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21-12-2015 | Original Article

The Effects of Attention Training on Health Anxiety: An Experimental Investigation

Auteurs: Julia Schwind, Maria Gropalis, Michael Witthöft, Florian Weck

Gepubliceerd in: Cognitive Therapy and Research | Uitgave 2/2016

Abstract

According to cognitive-behavioural theories, attentional biases, especially increased symptom-focused attention, are crucial for the maintenance of health anxiety. Therefore, the attention training technique (ATT) seems to be a promising approach in reducing body-focused attention and hypochondriacal fears in people with high health anxiety. However, previous research has never implemented ATT on its own but always in combination with psychoeducation. The present study experimentally investigates the isolated impact of ATT on self-reported body-focused attention, health anxiety, and attentional bias towards health threatening stimuli. Fifty-four students with elevated health anxiety were randomised into the following conditions: attention training group (ATG), which received ATT; ATG_body, which received a variation of ATT that focused on training attention towards the body; and a control group without intervention. The ATG and ATG_body spent 1 week actively practicing the trainings. Before and after the training phase, we assessed the self-report measures, and attentional bias by using the Emotional Stroop Task. The ATG displayed no effects on self-report measures of body-focused attention or health anxiety. Against our expectations, the ATG_body experienced a significant decrease in the attentional bias (p = .001, Cohen’s d = 0.93). Attention training towards the body in people with elevated health anxiety might, therefore, be beneficial in reducing illness-related attentional bias.

vorige artikel Unconscious Learning of Cognitive Structures with Emotional Components: Implications for Cognitive Behavior Psychotherapies

American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed.). Washington, DC: American Psychiatric Association.

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: American Psychiatric Association.

Anderson, A. K. (2005). Affective influences on the attentional dynamics supporting awareness. Journal of Experimental Psychology: General, 134(2), 258–281.CrossRef

Bar-Haim, Y. (2010). Research review: Attention bias modification (ABM): A novel treatment for anxiety disorders. Journal of Child Psychology and Psychiatry, 51(8), 859–870. doi:10.1111/j.1469-7610.2010.02251.x.CrossRefPubMed

Bar-Haim, Y., Lamy, D., Pergamin, L., Bakermans-Kranenburg, M. J., & van Ijzendoorn, M. H. (2007). Threat-related attentional bias in anxious and nonanxious individuals: A meta-analytic study. Psychological Bulletin, 133(1), 1–24. doi:10.1037/0033-2909.133.1.1.CrossRefPubMed

Beard, C., Sawyer, A. T., & Hofmann, S. G. (2012). Efficacy of attention bias modification using threat and appetitive stimuli: A meta-analytic review. Behavior Therapy, 43(4), 724–740. doi:10.1016/j.beth.2012.01.002.CrossRefPubMedPubMedCentral

Bleichhardt, G., & Weck, F. (2010). Kognitive Verhaltenstherapie bei Hypochondrie und Krankheitsangst (2nd ed.). Heidelberg: Springer.CrossRef

Boulet, J., & Boss, M. W. (1991). Reliability and validity of the Brief Symptom Inventory. Psychological Assessment, 3(3), 433–437. doi:10.1037/1040-3590.3.3.433.CrossRef

Broday, S. F. (1991). Internal consistency of the Brief Symptom Inventory for counseling-center clients. Psychological Reports, 68(1), 94. doi:10.2466/PR0.68.1.94-94.CrossRefPubMed

Buwalda, F. M., Bouman, T. K., & Duijn, M. A. J. (2008). The effect of a psychoeducational course on hypochondriacal metacognition. Cognitive Therapy and Research, 32(5), 689–701. doi:10.1007/s10608-007-9176-4.CrossRef

Buwalda, F. M., Bouman, T. K., & van Duijn, M. A. J. (2006). Psychoeducation for hypochondriasis: A comparison of a cognitive-behavioural approach and a problem-solving approach. Behaviour Research and Therapy, 45(5), 887–899. doi:10.1016/j.brat.2006.08.004.CrossRefPubMed

Cattell, R. B., & Warburton, F. W. (1967). Objective personality and motivation tests. Urbana: University of Illinois Press.

