1
|
Kralj A, Payne A, Holzhauer-Conti O, Young J, Meiser-Stedman R. Intrusive thoughts and memories in adolescents with major depressive disorder or post-traumatic stress disorder. BRITISH JOURNAL OF CLINICAL PSYCHOLOGY 2024; 63:543-557. [PMID: 38934114 DOI: 10.1111/bjc.12488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Accepted: 06/18/2024] [Indexed: 06/28/2024]
Abstract
OBJECTIVES Research in adults suggests that intrusive memories and intrusive thoughts (often referred to as intrusive cognitions) are common in members of the general population and are often seen in clinical disorders. However, little is known about the experience of intrusive cognitions in adolescents, particularly in adolescents with major depressive disorder (MDD) and post-traumatic stress disorder (PTSD). The present study sought to gather fundamental data on these phenomena (i.e., frequency, characteristics and appraisals of intrusive cognitions) in adolescents with MDD and PTSD. METHODS Adolescents aged 11-18 with MDD (n = 11), PTSD (n = 13) and a non-clinical control group (n = 25) completed structured interviews concerning their intrusive memories and thoughts. RESULTS Intrusive thoughts were common in all three groups but were particularly frequently experienced in the MDD group. Intrusive memories were expectedly very common in the PTSD group but also experienced by over half of the adolescents with MDD. Both clinical groups reported more negative emotions in response to their intrusive thoughts or memories and appraised these cognitions more negatively than the non-clinical group. CONCLUSION Intrusive memories and thoughts are common experiences in adolescents with MDD and PTSD. Emotions and appraisals relating to these cognitions may be targets for psychological intervention in this age group. However, small sample sizes limit the conclusions that can be drawn. Replication is needed with larger numbers of clinical participants.
Collapse
Affiliation(s)
- Aleksandra Kralj
- Department of Clinical Psychology and Psychological Therapies, Norwich Medical School, University of East Anglia, Norwich, UK
| | - Alexandra Payne
- Department of Clinical Psychology and Psychological Therapies, Norwich Medical School, University of East Anglia, Norwich, UK
| | - Olivia Holzhauer-Conti
- Department of Clinical Psychology and Psychological Therapies, Norwich Medical School, University of East Anglia, Norwich, UK
| | - Judith Young
- Department of Clinical Psychology and Psychological Therapies, Norwich Medical School, University of East Anglia, Norwich, UK
| | - Richard Meiser-Stedman
- Department of Clinical Psychology and Psychological Therapies, Norwich Medical School, University of East Anglia, Norwich, UK
| |
Collapse
|
2
|
Lee SW, Kim S, Lee H, Chang Y, Lee SJ. Neural correlates of thought-action fusion and their associations with rumination in patients with major depressive disorder. J Psychiatr Res 2024; 180:169-176. [PMID: 39426337 DOI: 10.1016/j.jpsychires.2024.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Revised: 07/12/2024] [Accepted: 10/09/2024] [Indexed: 10/21/2024]
Abstract
Thought-action fusion (TAF) is the metacognitive belief that the power of thoughts can have real-life consequences, often inducing unpleasant inner experiences and recruiting coping strategies such as rumination. Therefore, this study aimed to investigate the neural correlates of TAF and their associations with rumination in depression. A total of 37 patients with major depressive disorder (MDD) and 37 healthy controls (HCs) underwent functional magnetic resonance imaging with a TAF induction task and psychological assessments. In the TAF induction task, participants were asked to read the name of a close person (CP) or neutral person (NP) in association with negative (Neg) TAF and neutral (Neu) control statements. In this study, our TAF induction task activated brain regions, including the salient and default-mode networks, in the MDD and HC groups. However, along with higher likelihood TAF and rumination, behavioral data showed less negative feelings and longer reaction times under the NegCP condition in the MDD group compared with the HC group. Furthermore, in the MDD group, significantly higher activation in the bilateral caudate nuclei, left inferior frontal gyrus/anterior insula, putamen, and inferior parietal lobule under the NegCP condition was positively correlated with TAF and reflection. These findings suggest that during the TAF task, patients with MDD may activate different brain areas associated with the maintenance of high stimulus saliency and habit formation, which are important neural correlates linking TAF and rumination in depression.
Collapse
Affiliation(s)
- Sang Won Lee
- Department of Psychiatry, Kyungpook National University Chilgok Hospital, South Korea; Department of Psychiatry, School of Medicine, Kyungpook National University, South Korea
| | - Seungho Kim
- Department of Medical & Biological Engineering, Kyungpook National University, South Korea
| | - Hansol Lee
- Department of Medical & Biological Engineering, Kyungpook National University, South Korea
| | - Yongmin Chang
- Department of Molecular Medicine, School of Medicine, Kyungpook National University, South Korea; Department of Radiology, Kyungpook National University Hospital, South Korea.
| | - Seung Jae Lee
- Department of Psychiatry, School of Medicine, Kyungpook National University, South Korea; Department of Psychiatry, Kyungpook National University Hospital, South Korea.
| |
Collapse
|
3
|
Kelly-Turner K, Radomsky AS. Update and validation of the Beliefs about Losing Control Inventory-II (BALCI-II): a psychometric investigation. Cogn Behav Ther 2024:1-14. [PMID: 39373713 DOI: 10.1080/16506073.2024.2410833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 09/20/2024] [Indexed: 10/08/2024]
Abstract
The Beliefs about Losing Control Inventory (BALCI) was developed to assess negative beliefs about losing control in obsessive-compulsive disorder (OCD). Since its creation, research and theoretical work support negative beliefs about losing control as a potential transdiagnostic construct. The present study revised and expanded the original BALCI to be more inclusive of control-related concerns beyond those that would be expected in OCD (e.g. concerns about losing control over how one comes across to others in social anxiety disorder; SAD). Undergraduate students (N = 440) completed a questionnaire battery including the BALCI-II item pool. An exploratory factor analysis of the 32-item BALCI-II supported a four-factor solution. Three of the identified factors capture the feared consequences of losing control: 1) overwhelming emotions, 2) dangerous behaviour, and 3) madness. The fourth factor captures inflated beliefs about probability/severity of those losses. The BALCI-II was found to have good convergent and divergent validity, good to excellent internal, and retest reliability and was shown to have predictive utility in both OCD and SAD, above and beyond existing disorder-specific maladaptive belief domains. Results suggest the BALCI-II is an improvement over the previous version and supports the relevance of these beliefs beyond OCD.
