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Negative Automatic Evaluation and Better Recognition of Bodily Symptom Words in College Students with Elevated Health Anxiety

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Abstract

This study explored whether better recognition of symptom words is associated with stronger negative automatic evaluations of these words. We compared participants with health anxiety (HA; N = 27) to dysphoric (N = 29) and to non-health-anxious and non-dysphoric control participants (N = 28) in the Implicit Association Test (IAT) and in a word recognition task using health-threat-related, negative emotional, and neutral control words. Participants with HA made significantly more mistakes on the IAT than both other groups, in pairing the evaluation “harmless” with specific “symptoms” (p = .02, η2 = .10). Additionally, recognition performance was positively related to the IAT evaluation bias. The findings suggest that persons with HA automatically interpret symptoms as being more dangerous than the others saw them. This evaluation bias might explain the facilitation of access to symptom information in working memory that underlies cognitive biases observed in HA.

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References

  • Abramowitz, J. S., & Moore, E. L. (2007). An experimental analysis of hypochondriasis. Behaviour Research and Therapy, 45, 413–424.

    Article  PubMed  Google Scholar 

  • American Psychiatric Association (APA). (2000). Diagnostic and statistical manual of mental disorders—DSM IV—TR (4th edition, text revision). Washington, DC: American Psychiatric Association.

    Book  Google Scholar 

  • Asmundson, G. J. G., Taylor, S., Sevgur, S., & Cox, B. J. (2009). Health anxiety: Classification and clinical features. In G. J. G. Asmundson, S. Taylor, & J. Cox (Eds.), Health anxiety. Clinical and research perspectives on hypochondriasis and related conditions (pp. 3–21). Willey: Chichester.

    Google Scholar 

  • Bailer, J., & Witthöft, M. (2006). Modifizierte Kurzform des Health Anxiety Inventory (MK-HAI) von Salkovskis, Rimes, Warwick und Clark. In A. Glöckner-Rist (Ed.), ZUMA-Informationssystem. Elektronisches Handbuch sozialwissenschaftlicher Erhebungsinstrumente. Version 10.00. Mannheim: Zentrum für Umfragen, Methoden und Analysen.

  • Barsky, A. J. (2001). Somatosensory amplification and hypochondriasis. In V. Starcevic & D. R. Lipsitt (Eds.), Hypochondriasis: Modern perspectives on an ancient malady (pp. 223–248). New York: Oxford University Press.

    Google Scholar 

  • Barsky, A. J., Coeytaux, R. R., Sarnie, M. K., & Cleary, P. D. (1993). Hypochondriacal patients belief about good health. American Journal of Psychiatry, 150, 1185–1189.

    Google Scholar 

  • Bleichhardt, G., & Weck, F. (2007). Kognitive Verhaltenstherapie bei Hypochondrie und Krankheitsangst. Heidelberg: Springer.

    Google Scholar 

  • Bluemke, M., & Friese, M. (2006). Do features of stimuli influence IAT effects? Journal of Experimental Social Psychology, 42, 163–176.

    Article  Google Scholar 

  • Brosan, L., Hoppitt, L., Shelfer, L., Sillence, A., & Mackintosh, B. (2011). Cognitive bias modification for attention and interpretation reduces trait and state anxiety in anxious patients referred to an out-patient service: Results from a pilot study. Journal of Behavior Therapy and Experimental Psychiatry, 42(3), 258–264. doi:10.1016/j.jbtep.2010.12.006.

    Article  PubMed  Google Scholar 

  • Burton, C. M., Pedersen, S. L., & McCarthy, D. M. (2012). Impulsivity moderates the relationship between implicit associations about alcohol and alcohol use. Psychology of Addictive Behaviors. doi:10.1037/a0028742.

    PubMed  Google Scholar 

  • Cohen, J. (1992). A power primer. Psychological Bulletin, 112, 155–159.

    Article  PubMed  CAS  Google Scholar 

  • Creed, F., & Barsky, A. (2004). A systematic review of the epidemiology of somatisation disorder and hypochondriasis. Journal of Psychosomatic Research, 56, 391–408.

    Article  PubMed  Google Scholar 

  • De Houwer, J. (2003). The extrinsic affective simon task. Experimental Psychology, 50, 77–85.