Cisler, J. M., & Koster, E. H. (2010). Mechanisms of attentional biases towards threat in anxiety disorders: An integrative review. Clinical Psychology Review, 30(2), 203–216. doi:10.1016/j.cpr.2009.11.003.CrossRefPubMedPubMedCentral

de Houwer, J. (2006). What are implicit measures and why are we using them. In R. W. Wiers & A. W. Stacy (Eds.), The handbook of implicit cognition and addiction (pp. 11–28). Thousand Oaks, CA: Sage.CrossRef

de Houwer, J., & Moors, A. (2010). Implicit measures: Similarities and differences. In B. Garwonski & K. Payne (Eds.), Handbook of implicit social cognition: Measurement, theory, and application (pp. 176–193). New York: Guilford Press.

de Houwer, J., Teige-Mocigemba, S., Spruyt, A., & Moors, A. (2009). Implicit measures: A normative analysis and review. Psychological Bulletin, 135(3), 347–368. doi:10.1037/a0014211.CrossRefPubMed

Derogatis, L. R., & Melisaratos, N. (1983). The Brief Symptom Inventory: An introductory report. Psychological Medicine, 13(3), 595–605. doi:10.1017/S0033291700048017.CrossRefPubMed

Enock, P. M., Hofmann, S. G., & McNally, R. J. (2014). Attention bias modification training via smartphone to reduce social anxiety: A randomized, controlled multi-session experiment. Cognitive Therapy and Research, 38(2), 200–216. doi:10.1007/s10608-014-9606-z.CrossRef

Eysenck, M. W., Derakshan, N., Santos, R., & Calvo, M. G. (2007). Anxiety and cognitive performance: Attentional control theory. Emotion, 7(2), 336–353.CrossRefPubMed

Faul, F., Erdfelder, E., Lang, A. G., & Buchner, A. (2007). G*Power 3: A flexible statistical power analysis program for the social, behavioral, and biomedical sciences. Behavior Research Methods, 39(2), 175–191.CrossRefPubMed

Ferguson, E. (2009). A taxometric analysis of health anxiety. Psychological Medicine, 39(2), 277–285. doi:10.1017/S0033291708003322.CrossRefPubMed

Foa, E. B., & Kozak, M. J. (1986). Emotional processing of fear: Exposure to corrective information. Psychological Bulletin, 99(1), 20–35.CrossRefPubMed

Fox, E., Zougkou, K., Ashwin, C., & Cahill, S. (2015). Investigating the efficacy of attention bias modification in reducing high spider fear: The role of individual differences in initial bias. Journal of Behavior Therapy and Experimental Psychiatry, 49(Pt A), 84–93. doi:10.1016/j.jbtep.2015.05.001.CrossRefPubMedPubMedCentral

Franke, G. H. (2000). Brief Symptom Inventory von L. R. Derogatis (Kurzform der SCL-90-R)—Deutsche Version. Manual [Short version of the SCL-90-R - German version]. Göttingen: Beltz Test GmbH.

Gropalis, M., Bleichhardt, G., Hiller, W., & Witthöft, M. (2013). Specificity and modifiability of cognitive biases in hypochondriasis. Journal of Consulting and Clinical Psychology, 81(3), 558–565. doi:10.1037/a0028493.CrossRefPubMed

Hadjistavropoulos, H. D., Hadjistavropoulos, T., & Quine, A. (2000). Health anxiety moderates the effects of distraction versus attention to pain. Behaviour Research and Therapy, 38(5), 425–438. doi:10.1016/S0005-7967(99)00044-3.CrossRefPubMed

Hakamata, Y., Lissek, S., Bar-Haim, Y., Britton, J. C., Fox, N. A., Leibenluft, E., & Pine, D. S. (2010). Attention bias modification treatment: A meta-analysis toward the establishment of novel treatment for anxiety. Biological Psychiatry, 68(11), 982–990. doi:10.1016/j.biopsych.2010.07.021.CrossRefPubMedPubMedCentral

Hiller, W., & Rief, W. (2004). Internationale Skalen für Hypochondrie Deutschsprachige Adaptation des Whiteley-Index (WI) und der Illness Attitude Scales (IAS). Bern: Huber.