Collapse
Affiliation(s)
- Kenneth Kelly-Turner
- Department of Psychology, Concordia University, Montreal, 7141 Sherbrooke St. West, Montréal, Quebec H4B 1R6, Canada
| | - Adam S Radomsky
- Department of Psychology, Concordia University, Montreal, 7141 Sherbrooke St. West, Montréal, Quebec H4B 1R6, Canada
| |
Collapse
|
4
|
Mehra A, Chakravarty R. "Law of Attraction": A manifestation of psychological disorder or not? Asian J Psychiatr 2024; 100:104155. [PMID: 39083953 DOI: 10.1016/j.ajp.2024.104155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Revised: 04/27/2024] [Accepted: 06/27/2024] [Indexed: 08/02/2024]
Affiliation(s)
- Aseem Mehra
- Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
| | - Rahul Chakravarty
- Department of Psychiatry, Telemanas Project, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| |
Collapse
|
5
|
Krause S, Radomsky AS. 'Things that shouldn't be': a qualitative investigation of violation-related appraisals in individuals with OCD and/or trauma histories. Behav Cogn Psychother 2024; 52:463-477. [PMID: 38679952 DOI: 10.1017/s1352465824000201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/01/2024]
Abstract
BACKGROUND Cognitive models of mental contamination (i.e. feelings of internal dirtiness without contact with a contaminant) propose that these feelings arise when individuals misappraise a violation. However, an operational definition of 'violation' and identification of specific violation misappraisals is limited. AIMS This study's aim was to elaborate on cognitive models using qualitative data from those with lived experience to fill these gaps. METHOD Twenty participants with a diagnosis of obsessive-compulsive disorder and/or a trauma history took part in a semi-structured interview about violation. Grounded theory was used to analyse interview transcripts. DISCUSSION Three categories emerged, each with several themes - qualities of violation, violation-related appraisals, and violation-related behaviours. Different violation-related appraisals were associated with different emotions and urges. Specific self-focused appraisal sub-themes (i.e. permanence of consequences; self-worth; responsibility, self-blame and regret) were most closely related to emotions tied to mental contamination. These findings support and expand upon existing cognitive models of mental contamination, identifying key violation-related appraisals and differentiating between mental contamination-related appraisals and those related to other emotional sequelae. Future quantitative and experimental research can evaluate the potential of these appraisals as intervention targets.
Collapse
Affiliation(s)
- Sandra Krause
- Concordia University, Department of Psychology, Montreal, Quebec, Canada
| | - Adam S Radomsky
- Concordia University, Department of Psychology, Montreal, Quebec, Canada
| |
Collapse
|
6
|
Krause S, Radomsky AS. Development and psychometric evaluation of the Violation Appraisal Measure (VAM). Cogn Behav Ther 2024:1-22. [PMID: 39206950 DOI: 10.1080/16506073.2024.2395823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2024] [Accepted: 08/14/2024] [Indexed: 09/04/2024]
Abstract
Mental contamination refers to feelings of dirtiness and/or urges to wash that arise without direct contact with a contaminant. Cognitive models propose that this results from "serious, negative misappraisals of perceived violations". However, the specific violation misappraisals most relevant to mental contamination have yet to be established empirically, in part due to the lack of a comprehensive validated inventory of violation appraisals. Therefore, this study's aim was to develop and validate such a measure. Items for the new Violation Appraisal Measure (VAM) were developed from qualitative interviews, theoretical models, and previous empirical work. An Exploratory Factor Analysis was conducted in a sample of (n = 300) undergraduate participants, which revealed a four-factor structure: Responsibility/Self-Blame, Permanence, Mistrust, and Self-Worth. The VAM showed excellent internal consistency (α = 0.90), good convergent (r = .50 to .64) and adequate divergent (r = -.01 to .46) validity and was predictive of mental contamination symptoms over and above existing related appraisal measures, Δ F(1,289) = 29.35, p < .001, Δ R2 = 0.06. A Confirmatory Factor Analysis in a second sample of (n = 300) undergraduate students confirmed strong model fit for the four-factor structure of the VAM. The development of the VAM is an important contribution to the search for empirically based cognitive mechanisms in mental contamination and other violation-related sequelae.
Collapse
Affiliation(s)
- Sandra Krause
- Department of Psychology, Concordia University, Montreal, Quebec, Canada
| | - Adam S Radomsky
- Department of Psychology, Concordia University, Montreal, Quebec, Canada
| |
Collapse
|
7
|
Kahya Y, Inozu M, Clark DA. Thematic Content Analysis of Repugnant Intrusions in Highly Religious Canadian and Turkish Samples. JOURNAL OF RELIGION AND HEALTH 2024; 63:2821-2846. [PMID: 36737537 DOI: 10.1007/s10943-023-01747-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/17/2023] [Indexed: 06/18/2023]
Abstract
The degree of religiosity, a culturally relevant concept, has been associated with obsessive phenomena such as obsessional symptoms, the nature of unwanted intrusive thoughts, and responses to intrusive thoughts. Although previous research reported that repugnant (i.e., sexual and religious) intrusions had the lowest endorsement rates, these were also the most difficult to control and more likely to turn into obsessions. Highly religious individuals are more likely to be distressed by repugnant intrusions as the repugnant nature of intrusive thoughts critically threatens the perceived self. Thus, individuals with high religiosity may be more likely to respond to repugnant intrusions with dysfunctional strategies and thus become more vulnerable to OCD. This study presents the endorsement rates and qualitative features of sexual and religious intrusions among highly religious Canadian and Turkish samples. Highly religious participants were interviewed using the International Intrusive Thoughts Interview Schedule (IITIS). Thematic content analysis of the IITIS data was conducted with MAXQDA. Sexual intrusion themes of Forceful Sex, Gay Sex, Immoral Sex, and Sex with Undesirable People were identified in both samples. Religious intrusion themes of Questioning, How They Are Perceived by God, Violating Religious Doctrines, Punishment by God, and Worship also emerged in both samples. The percentages of these themes suggested the presence of cross-cultural qualitative similarities and differences.
