1. 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

2. 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)

3. Examples of Clinical Constructs  Inflated Responsibility (Salkovskis, 1985)  Intolerance of Uncertainty (Dugas et al., 1998)  Thought-Action Fusion (Shafran & Rachman, 2002)

4. 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

5. 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)

6. 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

7. Results – Experiment 1

8. Results – Experiment 2

9. 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)

10. 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”

11. Results – Inflated Responsibility

12. Results – Intolerance of Uncertainty

13. Results – Thought-Action Fusion

14. 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?