Nearly everyone experiences unwanted thoughts, images, and urges. Unwanted thinking takes many forms, such as a quitting smoker imagining putting a cigarette to his lips or a student's fleeting wish for her professor to be in a car accident. While these thoughts can be distressing for anyone, unwanted thinking sometimes develops into a clinically impairing problem.
A growing body of research suggests that it is not simply the presence of unwanted thinking that leads to clinical problems, but potentially the subjective way people interpret and respond to their unwanted thinking. For instance, a person who interprets their sudden wish for a family member to be in a car accident as a sign of their inner immorality (e.g., "Maybe this thought means that I really want the accident to happen; I must be an awful person!") may have an elevated risk of obsessive-compulsive disorder. Someone who dismisses the thought's meaning (e.g., "This thought is just a thought, it doesn't have any meaning about me.") wouldn't have the same heightened risk. Similarly, a quitting smoker who perceives nicotine craving as a sign of her body breaking down without nicotine may have a higher risk of relapse than if she viewed craving as a challenging but temporary experience. Importantly, this model of unwanted thinking can be applied across diverse content areas and identifies a mechanism that connects chronic mental and behavioral health conditions with real-time thinking processes.
The SCOUT lab is grounded in evaluations of this model within obsessive-compulsive and anxiety disorders. Recent lab work focuses on novel adaptations to craving in smoking, adding to past extensions we've conducted in older adulthood (described below).
Current lab work on nicotine craving occurs as part of a 5-year K23 grant we have been fortunate to receive from the National Institute on Drug Abuse. This project is intended to lead to better conceptualizations of craving, understanding of the link between craving and relapse, and improved methods for aiding individuals who are struggling with craving during quit attempts.
A critical process in unwanted thinking is the way individuals attempt to control their thinking. As one might expect, few people enjoy distressing thoughts, and unwanted thinking is frequently accompanied by attempts to banish it. Unfortunately, research into thought suppression (e.g., attempts to keep thoughts out of mind) suggests that control attempts often backfire and make unwanted thinking recur more than if no control attempt occurred.
In our past work, we have investigated the link between thought suppression and psychopathology, given that individuals with psychopathology tend to exhibit high levels of both unwanted thinking and thought suppression attempts. We've found that while individuals with psychopathology do experience higher levels of unwanted thinking than healthier individuals while suppressing, there is not much evidence that this abundance of unwanted thinking is caused by a lack of thought suppression ability (i.e., a suppression 'deficit'). Further, an overemphasis on how much thoughts recur during thought suppression misses the larger context in which thought suppression occurs - the subjective emotional experience of thought suppression. This perspective shift parallels advances about unwanted thinking described above, which suggest that having unwanted thinking is a normative phenomenon; instead, the way an individual interprets and responds to that thinking may lead to benign versus serious outcomes. Similarly, having difficulties controlling undesired thoughts is a common experience; it may be the way an individual interprets and responds to the challenge of control that is key.
Older adults experience a range of normal changes with aging that have profound consequences for their experience and management of unwanted thinking and distress. Unfortunately, current theories of unwanted thinking have not fully incorporated the ways older adults may be at risk or protected from negative health consequences. For instance, in the area of anxiety, older adults may shift from the typical harmful interpretations about unwanted thinking found among younger adults ("This thought must mean I'm immoral!") to more age-relevant interpretations about cognitive decline (e.g., "I can't seem to control this thought, maybe it's an early sign of dementia!"). Thus, by building theories of unwanted thinking using largely younger and middle-aged adults, the field may be overlooking major risk factors for emotion dysfunction after unwanted thinking in older adults.
At the same time, consistent with many lifespan theories of development, there is support for emotional advantages by older adults when dealing with unwanted thinking. Specifically, I've found that older adults experience less frequent and distressing everyday unwanted thinking, seem to maintain positive feelings better than younger adults when encountering unwanted thinking, and may employ methods for controlling their unwanted thinking that are less harmful than younger adults. I am interested in the connection between these differences in unwanted thinking and healthy older adults' greater lifetime experience with unwanted thinking, increased emphasis on goals that promote social and emotional well-being, and tendency to disengage selectively from goals that do not effectively align with their levels of cognitive resources, time, and energy.
In addition to my work on unwanted thinking, I am interested in using lifespan theories of development to understand the shifting relationships in older age between positive and negative affect and key health variables like personality, pain, sleep, and life satisfaction. These shifts have a direct impact not only for patients, but for health professionals treating community older adults whose subjective well-being may diverge sharply at times from their apparent objective physical health.
A final dimension of the SCOUT Lab's research centers on eHealth (electronic health) and mHealth (mobile health) technologies, which include the use of Internet, mobile phone, and other electronic technologies for assessment and intervention. This dimension tends to be sprinkled throughout the other substantive content interests. Interventions using health technologies are notable in that they 1) are adaptable to a wide variety of settings and diverse populations, giving them significant potential to broadly impact public health; 2) allow intervention or study content to be individually-relevant, which is particularly important given the diversity of patients requiring intervention; 3) permit intervention content to be delivered in a manner that is more ecologically valid than most traditional office interventions; 4) are accessible at most times and locations, including high-risk situations; 5) have few barriers related to learning and use, given the explosion of technology use across the lifespan; 6) are more private than office visits, potentially reducing stigma felt by patients around mental illness; and 7) can handle both assessment and intervention. Across interventions, the exact content and algorithms for individualizing treatment tend to be easy to modify, resulting in flexible interventions that can be modified as they are disseminated broadly and among new populations.
SCOUT Lab projects have involved collaborations on a range of eHealth and mHealth interventions for anxiety, alcohol dependence, nicotine dependence, insomnia, sexual health, diabetes, and pediatric encopresis, largely focusing on the efficacy or feasibility of such interventions. To further maximize the benefits of these interventions, we evaluate individual differences among these target populations that could provide guidelines for personalizing treatments.