Cognitive Processing in Anxiety Disorders

We investigate how biases in cognitive processes contribute to the onset and persistence of anxiety problems and whether it is important to change these processes in order to ameliorate anxiety. Our lab approaches these questions with theoretical and experimental psychopathology approaches. These approaches fall into four areas (outlined below):

1) Change in cognitive processes related to fear and anxiety

2) Activation of cognitive biases and their prediction of fear and other biases

3) Developmental factors in the role of cognitive processing in anxiety

4) Causal role of cognitive biases in changing fear

1. Change in cognitive processes

We study how automatic fear associations and other information processing biases change over the course of treatment. We first examined this question by looking at change in automatic cognitive processes following cognitive behavioral therapy for specific phobia, and work is ongoing in a treatment study for body dysmorphic disorder. Most notably, we have extended this question to the area of panic disorder to determine whether the trajectories of change in cognitive processes predict symptom reduction as hypothesized in cognitive models of anxiety. In this recent work, we used intensive, repeated assessments and advanced growth curve modeling techniques. By administering a battery of cognitive bias measures every three weeks during treatment, we can ask new questions about the time course of change so that we can determine whether cognitive change really precedes and predicts symptom reduction. These questions are important because currently we are able to help many people with anxiety treatments, but numerous individuals still do not benefit, and we do not know why some people improve while others continue to struggle. The goal of this work is to determine if change in automatic cognitive processing can help explain why the treatments work, and perhaps more importantly, why the treatments sometimes fail.

Representative Publications

Teachman, B. A., Smith-Janik, S. B., & Saporito, J. (2007). Information processing biases and panic disorder: Relationships among cognitive and symptom measures. Behaviour Research and Therapy, 45, 1791-1811.

Teachman, B. A. (2005). Information processing and anxiety sensitivity: Cognitive vulnerability to panic reflected in interpretation and memory biases. Cognitive Therapy and Research, 29, 483-503.

Teachman, B. A., & Woody, S. (2004). Staying tuned to research in implicit cognition: Relevance for clinical practice with anxiety disorders. Cognitive and Behavioral Practice, 11, 149-159.

Teachman, B. A., & Woody, S. (2003). Automatic processing among individuals with spider phobia: Change in implicit fear associations following treatment. Journal of Abnormal Psychology, 112, 100-109.

Teachman, B. A., Gregg, A., & Woody, S. (2001). Implicit processing of fear-relevant stimuli among individuals with snake and spider fears. Journal of Abnormal Psychology, 110, 226-235.

2. Activation of cognitive biases

In addition to looking at change processes, we examine how cognitive biases are activated, and differentially predict fear, avoidance and other biases. For instance, in obsessive-compulsive disorder (OCD) we have examined how beliefs about thought suppression and thought-action fusion exacerbate obsessional symptoms. Among individuals with specific fears and with social phobia, we are investigating implicit and explicit memory biases in the context of state anxiety and disgust provocations. We also examine how fear cognitions among ethnic minority groups vary in response to anxiety provocations.

Most recently, we are investigating how cognitive biases are related to other biases associated with fear. In collaboration with Drs. Dennis Proffitt and Jeanine Stefanucci, we are evaluating how fear is related to perceptual biases (e.g., how acrophobia is associated with overestimating heights while looking off a balcony), and the relationship of perceptual biases to cognitive biases. This line of work is important to establish the real-world implications of biased cognitive processing - to show that it predicts the symptoms, such as avoidance, that impair anxious individuals. Moreover, by distinguishing perceptual and cognitive biases, we can determine whether fear is associated with distortions in the ways people actually see, as well as interpret, their world.

Representative Publications

Smith-Janik, S., & Teachman, B. A. (in press). Impact of priming on explicit memory in spider fear. Cognitive Therapy and Research.

Magee, J. C., & Teachman, B. A. (in press). Why did the white bear return? Obsessive-compulsive symptoms and attributions for unsuccessful thought suppression. Behaviour Research and Therapy.

Gordon, T. L., & Teachman, B. A. (in press). Ethnic group differences in affective, behavioral, and cognitive markers of anxiety. Journal of Cross-Cultural Psychology.

Clerkin, E. M., & Teachman, B. A. (in press). Perceptual and cognitive biases in individuals with body dysmorphic disorder symptoms. Cognition and Emotion.

Teachman, B. A. (2007). Evaluating implicit spider fear associations using the Go/No-go Association Task. Journal of Behavior Therapy and Experimental Psychiatry, 38, 157-167.

Teachman, B. A. (2006). Pathological disgust: In the thoughts, not the eye, of the beholder. Anxiety, Stress and Coping, 19, 335-351.

