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THE BIDIRECTIONALITY HYPOTHESIS: ARE CLINICAL CONSTRUCTS BOTH CAUSES AND EFFECTS OF SYMPTOMS? Graham C L Davey, Gary Britton, Frances Meeten & Georgina Barnes UNIVERSITY OF SUSSEX
What are Clinical Constructs? • “Inferred states or processes derived most often from the clinical experiences of researchers or clinicians in their interactions with patients” (Davey, 2003) • Clinical Constructs have various functions: • To help understand psychopathology symptoms • To provide a basis for developing interventions • To link thoughts, beliefs and cognitive processes to subsequent symptoms (often in an implied causal manner)
Examples of Clinical Constructs • Inflated Responsibility (Salkovskis, 1985) • Intolerance of Uncertainty (Dugas et al., 1998) • Thought-Action Fusion (Shafran & Rachman, 2002)
The Development of Clinical Constructs • Describing the defining features of the construct • Developing an instrument to measure the construct • Validation of the measurement instrument against symptoms • Experimental manipulation of the construct and its effects on symptoms • Development of causal models of symptoms
The Bidirectionality Hypothesis • ‘Doubting’ and Checking Behaviour • Tallis (1995) • Van den Hout & Kindt (2003) • Radomsky& Alcolado (2010) • Negative Mood and Pathological Worrying • Buhr & Dugas (2009) • Johnston & Davey (1997) • McLaughlin, Borkovec & Sibrava (2007)
Experiments 1 & 2 – Inflated Responsibility & Negative Mood • Experiment 1 – The effect of manipulating Inflated Responsibility (using a vignette-based responsibility manipulation) on Negative Mood • Experiment 2 – The effect of manipulating Mood Valency (positive or negative) on self-reported measures of Inflated Responsibility
Experiment 3 • Exposure to Obsessive Aversive Thoughts (28 obsessive statements vs 4 obsessive/24 neutral statements) • Self-relevant vs Non-self-relevant • Effects on measures of: • Inflated Responsibility (Responsibility Attitude Scale) • Intolerance of Uncertainty (Intolerance of Uncertainty Scale) • Thought-Action Fusion (Thought Fusion Instrument, TFI)
Obsessive Statements • Statements largely taken from a study of abnormal and normal obsessional thoughts by Rachman & de Silva (1978) • Examples of obsessive statements: • “I will harm someone I love” • “I will push someone under a train” • Examples of neutral statements: • “I will have my usual breakfast” • “I will meet someone I know”
Conclusions • Are Clinical Constructs merely Re-descriptions of Symptoms? • “..when we describe people as exercising qualities of mind, we are not referring to occult episodes of which their overt acts and utterances are effects; we are referring to those utterances themselves” (Ryle, 1949, p26) • Is Anxious Psychopathology an Integrated Holistic Experience not easily Described in Box-and-Arrow Models? • Are Some Features of the Psychopathology Experience Mediators of Cognitive, Behavioural & Physiological Factors (e.g. Experienced Negative Mood)? • Should Clinical Psychology Researchers Re-Consider the Usefulness of Some Contemporary Explanatory Paradigms?