also provides the first test of a standardized intervention using an "interpretive bias training" paradigm to improve positive mood.

Hirsch CR, Mathews A, Clark DM, Williams R, Morrison J. · Department of Psychology, P.O. Box 77, Institute of Psychiatry, De Crespigny Park, London SE5 8AF, UK. · Behav Res Ther. · Pubmed #14583409 No free full text.

Abstract: Previous research has shown that, unlike non-anxious individuals, people with social phobia fail to generate non-threatening inferences when ambiguous social information is first encountered (i.e. 'on-line'; Hirsch and Mathews Journal of Abnormal Psychology, 109 (2000) 705-712). Patients with social phobia also report negative self-imagery in social situations, while individuals without high social anxiety do not. The negative self-imagery in social phobia may prevent the generation of non-threatening inferences. If so, then training non-anxious individuals to hold in mind a negative self-image should remove the 'on-line' non-threat inferential bias normally evident in this population. In the present study, low anxious volunteers were allocated to negative image training or a control task that did not manipulate self-imagery. Following negative image training, or the control task, volunteers read descriptions of job interviews and at certain points during the text performed lexical decisions. Some decisions were made after ambiguous text that could have been interpreted in both a threatening and a non-threatening manner. In a baseline condition, decisions were made following the text for which there was only one possible inference (either threat or non-threat). The results for the control group replicated earlier findings of a non-threat inferential bias for non-anxious individuals. In contrast, and as predicted, non-anxious volunteers who were trained to hold a negative image in mind lacked any non-threatening inferential bias, and also experienced higher levels of state anxiety.

Hayes S, Hirsch C, Mathews A. · Institute of Psychiatry, King's College London, London, UK. · J Abnorm Psychol. · Pubmed #18729625 No free full text.

Abstract: The authors report the first direct assessment of working memory capacity when people engage in worry. High and low worriers performed a random key-press task while thinking about a current worry or a positive personally relevant topic. High (but not low) worriers showed more evidence of restricted capacity during worry than when thinking about a positive topic. These findings suggest that high worriers have less residual working memory capacity when worrying than when thinking about other topics and, thus, have fewer attentional resources available to redirect their thoughts away from worry.

Fulcher EP, Mathews A, Hammerl M. · School of Psychology, University of the West of England, Bristol, BS16 1QY, UK. · J Behav Ther Exp Psychiatry. · Pubmed #17884011 No free full text.

Abstract: This study reports on the relationship between evaluative learning (EL) and attentional preference in children with varying degrees of anxiety, as measured by the Multidimensional Anxiety Scale for Children, and varying degrees of parental anxiety, as measured by scores on the Beck Anxiety Inventory (BAI). In the first experiment, 3 age groups (7-8, 10-11 and adults with mean age 26.8 years) were compared on a novel EL method, in which neutral images "morphed" over 1s into either smiling or angry adult faces. There were no differences in EL between the age groups-each showing a strong EL effect. In 2 subsequent experiments, we examined learning and attention to stimuli following EL trials in 7- to 8-year olds. In Experiment 2, panic/separation anxiety (PSA) and the mothers' BAI predicted the overall magnitude of EL. In addition, high PSA children were more likely to attend to a neutral stimulus previously paired with a negative stimulus than were low PSA children. In Experiment 3, only PSA was positively associated with the magnitude of EL. In the attention trials, high PSA children had longer fixation times on frowning faces than did low PSA children but unlike Experiment 2 PSA was not associated with preferential attention towards stimuli with acquired negative valence. These results indicate that associations between learning, attention and emotional information can be influenced by separation anxiety and maternal anxiety.

Murphy R, Hirsch CR, Mathews A, Smith K, Clark DM. · Department of Psychology, Institute of Psychiatry, London, UK. · Behav Res Ther. · Pubmed #17349970 No free full text.

Abstract: Previous research has shown that high socially anxious individuals lack the benign interpretation bias present in people without social anxiety. The tendency of high socially anxious people to generate more negative interpretations may lead to anticipated anxiety about future social situations. If so, developing a more benign interpretation bias could lead to a reduction in this anxiety. The current study showed that a benign interpretation bias could be facilitated (or 'trained') in a high socially anxious population. Participants in the benign training groups had repeated practice in accessing benign (positive or non-negative) interpretations of potentially threatening social scenarios. Participants in the control condition were presented with the same social scenarios but without their outcomes being specified. In a later recognition task, participants who received benign interpretation training generated more benign, and less negative, interpretations of new ambiguous social situations compared to the control group. Participants who received benign training also predicted that they would be significantly less anxious in a future social situation than those in the control group. Possible implications of the findings for therapeutic interventions in social phobia are discussed.

