Thoughts of agoraphobic people during scary tasks.

Abstract

The authors examined the occurrence of theoretically derived patterns of thinking in 74 agoraphobic participants as they drove alone or tolerated an enclosed place. During the increasingly scary tasks in a behavioral test hierarchy, participants responded to a periodic beep by stating aloud what they were thinking at that moment, yielding more than 1,800 tape-recorded statements. Content analyses revealed that participants were mainly preoccupied with their current anxiety (expressed in 29% of the statements) and with their self-efficacy (15%). Despite participants' mounting feelings of anxiety, fewer than 1% of their statements expressed a thought of danger or an anticipation of future anxiety or panic. The rarity of danger thoughts poses an explanatory challenge for all cognitive theories of phobia and especially for the perceived danger theory of A. T. Beck (1976) and A. T. Beck, G. Emery, and R. L. Greenberg (1985).

Fear and Phobia: A Critical Review and the Rational-Choice Theory of Neurosis

“…In support of his claim, Bandura noted that acrophobics display fear when found in tall buildings, because they are unable to quell horrendous thoughts despite the safety of their situation. However, findings inconsistent with this claim indicate that perception of danger is, in fact, a weak predictor of acrophobic behavior (Menzies & Clarke, 1995b;Williams, Turner, & Peer, 1985;Williams & Watson, 1985) and that agoraphobics are rarely preoccupied with thoughts of danger when confronted with their feared situation (Williams, Kinney, Harap, & Liebmann, 1997). Hence, as noted by Williams et al (1997), "rarity of danger thoughts poses an explanatory challenge for all cognitive theories of phobia and especially for the perceived danger theory" (p. 511).…”

“…However, although negative thoughts preoccupy the individual's attention when exposed to the stimuli that they fear (De Jongh, Muris, Schoenmakers, & Ter Horst, 1995;De Jongh, Muris, Ter Horst, & Duyx, 1995;De Jongh & Ter Horst, 1993;Kent & Gibbons, 1987;Thorpe & Salkovskis, 1995), some studies indicate that negative cognitions follow, rather than precede, the experience of fear (Wolpe & Rowan, 1988). Moreover, negative thoughts may be a direct consequence of the fear ("If I feel anxious, there must be danger"; Arntz, Rauner, & Van den Hout, 1995), and fear may also be experienced in the absence of negative cognitions (Barlow, Brown, & Craske, 1994;Fleet et al, 2000;Kushner & Beitman, 1990;Williams et al, 1997). …”

Coping Skills and Exposure Therapy in Panic Disorder and Agoraphobia: Latest Advances and Future Directions

“…Notwithstanding, the ASI does not lend evidence to whether such thoughts and feelings are actually occurring in real time. Here, further research on approaches such as the think-aloud paradigm (Davison, Vogel, & Coffman, 1997; Davison, Williams, Nezami, Bice, & DeQuattro, 1991; Williams, Kinney, Harap, & Liebmann, 1997) will allow testing of symptom appraisal in real time. An example for capturing “in-the-moment” appraisals during cognitive skill training and exposure, using the think-aloud technique, is described below (see “Think-Aloud Paradigm”).…”

“…In a recent pilot study, we tested the feasibility of a modified and extended version of the think-aloud paradigm (Davison et al, 1991, 1997; Williams et al, 1997). The paradigm is aimed at assessing concurrent, situation-specific, and participant representative thoughts both during skill acquisition and application.…”

“…This online method of recording verbalizations provides a sample of thinking that differs from the constraints of forced-choice formats and retrospective judgments (e.g., questionnaires), and appears to be less susceptible to responder biases inherent to retrospective judgments. Think-aloud methodologies have been used to evaluate thoughts during experimental exposure to feared situations (Williams et al, 1997) and are considered valid indicators of covert verbalizations when derived from instructions to “say in a continuous stream whatever one is saying to oneself at that moment” (vs. report upon what one thinks one has been saying over a past interval) and limited to brief snippets of time.…”