Collapse
Affiliation(s)
- Yasemin Kahya
- Department of Psychology, Faculty of Social Sciences and Humanities, Social Sciences University of Ankara, Hükümet Meydanı No: 2, 06050, Ulus, Altındağ, Ankara, Turkey.
| | - Mujgan Inozu
- Department of Psychology, Hacettepe University, Ankara, Turkey
| | - David A Clark
- Department of Psychology, University of New Brunswick, Fredericton, Canada
| |
Collapse
|
8
|
Jaeger T, Anglim J, Yang YH, Fuller-Tyszkiewicz M, Knight T, Moulding R. An ecological momentary assessment of OCD-relevant intrusions: Frequency, feared self, and concealment. Behav Res Ther 2024; 179:104558. [PMID: 38833900 DOI: 10.1016/j.brat.2024.104558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Revised: 04/21/2024] [Accepted: 05/06/2024] [Indexed: 06/06/2024]
Abstract
This study provides the first examination of the frequency, characteristics, and dynamics surrounding daily experiences of OCD-relevant intrusions among non-clinical participants (N = 54, Nobs = 2314) using ecological momentary assessment. It also examines the extent to which self-related constructs-participants' feared-self beliefs and their tendency to conceal aspects of self-relate to such intrusive phenomena. Participants completed a baseline questionnaire before reporting state depressed mood and intrusions up to five times per day (at semi-random intervals) for 14 days. Results suggest that questionnaire measures may result in underreporting of the frequency of intrusions, with most participants (80%) reporting at least one intrusion across the momentary observations, and 20% of observations indicating intrusive phenomena experienced since the previous momentary report. Baseline factors including OCD-related beliefs and feared self were related to the proportion of intrusions experienced, whereas self-concealment was not. Within the moment, state feared-self predicted intrusion-related distress, duration, perceived importance, the urge to act, and the need to control thoughts. The urge to conceal within the moment was significant but negatively related to perceived importance and the urge to act. Overall, this study provides evidence for the relevance of momentary measures of intrusions, and adds to evidence for self-beliefs in the dynamics of the disorder.
Collapse
Affiliation(s)
- Tess Jaeger
- Deakin University, Geelong, Australia; Orygen, Parkville, Australia; Centre for Youth Mental Health, University of Melbourne, Parkville, Australia.
| | | | | | | | - Tess Knight
- The Cairnmillar Institute (CMI), Hawthorn East, Australia
| | | |
Collapse
|
9
|
Stephenson C, Philipp-Muller A, Moghimi E, Nashed JY, Cook DJ, Shirazi A, Milev R, Alavi N. Effects of cognitive behavioural therapy and exposure-response prevention on brain activation in obsessive-compulsive disorder patients: systematic review and meta-analysis. Eur Arch Psychiatry Clin Neurosci 2024:10.1007/s00406-024-01852-6. [PMID: 38935215 DOI: 10.1007/s00406-024-01852-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 06/17/2024] [Indexed: 06/28/2024]
Abstract
Current psychotherapeutic treatments for OCD, while effective, have complex outcomes with mixed efficacy. Previous research has observed baseline brain activation patterns in OCD patients, elucidating some of the implications of this disorder. Observing the effects of evidence-based psychotherapeutics for OCD on brain activation (through MRI) may provide a more comprehensive outline of pathology. This systematic review and meta-analysis evaluated the effects of cognitive behavioural therapy (CBT) with exposure-response prevention (ERP) on brain activation in OCD patients. Academic databases were systematically searched, and the outcomes evaluated included changes in brain activation and symptom severity between baseline and post-treatment. Patients (n = 193) had confirmed OCD diagnosis and underwent protocolized CBT with ERP programs delivered by trained therapists. Participants in the CBT with ERP programs demonstrated significant improvements in symptom severity (Cohen's d = - 1.91). In general, CBT with ERP resulted in decreased activation post-treatment in the frontal (Cohen's d = 0.40), parietal (Cohen's d = 0.79), temporal (Cohen's d = 1.02), and occipital lobe (Cohen's d = 0.76), and cerebellum (Cohen's d = - 0.78). The findings support CBT with ERP's ability to improve brain activation abnormalities in OCD patients. By identifying regions that improved activation levels, psychotherapy programs may benefit from the addition of function-specific features that could improve treatment outcomes.
Collapse
|
10
|
Müller CL, Jelinek L, Schmidt AF, Mannsfeld AK, Miegel F, Cludius B. Mediation analyses of longitudinal data investigating temporal associations between inflated sense of responsibility, obsessive-compulsive symptoms, and anger suppression. J Clin Psychol 2024. [PMID: 38932513 DOI: 10.1002/jclp.23729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 05/10/2024] [Accepted: 06/01/2024] [Indexed: 06/28/2024]
Abstract
OBJECTIVE Cognitive theories emphasize the central role of anger and anger suppression in obsessive-compulsive disorder (OCD). According to these theories, anger suppression is seen as a consequence of OCD, whereas cognitive beliefs, such as an inflated sense of responsibility, are seen as antecedent factors. To extend the findings from cross-sectional studies, the current study investigated the temporal associations between OCD symptoms, an inflated sense of responsibility, and anger suppression. Consistent with cognitive considerations, we hypothesized that OCD symptoms mediate the association between feelings of responsibility and anger suppression. These associations were also explored in patients presenting particularly high checking-related symptoms. Further, the stability of effects beyond controlling for depressive symptoms and medication intake was explored. METHODS A total of N = 48 patients with OCD (50% female, M = 32.46 [SD = 10.63] years of age) completed measures on obsessive beliefs, OCD symptoms, and anger suppression at three assessment points: before and after a metacognitive intervention as well as at a follow-up 6 months later. Mediation models investigating symptom associations at these three timepoints were conducted. Exploratory analyses investigating these associations in individuals presenting high checking-related symptoms (n = 20) and testing the stability of effects beyond controlling for depressive symptoms and medication intake were conducted. RESULTS The sense of responsibility did not significantly predict the level of anger suppression. A temporal association between OCD symptoms (as assessed with the self-report measure) and anger suppression could be evidenced, which was stable beyond controlling for depressive symptoms and medication intake. Against the expectations based on cognitive theories, the sense of responsibility did not predict OCD symptoms. No mediating effect of OCD symptoms was found. CONCLUSION In line with cognitive viewpoints, the present study shows that higher OCD symptoms predict higher levels of anger suppression in a longitudinal design, thereby contributing to the suppression of anger. This effect seems to be independent from depressive symptoms and medication intake. The effect of sense of responsibility on OCD symptoms was less clear and could only be found in the subgroup of patients with OCD and checking-related symptoms, who generally presented higher levels of responsibility. Overall, this is the first study demonstrating temporal associations between OCD symptoms and anger suppression. Acknowledging that anger and anger suppression may be a consequence of OCD symptoms and may also affect aspects of psychotherapy, which can ultimately inform future adjustments to psychotherapeutic treatment.
