Irrational Beliefs and the Anxiety Disorders

This study investigated the levels of irrationality reported by a clinical sample of anxiety disorder patients, including simple and social phobics, panic disorder patients, agoraphobics, and obssessive compulsive patients. The levels of irrationality were compared between these groups and a group of normal control subjects, using the Rational Behavior Inventory (RBI). Agoraphobic patients were significantly less rational than control subjects on six of the RBI's subfactors and the total score of the Inventory. Patients in all diagnostic categories except simple phobia were significantly different from control subjects on the projected misfortune subfactor, and patients in all categories except simple phobia and panic disorder were significantly different from controls on the total RBI score. There were only four instances where patients in anxiety disorder categories significantly differed from each other in levels of irrationality. The implications of these findings, methodological limitations, and directions for future research are discussed. Joseph A. Himle, ACSW is a Clinical Social Worker at the Anxiety Disorders Program, Department of Psychiatry, University of Michigan. David P. Himle, Ph.D. is an Associate Professor of Social Work at the University of Michigan. Bruce A. Thyer, Ph.D. is an Associate Professor of Social Work, University of Georgia and Faculty Fellow at the University Affiliated Program. He is also an Associate Clinical Professor at the Department of Psychiatry and Health Behavior, Medical College of Georgia. Send requests for reprints to Joseph A. Himle, Department of Psychiatry, University of Michigan Hospitals, Ann Arbor, MI 48109-08400. 155 9 1989 Human Sciences Press 156 Journal of Rational-Emotive & Cognitive-Behavior Therapy The current use of cognitive-behavioral treatment techniques relies upon the theory that many psychiatric disorders, including pathological anxiety, are caused or maintained by irrational beliefs (Ellis & Grieger, 1977; Beck & Emery, 1985). This theory has been partially supported by several correlational studies with analogue samples, which have demonstrated that irrational beliefs are associated with certain types of psychiatric symptomatology, such as state anxiety phobic anxiety, obsessive compulsiveness, depression and psychoticism (Himle, Thyer, and Papsdorf, 1982; Thyer, Papsdor~ and Kilgore, 1983). A few studies have also demonstrated that irrational beliefs are also present among clinical patients exhibiting particular types of phobic anxiety. Sutton-Simon and Goldfried (1979) have reported statistically significant, though modest correlations between irrational beliefs, as measured by the Irrational Beliefs Test, and social anxiety as measured by the Social Avoidance and Distress Scale, and also between irrational beliefs and acrophobia as measured by the Fear of Heights Survey. Thyer, Papsdorf and Kramer (1983) reported that irrational thinking as measured by the Rational Behavior Inventory was significantly correlated, though minimally, with general phobic anxiety as measured by the Fear Survey Schedule. They attributed the minimal association with phobic anxiety to the fact that most of their subjects attributed their phobias to experiences which were best explained by classical conditioning factors, rather than by cognitive distortions. Mizes, Landolf-Frische, and Grossman-McKee (1987) also reported significant correlations between rationality scores, as measured by the Rational Behavior Inventory and the Irrational Beliefs Test, and scores on the Fear Questionnaire among patient groups of simple phobics, and agoraphobics. In addition, some studies have presented clinical and anecdotal observations which suggest that anxious patients report self-statements similar to Ellis' (1973) categorization of irrational beliefs. For example, Beech and Vaughan (1978) reported that phobic and obsessional patients have serious difficulty making decisions and a predisposition to avoid life's problems. Reed (1985) stated that obsessional patients had an excessive fear of losing self-control, conformed in an excessive manner to social prescriptions for proper conduct, and were the ultimate perfectionists. Beck and Emery (1985) stated that the fear of loss of emotional control was characteristic of patients exhibiting panic attacks. They described social phobics as individuals who had an excessive fear of being evaluated by others, and who experienced shame Joseph A. Himle, David P. Himle, and Bruce A. Thyer 157 and fear of abandonment because of personal mistakes and failures in life. In addition, it has been suggested by Sutton-Simon and Goldfried (1979) that social anxiety has a larger cognitive component than acrophobia, because social anxiety involves implicit cognitive concerns with the evaluation of others, while acrophobia may be related to conditioned anxiety responses accompanied by minimal cognitive distortion. In spite of this evidence, a number of authors have suggested that further replications of the nature of irrational beliefs among clinical samples are needed, that the validity of the Rational Behavior Inventory needs to be established for specific classes of anxiety disorders, and that research is lacking into the specific irrational beliefs among obsessive-compulsives (Martzke, Andersen, & Cacioppo, 1987; Emmelkamp, 1987). Therefore, to further examine and clarify the relationship between various types of anxiety disorders and irrational thinking, this present study reports the results of an assessment of the levels of irrationali ty between groups of clinically anxious patients, as categorized by the use of DSM-III criteria (American Psychiatric Association, 1980), and a group of normal controls.