L9: Intrusive thinking

Question 1

What are intrusive thoughts?

Answer 1

• classic: any distinct, identifiable cognitive event that is unwanted, unintended, and recurrent. interrupts flow of though & task perf, is associated w negative affect, and is difficult to control
• brief: conscious involuntary, unwanted thought
• not always unwanted so better def: interruptive, salient, experienced mental events

Question 2

What is the typical content of intrusive thoughts?

Answer 2

• past & future emotionally salient events
• unsolved problems/tasks
• uncertain events
• dissonant facts, events, or beliefs in your life
• frequent stimuli (earworms)
• images (representation & the accompanying experience of sensory info without a direct external stimulus (seeing somethign in your mind that isnt actually there, but can also be in other ways like you hear in your mind, or smell, or taste ex: Proust’s madeleine), here & now quality, strong link to emotions: intrusions often take this form

Question 3

How can intrusive thoughts be triggered?

Answer 3

seem to come out of nowhere, but usually triggered by associated cues & can be mediated by availbaility of control resources (lack of sleep, stress, intoxication etc) to resist unwanted intrusions
external cues: sight, sounds, smells (can bring up intrusive memories, a type of intrusive thoughts)
internal cues: mood/physiology (mood-congruent intrusive thoughts)

Question 4

What are some reasons why people would want to exclude intrusions from awareness? Situations when we want to gain control over them

How do intrusions interfere with daily life

Answer 4

its about the moment when they appear, not the content, that makes it interfere with daily life. some situations
1. for concentration during tasks
2. When executing high performance cognitive and motor skills (for ex for atheletes)
3. When regulating pain (we want to control intrusions about the pain itself in order to cope w it)
4. When regulating affect (some intrusions elicit strong emotions so to regulate those emotions we want to control the thoughts)
5. When **persisting in the face of failure ** (some intrusions can be repetitively about past failures, so in order to move forward we need to control those thoughts)
6. To protect self image
7. To justify inappropriate behaviour
8. To maintain attitudes & beliefs (for ex if ur religious u want to control intrusions about doubts on god)
9. To forgive others & maintain attachment (suprress intrusions about a conflict for ex)

Question 5

What is the difference between intrusive memory & intrusive thought?

Answer 5

related but different
memory: about something that already happened
thought: something that you imagine

Question 6

What is the differences between involuntary memories/thoughts and intrusive memories/thoughts?

Answer 6

intrusive ones are INTERRUPTIVE and SALIENT, they distract you and take your attention

Question 7

Is mind wandering an everyday manifestation of intrusive thinking?

Answer 7

• though often unwanted/interfering, it does contribute to progress on other problems
• its unintended (we are often not aware that were doing it)
• althought it happens 50% of the day, the content varies a lot, so its kinda/kinda not recurrent
• not always associated with negative affect
• depends on person whether they think its difficult to control
  -> so mind wandering is often, but not always, a form of everyday intrusive thought

Question 8

How do intrusions manifest in different mental disorders?

Answer 8

high prevalence in clinical samples
OCD, panic disorder, healthy anxiety, social anxiety, eating disorder, psychosis etc: intrusive thoughts (on future, hypothetical catastrophic outcomes, or different realityà
PTSD, depression: intrusive memory on past events (very common after trauma)

Question 9

What are the main manifestations of intrusive thinking in PTSD?

Answer 9

• intrusive memories (recurrent, unwanted, involuntary, and distressing memories of a traumatic event)
• flashbacks: reliving the traumatic event viscerally, as if it were happpening again
• upsetting dreams/nightmares about a traumatic event
• severe emotional distress/physical reactiosn to cues that remind an individiual of the event

intrusive memories & flashbacks often precipitated by environmental cues that remind individual of trauma

Question 10

What characterises intrusive memories of trauma?

Answer 10

• very common after trauma
• sensitive but not specific predictor of later PTSD dev
• usually involve sensory experiences (sounds, visuals, thoughts etc)
• drive other symptoms (evoke distress, cogntivie avoidance, hypervigilance etc)

Question 11

What characterises intrusive thoughts in OCD?

