Concreteness of thoughts and images during suppression and expression of worry.

The avoidance theory of worry (Borkovec, Alcaine, & Behar, 2004) posits that the verbal-linguistic (versus imagery-based) nature of worry elicits abstract (versus concrete) processing, which inhibits affective responding and generates a host of negative consequences. Although suppression of worrisome thinking is maladaptive (Purdon, 1999), expression of worry using vivid imagery may increase concreteness of worrisome thinking and facilitate more adaptive emotional responding. The present study examined whether the valence, content, and expression of mentation impacts concreteness of thought. Participants (N = 62) were randomly assigned to verbalize their thoughts while engaging in either verbal-linguistic- or imagery-based mentation about both worrisome and neutral topics. Participants were also randomly assigned to engage in a 5-min period of suppressing or expressing the target stimuli before engaging in 5-min of freely expressing the targets. Verbalizations of mental content were coded for level of abstractness/concreteness. For neutral stimuli, imagery-based mentation led to greater concreteness than did verbal-linguistic mentation; however, for worrisome stimuli, imagery-based mentation did not enhance concreteness. In addition, for neutral (but not worrisome) stimuli, an initial period of suppression was associated with increased concreteness during subsequent expression. Imagery-based mentation about worrisome stimuli may not enhance concreteness; moreover, unlike suppression of neutral stimuli, suppression of worrisome stimuli may maintain, rather than ameliorate, abstractness of thought.

The effects of a randomized trial of brief forms of stress management on RAGE-associated S100A8/A9 in patients with breast cancer undergoing primary treatment.

BACKGROUND: Women with breast cancer (BCa) experience heightened distress, which is related to greater inflammation and poorer outcomes. The s100 protein family facilitates the inflammatory response by regulating myeloid cell function through the binding of Toll-like receptor 4 and the receptor for advanced glycation end products (RAGE). The heterodimer s100A8/A9 RAGE ligand is associated with hastened tumor development and metastasis. Previously, a 10-week stress-management intervention using cognitive behavioral therapy (CBT) and relaxation training (RT) was associated with less leukocyte inflammatory gene expression in patients with BCa; however, its impact on s100A8/A9 was not examined. Because a 10-week intervention may be impractical during primary treatment for BCa, the authors developed briefer forms of CBT and RT and demonstrated their efficacy in reducing distress over 12 months of primary treatment. Here, the effects of these briefer interventions were tested effects on s100A8/A9 levels over the initial 12 months of BCa treatment. METHODS: Postsurgical patients with BCa (stage 0-IIIB) were randomized to a 5-week, group-based condition: CBT, RT, or health education control (HE). At baseline and at 12 months, women provided sera from which s100A8/A9 levels were determined using any enzyme-linked immunosorbent assay. RESULTS: Participants (mean age ± standard deviation, 54.81 ± 9.63 years) who were assigned to either CBT (n = 41) or RT (n = 38) had significant s100A8/A9 decreases over 12 months compared with those who were assigned to HE (n = 44; F[1,114]  = 4.500; P = .036) controlling for age, stage, time since surgery, and receipt of chemotherapy or radiation. Greater increases in stress-management skills from preintervention to postintervention predicted greater reductions in s100A8/A9 levels over 12 months (ß = -0.379; t[101]  = -4.056; P < .001). CONCLUSIONS: Brief, postsurgical, group-based stress management reduces RAGE-associated s100A8/A9 ligand levels during primary treatment for BCa.

The Effects of Worry and Relaxation on Flexibility During Cognitive Restructuring.

Worry is associated with inflexibility in cognitive, emotional, and physiological functioning. In addition, worry's negative valence and abstract level of construal are rigid characteristics that contribute to its nonadaptive consequences. Relaxation and cognitive therapy aim to increase flexibility in chronic worriers, and may have greater efficacy when administered in combination. We examined the extent to which relaxation enhances and/or worry inhibits cognitive flexibility during a cognitive restructuring exercise in which participants generated alternative predictions for their worries. Participants ( n = 189) were randomly assigned to engage in relaxation, worry, or neutral thinking prior to cognitive restructuring. We measured the number and perceived likelihood of alternative predictions generated by participants, and coded those alternative predictions for their degree of positive valence, negative valence, and level of construal (abstractness to concreteness). Worry and relaxation did not lead to different numbers or perceived likelihood of alternative predictions. However, compared with participants with minimal symptoms of generalized anxiety disorder (GAD), those with elevated symptoms of GAD who engaged in prior worry generated alternative predictions characterized by greater negative valence and more abstractness (i.e., less concreteness). We also found that greater negative valence of alternative predictions was associated with more abstractness, whereas greater positive valence of alternative predictions was associated with more concreteness. These findings suggest that after engaging in worry, individuals with GAD may be less able to flexibly shift from the use of nonadaptive characteristics (negative valence, abstractness) associated with feared outcomes to the use of more adaptive characteristics (positive valence, concreteness) when considering alternative predictions.