Collapse
Affiliation(s)
- Celina L Müller
- Department of Clinical Psychology and Psychotherapy, LMU Munich, Munich, Germany
| | - Lena Jelinek
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Alexander F Schmidt
- Institute of Psychology, Social and Legal Psychology, Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Anna K Mannsfeld
- Department of Clinical Psychology and Psychotherapy, LMU Munich, Munich, Germany
| | - Franziska Miegel
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Barbara Cludius
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Department of Clinical Psychology and Psychotherapy of Adulthood, University of Bremen, Bremen, Germany
| |
Collapse
|
11
|
Rigoux L, Stephan KE, Petzschner FH. Beliefs, compulsive behavior and reduced confidence in control. PLoS Comput Biol 2024; 20:e1012207. [PMID: 38900828 PMCID: PMC11218963 DOI: 10.1371/journal.pcbi.1012207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Revised: 07/02/2024] [Accepted: 05/28/2024] [Indexed: 06/22/2024] Open
Abstract
OCD has been conceptualized as a disorder arising from dysfunctional beliefs, such as overestimating threats or pathological doubts. Yet, how these beliefs lead to compulsions and obsessions remains unclear. Here, we develop a computational model to examine the specific beliefs that trigger and sustain compulsive behavior in a simple symptom-provoking scenario. Our results demonstrate that a single belief disturbance-a lack of confidence in the effectiveness of one's preventive (harm-avoiding) actions-can trigger and maintain compulsions and is directly linked to compulsion severity. This distrust can further explain a number of seemingly unrelated phenomena in OCD, including the role of not-just-right feelings, the link to intolerance to uncertainty, perfectionism, and overestimation of threat, and deficits in reversal and state learning. Our simulations shed new light on which underlying beliefs drive compulsive behavior and highlight the important role of perceived ability to exert control for OCD.
Collapse
Affiliation(s)
- Lionel Rigoux
- Max Planck Institute for Metabolism Research, Cologne, Germany
- Translational Neuromodeling Unit, Institute for Biomedical Engineering, University of Zurich and Swiss Federal Institute of Technology Zurich, Zurich, Switzerland
| | - Klaas E. Stephan
- Max Planck Institute for Metabolism Research, Cologne, Germany
- Translational Neuromodeling Unit, Institute for Biomedical Engineering, University of Zurich and Swiss Federal Institute of Technology Zurich, Zurich, Switzerland
| | - Frederike H. Petzschner
- Robert J. and Nancy D. Carney Institute for Brain Science, Brown University, Providence, Rhode Island, United States of America
- Department of Psychiatry and Human Behavior, Brown University, Providence, Rhode Island, United States of America
- Center for Digital Health, Brown University, Providence, Rhode Island, United States of America
| |
Collapse
|
12
|
Baltacı S, Gençöz T, Sarı S. "This Is a Disease" and "Disease Has No Sin": Discourse Constructions of Individuals With Obsessive-Compulsive Disorder With Regard to Being Diagnosed. QUALITATIVE HEALTH RESEARCH 2024; 34:444-457. [PMID: 38041545 DOI: 10.1177/10497323231208988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/03/2023]
Abstract
Obsessive-compulsive disorder (OCD) symptoms have different cultural images in society. Deconstructive psychology studies can contribute to understanding the dominant discourse surrounding these patients, given the prevalence of OCD. The objective of this study was to investigate the discourse of participants regarding "having/receiving a diagnosis of OCD" and the function of this discourse. The research approach was qualitative and language-based, specifically employing Lacanian Discourse Analysis (LDA) perspective. The possible questions and prompts were determined along with the research team, and seven semi-structured interviews were conducted with six participants diagnosed with OCD. The interviews explored how participants referred to their diagnosis, the language they used, and the function of this discourse. The findings revealed that participants diagnosed with OCD insistently used the term "disease" to explain their peculiar and distressing situations, referring to "medical discourse" with expressions such as "This is a disease" and "This disorder." Additionally, they often utilized "religious discourse" with the statements like "Disease has no sin" and "The sick and insane are exempt from their responsibilities." The findings of the current research indicated that when individuals with OCD "receive a name" through a recognized diagnosis, they experience a sense of recognition and validation for their OCD-related problems. Consequently, individuals diagnosed with OCD tend to find "legitimacy" for their irrational or unwanted thoughts and behaviors by taking comfort from their diagnosis. This study provides valuable insights into an understanding of patients with OCD. The findings are discussed in the context of their implications for both theoretical and applied research.
Collapse
Affiliation(s)
- Sinem Baltacı
- Department of Psychology, Yalova University, Yalova, Turkey
| | - Tülin Gençöz
- Department of Psychology, Middle East Technical University, Ankara, Turkey
| | - Sevda Sarı
- Department of Psychology, Haliç University, İstanbul, Turkey
| |
Collapse
|
13
|
Sandstrom A, Radomsky AS. Beliefs about losing control and other OCD-related cognitions: An experimental investigation. J Behav Ther Exp Psychiatry 2024; 82:101919. [PMID: 37948951 DOI: 10.1016/j.jbtep.2023.101919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 09/18/2023] [Accepted: 10/25/2023] [Indexed: 11/12/2023]
Abstract
BACKGROUND AND OBJECTIVES Cognitive theories of obsessive-compulsive disorder (OCD) suggest that dysfunctional beliefs influence symptoms. However, well-established belief domains do not fully explain OCD symptomatology, suggesting other cognitive mechanisms may be involved. An additional belief domain which may play a role in OCD is beliefs about losing control. Indeed, these beliefs have been found to be associated with OCD symptoms. However, the relationships between beliefs about losing control and other OCD phenomena, including other relevant dysfunctional beliefs, is unclear. The aim of this study was to examine the relationships between beliefs about losing control and appraisals hypothesized to be relevant to OCD. METHODS A total of 163 participants completed the experimental protocol, wherein they received false (positive or negative) feedback regarding the likelihood they may lose control and completed a vignette task asking them to read hypothetical scenarios relevant to OCD concerns (checking, and aggressive thoughts). Vignettes were followed by questions and prompts used to measure OCD-relevant appraisals. RESULTS Based on MANOVAs, beliefs about losing control had a significant impact on appraisals in the checking, F (151) = 5.55, p = .001, and aggressive thoughts, F (151) = 2.898, p = .037, vignettes. However, planned comparison indicated that in the aggressive thoughts vignettes, this effect was in the opposite direction than was hypothesized. LIMITATIONS The losing control induction may have inadvertently influenced participants' beliefs about the utility of thought control. CONCLUSIONS Findings provide preliminary evidence for an association between beliefs about losing control and OCD-relevant appraisals.
