The work within this thesis examined aspects of emotion processing among non-clinical females who varied in levels of eating-related psychopathology. Five studies employed a quantitative approach in order to assess potential deficits in both the control and experience of emotion. To examine the experience of emotion, Studies 1, 2 and 3 assessed the attentional processing of emotional stimuli in those with high and low levels of eating-related psychopathology. In Studies 1 and 2, specific components of attention bias including orientation, disengagement and avoidance were assessed in order to explore their role in contributing to disordered eating behaviour. Findings from these studies did not reveal any differences in attentional orienting between those with high and low levels of eating-related psychopathology. However, when primed with happy faces, those with high levels of disordered eating were significantly quicker than those with low levels to disengage from threat-relevant words. This finding could be interpreted in terms of emotional arousal with happy facial displays providing a protective function against subsequently presented stimuli. With regards to emotional avoidance, those with higher levels of eating-related psychopathology were more likely to avoid emotional displays relative to those with lower levels. In fact, a higher drive to achieve thinness was shown to predict a greater avoidance of both angry and happy facial expressions. Interestingly, depression, anxiety and alexithymia were all shown to impact upon attentional processing. In Study 3, the efficacy of attention training in reducing attentional biases towards threat in women with varying levels of disordered eating was examined. Importantly, a single session of attention training was found to be successful in modifying previously observed attentional biases towards threat. However, eating-related psychopathology was shown to have only a partial influence on participants attention processing. These findings suggest that the success of attention training may be independent of disordered eating. To examine the control of emotion within a non-clinical population, Study 4 utilised self-report questionnaires to explore associations between deficits in emotional functioning and severity of eating-related psychopathology. The data obtained from this questionnaire-based investigation are reported in a series of three short studies. Specifically, Study 4.1 of this chapter examined the relationship between difficulties in the regulation of emotion within eating-related psychopathology. Furthermore, Studies 4.2 and 4.3 set out to explore some of the factors which may influence emotion processing, such as pessimistic attitudes regarding emotional expression. Across all studies, the role of depression, anxiety and alexithymia as potential confounding factors was considered. Findings revealed a significant relationship between eating-related psychopathology and difficulties regulating emotion. Dysfunctional or negative attitudes towards the expression of emotion were also linked to a greater number of eating disorder-related concerns and behaviours. However, many of the associations between eating-related psychopathology and impaired emotional functioning were no longer apparent when depression, anxiety and alexithymia had been statistically accounted for. These findings not only support previous research, but highlight the importance of mood and alexithymia in contributing to the emotional deficits observed. Finally, Study 5 aimed to explore the potential consequences of inadequate emotion processing within eating-related psychopathology. Self-report measures were utilised to assess the frequency of eating-related intrusive thoughts in those with high levels of eating-related psychopathology. As predicted, those with greater levels of disordered eating reported experiencing a higher frequency of thoughts or intrusions relating to eating. This may point towards a failure to successfully process emotional experience in this group. Taken together, this body of work enhances the current understanding of the role of emotion processing in contributing to both the onset and maintenance of disordered eating. These findings also emphasise the key role of mood and alexithymia in influencing the relationship between emotional functioning and eating-related psychopathology. Therefore further research examining emotion processing within disordered eating must acknowledge the potential contribution of depression, anxiety and alexithymia. Furthermore, the present findings provide clear support for the development of a model of cognitive-emotion processing within eating-related psychopathology. The implications of these findings for both eating disorder treatment and prevention are discussed. Possible directions for future research are also identified.

