On the scientific status of cognitive appraisal models of anxiety disorder

doi:10.1016/S0005-7967(00)00073-5

Behaviour Research and Therapy

Volume 39, Issue 5, May 2001, Pages 513-521

https://doi.org/10.1016/S0005-7967(00)00073-5 Get rights and content

Abstract

The cognitive paradigm for understanding and treating anxiety disorders comprises two distinct and potentially incompatible approaches: appraisal and information-processing. Advocates of the latter approach have sharply criticized the scientific adequacy of the appraisal models popularized by cognitive therapists. The purpose of this essay is to provide a reappraisal of these critiques of appraisal, and to defend an argument for methodological pluralism.

Section snippets

The appraisal approach

When people refer to “the” cognitive approach to emotional disorders, they usually mean the tradition inaugurated by Beck (1976). Like most psychiatrists of his generation, Beck was trained in psychoanalysis, but soon saw its limitations (Weishaar, 1993). In response to these limitations, Beck articulated a markedly influential theory and therapy for treating depression. Not only has his approach transformed the field of mood disorders, it has likewise revolutionized how people conceptualize

Critique of the appraisal approach

Despite its track record for inspiring effective treatments, the appraisal approach has provoked sharp criticism from other cognitivists. Thus, Lang (1988) argues that it rests on “an inherently limited level of discourse” (p. 221), noting that

It has the force of a good story, and does not ask us to believe in any cognitive mechanism beyond those that have been familiar to playwrights and novelists for centuries. Above all, it can be readily comprehended by the patient, whose cooperation can

Reappraising critiques of appraisal

Critiques issuing from either inside (e.g., MacLeod, 1993) or outside (e.g., Klein & Klein, 1989) the cognitive paradigm have not slowed the appraisal approach, especially in terms of treatment development. Whether therapies based on the cognitive appraisal approach will consistently outperform behavioral and pharmacologic interventions remains an open empirical question. Nevertheless, the appraisal approach has been markedly more therapeutically fruitful than has the information-processing

Conclusions

Taken together, the arguments and counterarguments about self-report, introspection, and appraisal reviewed here strongly indicate that a methodological pluralism is warranted. Sometimes self-reports are just as useless and misleading as the critics charge. But sometimes, depending on one's question, they can be precisely what is needed. If one seeks to divine a patient's beliefs, the patient's self-report is essential. Likewise, certain phenomena, such as obsessions, have no outward

Acknowledgments

This article is based on a Millennium Lecture entitled “Psychological Mechanisms of Anxiety Disorders” delivered at the meeting of the Anxiety Disorders Association of America, March 2000, in Washington DC. I thank Susan A. Clancy for her comments on a previous draft of this article