Answer 11

• in OCD, “intrusive” means feeling “of being out of control”
• OCD worsen over time because of amplifying interaction between the intrusive events eliciting responses and the response amplifying the intrusive event
• often ego-dystonic & cause anxiety
• Reflection of resistance of intrusive thoughts reinforces their frequency & strength, leading to obsessionality
• Obsessionality is characterized by the inability to shift focus away from intrusive thoughts
• Compuslivity involves being forced to think about intrusive thoughts contrary to one’s willpower
• Obsessions -> compulsions which temporarily reduce anxiety but ultimatly become intrusive themselves
• intrusive thoughts can become so overwhelming that reality testing is disturbed

Question 12

What characterizes intrusive thinking in Substance Use Disorder?

Answer 12

• related to drug use
• initally may be seen as non-intrusive/pleasurable, but as disease progresses, become perceived as intrusions
• can arise during acute withdrawal or long after last consumption
• can lead to relapse or continued drug use

Question 13

What characterizes intrusive thinking in mood disorders?

Answer 13

• not core feature, but can play role
• rumination (in depression) involves repetitive focusing on personal shortcomings & mistakes, often interrupting other takss & contributing to symptoms
• suicidal thoughts may involve intrusive imagery (which can be unwanted & interruptive)
• negative automatic thoughts (becks cogntivie model) are fast interpretations triggered by events that reinforce negative beliefs
• manic episodes in bipolar may feature flight of ideas, characterized by rapid/unrelated thoguths, sometimes experiences as loss of control

Question 14

What characterizes intrusive thinking in anxiety disorders?

Answer 14

2 types of anxiety: anxiety arousal (panic) & anxious apprehension (worry)
in arousal
- intrusions on objects & somatic symptoms
in apprehension
- intrusions on future events, ways to avoid fear, potential harm associated w event
- may experience distress due to intolerance of uncertaintly
general
- may recognise unrealistic nature of their fears -> distress & additional intrusive thoughts related to self-evaluation
- future oriented intrusions

Question 15

What characterizes intrusive thinking in psychosis?

Answer 15

delusions not perceived as interruptive / egodystonic so not seen as intrusions

Question 16

What characterizes intrusive thinking in ADHD?

Answer 16

• classification of distracting thoughts as intrusions is debated
• to external observers, these internal thoughts may appear disruptive/maladaptive
• internal thoughts in ADHD less salient, less specific, and less unwanted than in other disorders
• but excessive disruptive mind wandering
• the low treshold for distraction in ADHD may render concept of intrusions irrelevant (cause mindwandering is default mode)

Question 17

What are the debated features that define intrusive thinking

Answer 17

• Conscious thought: typically yes, but confuse w term meta consciousness. so prefer term “experienced mental events” over “conscious thought”
• Unwantedness/desirability: debatable whether they are always unwanted so want a more specific term
• Involuntary/unwanted: debated, so use term involuntary only in narrow def
• Disruptiveness: yes always (though person themselves might not see that in the moment)
• Salience: capture attention always
• Valence: they are not always unpleasant!, they are salient but not negative in valence
• Content & Shape: not defining faeature since can take so many forms
• Punctate vs Extended: debatable whether extended processes should be labeled as intrusive
• Recurrence: frequency def matters in defining intrusions (especially to see if they are clinical)
• Trigger: sig interruption when trigger observed
• Agency: yes needed in def, since thoughts must be attribtued to onesefl rather than external agency

Question 18

What are some other mental disorders w intrusive thoughts and how do they manifest?

Answer 18

• substance use disorder (craving)
• mood disorders (rumination, flash forward)
• anxiety (worry)
• bipolar disorder (flash forward)
• psychosis (hallucinations, thought insertions)
• ADHD (impulsive action, inattion, mind wandering)

Question 19

What makes intrusions clinical/problematic?

Answer 19

frequency, intensity/vividness/distress, avoidance (including dissociation) resulting from the distress, maladaptive reappraisal (how you interpret them, if you think youre going crazy or immoral, or general thought-action fusion)

Question 20

What is thought-action fusion?

Answer 20

thinking that having a certain intrusive thought makes the action more likely
makes OCD dev more likely

Question 21

How can we study intrusive thoughts?

Answer 21

• experience/thought sampling (ex: indicate whenever they have an intrusion they need to report it)
• trauma film paradigm
• think/no think paradigm

Question 22

What is the trauma film paradigm?