    Article  PubMed  Google Scholar 

  • De Jong, P. J., Sportel, B. E., de Hullu, E. E., & Nauta, M. H. (2012). Co-occurrence of social anxiety and depression symptoms in adolescence: Differential links with implicit and explicit self-esteem? Psychological Medicine, 42(3), 475–484. doi:10.1017/S0033291711001358.

    Article  PubMed  Google Scholar 

  • Dolan, R. J. (2002). Emotion, cognition, and behavior. Science, 298, 1191–1194.

    Article  PubMed  CAS  Google Scholar 

  • Egloff, B., & Schmukle, S. C. (2002). Predictive validity of an Implicit Association Test for assessing anxiety. Journal of Personality and Social Psychology, 83, 1455.

    Article  Google Scholar 

  • Egloff, B., Schwerdtfeger, A., & Schmukle, S. C. (2005). Temporal stability of the Implicit Association Test–Anxiety. Journal of Personality Assessment, 84, 82–88.

    Article  PubMed  Google Scholar 

  • Fazio, R. H., & Olson, M. A. (2003). Implicit measures in social cognition research: Their meaning and uses. Annual Review of Psychology, 54, 297–327.

    Article  PubMed  Google Scholar 

  • Ferguson, E., Moghaddam, N. G., & Bibby, P. A. (2007). Memory bias in health-anxiety is related to the emotional valence of health-related words. Journal of Psychosomatic Research, 62, 263–274.

    Article  PubMed  Google Scholar 

  • Fiedler, K., Messner, C., & Bluemke, M. (2006). Unresolved problems with the ‘I’, the ‘A’, and the ‘T’: A logical and psychometric critique of the Implicit Association Test (IAT). European Review of Social Psychology, 17, 74–147.

    Article  Google Scholar 

  • Friese, M., & Fiedler, K. (2010). Being on the lookout for validity. Comment on Sriram and Greenwald (2009). Experimental Psychology, 57, 228–232.

    Article  PubMed  Google Scholar 

  • Fulton, J. J., Marcus, D. K., & Merkey, T. (2011). Irrational health beliefs and health anxiety. Journal of Clinical Psychology, 67, 527–538.

    Article  PubMed  Google Scholar 

  • Gemar, M. C., Segal, Z. V., Sagrati, S., & Kennedy, S. J. (2000). Mood-induced changes on the Implicit Association Test in recovered depressed patients. Journal of Abnormal Psychology, 110, 282–289.

    Article  Google Scholar 

  • Gräfe, K., Zipfel, S., Herzog, W., & Löwe, B. (2004). Screening psychischer Störungen mit dem “Gesundheitsfragebogen für Patienten (PHQ-D)”. Ergebnisse der deutschen Validierungsstudie. Diagnostica, 50, 171–181.

    Article  Google Scholar 

  • Green, D. M., & Swets, J. A. (1966). Signal detection theory and psychophysics. New York: Wiley.

    Google Scholar 

  • Greenwald, A. G., McGhee, D. E., & Schwartz, J. L. K. (1998). Measuring individual differences in implicit cognition: The Implicit Association Test. Journal of Personality and Social Psychology, 74, 1464–1480.

    Article  PubMed  CAS  Google Scholar 

  • Greenwald, A. G., Nosek, B. A., & Banaji, M. R. (2003). Understanding and using the Implicit Association Test: I. An improved scoring algorithm. Journal of Personality and Social Psychology, 85, 197–216.

    Article  PubMed  Google Scholar 

  • Greenwald, A. G., Poehlman, T., Uhlmann, E., & Banaji, M. R. (2009). Understanding and using the Implicit Association Test: III. Meta-analysis of predictive validity. Journal of Personality and Social Psychology, 97, 17–41. doi:10.1037/a0015575.

    Google Scholar 

  • Haenen, M.-A., de Jong, P. J., Schmidt, A. J. M., Stevens, S., & Visser, L. (2000). Hypochondriacs‘estimation of negative outcomes: domain-specificity and responsiveness to reassuring and alarming information. Behaviour Research and Therapy, 38, 819–833.

    Article  PubMed  CAS  Google Scholar 

  • Hakamata, Y., Lissek, S., Bar-Haim, Y., Britton, J., Fox, N., Leibenluft, E., et al. (2010). Attention bias modification treatment: A meta-analysis towards the establishment of novel treatment for anxiety. Biological Psychiatry, 68, 982–990.

    Article  PubMed  Google Scholar 

  • Hautzinger, M., Keller, F., & Kühner, C. (2007). Deutsche Adaptation des Beck Depressions-Inventars BDI-II. Frankfurt: Harcourt Test Services.