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Beginning in the 1980s, experimental psychopathologists increasingly adapted the concepts and paradigms of cognitive science to elucidate information-processing abnormalities that may figure in the etiology and maintenance of anxiety disorders. Assessment and modification of attentional biases for threat has been a major theme in this research program. The field has witnessed the development of progressively more sophisticated approaches for isolating attentional processes from other cognitive processes in the service of accurate assessment and treatment. Yet the field is now in crisis as foundational concerns about the reliability of basic measures of attentional bias for threat (ABT) have emerged. Moreover, recent research points to theoretical revisions deemphasizing ABT as a stable, near-universal feature of anxiety disorders, and stressing deficits in executive control as the primary attentional problem linked to anxiety.
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Finally, in an important extension of the metacognitive model, Exner, Martin, & Rief (2009) have shown that monitoring one's thoughts are an important cause of memory deficits common in OCD, as we discuss below. Unlike much of the research on dysfunctional beliefs and metacognition, research on cognitive deficits and information-processing biases do not rely on self-report, but rather on behavioral measures such as reaction time and neuropsychological assessment (McNally, 2001). Consequently, this line of research may reveal important etiological information about the disorder that is not readily accessible to patients' awareness.
During the past 30 years, experimental psychopathologists have conducted many studies aiming to elucidate the cognitive abnormalities that may figure in the etiology and maintenance of OCD. In this paper, we review research on both dysfunctional beliefs and cognitive deficits in OCD, as findings from both traditional self-report and information-processing approaches provide distinct sources of information concerning cognitive abnormalities. First, we discuss dysfunctional beliefs and metacognitive beliefs implicated in the disorder. Research has identified a number of maladaptive appraisals (e.g., heightened responsibility) and metacognitive beliefs (e.g., need to control one’s thoughts) that are associated with the disorder, yet these are not invariably present in all cases of OCD. Next, we review the literature on memory and attentional deficits and biases in OCD. This line of research shows inconsistent evidence for deficits in memorial and attentional processes, but does indicate that people with the disorder have memory and attention biases that may be related to metacognitive beliefs about their ability to remember and attend to stimuli. Finally, we discuss recent work that suggests that people with OCD have reduced access to internal states, thus causing them to engage in rituals to resolve persistent uncertainty. Implications and future directions are discussed.
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Cognitions and emotions are considered important determinants of eating behaviour in cognitive behavioural models of obesity. Ecological data on these determinants is still limited. The present study investigated cognitions and emotions of overweight (n = 57) and healthy-weight (n = 43) participants via Ecological Momentary Assessment.
It was found that eating-related cognitions mainly focused on desire and taste. Unexpectedly, dysfunctional cognitions (i.e., thoughts that may promote overeating) did not occur more often for overweight participants in almost all cases. So, the present EMA study provides no evidence for a role of dysfunctional cognitions in obesity-promoting eating behaviour when assessing eating-related cognitions immediately prior to eating events using a free-text format assessment.
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Ces résultats sont en contradiction avec les hypothèses découlant du modèle cognitif des troubles du comportement alimentaire. Les implications cliniques et pour de futures recherches de ces résultats sont discutés.
Memory bias for weight and shape related words was investigated in 42 young women university students. According to the eating disorders cognitive model proposed by Vitousek and Hollon, 1990 [3], women suffering from eating disorder develop self-schemas about weight and shape considered to be at the core of eating disorder pathology. Self-schemas about weight and shape appear to bias information processing with a confirmatory objective. Cognitive biases for congruent information, such as memory bias for negative information about weight and shape, are believed to be implicated in the development and maintenance of eating disorders (Williamson et al., 1999) [4]. The literature supports this cognitive model in clinical samples, with women suffering of anorexia nervosa, bulimia nervosa or binge eating disorder (McNally, 2001; King et al., 1991) [5,6]. Results, however, are inconsistent in non-clinical samples or women with subclinical eating disorders (Hunt and Cooper, 2001; Israeli and Stewart, 2001) [10,11]. These inconsistencies could be linked to the use of different methodologies to evaluate memory bias or the lack of pre-test methods for experimental material. Taking into account suggestions from previous researcher in this field, the objective of this study was to investigate whether a non-clinical sample of women with eating disorder or high body dissatisfaction demonstrate a memory bias congruent with their concerns.
