This paper describes some of the ways in which ruminative rehearsal and repetitive processing of phobic events may maintain or enhance anxious responding. It focuses on laboratory studies of repetitive rehearsal of potential phobic outcomes and repetitive processing of interoceptive cues. Rehearsal of threatening outcomes whilst in anxious mood has been shown to result in a short term enhancement and resistance to extinction of phobic responses. Increased attention to and discrimination of bodily cues (interoception) has also been shown to result in enhanced phobic responding and increased resistance to extinction. This latter finding appears to result from interoception (1) inflating the threatening nature of the outcome, and (2) leading the individual to reject contradictory information from other sources.

Intrusive recollections are very common immediately after traumatic events and are considered necessary aspects of emotional processing. However, if these intrusive recollections persist over a long time, they are linked to long-term psychiatric disorder, especially Posttraumatic Stress Disorder (PTSD). This paper discusses the need to investigate factors involved in the maintenance of intrusive traumatic recollections. It is suggested that the idiosyncratic meaning of the intrusive recollections predicts the distress caused by them, and the degree to which the individual engages in strategies to control the intrusions. These control strategies maintain the intrusive recollections by preventing a change in the meaning of the trauma and of the traumatic memories. It is further suggested that what is needed is a comprehensive assessment of the processes that prevent change in meaning, going beyond the assessment of avoidance. In particular, safety behaviours, dissociation and numbing, suppression of memories and thoughts about trauma, rumination, activation of other emotions such as anger and guilt and corresponding cognitions, and selective information processing (attentional and memory biases) may be involved in the maintenance of intrusive recollections. Preliminary data supporting these suggestions from studies of individuals involved in road traffic accidents and survivors of child sexual abuse are described.

Trauma symptoms, coping and personality were assessed in 44 victims of the Perth flood. The sample was characterized by high levels of intrusions, numbness, arousal and general emotional distress. General levels of symptomatology were predicted by two coping strategies: emotion-focused coping and thought suppression. Overall trauma symptoms and emotion-focused coping were associated with the personality trait of neuroticism. These data are consistent with the Wells and Matthews (1994a) model of affective disorders and stress. The model proposes that certain types of emotion-focused coping tend to lead to greater access to negative self-beliefs, and that thought suppression tends to prime subsequent intruding thoughts. A second personality trait, private self-consciousness, was associated with relatively greater levels of numbing symptoms, and relatively lower levels of arousal symptoms. This patterning of symptoms may result from use of ruminative coping strategies. Hence, intrusions of trauma-related material are not simply a function of automatic activation of a fear network, but are also influenced by the person's voluntary efforts to deal with the aftermath of the event.

In this paper, an account of auditory hallucinations is outlined, incorporating the phenomena of intrusive thoughts; this is done with reference to the prevailing cognitive models of auditory hallucinations. The account proposes that metacognitive beliefs inconsistent with intrusive thoughts lead to their external attribution as auditory hallucinations, and that such a misattribution is maintained by reducing cognitive dissonance. It is also suggested that the appraisal of the resulting hallucinatory experience elicits behavioural, emotional and physiological responses that may be involved in the maintenance process. The possibility of extending such an account to certain other positive symptoms is discussed, and the theoretical and clinical implications of such an account are considered, and illustrated with a case example. Finally, a number of testable predictions are made.

According to the cognitive theory, obsessional problems occur when the occurrence and/or content of intrusive thoughts are interpreted as a sign of increased personal responsibility for some harmful outcome to oneself or others. The link between normal intrusive thoughts and obsessional thoughts is outlined. Current definitions of “neutralizing” and “responsibility” within the cognitive framework are examined and clarified. Responsibility-driven attempts to control cognitive activity explain obsessional and compulsive phenomena better than generalized deficit models. Recent descriptions of “meta-cognitive” factors in obsessions echo the existing cognitive model and have similar implications. An extension of the cognitive-behavioural model suggests a link between thought suppression and the perception of responsibility and to concerns about failure to act (omissions).

A meta-cognitive classification and analysis of factors contributing to the development of problematic worry is presented. Dimensions of meta-beliefs, meta-worry, cognitive consciousness, and strategies can be distinguished. A cognitive model of Generalized Anxiety Disorder is advanced based on this framework in which GAD results from an interaction between the motivated use of worry as a coping strategy, negative appraisal of worry, and worry control attempts. These factors result from combinations of dysfunctional meta-beliefs and contribute to subjectively diminished cognitive control. The model presents new implications for a cognitive therapy of GAD, and these are illustrated with a single case treatment study.