Collapse
Affiliation(s)
- Andrea Sandstrom
- Concordia University, Department of Psychology, 7141 Rue Sherbrooke Ouest, Montreal, Quebec, H4B 1R6, Canada
| | - Adam S Radomsky
- Concordia University, Department of Psychology, 7141 Rue Sherbrooke Ouest, Montreal, Quebec, H4B 1R6, Canada.
| |
Collapse
|
14
|
Radomsky AS, Ouellet-Courtois C, Golden E, Senn JM, Parrish CL. Putting things right: An experimental investigation of memory biases related to symmetry, ordering and arranging behaviour. J Behav Ther Exp Psychiatry 2024; 82:101914. [PMID: 37793286 DOI: 10.1016/j.jbtep.2023.101914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 08/17/2023] [Accepted: 09/27/2023] [Indexed: 10/06/2023]
Abstract
BACKGROUND AND OBJECTIVES Research indicates the presence of both explicit and implicit memory biases for threat. However, empirical support for the presence of memory biases related to symmetry, ordering and arranging is lacking, despite the fact that many individuals report anxiety associated with their personal belongings being out of place. The aim of this experiment was to examine memory biases for disorderliness and their associations with symmetry, ordering and arranging symptoms. METHODS Eighty undergraduate participants were assigned to one of four conditions, consisting of rooms in which objects were arranged according to different levels of disorderliness (orderly, slightly disorderly, slightly orderly, and disorderly). Participants next completed a memory task in which their memory for disordered vs. ordered objects was assessed. Measures of OCD symptoms, preference for symmetry, OCD belief domains, anxiety and depression were completed. RESULTS Analyses indicated that participants in the slightly disorderly condition showed significantly better recall and recognition for the disordered items than for the ordered items, and that those in the slightly orderly condition showed the same pattern in recall, but not recognition. No associations were found between a preference for symmetry and memory biases. LIMITATIONS The sample scored particularly low on our measure of symptoms of preference for symmetry, compromising the generalizability of our results. CONCLUSIONS Findings provide evidence for a general memory bias for disorderliness, although this bias does not appear to be associated with symmetry, ordering and arranging symptoms. Results are discussed from a cognitive-behavioural perspective with the consideration of feelings of incompleteness.
Collapse
Affiliation(s)
- Adam S Radomsky
- Concordia University, Department of Psychology, 7141 Rue Sherbrooke Ouest, Montreal, Quebec, H4B 1R6, Canada.
| | - Catherine Ouellet-Courtois
- Concordia University, Department of Psychology, 7141 Rue Sherbrooke Ouest, Montreal, Quebec, H4B 1R6, Canada
| | - Elissa Golden
- Concordia University, Department of Psychology, 7141 Rue Sherbrooke Ouest, Montreal, Quebec, H4B 1R6, Canada
| | - Jessica M Senn
- Concordia University, Department of Psychology, 7141 Rue Sherbrooke Ouest, Montreal, Quebec, H4B 1R6, Canada
| | - Chris L Parrish
- Concordia University, Department of Psychology, 7141 Rue Sherbrooke Ouest, Montreal, Quebec, H4B 1R6, Canada
| |
Collapse
|
15
|
Sandstrom A, Krause S, Ouellet-Courtois C, Kelly-Turner K, Radomsky AS. What's control got to do with it? A systematic review of control beliefs in obsessive-compulsive disorder. Clin Psychol Rev 2024; 107:102372. [PMID: 38091769 DOI: 10.1016/j.cpr.2023.102372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 10/15/2023] [Accepted: 12/01/2023] [Indexed: 01/17/2024]
Abstract
Current conceptualizations of control-related beliefs in Obsessive-Compulsive Disorder (OCD) have largely been limited to beliefs about the need to control thoughts. Although growing evidence supports the notion of considering broader control-related constructs in this disorder, there has been limited research aimed at integrating findings across studies, making it difficult to determine how different control-related beliefs may influence OCD symptoms. The current review sought to systematically analyze findings from all studies investigating the relationship between control beliefs and OCD. The systematic search identified 157 eligible articles that assessed the relationship between control beliefs and OCD symptoms. Results suggested that certain control beliefs (e.g., importance of/need to control of thoughts, sense of control, beliefs about losing control) may be more closely associated with OCD than others (e.g., locus of control, and desire for control). In general, control beliefs were positively associated with OCD, with effect sizes ranging from small to large depending on the symptom domain. Based on limited studies, the only control belief which demonstrated specificity to OCD was ICT. Findings support the importance of integrating additional control beliefs in conceptualizations of OCD and provide evidence to support the benefits of targeting these beliefs in cognitive behavioural therapy.
