تعدیل رابطه بین فعال شدن سندرم شناختی توجه و علائم آسیب شناسی روانی با کنترل توجه

Abstract Wells’s (2009) metacognitive theory suggests that inflexible and recurrent styles of thinking in response to negative thoughts, feelings, and beliefs exacerbate symptoms of psychopathology. Such styles of thinking underlie the cognitive attentional syndrome (CAS). Using a large nonclinical sample (N = 456), the present study examined whether attentional control moderates the relationship between activation of the CAS and symptoms of psychopathology (i.e., depression, anxiety, and stress symptoms). Consistent with predictions, relationships between activation of the CAS and assessed symptoms became increasingly stronger as attentional control decreased. Thus, for individuals who have a relative inability to disengage and shift attention from threat information (i.e., low attentional control), use of CAS-relevant coping strategies (e.g., rumination, worry) appears to be associated with especially deleterious psychological effects. Conceptual and therapeutic implications are discussed.

1. Introduction A transdiagnostic approach is based on the notion that the focus of theory and treatment should be on features that cut across psychological disorders (Mansell, Harvey, Watkins, & Shafran, 2008). Wells’s (2009) metacognitive model offers a promising transdiagnostic approach for conceptualizing and treating psychopathology, particularly for mood and anxiety disorders. According to Wells, metacognitive theory “deals with the way that people think and it assumes the problem rests with inflexible and recurrent styles of thinking in response to negative thoughts, feelings and beliefs” (p. 3). Wells termed this style of thinking as the cognitive attentional syndrome (CAS), which is marked by repetitive forms of thought (e.g., rumination, worry) and other maladaptive coping behaviors (e.g., thought suppression). The CAS is believed to develop due to metacognitive beliefs about the usefulness of repetitive forms of thought and maladaptive coping behaviors. For example, an individual might hold positive beliefs about using repetitive forms of thought to reduce the likelihood of perceived threat (e.g., Worrying about the future means I can avoid danger; Wells, 2009). Such metacognitive beliefs purportedly lead to the development of a propensity for responding to negative thoughts, feelings, and beliefs with CAS-relevant coping strategies that maintain negative emotionality and strengthen maladaptive beliefs ( Wells, 2009). Wells’s metacognitive theory differs from more traditional cognitive-behavioral perspectives in that it suggests that maladaptive beliefs are influenced by CAS-relevant coping strategies. That is, the theory holds that CAS-relevant coping strategies – and not the underlying maladaptive beliefs per se – lead to emotional and behavioral consequences. Wells asserts that the use of CAS-relevant coping strategies is associated with a number of deleterious outcomes, including development of attentional bias for perceived threat. A bias for attending to threat is thought to exacerbate mood and anxiety symptoms. As such, reducing use of CAS-relevant coping strategies is a core treatment goal of metacognitive therapy ( Wells, 2009). Consistent with metacognitive theory, individual differences in the ability to disengage from threat have been implicated in the maintenance and exacerbation of psychopathology. More specifically, Mathews (2004) stated that the “failure to disengage attention from threat information may be one causal factor in maintaining anxiety, by increasing the awareness of potential dangers. If so, then good attentional control may help to counter these adverse consequences, whereas poor control may exacerbate them.” (p. 1023). In support of Mathews’s assertion, research has shown that attentional control (AC: i.e., the use of top-down executive attentional processes to regulate bottom-up emotional responses; Derryberry & Reed, 2002) is positively associated with indicators of positive well-being (e.g., positive affect) and inversely associated with indicators of negative well-being (e.g., neuroticism: Compton, 2000 and Eisenberg et al., 2000). Research has provided additional support for the possibility that AC might serve as a protective individual difference variable against psychological symptoms. For example, research has shown that higher AC is associated with significantly faster recovery from trauma re-telling induced negative affect (Bardeen & Read, 2010) and lower AC is associated with externalizing behaviors and relatively poor social adaptation (Eisenberg et al., 2000). Further, AC has been shown to moderate the relation between emotional distress (i.e., trait anxiety, posttraumatic stress symptoms) and the ability to disengage from threat stimuli (Bardeen and Orcutt, 2011 and Derryberry and Reed, 2002). That is, individuals with higher levels of emotional distress have greater difficulty disengaging from threat stimuli; however, among these individuals, those with higher AC disengage and shift attention significantly faster from threat information than those with lower AC (Bardeen & Orcutt, 2011). Taken together, findings suggest that higher levels of AC facilitate disengagement from threat, which in turn may improve emotional well-being. Based on this information, AC may help link activation of the CAS to symptoms of psychopathology. This possibility is consistent with Spada, Georgiou, and Wells (2010), who proposed that the occurrence of symptoms of psychopathology is due to the joint impact of CAS-relevant metacognitive beliefs and AC. More specifically, Spada et al. opined that “individuals experiencing high states of anxiety may do so because of a combination of maladaption in metacognitions and dysfunction in attentional control” (p. 65). However, despite proposing that these two variables work in concert with one another, Spada et al. only examined the main effects of CAS-relevant metacognitive beliefs and AC in relation to symptoms of psychopathology, with both of these variables evidencing unique relations with symptoms of psychopathology (i.e., state anxiety). As described above, it is our position that such main effects might be qualified by an interactive effect between maladaption in metacognitions and AC. More specifically, individuals high versus low in AC may be able to more easily disengage from threat information associated with use of CAS-relevant coping strategies. The relative inability of individuals with low AC to disengage from threat information in combination with the use of CAS-relevant coping strategies may lead to an exacerbation of mood and anxiety symptoms. Alternatively, the relative ability of individuals with high AC to disengage from threat associated with use of CAS-relevant coping strategies should serve as a protective factor against the deleterious effects of such coping strategies on psychological symptoms. If this pattern of relations is tenable, AC should moderate the relationship between activation of the CAS and symptoms of psychopathology. That is, the relationship between activation of the CAS and these symptoms should grow increasingly stronger as AC decreases. The present study sought to examine this possibility.