The first part of the thesis explored the pattern of emotional reactivity amongst individuals with Borderline Personality Disorder (BPD). A previous review (Rosenthal, Gratz, Kosson, Cheavens, Lejuez & Lynch, 2008) claimed that a discrepancy exists in the subjective versus objective patterns of responding to emotional stimuli in those with BPD. The present review assessed the reliability of such findings by reviewing a more homogenous sample of studies that had used similar methodological procedures, in addition to a range of subjective and objective measures. It also aimed to investigate psychophysiological factors associated with this proposed divergent pattern of responding. The methodological quality of all included studies was assessed. The evidence reviewed disputes claims that BPD individuals display diminished physiological reactivity, despite equal or higher self-reported emotional reactivity than controls. Instead, the present review found that individuals with BPD react more severely (both psychologically and physiologically) to experimental stimuli, than controls, particularly when the stimuli is personally-relevant. Disruption of specific brain structures involved in the regulation of emotion within the Autonomic Nervous System (ANS) are implicated in this heightened profile of emotional reactivity. Furthermore, present state dissociation acts as a defence mechanism which appears to limit cognitive processing abilities such as problem-solving, attention and concentration in those with BPD. The second part of the thesis described a randomised controlled study investigating the effects of an attention training technique on pain tolerance. The Attention Training Technique (ATT; Wells, 1990) is a brief technique used in metacognitive therapy to modify attentional control. The effect of ATT versus Progressive Muscular Relaxation (PMR) on pain tolerance was examined in a sample of individuals who had experienced early childhood trauma (N=57). Participants were randomly assigned to either the ATT condition (N = 29) or the PMR condition (N = 28). A laboratory stressor was included: The Cold Pressor Task (CPT) as an objective measure of pain tolerance. Results supported the hypothesis that ATT modified performance on the CPT. Individuals assigned to the ATT condition were able to persist significantly longer with the CPT than those in the PMR condition. Theoretical and clinical implications of the findings are discussed. Results provide preliminary evidence for the possible benefits of ATT within medical settings. The third part of the thesis critically reflected on the methodological issues and dilemmas presented by the systematic review process, as well as the methodological and ethical issues raised by the research study.

L’attention est un sujet qui concerne l’enseignant depuis l’émergence de la relation maître élève. Le terme fait partie de la doxa scolaire mais qu’en est-il de son lien avec l’éducation ? Notre recherche présente une analyse pluriréférentielle des théories concernant sa nature et son lien avec l’apprentissage. Un historique des perspectives philosophiques cherche à répondre aux questions « l’attention peut-elle s’éduquer et si oui, comment ? » De l’antiquité au XVIIème siècle, une réponse affirmative fait place à des méthodes centrées autour de la maîtrise de la perception, le corps et les passions. Du XVIII au XIXème siècle c’est l’aspect volontaire du phénomène attentionnel qui engage les philosophes et les pédagogues alors qu’au cours du XIXème siècle l’attention est transformée en objet de science puis rejetée à cause de sa nature insaisissable. A l’aube du XXème siècle le thème de l’éducabilité de l’attention est plus évanescent. Ce sont les apports philosophiques, psychologiques et neuroscientifiques qui conçoivent l’attention comme élément fondamental de la cognition incarnée et qui nous permettent d’aborder la problématique de la pertinence des apprentissages scolaires pour éduquer le phénomène attentionnel. Ces derniers confirment le bien fondé des savoirs philosophiques datant de l’Antiquité sur l’éducation de l’attention. Toutefois l’analyse des connaissances, des croyances et des pratiques enseignantes actuelles nous montre un décalage prononcé entre ces dernières et les savoirs théoriques exposés. La littérature insiste sur la nécessité d’éduquer l’attention mais les enseignants gardent des pratiques qui reflètent les recommandations du XIXème siècle. / This dissertation adopts a multi-referential approach for the analysis of the problem of attention. An historical survey of the philosophical literature proposes to answer the question of whether or not attention can be educated. Philosophers from Antiquity to the 17th century advance the existence of attention as a mental entity or a mode of thinking. They link attention with the mastery of the intellect, the body and the passions, and confirm the need for its education. From the 18th to the 19th century the voluntary nature of the faculty of attention captures the interest of scholars. At the end of the 19th century attention is objectified, examined by science then rejected as a worthy subject of research owing to its elusive nature. We address the problem of educating attention or Attention Training (AT) through the lens of more recent philosophical, psychological and neuroscientific texts conceptualizing attention as a principal component of embodied cognition. This perspective credits methods dating back to Antiquity with a capacity for the education of attention. Our mixed methods research demonstrates an important gap between the theoretical literature and current teacher epistemology and practice. Although the literature argues in favor of adopting interoceptive practices, teachers tend to prioritize exteroceptive and behaviorist methods dating back to the 19th and early 20th century.