Collapse
Affiliation(s)
- Andrea Sandstrom
- Concordia University, Department of Psychology, 7141 Rue Sherbrooke Ouest, Montreal, Quebec H4B 1R6, Canada
| | - Sandra Krause
- Concordia University, Department of Psychology, 7141 Rue Sherbrooke Ouest, Montreal, Quebec H4B 1R6, Canada
| | - Catherine Ouellet-Courtois
- Concordia University, Department of Psychology, 7141 Rue Sherbrooke Ouest, Montreal, Quebec H4B 1R6, Canada
| | - Kenneth Kelly-Turner
- Concordia University, Department of Psychology, 7141 Rue Sherbrooke Ouest, Montreal, Quebec H4B 1R6, Canada
| | - Adam S Radomsky
- Concordia University, Department of Psychology, 7141 Rue Sherbrooke Ouest, Montreal, Quebec H4B 1R6, Canada.
| |
Collapse
|
16
|
Morris OJ, Wiese AD, Pinciotti CM, Pacheco R, Mallen MCM, Schweissing EJ, Soileau KJ, Crowley JJ, Storch EA. Obsessive-compulsive disorder among individuals of Hispanic and Latin American ancestry: Cultural considerations for assessment and psychotherapy. Bull Menninger Clin 2024; 88:148-170. [PMID: 38836850 PMCID: PMC11521111 DOI: 10.1521/bumc.2024.88.2.148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/06/2024]
Abstract
Research specific to obsessive-compulsive disorder (OCD) among individuals of Hispanic and Latin American (H/L) ancestry is limited, as are culturally relevant assessment and treatment recommendations. This article discusses the implications of underrepresentation of H/L populations in OCD research and emphasizes the need to consider issues related to assessment, treatment, and structural barriers that hinder delivery of culturally appropriate first-line psychotherapy. Recommendations for assessment and treatment are provided to aid clinicians in distinguishing culturally normative thoughts and behaviors from OCD, as well as to inform the implementation of psychotherapeutic interventions with cultural humility. This manuscript offers recommendations for future research to tackle health equity concerns with respect to assessment and treatment and structural factors limiting access to culturally appropriate psychotherapy. Wide-scale efforts are needed to comprehensively understand how H/L cultures intersect with various OCD presentations and to further disseminate treatments to populations that have historically lacked access to mental health care.
Collapse
Affiliation(s)
- Olivia J Morris
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas
| | - Andrew D Wiese
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas
| | - Caitlin M Pinciotti
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas
| | | | | | | | - Keaton J Soileau
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas
| | - James J Crowley
- Department of Genetics and with the and the Department of Psychiatry, University of North Carolina, Chapel Hill, North Carolina
| | - Eric A Storch
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas
| |
Collapse
|
17
|
Lazarov A, Liberman N, Dar R. The Seeking Proxies for Internal States (SPIS) Model of OCD - A Comprehensive Review of Current Findings and Implications for Future Directions. Curr Neuropharmacol 2024; 22:1807-1825. [PMID: 37881091 PMCID: PMC11284725 DOI: 10.2174/1570159x21666230920165403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 04/17/2023] [Accepted: 05/19/2023] [Indexed: 10/27/2023] Open
Abstract
The Seeking Proxies for Internal States (SPIS) model of obsessive-compulsive disorder (OCD) explains symptoms of OCD as stemming from attenuated access to internal states, which is compensated for by using proxies, which are indices of these states that are more discernible or less ambiguous. Internal states in the SPIS model are subjective states that are not accessible to others, encompassing physiological states, motivations, preferences, memories, and emotions. Compensatory proxies in OCD include fixed rules and rituals as well as seeking and relying on external information. In the present review, we outline the SPIS model and describe its basic tenets. We then use the SPIS conceptualization to explain two pivotal OCD-related phenomena - obsessive doubt and compulsive rituals. Next, we provide a detailed overview of current empirical evidence supporting the SPIS in several domains, including physiological states, emotions, sense of understanding, decision-making, and sense of agency. We conclude by discussing possible neural correlates of the difficulty in accessing internal states, focusing on the anterior insular cortex (AIC) and highlighting potential clinical implications of the model to the treatment of OCD.
Collapse
Affiliation(s)
- Amit Lazarov
- School of Psychological Sciences, Tel Aviv University, Tel Aviv 69978, Israel
| | - Nira Liberman
- School of Psychological Sciences, Tel Aviv University, Tel Aviv 69978, Israel
| | - Reuven Dar
- School of Psychological Sciences, Tel Aviv University, Tel Aviv 69978, Israel
| |
Collapse
|
18
|
Olofsdotter Lauri K, Aspvall K, Mataix-Cols D, Serlachius E, Rück C, Andersson E. An online self-guided cognitive intervention for unwanted intrusive thoughts about harming infants in new parents: initial randomised controlled trial with mediation analysis. Cogn Behav Ther 2023; 52:585-602. [PMID: 37395079 DOI: 10.1080/16506073.2023.2229015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 06/14/2023] [Indexed: 07/04/2023]
Abstract
Approximately one-fifth of new parents struggle with unwanted intrusive thoughts (UITs) about intentionally harming their child. This study evaluated the initial efficacy, feasibility and acceptability of a novel online self-guided cognitive intervention for new parents with distressing UITs. Self-recruited parents (N = 43, 93% female, age 23-43 years) of children 0-3 years reporting daily distressing and impairing UITs were randomized to the 8-week self-guided online cognitive intervention or to waiting-list. The primary outcome was change on the Parental Thoughts and Behaviour Checklist (PTBC) from baseline to week 8 (post-intervention). The PTBC and negative appraisals (mediator) were assessed at baseline, weekly, post-intervention and at the 1-month follow-up. Results showed that the intervention led to statistically significant reductions in distress and impairment associated with UITs at post-intervention (controlled between-group d = 0.99, 95% CI 0.56 to 1.43), which were maintained at the 1-month follow-up (controlled between-group d = 0.90, 95% CI 0.41 to 1.39). The intervention was deemed to be feasible and acceptable by the participants. Change in negative appraisals mediated reductions in UITs but the model was sensitive to mediator-outcome confounders. We conclude that this novel online self-guided cognitive intervention can potentially reduce the distress and impairment associated with UITs in new parents. Large-scale trials are warranted.Abbreviations: UITs: Unwanted Intrusive Thoughts PTBC: Parental Thoughts and Behaviour Checklist.