Hiller, W., Rief, W., & Fichter, M. M. (2002). Dimensional and categorical approaches to hypochondriasis. Psychological Medicine, 32(4), 707–718. doi:10.1017/S0033291702005524.CrossRefPubMed

Höfling, V., & Weck, F. (2013). Assessing bodily preoccupations is sufficient: Clinically effective screening for hypochondriasis. Journal of Psychosomatic Research, 75(6), 526–531. doi:10.1016/j.jpsychores.2013.10.011.CrossRefPubMed

Inquisit. (2008). Inquisit. Seattle, WA: Millisecond software.

Karademas, E. C., Christopoulou, S., Dimostheni, A., & Pavlu, F. (2008). Health anxiety and cognitive interference: Evidence from the application of a modified Stroop task in two studies. Personality and Individual Differences, 44(5), 1138–1150. doi:10.1016/j.paid.2007.11.007.CrossRef

Kellner, R. (1986). Somatization and hypochondriasis. New York: Praeger-Greenwood Publishers.

Kerstner, T., Witthöft, M., Mier, D., Diener, C., Rist, F., & Bailer, J. (2015). A diary-based modification of symptom attributions in pathological health anxiety: Effects on symptom report and cognitive biases. Journal of Consulting and Clinical Psychology, 83(3), 578–589. doi:10.1037/a0039056.CrossRefPubMed

Krautwurst, S., Gerlach, A. L., Gomille, L., Hiller, W., & Witthöft, M. (2014). Health anxiety—An indicator of higher interoceptive sensitivity? Journal of Behavior Therapy and Experimental Psychiatry, 45(2), 303–309. doi:10.1016/j.jbtep.2014.02.001.CrossRefPubMed

Lecci, L., & Cohen, D. J. (2002). Perceptual consequences of an illness-concern induction and its relation to hypochondriacal tendencies. Health Psychology, 21(2), 147–156. doi:10.1037//0278-6133.21.2.147.CrossRefPubMed

Lecci, L., & Cohen, D. (2007). Altered processing of health threat words as a function of hypochondriacal tendencies and experimentally manipulated control beliefs. Cognition and Emotion, 21(1), 211–224. doi:10.1080/02699930600625248.CrossRef

Longley, S. L., Broman-Fulks, J. J., Calamari, J. E., Noyes, R., Wade, M., & Orlando, C. M. (2010). A taxometric study of hypochondriasis symptoms. Behavior Therapy, 41(4), 505–514. doi:10.1016/j.beth.2010.02.002.CrossRefPubMed

Longley, S. L., Watson, D., & Noyes, R. (2005). Assessment of the hypochondriasis domain: The multidimensional inventory of hypochondriacal traits (MIHT). Psychological Assessment, 17(1), 3–14. doi:10.1037/1040-3590.17.1.3.CrossRefPubMed

MacLeod, C., Mathews, A., & Tata, P. (1986). Attentional bias in emotional disorders. Journal of Abnormal Psychology, 95(1), 15–20. doi:10.1037/0021-843X.95.1.15.CrossRefPubMed

Marcus, D. K., Gurley, J. R., Marchi, M. M., & Bauer, C. (2007). Cognitive and perceptual variables in hypochondriasis and health anxiety: A systematic review. Clinical Psychology Review, 27(2), 127–139. doi:10.1016/j.cpr.2006.09.003.CrossRefPubMed

Martin, A., & Jacobi, F. (2006). Features of hypochondriasis and illness worry in the general population in Germany. Psychosomatic Medicine, 68(5), 770–777. doi:10.1097/01.psy.0000238213.04984.b0.CrossRefPubMed

Martínez, M. P., & Belloch, A. (2004). Efectos de un tratamiento cognitivo-conductual para la hipocondría en los sesgos atencionales. International Journal of Clinical Health Psychology, 4(2), 299–311.