3. Results 3.1. Moderating role of AC 3.1.1. Depression Descriptive statistics and zero-order correlations among the study variables are presented in Table 1. Regression results revealed that both the CAS (β = .45) and AC (β = −.16) were significantly associated with depression scores in Step 1 (R2 = .26; ps < .01). As predicted, the interaction between the CAS and AC (β = −.14) explained additional significant variance (ΔR2 = .02, p < .01) in depression scores in Step 2. Simple effects of this interaction are depicted in Fig. 1. As shown, the CAS shared a significant positive association with depression scores at both low levels of AC (simple effect: β = .60, p < .01) and high levels of AC (simple effect: β = .30, p < .01). Table 1. Descriptive statistics and zero-order correlations. Variable Mean (SD) 1 2 3 4 1. Cognitive attentional syndrome-1 41.55 (20.68) – 2. Attentional control scale 51.73 (9.10) −.23 – 3. DASS-21-depression 3.50 (4.56) .49 −.27 – 4. DASS-21-anxiety 2.76 (3.68) .49 −.20 .67 – 5. DASS-21-stress 4.28 (4.50) .57 −.28 .78 .75 Note: N = 451. All rs significant at p < .01 (two-tailed). DASS-21 = depression, anxiety, stress scale-21-item version. Table options Moderating effect of attentional control (AC) on the relationship between ... Fig. 1. Moderating effect of attentional control (AC) on the relationship between activation of the cognitive attentional syndrome (CAS) and depression symptoms. AC = Attentional control scale; CAS = cognitive attentional syndrome-1; Depression = depression scale of depression, anxiety, stress scale-21-item version. Figure options 3.1.2. Anxiety Regression results revealed that both the CAS (β = .47, p < .01) and AC (β = −.09, p < .05) were significantly associated with anxiety scores in Step 1 (R2 = .25). As predicted, the interaction between the CAS and AC (β = −.10) explained additional significant variance (ΔR2 = .01, p < .05) in anxiety scores in Step 2. Simple effects of this interaction are depicted in Fig. 2. As shown, the CAS shared a significant positive association with anxiety scores at both low levels of AC (simple effect: β = .57, p < .01) and high levels of AC (simple effect: β = .37, p < .01). Moderating effect of attentional control (AC) on the relationship between ... Fig. 2. Moderating effect of attentional control (AC) on the relationship between activation of the cognitive attentional syndrome (CAS) and anxiety symptoms. AC = attentional control scale; CAS = cognitive attentional syndrome-1; Anxiety = anxiety scale of depression, anxiety, stress scale-21-item version. Figure options 3.1.3. Stress Regression results revealed that both the CAS (β = .54) and AC (β = −.15) were significantly associated with stress scores in Step 1 (R2 = .35; ps < .01). As predicted, the interaction between the CAS and AC (β = −.14) explained additional significant variance (ΔR2 = .02, p < .01) in stress scores in Step 2. Simple effects of this interaction are depicted in Fig. 3. As shown, the CAS shared a significant positive association with stress scores at both low levels of AC (simple effect: β = .68, p < .01) and high levels of AC (simple effect: β = .40, p < .01). Moderating effect of attentional control (AC) on the relationship between ... Fig. 3. Moderating effect of attentional control (AC) on the relationship between activation of the cognitive attentional syndrome (CAS) and stress symptoms. AC = attentional control scale; CAS = cognitive attentional syndrome-1; Stress = stress scale of depression, anxiety, stress scale-21-item version.