Collapse
Affiliation(s)
- Klara Olofsdotter Lauri
- Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Kristina Aspvall
- Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - David Mataix-Cols
- Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Eva Serlachius
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Christian Rück
- Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Erik Andersson
- Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| |
Collapse
|
19
|
Ferrão JVB, do Rosário MC, Fontenelle LF, Ferrão YA. Prevalence and psychopathology features of mental rituals in patients with obsessive-compulsive disorder: A descriptive exploratory study of 1001 patients. Clin Psychol Psychother 2023; 30:1520-1533. [PMID: 37554049 DOI: 10.1002/cpp.2890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Revised: 07/04/2023] [Accepted: 07/17/2023] [Indexed: 08/10/2023]
Abstract
INTRODUCTION Mental rituals (MR) are compulsions with no overt behavioural or motoric signs. It is presently unclear whether MR found in obsessive-compulsive disorder are associated with a distinctive clinical profile. OBJECTIVES The main objectives of this paper were to assess the prevalence and psychopathological correlates of mental rituals in a large sample of OCD patients. METHODS This exploratory case-control study compared 519 patients with versus 447 without MR in terms of sociodemographics, presence and severity of obsessive-compulsive symptoms, psychiatric comorbidities, sensory phenomena, suicidality, and insight. RESULTS Current MR were found in 51.8%, while lifetime MR were found in 55.4% of the sample. The multiple logistic regression model determined that the most relevant clinical factors independently associated with current MR in OCD patients were the absence of any sensory phenomena and the presence of lifetime suicide ideation. CONCLUSION Due to its relation to OCD clinical aspects, MR are a frequent feature among OCD patients. It also seems to be associated with a range of features that are probably relevant for treatment, especially sensory phenomena and suicidality.
Collapse
Affiliation(s)
- João Vítor Bueno Ferrão
- Medical School, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, Brazil
| | - Maria Conceição do Rosário
- Brazilian Consortium for Research on Obsessive-Compulsive Spectrum Disorders (C-TOC), Unidade de Psiquiatria da Infância e Adolescência (UPIA), Escola Paulista de Medicina, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
| | - Leonardo F Fontenelle
- Brazilian Consortium for Research on Obsessive-Compulsive Spectrum Disorders (C-TOC), Departamento de Psiquiatria e Medicina Legal da Faculdade de Medicina da Universidade Federal do Rio de Janeiro (UFRJ) e da Faculdade de Medicina da Universidade Federal Fluminense (UFF), Instituto DOr de Pesquisa e Ensino (IDOR), Rio de Janeiro, Brazil
| | - Ygor Arzeno Ferrão
- Brazilian Consortium for Research on Obsessive-Compulsive Spectrum Disorders (C-TOC), Clinical Neurosciences, Medical School, Programa de Pós- Graduação em Ciências da Saúde, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, Brazil
| |
Collapse
|
20
|
Khayrullina G, Panfilova E, Martynova O. Increased error rate and delayed response to negative emotional stimuli in antisaccade task in obsessive-compulsive disorder. Int J Psychophysiol 2023; 192:62-71. [PMID: 37604280 DOI: 10.1016/j.ijpsycho.2023.08.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Revised: 08/02/2023] [Accepted: 08/17/2023] [Indexed: 08/23/2023]
Abstract
Ample evidence links impaired inhibitory control, attentional distortions, emotional dysregulation, and obsessive-compulsive disorder (OCD). However, it remains unclear what underlies the deficit that triggers the OCD cycle. The present study used an antisaccade paradigm with emotional valences to compare eye movement patterns reflecting inhibitory control and attention switching in OCD and healthy control groups. Thirty-two patients with OCD and thirty healthy controls performed the antisaccade task with neutral, positive, and negative visual images served as fixation stimuli. Presentation of the fixation stimulus overlapped with target stimuli appearance for 200 ms. The OCD group showed more errors to negative stimuli than the control group and they also performed antisaccades more slowly to negative and neutral stimuli than positive ones. Other patterns, including mean gaze velocity of correct antisaccades did not differ between groups. The mean gaze velocity of correct antisaccades was higher for negative and positive stimuli than for neutral stimuli in both groups. The peak velocity parameter did not show any differences either between groups or between valences. The findings support a hypothesis that an attentional bias toward negative stimuli interferes with inhibitory control in OCD.
Collapse
Affiliation(s)
- Guzal Khayrullina
- Institute of Higher Nervous Activity and Neurophysiology RAS, Butlerova 5A, Moscow 117484, Russia; Centre for Cognition and Decision Making, Institute for Cognitive Neuroscience, National Research University Higher School of Economics, Myasnitskaya 20, Moscow 101000, Russia.
| | - Elizaveta Panfilova
- Institute of Higher Nervous Activity and Neurophysiology RAS, Butlerova 5A, Moscow 117484, Russia
| | - Olga Martynova
- Institute of Higher Nervous Activity and Neurophysiology RAS, Butlerova 5A, Moscow 117484, Russia; Centre for Cognition and Decision Making, Institute for Cognitive Neuroscience, National Research University Higher School of Economics, Myasnitskaya 20, Moscow 101000, Russia
| |
Collapse
|
21
|
Chiang B, Purdon C. A study of doubt in obsessive-compulsive disorder. J Behav Ther Exp Psychiatry 2023; 80:101753. [PMID: 37247970 DOI: 10.1016/j.jbtep.2022.101753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 04/19/2022] [Accepted: 05/19/2022] [Indexed: 05/31/2023]
Abstract
BACKGROUND AND OBJECTIVES Obsessive-compulsive disorder (OCD) has been referred to as the "doubting disease," yet there has been little foundational research on its phenomenology and characteristics. Studies of doubt have relied on researchers' idiosyncratic conceptualizations of the construct, resulting in varied assessment methods and different prevalence rates (11-75%). We examined the nature and characteristics of doubt in people with clinical and subclinical OCD so as to identify its nature and characteristics, and factors that may be unique to OCD. METHODS A semi-structured interview about doubt was administered to people with OCD (N = 44) and with subclinical OCD (N = 21). RESULTS Doubt was highly prevalent and manifested as a form of obsession, uncertainty about whether a task was done properly, and/or lack of confidence in memory and perceptions. All participants took action to resolve doubt and/or proactively pre-empt or reduce future doubt. Doubt was deeply connected to negative core beliefs about the self. The groups did not differ on their experience of doubt, except that greater symptom severity was associated with greater interference from doubt, less ability to resist it, and less success of proactive, but not reactive, strategies to manage it. LIMITATIONS We relied on retrospective report, and the subclinical group was relatively small. CONCLUSIONS In subclinical and clinical OCD, doubt is pervasive, manifests in three domains, is connected to negative core beliefs, and is highly aversive. Continued empirical study of doubt is essential to proper assessment and to development of theories and treatment of OCD.