McEvoy, P. M., & Perini, S. J. (2009). Cognitive behavioral group therapy for social phobia with or without attention training: A controlled trial. Journal of Anxiety Disorders, 23(4), 519–528. doi:10.1016/j.janxdis.2008.10.008.CrossRefPubMed

Mogg, K., & Bradley, B. P. (1998). A cognitive-motivational analysis of anxiety. Behaviour Research and Therapy, 36(9), 809–848. doi:10.1016/S0005-7967(98)00063-1.CrossRefPubMed

Mogoaşe, C., David, D., & Koster, E. H. W. (2014). Clinical efficacy of attentional bias modification procedures: An updated meta-analysis. Journal of Clinical Psychology, 70(12), 1133–1157. doi:10.1002/jclp.22081.CrossRefPubMed

Owens, K. M. B., Asmundson, G. J. G., Hadjistavropoulos, T., & Owens, T. J. (2004). Attentional bias toward illness threat in individuals with elevated health anxiety. Cognitive Therapy and Research, 28(1), 57–66. doi:10.1023/B:COTR.0000016930.85884.29.CrossRef

Papageorgiou, C., & Wells, A. (1998). Effects of attention training on hypochondriasis: A brief case series. Psychological Medicine, 28(1), 193–200. doi:10.1017/S0033291797005825.CrossRefPubMed

Papageorgiou, C., & Wells, A. (2000). Treatment of recurrent major depression with attention training. Cognitive and Behavioral Practice, 7(4), 407–413. doi:10.1016/S1077-7229(00)80051-6.CrossRef

Raymond, J. E., Shapiro, K. L., & Arnell, K. M. (1992). Temporary suppression of visual processing in an RSVP task: An attentional blink? Journal of Experimental Psychology: Human Perception and Performance, 18(3), 849–860. doi:10.1037/0096-1523.18.3.849.PubMed

Sirri, L., Grandi, S., & Fava, G. A. (2008). The illness attitude scales. A clinimetric index for assessing hypochondriacal fears and beliefs. Psychotherapy and Psychosomatics, 77(6), 337–350. doi:10.1159/000151387.CrossRefPubMed

Valmaggia, L. R., Bouman, T. K., & Schuurman, L. (2007). Attention training with auditory hallucinations: A case study. Cognitive and Behavioral Practice, 14(2), 127–133. doi:10.1016/j.cbpra.2006.01.009.CrossRef

Warwick, H. M. C., & Salkovskis, P. M. (1990). Hypochondriasis. Behaviour Research and Therapy, 28(2), 105–117. doi:10.1016/0005-7967(90)90023-C.CrossRefPubMed

Weck, F., Bleichhardt, G., & Hiller, W. (2009). Stellen Erfahrungen mit Krankheiten einen spezifischen Risikofaktor für Krankheitsängste dar? Zeitschrift für Klinische Psychologie und Psychotherapie, 38(2), 89–99. doi:10.1026/1616-3443.38.2.89.CrossRef

Weck, F., Bleichhardt, G., & Hiller, W. (2010). Screening for hypochondriasis with the Illness Attitude Scales. Journal of Personality Assessment, 92(3), 260–268. doi:10.1080/00223891003670216.CrossRefPubMed

Weck, F., Bleichhardt, G., Witthöft, M., & Hiller, W. (2011). Explicit and implicit anxiety: Differences between patients with hypochondriasis, patients with anxiety disorders, and healthy controls. Cognitive Therapy and Research, 35(4), 317–325.CrossRef

Weck, F., & Höfling, V. (2014). Assessment of implicit health attitudes: A multitrait–multimethod approach and a comparison between patients with hypochondriasis and patients with anxiety disorders. Journal of Personality Assessment, 97(1), 1–11//55–65. doi:10.1080/00223891.2014.913253.