Answer 22

when we want to have a lot of control about the event related to the intrusive thoughts. we show ppl distressing clips & then ask them to write down all related intrusive thoughts in a diary for a week. then do a VOLUNTARY memory task & compare. see what is stored in long term memory or not etc (cognitive theories of PTSD)

Question 23

What is the think/no think paradigm?

Answer 23

based on cognitive theories of intrusive thinking
associative learning task where during learning condition you learn associations between a word and a picture in 3 different conditins and in 2nd phase, word is presented again and you’re either asked to think of associated pic (think) or to block thoughts of the associated pic (no think, retrieval suppression) or word is not presented at all.
results
- no think condition makes intrusions less likely & makes voluntarily retrieving the memory of the pic harder as well
-> this is why you need to keep exposing yourself to cues (like the word) that remind you of the trauma, because we get better at suppressing the associated image

Question 24

What are the misconceptions about retrieval suppression?

Answer 24

• its not the white bear supprssion (checking whether you are not thinking about a specific thought), its more general, youre suppressing the retrieval of something related to the word, not the actual word
• not expressive suppression (mainly motor control, “poker face”)
• not (cognitive) avoidance (of reminders, “not dealing with problem”)
• not general distraction (avoiding)

Question 25

What are the pros and cons of think/no think paradigm?

Answer 25

pros
- control over event & prei trauma factors
- golden standard for accuracy of memory, which allows for comparison to measures of voluntary recall
- control over timing of intrusion (ideal for concurrent neural/physio assessments)
- clear inference of involuntariness (participants are instructed to suppress, but sometimes fail)
cons
- requires meta-awareness
- demand bias? (participants are instructed to suppress)
- low ecological validity

Question 26

What do the cognitive theories of intrusive thinking say?

Answer 26

poor cognitive control leads to involuntary retrievals of past & imagined events (normally cognitive control leads to retrieval suppression)
- insufficient inhibition of hippocampus & amygdala
- lack of sleep & pre-existing conditions can worsen this, creating a vicious cycle

Question 27

What are the pros and cons of the trauma film paradigm?

Answer 27

pros:
- control over event & peri trauma factors
- golden standard for accuracy of memory, which allows comparison intrusive thoughts w voluntary recall
- relatively high ecological validity
cons:
- requires meta-awarenss
- film only a proxy for trauma
- no control over timing of intrusions
- involuntariness diffuclt to verify

(diary is form of experience sampling in real-life setting)

Question 28

What is the cognitive theories of PTSD?

Trauma hotspots

Answer 28

overwhelming stress -> over-consolidation of perceptual aka sensory elements, which impairs integration with contextual features in autobio memory
these elements that are overconsolidated are also called “hotspots” of trauma memories
they are loose, sensory fragments, often of the worst moments, that are poorly integrated w other episodic info and just pop up

Question 29

How can we study trauma hotspots emerge?

Answer 29

show ppl distressing videos & ask what they think would be most likely to bring intrusions & neuroimaging

Question 30

What are the pros and cons of experience/thought sampling?

Answer 30

pros:
- “naturally” occuring intrusions
- translation from lab to real life

cons:
- requires meta awareness, which can be compromised in clinical pop (might not realize immediately that you had an intrusion)
- in healthy pop, the concept of intrusions is quite abstract so might not know what to detect
- no control over event factors (in case of intrusions relating to past events)
- no control over timing of intrusion (so person might not have any intrusions while in the lab)
- involuntariness difficult to verify (hard to know whether it was really involuntary thoughts)

Question 31

Why do we have intrusive thoughts?

Answer 31

• to guide future behaviour, so as a warning signal (remembering past catastrophes, simulating future scenarious to assess danger)
• epiphenomenon? as in its just a by product of whatever we’re processing
• to process salient experiences -> intrusions as a window of opportunity to modify or process a memory during reconsolidation maybe
• as a conditioned response (neutral stimulus (CS) triggers intrusions of aversive outcome (US), when intrusions are excessive or fail to extinguish -> clinical)
• to help us understand incopllete tasks

Question 32

How does long term memory underlie intrusive thinking?

Answer 32

• intrusions often have contents related to info in the long term memory (both autiobio memories & imagined fear events)
• intrusions about encoded content can be seen as involuntary retrieval
• instrusive memories may be stronger or worse memories

for interventions
- focus on encoding (eg encoding suppression, or retreiveal (eg memory modification) processes)

Question 33

What influences how intrusive an emotional memory will be?