Woody, S., & Teachman, B. A. (2000). Intersection of disgust and fear: Normative and pathological views. Clinical Psychology: Science and Practice, 7, 291-311.

3. Developmental factors

We also integrate developmental approaches to better understand how cognitive processes relate to trajectories of anxiety symptoms across the lifespan. In younger samples, we have worked on evaluations of OCD in children, the longitudinal prediction (by implicit fear associations) of social anxiety symptoms in adolescents, and information-processing biases in children with spider fears. In addition, we are evaluating the fit of cognitive models of anxiety in older adulthood, including trying to understand how age-related changes in cognitive processing and worry (e.g., worries about cognitive decline) influence the expression and regulation of anxiety . Further, we are currently starting a line of studies to evaluate the nature of intrusive thoughts and their link to anxiety problems in older adults. At both ends of the age spectrum, understanding how cognitive processing and anxiety function differently as a result of developmental differences is critical to prevent the onset of anxiety problems in young persons, promote successful aging and reduce the morbidity and mortality associated with anxiety in older persons.

Representative Publications

Teachman, B. A. (2007). Linking obsessional beliefs to OCD symptoms in older and younger adults. Behaviour Research and Therapy, 45 , 1671-1681 .

Teachman, B. A., & Allen, J. P. (2007). Development of social anxiety: Social interaction predictors of implicit and explicit fear of negative evaluation. Journal of Abnormal Child Psychology, 35, 63-78.

Teachman, B. A., Siedlecki, K. L., & Magee, J. (2007). Aging and symptoms of anxiety and depression: Structural invariance of the tripartite model. Psychology and Aging, 22 , 160-170.

Teachman, B. A. (2006). Aging and negative affect: The rise and fall and rise of anxiety and depression symptoms. Psychology and Aging, 21, 201-207.

4. Causal role of cognitive biases in changing fear

Finally, we are examining the causal link between changes in cognitive biases and fear reduction. With the advent of new techniques in cognitive science, we can test information-processing models of etiology more directly. For instance, we trained interpretation biases away from threat cues to decrease fear responding among high fear and phobic samples, and we are currently examining how training less threatening implicit associations can reduce social anxiety symptoms. We have also used experimental manipulations to increase or decrease cognitive biases to determine their impact on anxiety symptoms (e.g., in OCD, we shifted beliefs about the importance and immorality of intrusive thoughts. These demonstrations are significant because they permit evaluation of the causal (rather than simply correlational) claims that underlie cognitive theories of anxiety, and also because they offer promise for new interventions to help the many people who do not respond to currently available treatments.

Representative Publications

Teachman, B. A., & Addison, L. M. (in press). Training interpretation biases away from threat in spider fear. Cognitive Therapy and Research.

Teachman, B. A., & Clerkin, E. M. (2007). Obsessional beliefs and the implicit and explicit morality of intrusive thoughts. Cognition and Emotion, 21, 999-1024.

Teachman, B. A., Woody, S. R., & Magee, J. (2006). Implicit and explicit appraisals of the importance of intrusive thoughts. Behaviour Research and Therapy, 44 , 785-805.

These research endeavors are all designed to help address the fundamental question of why individuals with anxiety disorders interpret their environment in such a threatening way, and test approaches to reduce these maladaptive interpretations. Our lab integrates tools and perspectives from other fields, such as social cognition and perception, to investigate clinical phenomena in unique and externally valid ways. Further, the work is designed to be translational in terms of using basic science experimental approaches in applied ways. We are driven by a desire to understand how and why people think differently when they are anxious so that we can help change this biased thinking to relieve the suffering associated with anxiety disorders.

Clinical Applications of Stigma Research

Building from the social cognition literature and our understanding of how to modify negative beliefs and attitudes about stigmatized groups, we are examining how automatic biases affect clinical populations. Related investigations include implicit biases against persons with mental illness from the perspective of both healthy populations and persons with severe mental illness, and consideration of how these biases prevent clinical populations from seeking treatment. In addition, we have applied the study of automatic biases to obese populations to evaluate how anti-fat biases can be altered, and the impact of these biases among health professionals.

Representative Publications:

Teachman, B. A., Wilson, J., & Komarovskaya, I. (2006). Implicit and explicit stigma of mental illness in diagnosed and healthy samples. Journal of Social and Clinical Psychology, 25, 75-95.

Teachman, B. A., Gapinski, K., Brownell, K., Rawlins, M., & Jeyaram, S. (2003). Demonstrations of implicit anti-fat bias: The impact of providing causal information and evoking empathy. Health Psychology, 22, 68-78.

Teachman, B. A., & Brownell, K. (2001). Implicit anti-fat bias among health professionals: Is anyone immune? International Journal of Obesity, 25, 1-7.