    Google Scholar 

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

  • Hiller, W., Rief, W., & Fichter, M. M. (2002). Dimensional and categorical approaches to hypochondriasis. Psychological Medicine, 32, 707–718.

    Article  PubMed  CAS  Google Scholar 

  • Hofman, W., Gawronski, B., Gschwender, T., Le, H., & Schmitt, M. (2005). A meta-analyses on the correlation between the Implicit Association Test and explicit self-report measures. Personality and Social Psychology Bulletin, 31, 1369–1385.

    Article  Google Scholar 

  • Inquisit 2.0.61.004.4 (2007). Computer software. Seattle, WA: Millisecond Software LLC.

  • Jasper, F., & Witthöft, M. (2011). Health anxiety and attentional bias: The time course of vigilance and avoidance in light of pictorial illness information. Journal of Anxiety Disorders, 25, 1131–1138.

    Article  PubMed  Google Scholar 

  • Kertzman, S., Vainder, M., Vishne, T., Aizer, A., Kotler, M., & Dannon, P. N. (2010). Speed-accuracy tradeoff in decision-making performance among pathological gamblers. European Addiction Research, 16(1), 23–30. doi:10.1159/000253861.

    Article  PubMed  Google Scholar 

  • Kornadt, A. E., Witthöft, M., Rist, F., & Bailer, J. (2009). Affekt-modulierte Aufmerksamkeits-Prozesse unter Arbeitsgedächtnisbelastung bei Krankheitsangst. Zeitschrift für Klinische Psychologie und Psychotherapie: Forschung und Praxis, 38, 194–202.

    Article  Google Scholar 

  • Kroenke, K., Spitzer, R. L., & Williams, J. B. W. (2001). The PHQ-9: Validity of a brief depression severity measure. Journal of General Internal Medicine, 16, 606–613.

    Article  PubMed  CAS  Google Scholar 

  • Lane, K. A., Banaji, M. R., Nosek, B. A., & Gurley, J. R. (2007). Understanding and using the Implicit Association Test: IV. What we know (so far) about the method. In B. Wittenbrink & N. Schwartz (Eds.), Implicit measures of attitudes (pp. 60–102). New York: Guilford Press.

    Google Scholar 

  • Lefaivre, M. J., Watt, M. C., Stewart, S. H., & Wright, K. D. (2006). Implicit associations between anxiety-related symptoms and catastrophic consequences in high-anxiety sensitive individuals. Cognition and Emotion, 20, 295–308. doi:10.1080/02699930500336466.

    Article  Google Scholar 

  • Longley, S. L., Watson, D., & Noyes, R. (2005). Assessment of the hypochondriasis domain: The multidimensional inventory of hypochondriacal traits (MIHT). Psychological Assessment, 17, 3–14.

    Article  PubMed  Google Scholar 

  • Looper, K. J., & Kirmayer, L. J. (2001). Hypochondriacal concerns in a community population. Psychological Medicine, 31, 577–584.

    Article  PubMed  CAS  Google Scholar 

  • Löwe, B., Kroenke, K., Herzog, W., & Gräfe, K. (2004). Brief report: Measuring depression outcome with a brief self-report instrument: Sensitivity to change of the Patient Health Questionnaire (PHQ-9). Journal of Affective Disorders, 81, 61–66.

    Article  PubMed  Google Scholar 

  • Löwe, B., Spitzer, R. L., Zipfel, S., & Herzog, W. (2002). PHQ-D, Gesundheitsfragebogen für Patienten. 2. Auflage. Manual. Komplettversion und Kurzform. Autorisierte deutsche Version des “Prime MD Patient Health Questionnaire (PHQ)”. Heidelberg: Medizinische Universitätsklinik, Pfitzer.

  • MacLeod, C., & Mathews, A. (2012). Cognitive bias modification approaches to anxiety. The Annual Review of Clinical Psychology, 8, 189–217.

    Article  Google Scholar 

  • Marcus, D. K. (1999). The cognitive-behavioral model of hypochondriasis: Misinformation and triggers. Journal of Psychosomatic Research, 47, 79–91.

    Article  PubMed  CAS  Google Scholar 

  • 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, 127–139.

    Article  PubMed  Google Scholar 

  • Mierke, J., & Klauer, K. C. (2003). Method-specific variance in the Implicit Association Test. Journal of Personality and Social Psychology, 85, 1180–1192.