Weck, F., Neng, J. M. B., & Stangier, U. (2013). The effects of attention training on the perception of bodily sensations in patients with hypochondriasis: A randomized controlled pilot trial. Cognitive Therapy and Research, 37(3), 514–520. doi:10.1007/s10608-012-9482-3.CrossRef

Wells, A. (1990). Panic disorder in association with relaxation induced anxiety: An attentional training approach to treatment. Behavior Therapy, 21(3), 273–280. doi:10.1016/S0005-7894(05)80330-2.CrossRef

Wells, A. (2007). The attention training technique: Theory, effects, and a metacognitive hypothesis on auditory hallucinations. Cognitive and Behavioral Practice, 14(2), 134–138. doi:10.1016/j.cbpra.2006.01.010.CrossRef

Wells, A., & Matthews, G. (1994). Attention and emotion: A clinical perspective. Hove: Lawrence Erlbaum.

Wells, A., White, J., & Carter, K. (1997). Attention training: Effects on anxiety and beliefs in panic and social phobia. Clinical Psychology and Psychotherapy, 4(4), 226–232. doi:10.1002/(SICI)1099-0879(199712)4:4<226::AID-CPP129>3.0.CO;2-M.CrossRef

Williams, J. M. G., Mathews, A., & MacLeod, C. (1996). The emotional Stroop task and psychopathology. Psychological Bulletin, 120(1), 3–24. doi:10.1037/0033-2909.120.1.3.CrossRefPubMed

Williams, P. G., Wasserman, M. S., & Lotto, A. J. (2003). Individual differences in self-assessed health: An information-processing investigation of health and illness cognition. Health Psychology, 22, 3–11.CrossRefPubMed

Witthöft, M. (2011). Besonderheiten der Aufmerksamkeitsregulation bei Gesundheitsängsten. In W. Hoefert & C. Klotter (Eds.), Gesundheitsängste (pp. 285–303). Heidelberg: Springer.

Witthöft, M., Haaf, A., Rist, F., & Bailer, J. (2010). Erfassung von Krankheitsangst mit dem Multidimensional Inventory of Hypochondriacal Traits (MIHT). Diagnostica, 56(1), 2–12. doi:10.1026/0012-1924/a000005.CrossRef

Witthöft, M., Kerstner, T., Ofer, J., Mier, D., Rist, F., Diener, C., & Bailer, J. (2015a). Cognitive biases in pathological health anxiety: The contribution of attention, memory, and evaluation processes. Clinical Psychological Science. doi:10.1177/2167702615593474.

Witthöft, M., Rist, F., & Bailer, J. (2008). Enhanced early emotional intrusion effects and proportional habituation of threat response for symptom and illness words in college students with elevated health anxiety. Cognitive Therapy and Research, 32(6), 818–842. doi:10.1007/s10608-007-9159-5.CrossRef

Witthöft, M., Weck, F., & Gropalis, M. (2015b). The multidimensional inventory of hypochondriacal traits (MIHT): Factor structure, specificity, reliability, and validity in patients with hypochondriasis. Assessment, 22(3), 261–376. doi:10.1177/1073191114545489.CrossRef

Yang, W., Ding, Z., Dai, T., Peng, F., & Zhang, J. X. (2015). Attention bias modification training in individuals with depressive symptoms: A randomized controlled trial. Journal of Behavior Therapy and Experimental Psychiatry, 49(Pt A), 101–111. doi:10.1016/j.jbtep.2014.08.005.CrossRefPubMed

Titel: The Effects of Attention Training on Health Anxiety: An Experimental Investigation
Auteurs: Julia Schwind
Maria Gropalis
Michael Witthöft
Florian Weck
Publicatiedatum: 21-12-2015
Uitgeverij: Springer US
Gepubliceerd in: Cognitive Therapy and Research / Uitgave 2/2016
Print ISSN: 0147-5916
Elektronisch ISSN: 1573-2819
DOI: https://doi.org/10.1007/s10608-015-9745-x

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The Effects of Attention Training on Health Anxiety: An Experimental Investigation

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Andere artikelen Uitgave 2/2016

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A Comparison of Single-Session Positive Reappraisal, Cognitive Restructuring and Supportive Counselling for Older Adults with Type 2 Diabetes

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