Participants (n = 42) were invited to view target and control words, i.e., positive, negative and neutral words related to weight and shape and positive, negative and neutral words not related to weight and shape. They performed a self-referent encoding task during the exposition to words and recall memory was subsequently assessed. Self-report measures were taken in order to evaluate body dissatisfaction and eating behaviour.
Non-parametric statistical analysis indicated that all women demonstrated a memory bias to weight and shape related words compared to control words. Indeed, Wilcoxon test is significant (z = 2.82, P = 0.005), indicating that all women selectively recall more weight and shape related words than not related ones. On the other hand, no difference was found between groups. Indeed, Mann-Whitney T test is not significant (z = −0.57; P = 0.57), indicating that women with body dissatisfaction do not recall more weight and shape related words than women satisfied. Likewise, women suffering of eating disorders do not recall more weight and shape related words than women without eating disorder (z = −0.38: P = 0.70). Moreover, women did not recall more negative weight and shape related words (those congruent with their preoccupations) than positive or neutral ones.
These findings are in contradiction with hypothesis based on the eating disorders cognitive model (Vitousek and Hollon, 1999; Williamson et al., 1999) [3,4]. Indeed, all women demonstrated a memory bias for information related to self-schemas about weight and shape. These results suggest that the self-schema about weight and shape was activated for all women and thus available for information processing. Therefore, availability of this specific self-schema about weight and shape do not appear to be the core of eating disorders in so far as it seems to be adopted by women without body dissatisfaction or eating disorder. The preferential use of this self-schema about weight and shape by women suffering of eating disorder in information processing, instead of another self-schema, could be a factor in the development and maintenance of eating disorders. Results show also that women did not selectively recall congruent information, i.e., negative words related to weight and shape. These results could have implications for therapeutic interventions in eating disorders. Indeed, it could be relevant to target not only worries about be or becoming fat, but also the desire to be thin. Indeed, results suggest that this theme, drive for thinness, could be an important factor of vulnerability to certain women and could lead them to adopt unhealthy behaviours in order to achieve an ideally thin body. Therefore, prevention programs should target the development and assimilation of self-schemas not related to weight and shape as well as the drive for thinness.
Threat-confirming belief bias and symptoms of anxiety disorders
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Citation Excerpt :
Dysfunctional beliefs are assumed to play an important role in the acquisition and persistence of anxiety disorders (e.g., Beck, 1976; McNally, 2001).
This study tested the hypothesis that a generally enhanced threat-confirming reasoning style would set people at risk for the development of anxiety disorders. Therefore, a non-clinical student sample (N = 146) was presented with a series of linear syllogisms referring to threatening and safety themes and with the anxiety subscale of the SCL-90 and trait anxiety in order to correlate reasoning with anxiety. Half of the syllogisms' conclusions were in line and half were in conflict with generally believable threat and safety related convictions (e.g., potassium cyanide is more toxic than tylenol; The Netherlands are safer than Afghanistan). For each type of syllogism, half was logically valid and half invalid. Overall, participants showed a clear interference of believability on logical reasoning, which is known as the belief bias effect. Furthermore, in line with the idea that people are generally characterized by a better safe than sorry strategy, the pattern indicated that the participants took more time to solve invalid threat related syllogisms as well as valid safety related syllogisms. This threat-confirming belief bias was however not especially pronounced in participants reporting relatively intense anxiety symptoms. Thus, the present findings do not lend support to the idea that a generally enhanced threat-confirming belief bias is a diathesis for the development of anxious psychopathology.

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Invited essayOn the scientific status of cognitive appraisal models of anxiety disorder

Abstract

Section snippets

The appraisal approach

Critique of the appraisal approach

Reappraising critiques of appraisal

Conclusions

Acknowledgments

Cognition

Behaviour Research and Therapy

Behaviour Research and Therapy

Behaviour Research and Therapy

Cognitive Psychology

Journal of Behavior Therapy and Experimental Psychiatry

Behaviour Research and Therapy

Journal of Anxiety Disorders

Behaviour Research and Therapy

Behaviour Research and Therapy

Behaviour Research and Therapy

Caudate glucose metabolic rate changes with both drug and behavior therapy for obsessive-compulsive disorder

Archives of General Psychiatry

Cognitive therapy and the emotional disorders

Anxiety disorders and phobias

(Review of the book Verbal behavior)

Language

Matter and consciousness

A comparison of cognitive therapy, applied relaxation and imipramine in the treatment of panic disorder

British Journal of Psychiatry

A cognitive model of social phobia

Verbal reports as data

Psychological Review

Invited essay
On the scientific status of cognitive appraisal models of anxiety disorder