Cognitive mechanisms and resilience in UK-based general practitioners: cross-sectional findings.

BACKGROUND: Being a general practitioner (GP) is a stressful occupation, and the strain GPs are under can have negative effects on their psychological well-being, as well as on the patients' experience of healthcare. Resilience can help buffer against this and is a dynamic process by which one can cope with adversity and stress. AIMS: This study aimed to identify modifiable cognitive mechanisms related to resilience in GPs, specifically interpretation bias and cognitive reappraisal. METHODS: One hundred and fourteen GPs completed an online cross-sectional correlational study. This comprised questionnaires assessing resilience, emotional distress, work environment and cognitive mechanisms (emotion regulation), as well as a task assessing interpretation bias. RESULTS: Resilience of GPs was negatively correlated with measures of emotional distress. Furthermore, resilience was positively correlated with positive interpretation bias (r = 0.60, ρ = 0.60, P < 0.01) and cognitive reappraisal (r = 0.39, ρ = 0.40, P < 0.01). In a hierarchical regression, positive interpretation bias (B = 0.25, SE B = 0.06, ß = 0.39, P < 0.01) was a significant independent predictor of resilience when controlling for depression, anxiety and stress. CONCLUSIONS: This is the first study to establish an association between resilience and positive interpretation bias and cognitive reappraisal in GPs. Future research should use longitudinal designs to determine if they have a causal role in promoting resilience, and importantly whether interventions focusing on these processes may foster resilience in less resilient GPs.

An attention and interpretation bias for illness-specific information in chronic fatigue syndrome.

BACKGROUND: Studies have shown that specific cognitions and behaviours play a role in maintaining chronic fatigue syndrome (CFS). However, little research has investigated illness-specific cognitive processing in CFS. This study investigated whether CFS participants had an attentional bias for CFS-related stimuli and a tendency to interpret ambiguous information in a somatic way. It also determined whether cognitive processing biases were associated with co-morbidity, attentional control or self-reported unhelpful cognitions and behaviours. METHOD: A total of 52 CFS and 51 healthy participants completed self-report measures of symptoms, disability, mood, cognitions and behaviours. Participants also completed three experimental tasks, two designed specifically to tap into CFS salient cognitions: (i) visual-probe task measuring attentional bias to illness (somatic symptoms and disability) v. neutral words; (ii) interpretive bias task measuring positive v. somatic interpretations of ambiguous information; and (iii) the Attention Network Test measuring general attentional control. RESULTS: Compared with controls, CFS participants showed a significant attentional bias for fatigue-related words and were significantly more likely to interpret ambiguous information in a somatic way, controlling for depression and anxiety. CFS participants had significantly poorer attentional control than healthy individuals. Attention and interpretation biases were associated with fear/avoidance beliefs. Somatic interpretations were also associated with all-or-nothing behaviour and catastrophizing. CONCLUSIONS: People with CFS have illness-specific biases which may play a part in maintaining symptoms by reinforcing unhelpful illness beliefs and behaviours. Enhancing adaptive processing, such as positive interpretation biases and more flexible attention allocation, may provide beneficial intervention targets.

A systematic review of the literature on interpretation bias and its physiological correlates.

An important, yet under-explored area of interpretation bias research concerns the examination of potential physiological correlates and sequalae of this bias. Developing a better understanding of the physiological processes that underpin interpretation biases will extend current theoretical frameworks underlying interpretation bias, as well as optimise the efficacy of cognitive bias modification for interpretation (CBM-I) interventions aimed at improving symptoms of emotional disorders. To this end, systematic searches were conducted across the Web of Science, PsycInfo and Pubmed databases to identify physiological markers of interpretation bias. In addition, grey literature database searches were conducted to compliment peer-reviewed research and to counter publication bias. From a combined initial total of 898 records, 15 studies were included in qualitative synthesis (one of which was obtained from the grey literature). Eligible studies were assessed using a quality assessment tool adapted from the Quality Checklist for Healthcare Intervention Studies. The searches revealed seven psychophysiological correlates of interpretation bias, namely event-related potentials, heart rate and heart rate variability, respiratory sinus arrythmia, skin conductance response, pupillometry, and electromyography. The respective theoretical and practical implications of the research are discussed, followed by recommendations for future research.

A preliminary investigation of schematic beliefs and unusual experiences in children.

BACKGROUND: In cognitive models of adult psychosis, schematic beliefs about the self and others are important vulnerability and maintaining factors, and are therefore targets for psychological interventions. Schematic beliefs have not previously been investigated in children with distressing unusual, or psychotic-like, experiences (UEDs). The aim of this study was firstly to investigate whether a measure of schematic beliefs, originally designed for adults with psychosis, was suitable for children; and secondly, to examine the association of childhood schematic beliefs with internalising and externalising problems and with UEDs. METHOD: Sixty-seven children aged 8-14 years, with emotional and behavioural difficulties, completed measures of UEDs, internalising (depression and anxiety), and externalising (conduct and hyperactivity-inattention) problems, together with the Brief Core Schema Scales (BCSS). RESULTS: The BCSS was readily completed by participants, and scale psychometric properties were good. Children tended to view themselves and others positively. Internalising and externalising problems and UEDs were all associated with negative schematic beliefs; effect sizes were small to medium. CONCLUSIONS: Schematic beliefs in young people can be measured using the BCSS, and negative schematic beliefs are associated with childhood psychopathology and with UEDs. Schematic beliefs may therefore form a useful target in psychological interventions for young people with UEDs.

Impaired positive inferential bias in social phobia.

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.

Negative self-imagery blocks inferences.

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.

Life review of an older adult with memory difficulties.

The natural life review process involves emotional processing of events from the individual's past. Life review therapy (LRT) addresses issues regarding unresolved conflicts, guilt and resentment which the client has particular difficulty in reviewing independently. People with memory problems may have difficulty mentally manipulating a number of pieces of information at the same time. Since LRT involves recollection of past experiences (events, emotions and relationships) which need to be processed and integrated with the person's current understanding, individuals with memory problems may find this process difficult, though not impossible. This article is written in order to demonstrate that LRT can be useful for people with memory difficulties, provided that individual sessions are tailored to their particular cognitive abilities. A case is presented of an older adult, with above-average intellectual abilities, who became distressed when recollecting her childhood. LRT was conducted in a manner that took account of the memory difficulties and utilized a variety of therapeutic techniques. LRT was beneficial for this client despite her memory difficulties, since, following therapy, she was no longer distressed when thinking about her childhood.