Erythrophobie wird als klinische Bezeichnung für die Angst zu erröten verwendet, wenn das Einzelsymptom Erröten im Vordergrund einer Angstproblematik steht. Die vorliegende Übersicht beruht auf einer umfangreichen Literaturrecherche und wird ergänzt durch eigene klinische Beobachtungen aus einer Pilotstudie zur kognitiv-behavioralen Gruppentherapie der Errötungsangst. Wir referieren den aktuellen Kenntnisstand zu Erythrophobie in Bezug auf die differentialdiagnostische Einordnung, auf ätiologische und pathogenetische Konzepte sowie auf die Verhaltenstherapie der Störung. Insgesamt zeigt die Übersicht, dass Erythrophobie am sinnvollsten als Subsyndrom der Sozialen Phobie beschrieben werden kann. Patienten mit Errötungsangst als Hauptbeschwerde unterscheiden sich jedoch von anderen Patienten mit Sozialer Phobie im Hinblick auf Behandlungsanliegen, Inanspruchnahmeverhalten, Behandlungserwartung und Therapieziele sowie durch spezifische aufrechterhaltende Mechanismen der Störung, insbesondere durch eine übertriebene und inflexible Aufmerksamkeitsfokussierung auf körperliche Symptome. Der Einsatz eines Aufmerksamkeitstrainings als spezifisches Behandlungsmodul bei Errötungsangst ist vielversprechend und sollte in bekannte Ansätze zur Therapie der Sozialen Phobie integriert werden. Abschließend werden Impulse für weiterführende Forschungsaktivitäten skizziert. / Erythrophobia is the pathological form of fear of blushing. This review is based upon an extensive literature research and supplemented by clinical observations from a pilot study of a cognitive-behavioural group therapy for fear of blushing. Current knowledge about fear of blushing is reported regarding diagnostic considerations, aetiologic and pathogenetic mechanisms, and cognitive-behavioural therapy. In conclusion, this review indicates that fear of blushing should be classified as a sub-syndrome of social phobia. Patients suffering from fear of blushing as predominant complaint differ from other patients with social phobia in health-care utilisation, treatment expectation and treatment goals. However, the most prominent difference lies in the exaggerated and inflexible self-focused attention these patients direct to their arousal and bodily symptoms. Therefore, attention training as a specific treatment unit is promising and should be integrated in standard treatment approaches for social phobia. Finally, options for further research are outlined. / Dieser Beitrag ist mit Zustimmung des Rechteinhabers aufgrund einer (DFG-geförderten) Allianz- bzw. Nationallizenz frei zugänglich.

Erythrophobie wird als klinische Bezeichnung für die Angst zu erröten verwendet, wenn das Einzelsymptom Erröten im Vordergrund einer Angstproblematik steht. Die vorliegende Übersicht beruht auf einer umfangreichen Literaturrecherche und wird ergänzt durch eigene klinische Beobachtungen aus einer Pilotstudie zur kognitiv-behavioralen Gruppentherapie der Errötungsangst. Wir referieren den aktuellen Kenntnisstand zu Erythrophobie in Bezug auf die differentialdiagnostische Einordnung, auf ätiologische und pathogenetische Konzepte sowie auf die Verhaltenstherapie der Störung. Insgesamt zeigt die Übersicht, dass Erythrophobie am sinnvollsten als Subsyndrom der Sozialen Phobie beschrieben werden kann. Patienten mit Errötungsangst als Hauptbeschwerde unterscheiden sich jedoch von anderen Patienten mit Sozialer Phobie im Hinblick auf Behandlungsanliegen, Inanspruchnahmeverhalten, Behandlungserwartung und Therapieziele sowie durch spezifische aufrechterhaltende Mechanismen der Störung, insbesondere durch eine übertriebene und inflexible Aufmerksamkeitsfokussierung auf körperliche Symptome. Der Einsatz eines Aufmerksamkeitstrainings als spezifisches Behandlungsmodul bei Errötungsangst ist vielversprechend und sollte in bekannte Ansätze zur Therapie der Sozialen Phobie integriert werden. Abschließend werden Impulse für weiterführende Forschungsaktivitäten skizziert. / Erythrophobia is the pathological form of fear of blushing. This review is based upon an extensive literature research and supplemented by clinical observations from a pilot study of a cognitive-behavioural group therapy for fear of blushing. Current knowledge about fear of blushing is reported regarding diagnostic considerations, aetiologic and pathogenetic mechanisms, and cognitive-behavioural therapy. In conclusion, this review indicates that fear of blushing should be classified as a sub-syndrome of social phobia. Patients suffering from fear of blushing as predominant complaint differ from other patients with social phobia in health-care utilisation, treatment expectation and treatment goals. However, the most prominent difference lies in the exaggerated and inflexible self-focused attention these patients direct to their arousal and bodily symptoms. Therefore, attention training as a specific treatment unit is promising and should be integrated in standard treatment approaches for social phobia. Finally, options for further research are outlined. / Dieser Beitrag ist mit Zustimmung des Rechteinhabers aufgrund einer (DFG-geförderten) Allianz- bzw. Nationallizenz frei zugänglich.