Answer 33

• processes during & after the time of encoding
• emotional intensity (can be reduced using control processes lthat limit encoding & consodilation)
  -> evidence of an interaction between amygadala (+sensory areas: sensory, emotional aspects of memory) & hippocampus (neutral, declarative aspects)

Question 34

How can intrusions modify memories?

Answer 34

• extinction: repeatedly presenting the conditioned stimulus reduces behavioral expression of memory
• reconsolidation: an isolated retrieval can be used to either strengthen or weaken the memory trace through molecular processes

Question 35

How can involuntary retrieval, aka intrusive memories, be suppressed?

Answer 35

→ retrieval suppression: trying to stop the ongoing retrieval process

→ retrieval-induced forgetting: forgetting of competing memory traces when trying to focus only on a specific one while suppressing others

Question 36

What are some arguments pro suppression as a way to deal with intrusions?

Answer 36

1. Suppressing unwelcome thoughts can have functional purposes, e.g. focusing on a task
2. Emotional balance after trauma necessitates active thought regulation to get over the trauma
3. People’s memories of trauma usually diminish over time which is considered healthy coping
4. Anxiety about intrusive thoughts is considered less healthy than accepting them
5. The proposal against controlling thoughts is against findings about attentional control saying that controlling cognition and behavior is desirable

Question 37

What are some arguments against suppression as a way of dealing w intrusions?

Answer 37

white bear paradigm supports statements against suppression. Participants are asked to not think of a certain thought for 5 minutes, then given 5 minutes to think freely of anything. Those asked to suppress think more about the certain thought than those who were not asked (rebound effect).

Question 38

What is some critique on the white bear paradigm?

Answer 38

→ requires the person to ask oneself whether they are succeeding in the task (”Am I thinking of a white bear?”) to check if they are

→ the white bear suppression inventory measures both thought suppression frequency and experience of intrusiveness, but only the latter correlates with clinical symptoms

→ the white bear task may not be a reliable measure of suppression as it may not reflect the clinical reality

→ suppression in clinical individuals may simply not be functioning properly

→ retrieval suppression has been equated with other terms (e.g. expressive suppression in emotion regulation which requires motor control, or avoidance) which may well have negative consequences

⇒ retrieval suppression aims at stopping or cancelling retrieval, which gives focus to mnemonic processes and necessitates the person confronting reminders to memories and adjusting them

Question 39

What method can be used to study retrieval suppression?

Answer 39

think/no think task

Question 40

What method can be used to study retrieval induced forgetting?

Answer 40

thought substitution: participatns asked to stop retrieval of an unwanted memory by retrieving diversions either created by the self or given
retrieval practice paradigm

Question 41

How does retrieval induced forgetting work?

Answer 41

During selective memory retrieval, one needs to retrieve a specific event, idea, or fact. Reminders are, however, often associated with a lot of memory traces so retrieval competition arises. Thus, inhibitory control processes mediated by the prefrontal lobe are necessary to suppress competing memories and retrieve the wished-for one. The effects on the inhibited traces cause forgetting.
Retrieval-induced forgetting is especially effective if it is motivated. This may be shown by, for example, a positivity bias after an argument with someone important to the person, where one is motivated to forget the negative contents of the argument.

Question 42

What is experience/thought sampling?

Answer 42

focuses on studying mind wandering. For example, participants may be pressing buttons and must catch themselves the moment they mind wander and report it. Participants can also be probed at random times and asked whether they are mind wandering.

Question 43

What is pavlovian conditioning?

Answer 43

pairs an initially neutral stimulus with an aversive stimulus repeatedly (CS+) and another stimulus is never paired (CS-). The CS+ then should elicit a defensive response which can be measured.

Question 44

What is the retrieval practice paradigm?

Answer 44

used to study retrieval-induced forgetting. Here, participants have to remember multiple associations for a certain cue and are then asked to retrieve only a subset, not all, associations. This is also studied in rats where multiple objects are encoded and only one is retrieved which leads to forgetting the other objects (spontaneous object recognition paradigm). This latter helps understand the neurobiological basis of memory inhibition mechanisms.