Huppert JD, Pasupuleti RV, Foa EB, Mathews A. · Center for the Treatment and Study of Anxiety, University of Pennsylvania School of Medicine, 3535 Market St, Suite 600N, Philadelphia, PA 19104, USA. · Behav Res Ther. · Pubmed #17336922 No free full text.

Abstract: Cognitive theories propose that the resolution of ambiguity is related to the maintenance of social anxiety. A sentence completion task was used to examine how individuals high (n=26) and low (n=23) in social anxiety resolve ambiguous social sentences. Individuals were asked to generate as many responses as came to mind for each sentence, and then to endorse the response that best completes the sentence. Total responses, first responses, and endorsed responses were examined separately. Results indicated that high anxious individuals had more negative and anxious responses and fewer positive and neutral responses than low anxious individuals on all sentence completion measures. In contrast, a self-report measure of interpretation bias indicated that more of negative and anxious appraisals were related to social anxiety, while positive and neutral appraisals were not. Results are discussed in terms of a multi-stage processing model of interpretation biases.

Hirsch CR, Mathews A, Clark DM. · Department of Psychology, Institute of Psychiatry, De Crespigny Park, London SE5 8AF, UK. · Behav Res Ther. · Pubmed #17178103 No free full text.

Abstract: Prior work suggests that variations in self-imagery can influence the emotional interpretations people make about social situations. The current experiment investigated the converse possibility: that inducing an inferential bias can change the content of self-related images. The effects of repeated practice in accessing either negative or positive social outcomes was tested by having participants report on self-images generated during subsequent experience with ambiguous social situations. Participants and independent judges rated the content of participants' self-images as being more negative after prior practice in accessing negative rather than positive social outcomes. Furthermore, participants who practiced accessing negative outcomes rated their anticipated anxiety in an imagined stressful social situation as being greater, and their expected social performance as poorer than participants in the positive outcome group. Groups did not differ in state anxiety levels when making their ratings, so it is unlikely that any observed differences between groups can be attributed to mood effects. We suggest that this finding is consistent with the hypothesis that inferential biases and content of self-images can interact with each other and may together serve to maintain social anxiety.

Wilson EJ, MacLeod C, Mathews A, Rutherford EM. · Department of Psychology, University of Western Australia, Nedlands, Australia. · J Abnorm Psychol. · Pubmed #16492101 No free full text.

Abstract: Elevated anxiety vulnerability is associated with a tendency to interpret ambiguous stimuli as threatening, but the causal basis of this relationship has not been established. Recently, procedures have been developed to systematically manipulate interpretive bias, but the impact of such manipulation on anxiety reactivity to a subsequent stressor has not yet been examined. In the present study, training procedures were used to induce interpretive biases favoring the threatening or nonthreatening meanings of ambiguous information in a sample of 48 undergraduate students. Following this interpretive training, participants' emotional reactions to a stressful video were assessed. The finding that the manipulation of interpretive bias modified emotional reactivity supports the hypothesis that interpretive bias can indeed play a causal role in anxiety vulnerability.

Hirsch CR, Mathews A, Clark DM, Williams R, Morrison JA. · Institute of Psychiatry, De Crespigny Park, London SE5 8NX, UK. · J Behav Ther Exp Psychiatry. · Pubmed #15913541 No free full text.

Abstract: This study tests the causal role of negative self-imagery in social anxiety. Low public-speaking anxious volunteers rehearsed a negative self-image, a positive self-image or a control image prior to giving a speech. As predicted, the negative image group felt more anxious, believed they performed less well and reported more negative thoughts than the positive image group. These findings do not appear to be due to changes in state anxiety, since they remained unchanged when anxiety was controlled in an analysis of covariance. The negative image group also reported more anxiety than the control group. Given that participants do not currently have anxiety problems, the findings are consistent with the idea that negative self-imagery has a causal role in the development and maintenance of social anxiety.

Constans JI, McCloskey MS, Vasterling JJ, Brailey K, Mathews A. · Mental Health Service, Veterans Affairs Medical Center, and Department of Psychiatry and Neurology, Tulane University School of Medicine, New Orleans, LA 70112-1262, USA. · J Abnorm Psychol. · Pubmed #15122951 No free full text.