根據Koster、De Lissnyder、Derakshan及De Raedt（2011）的注意力轉移困難假說，憂鬱者因注意力控制能力受損，而難以從負向訊息中轉移注意力，進而引發反芻，並再度強化憂鬱症狀。雖然反芻可再細分為深思反省與苦惱自責式反芻，但Koster等人未探究注意力轉移困難對苦惱自責式反芻的影響。此外，過往注意力訓練研究作業眾多且效果不一，又偏重改善個體注意力投入以減緩憂鬱。然而，卻鮮少探討注意力訓練對注意力轉移困難的介入，能否改善個體的苦惱自責式反芻程度。因此，本研究將同時探討注意力訓練能否改變高苦惱自責式反芻者對負向訊息的注意力偏誤（含注意力投入與轉移困難），進而降低苦惱自責式反芻程度。本研究以點偵測作業為注意力訓練作業，將高、低苦惱自責式反芻者隨機分派至注意力訓練組或注意力訓練控制組，接受為期兩週、共四次的注意力訓練，並於前、後測階段注意力測量作業中，檢驗對負向訊息的注意力偏誤與三階段中苦惱自責式反芻程度。本研究結果發現高苦惱自責式反芻者對負向訊息無明顯注意力偏誤，注意力訓練作業對高苦惱自責式反芻者的注意力歷程未有明顯影響，乃至苦惱自責式反芻程度的時序變化與接受注意力訓練與否無明顯關聯。本研究結果不支持原先假設、注意力困難假說及過去研究結果。然而，過往學者多強調個體高度負向認知與憂鬱情緒對注意力偏誤的影響，故本研究事後同時納入憂鬱與苦惱自責式反芻程度，欲探討憂鬱苦惱自責式反芻者對負向訊息有無注意力偏誤，乃至注意力訓練對憂鬱苦惱自責式反芻者注意力偏誤的訓練效果。本研究結果僅發現在修正版Posner作業中，憂鬱苦惱自責式反芻者更容易將注意力從負向訊息中轉移開來；在點偵測作業中，未有組間效果；在注意力訓練中，未有訓練效果。最後，本研究將於討論中，探討研究結果的可能原因，並提出本研究限制與未來研究上的建議。 / According to the impaired disengagement hypothesis (Koster, De Lissnyder, Derakshan, & De Raedt, 2011), the dysphoric that are difficult to disengage from negative stimuli due to low attentional control tend to ruminate, and then even worsen their depressive symptoms. Actually, rumination can be differentiated into two components: reflective pondering and brooding, but the core tenet of impaired disengagement hypothesis only puts the emphasis on rumination rather than brooding. Besides, there are many studies investigating the attention-training effects on depressive symptoms rather than rumination. To date, no studies even have investigated the training effects on impaired disengagement and brooding. Therefore, we aimed to examine the effects of attention training on attention bias toward negative stimuli, impaired disengagement from negative stimuli and brooding level in brooders. We investigated the training effect in brooding and non-psychiatric control participants via dot-probe task. During a two-week period, all of the participants were randomly assigned to complete 4 sessions of either attention training or no training. Also, participants completed two attentional tasks examined attention bias at baseline and post-training, and self-reported questionnaires of brooding and depressive symptoms at baseline, post-training, and follow-up. Overall, results indicate that brooders didn’t show attention bias to negative stimuli. Also, no beneficial effects of attention training on attention bias and brooding level were found in brooders. The previous hypothesis, impaired disengagement hypothesis and studies in the past were not supported. However, many cognitive models of depression have postulated that individuals with high levels of negative cognition and depressive affect tend to maintain their attention toward negative information. Therefore, we took levels of depression and brooding into account, and aimed to examine the effects of attention training on both attention bias toward negative stimuli and impaired disengagement from negative stimuli in depressive brooders. Results indicate that depressive brooders tend to disengage from negative stimuli in modified Posner task. No other findings in dot-probe task and attention-training task. Implications of these findings in depressive brooders are discussed and directions for future research are advanced.