    Article  PubMed  Google Scholar 

  • Nock, M., & Banaji, M. R. (2007). Assessment of self-injurious thoughts using a behavioral test. The American Journal of Psychiatry, 164, 820–823.

    Article  PubMed  Google Scholar 

  • Nosek, B. A., & Banaji, M. R. (2001). The go/no-go association task. Social Cognition, 19, 625–664.

    Article  Google Scholar 

  • Nosek, B. A., Greenwald, A. G., & Banaji, M. R. (2007). The Implicit Association Test at age 7: A methodological and conceptual review. In J. A. Bargh (Ed.), Automatic processes in social thinking and behavior (pp. 265–292). UK: Psychology Press.

    Google Scholar 

  • Noyes, R., Happel, R., & Yagla, S. (1999). Correlates of hypochondriasis in a nonclinical population. Psychosomatics, 40, 461–469.

    Article  PubMed  Google Scholar 

  • Noyes, R. J., Stuart, S., Langbehn, D. R., Happel, R. L., Longley, S. L., Muller, B. A., et al. (2003). Test of an interpersonal model of hypochondriasis. Psychosomatic Medicine, 65, 293–300.

    Article  Google Scholar 

  • Noyes, R. J., Stuart, S., Langbehn, D. R., Happel, R. L., Longley, S. L., & Yagla, S. J. (2002). Childhood antecedents of hypochondriasis. Psychosomatics, 43, 282–289.

    Article  PubMed  Google Scholar 

  • Olatunji, B., Deacon, B. J., & Abramowitz, J. S. (2009a). Is hypochondriasis an anxiety disorder? British Journal of Psychiatry, 194, 481–482.

    Article  PubMed  Google Scholar 

  • Olatunji, B. O., Wolitzky-Taylor, K. B., Elwood, L., Connolly, K., Gonzales, B., & Armstrong, T. (2009b). Anxiety sensitivity and health anxiety in a nonclinical sample: Specificity and prospective relations with clinical stress. Cognitive Therapy and Research, 33, 416–424.

    Article  Google Scholar 

  • Pauli, P., & Alpers, G. W. (2002). Memory bias in patients with hypochondriasis and somatoform pain disorder. Journal of Psychosomatic Research, 52, 45–53.

    Article  PubMed  Google Scholar 

  • Payne, B. K., Cheng, C. M., Govorun, O., & Stewart, B. D. (2005). An inkblot for attitudes: Affect misattribution as implicit measurement. Journal of Personality and Social Psychology, 89, 277–293.

    Article  PubMed  Google Scholar 

  • Pilowsky, I. (1967). Dimensions of hypochondriasis. British Journal of Psychiatry, 113, 89–93.

    Article  PubMed  CAS  Google Scholar 

  • Plamondon, R., & Alimi, A. M. (1997). Speed/accuracy trade-offs in target-directed movements. Behavioral and Brain Sciences, 20, 279–349.

    PubMed  CAS  Google Scholar 

  • Poehlmann, A., Uhlmann, E., Greenwald, A. G., & Banaji, M. R. (2005). Understanding and using the Implicit Association Test III: A meta-analysis of predictive validity. http://faculty.washington.edu/agg/pdf/IAT.Meta-analysis.16Sep05.pdf [Electronic version].

  • Rachman, S. S. (2012). Health anxiety disorders: A cognitive construal. Behaviour Research and Therapy, 50(7–8), 502–512. doi:10.1016/j.brat.2012.05.001.

    Article  PubMed  CAS  Google Scholar 

  • Ratcliff, R. (1990). Connectionist models of recognition memory: Constraints imposed by learning and forgetting functions. Psychological Review, 97, 285–308.

    Article  PubMed  CAS  Google Scholar 

  • Rief, W., Hiller, W., Geissner, E., & Fichter, M. M. (1994). Hypochondrie: Erfassung und erste klinische Ergebnisse. Zeitschrift für Klinische Psychologie, 23, 34–42.

    Google Scholar 

  • Rief, W., Hiller, W., Goebel, G., & Fichter, M. M. (1995). Zur zeitlichen Stabilität der Angaben hypochondrischer und somatoformer Symptome. Diagnostica, 41, 172–180.

    Google Scholar 

  • Rothermund, K., & Wentura, D. (2004). Underlying processes in the Implicit Association Test: Dissociating salience from associations. Journal of Experimental Psychology: General, 133, 139–165.