Abstract: Sixty combat veterans with posttraumatic stress disorder performed an emotional Stroop task under 1 of 4 contextual conditions designed to test theoretical explanations for an attentional bias suppression effect. Results revealed that when the emotional Stroop task was performed under conditions involving a future threat of either watching a combat video or giving a speech, attentional bias was inhibited. There was limited support for the prediction that the suppression effect was strongest when stressor content matched word content on the Stroop. In contrast to participants in the threat conditions, veterans who believed that they would receive additional compensation for speeded color naming or who believed that they would have no other experimental demands were slower when color naming combat-threat words. Potential theoretical explanations of the findings are discussed.

Wood J, Mathews A, Dalgleish T. · Cognition and Brain Sciences Unit, Medical Research Council, Cambridge, England. · Emotion. · Pubmed #12899195 No free full text.

Abstract: In 3 experiments, the authors investigated whether anxiety proneness is associated with impaired inhibitory processing. Participants made speeded decisions requiring inhibition of threatening or neutral meanings of ambiguous words, which were inappropriate in their current context. In Experiment 1 there were no differences found in inhibitory processing associated with anxiety. However, in Experiment 2, when the capacity for controlled processing was reduced by imposition of a mental load, anxious individuals showed a response pattern consistent with a general impairment of inhibitory processing. In Experiment 3, a group who had experienced a traumatic event also showed evidence of impaired inhibition, despite the absence of additional load. Thus anxiety proneness is associated with a general deficit of inhibitory processing, but this may be revealed only under conditions that limit the availability of controlled processing resources.

Hirsch CR, Clark DM, Mathews A, Williams R. · Department of Psychology, Institute of Psychiatry, De Crespigny Park, London SE5 8AF, UK. · Behav Res Ther. · Pubmed #12880646 No free full text.

Abstract: Patients with social phobia often experience negative self-images in social situations. The current study investigated whether negative self-images have a causal role in maintaining social phobia. Patients with social phobia participated twice in a conversation with a stranger, once whilst holding their usual negative self-image in mind and once whilst holding a less negative (control) self-image in mind, with order counterbalanced across participants. Compared to the control image condition, when participants held the negative image in mind they experienced greater anxiety, rated their anxiety symptoms as being more visible, and rated their performance as poorer. An assessor who did not know which image was being held also rated participants' anxiety as more evident and their behaviour as less positive when the negative image was being held in mind. Finally, when participant and assessor ratings were compared, participants underestimated their performance and overestimated the visibility of their anxiety to a significantly greater extent in the negative imagery condition. Taken together, these results support the hypothesis that negative self-imagery has a causal role in maintaining social phobia.

Diefenbach GJ, McCarthy-Larzelere ME, Williamson DA, Mathews A, Manguno-Mire GM, Bentz BG. · Department of Psychology, Louisiana State University, Baton Rouge, Louisiana, USA. · Depress Anxiety. · Pubmed #11754134 No free full text.

Abstract: Worry content as assessed by using a modified Worry Domains Questionnaire (WDQ) was compared among participants diagnosed with a depressive disorder, generalized anxiety disorder (GAD), and both a depressive disorder and GAD. A discriminant function analysis of worry domains yielded two significant functions. The worry domains Lack of Confidence, Aimless Future, Relationships, and Financial Concerns loaded significantly on Function 1, which was termed "Depressive Worries." The worry domain Loss of Control loaded significantly on Function 2, which was termed "Anxious Worries." The three participant groups differed in their pattern of worries in a way that lends support to the content-specificity hypothesis for both depression and anxiety. In addition, multiple regression analysis indicated that WDQ domain scores (in particular the Aimless Future domain) predicted the severity of depressive symptoms even after the variance contributed by anxiety symptoms was removed from the analysis. These findings suggest that the content of a person's worries may be significantly associated with the presence of depression, anxiety, or comorbid depression and anxiety.

Hirsch CR, Mathews A. · Institute of Psychiatry, University of London, London, England. · J Abnorm Psychol. · Pubmed #11195994 No free full text.

Abstract: People with social phobia report anticipatory and retrospective judgments about social situations that appear consistent with a negative interpretative bias. However, it is not at all clear that biased interpretative inferences are made "on-line;" that is, at the time that ambiguous information is first encountered. In a previous study, volunteers who were anxious about interviews were found to lack the positive on-line inferential bias that was characteristic of nonanxious controls but also failed to show a bias favoring threatening inferences (C. R. Hirsch & A. Mathews, 1997). This finding was confirmed in the present study, in which social phobic patients showed no evidence of making on-line emotional inferences, in contrast with socially nonanxious controls who were again clearly biased in favor of positive inferences. The authors concluded that nonanxious individuals are characterized by a benign on-line inferential bias, but that this is impaired in people with social phobia.