    Article  Google Scholar 

  • Salkovskis, P. M., Rimes, K. A., Warwick, H. M. C., & Clark, D. M. (2002). The Health Anxiety Inventory: Development and validation af scales for the measurement of health anxienty and hypochondriasis. Psychological Medicine, 32, 843–853.

    Article  PubMed  CAS  Google Scholar 

  • Spitzer, R. L., Krönke, K., & Williams, J. B. W. (1999). Validation and utility of a self-report version of PRIME-MD: The PHQ primary care study. Journal of the American Medical Association, 282, 1737–1744.

    Article  PubMed  CAS  Google Scholar 

  • Stroop, J. R. (1935). Studies of interference in serial verbal reactions. Journal of Experimental Psychology, 18, 643–662.

    Article  Google Scholar 

  • Taylor, S., & Asmundson, G. J. G. (2004). Treating health anxiety. A cognitive-behavioral approach. New York: The Guilford Press.

    Google Scholar 

  • Teachman, B. A., Gregg, A. P., & Woody, S. R. (2001). Implicit associations for fear-relevant stimuli among individuals with snake and spider fears. Journal of Abnormal Psychology, 110, 226–235. doi:10.1037/0021-843X.110.2.226.

    Article  PubMed  CAS  Google Scholar 

  • Warwick, H. M. C., & Salkovskis, P. M. (1990). Invited essay. Hypochondriasis. Behavior Research and Therapy, 28, 105–117.

    Article  CAS  Google Scholar 

  • Weck, F., Bleichhardt, G., & Hiller, W. (2009). Stellen Erfahrungen mit Krankheit einen spezifischen Risikofaktor für Krankheitsängste dar? Zeitschrift für Klinische Psychologie und Psychotherapie, 38, 89–99.

    Article  Google Scholar 

  • 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, 317–325.

    Article  Google Scholar 

  • Weck, F., Neng, J. M. B., Richtberg, S., & Stangier, U. (2012a). The restrictive concept of good health in patients with hypochondriasis. Journal of Anxiety Disorders, 26, 792–798.

    Article  PubMed  Google Scholar 

  • Weck, F., Neng, J. M. B., Richtberg, S., & Stangier, U. (2012b). Dysfunctional beliefs about symptoms and illness in patients with hypochondriasis. Psychosomatics, 53, 148–154.

    Article  PubMed  Google Scholar 

  • Wickelgren, W. A. (1977). Speed-accuracy tradeoff and information processing dynamics. Acta Psychologica, 41, 67–85.

    Article  Google Scholar 

  • Williams, P. G. (2004). The psychopathology of self-assessed health: A cognitive approach to health anxiety and hypochondriasis. Cognitive Therapy and Research, 28, 629–644.

    Article  Google Scholar 

  • Witthöft, M., Haaf, A., Rist, F., & Bailer, J. (2010). Erfassung von Krankheitsangst mit dem Multidimensional Inventory of Hypochondriacal Traits (MIHT). Diagnostica, 56, 2–12.

    Article  Google Scholar 

  • 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, 818–842.

    Article  Google Scholar 

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Authors and Affiliations

  1. Department of Quality Management and Social Medicine, University Freiburg—Medical Center, Albert-Ludwigs-Universität/Universitätsklinikum Freiburg, Engelbergerstraße 21, Freiburg, 79106, Germany

    Erika Schmidt

  2. Johannes Gutenberg-Universität, Mainz, Germany

    Michael Witthöft

  3. Friedrich-Schiller-Universität, Jena, Germany

    Anna Kornadt

  4. Westfälische Wilhelms-Universität, Münster, Germany

    Fred Rist

  5. Zentralinstitut für Seelische Gesundheit, Mannheim, Germany

    Josef Bailer

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  1. Erika Schmidt
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Correspondence to Erika Schmidt.

Appendix

Appendix

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Table 2 Words in Implicit Association Test (IAT)
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Table 3 Words in recognition task
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Table 4 Signal-detection-theory-based presentation of recognition task responses and of calculating d′
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Schmidt, E., Witthöft, M., Kornadt, A. et al. Negative Automatic Evaluation and Better Recognition of Bodily Symptom Words in College Students with Elevated Health Anxiety. Cogn Ther Res 37, 1027–1040 (2013). https://doi.org/10.1007/s10608-013-9540-5

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