Collapse
Affiliation(s)
- Brenda Chiang
- Department of Psychology, University of Waterloo, Waterloo, ON, Canada; Parkwood Institute, Operational Stress Injury Clinic - GTA Site, Toronto, ON, Canada.
| | - Christine Purdon
- Department of Psychology, University of Waterloo, Waterloo, ON, Canada.
| |
Collapse
|
22
|
Millar JFA, Coughtrey AE, Healy A, Whittal M, Shafran R. The current status of mental contamination in obsessive compulsive disorder: A systematic review. J Behav Ther Exp Psychiatry 2023; 80:101745. [PMID: 37247969 DOI: 10.1016/j.jbtep.2022.101745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 04/07/2022] [Accepted: 04/23/2022] [Indexed: 05/31/2023]
Abstract
BACKGROUND AND OBJECTIVES Over the past 25 years Mental Contamination (MC) has become recognised as a distinct construct, particularly in relation to Obsessive Compulsive Disorder (OCD). MC is defined as feelings of contamination, often located internally, that arise in the absence of contact with a contaminant, with the source proposed to be human. Despite considerable interest from researchers and clinicians, there has not been a systematic review on the relationship between MC and OCD. Therefore, a systematic review was conducted to summarise and synthesise the current status of phenomenological and experimental evidence, mechanisms, assessment, measurement, and treatment of MC in OCD (PROSPERO: CRD42021223119). METHODS All study designs were eligible provided the focus of the study was on MC and the implications of the study were linked to OCD. We searched PsychINFO, Embase, Medline, Ethos, ProQuest, conference abstracts and trial registries between 1990 and 2021. The Mixed Methods Appraisal tool was used to assess methodological quality of included studies. RESULTS We found 58 reports with a total of 67 studies that met criteria for inclusion in the review. Twenty-three of these studies used clinical samples, 28 were experimental, 12 focused on phenomenology and 8 addressed treatment. The quality of the studies was variable. LIMITATIONS Grey literature was not included, thus there may be further unpublished MC studies that have not been included in the review. CONCLUSIONS Based on the findings, mental contamination is a robust clinical construct within OCD that has important implications for understanding and treating the disorder.
Collapse
Affiliation(s)
| | | | | | - Maureen Whittal
- Vancouver CBT Centre and University of British Columbia, Canada
| | | |
Collapse
|
23
|
Miegel F, Daubmann A, Moritz S, Balzar A, Yassari AH, Jelinek L. Obsessive-Compulsive Symptom Dimensions and Their Relationships with Obsessive Beliefs: A Structural Equation Modeling Analysis. Psychiatr Q 2023; 94:345-360. [PMID: 37410191 DOI: 10.1007/s11126-023-10037-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/13/2023] [Indexed: 07/07/2023]
Abstract
Dysfunctional beliefs are central in the development and maintenance of obsessive-compulsive disorder (OCD) as well as its treatment. Yet, research suggests that not all dysfunctional beliefs are equally important for each of the symptom dimensions of OCD. However, results are inconsistent in that studies contradict each other regarding the associations between specific symptom dimensions and belief domains. The aim of the present study was to clarify which belief domain is specifically associated with which OCD symptom dimension. Results could help to tailor treatments more specifically to the patient's OCD symptom dimension. In- and outpatients with OCD (N = 328; 43.6% male and 56.4% female) filled out questionnaires on symptom dimensions of OCD (Obsessive-Compulsive Inventory Revised) and dysfunctional beliefs (Obsessive Beliefs Questionnaire). A structural equation model analysis was conducted to identify the associations between dysfunctional beliefs and symptom dimensions. Our results showed that perfectionism/intolerance of uncertainty was associated with hoarding and symmetry/ordering, (2) overestimation of threat/inflated responsibility was associated with checking compulsions, and (3) importance of thoughts/control of thoughts was associated with obsessing. These results were largely supported by a backward selection. Our results demonstrated associations of specific dysfunctional beliefs and specific OCD symptom dimensions. However, future studies are necessary to replicate these findings with other measures (e.g., clinician ratings).
Collapse
Affiliation(s)
- Franziska Miegel
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany.
| | - Anne Daubmann
- Department of Medical Biometry and Epidemiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Steffen Moritz
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | - Alicia Balzar
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | - Amir-Hosseyn Yassari
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | - Lena Jelinek
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| |
Collapse
|
24
|
Semeniuc S, Păduraru AE, Soponaru C. Guilt, Disgust, and Not Just Right Experience Mediate the Effect of Demanding Parent Mode on Obsessive-Compulsive-Disorder-like Tendencies, and Punitive Parent Mode Moderates This Mediation. Behav Sci (Basel) 2023; 13:700. [PMID: 37753978 PMCID: PMC10526000 DOI: 10.3390/bs13090700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 08/18/2023] [Accepted: 08/21/2023] [Indexed: 09/28/2023] Open
Abstract
The main objective of the present study was to examine, in a non-clinical population, the validity of a moderated mediation model for obsessive mental functioning. The research was conducted on a sample of 205 participants. Data were collected using the Psychiatric Screening and Diagnostic Questionnaire, Young's Modes Questionnaire-form SMI-2, Padua Inventory of Obsessive-Compulsive Symptoms, Fear of Guilt Scale in OCD, Disgust Propensity and Sensitivity Scale-Revised, and Not Just Right Experiences Questionnaire-Revised. The results revealed that there is a significant positive, indirect effect of the Demanding Parent mode on OCD-like tendencies, which is completely mediated by fear of guilt, tendency and sensitivity to disgust, and Not Just Right Experiences severity. The Punitive Parent mode moderates only the indirect effect of the Demanding Parent mode mediated by fear of guilt, not the indirect effect mediated by disgust tendency and sensitivity and Not Just Right Experiences severity. Also, the indirect effect of the Demanding Parent mode on obsessive tendencies mediated by fear of guilt is significant only at medium and high values of the Punitive Parent mode, not at low values of the moderator. Our results provide a novel direction targeting the direct therapeutic intervention on demanding and punitive internal dialogue, complementing the classical CBT intervention protocol.
Collapse
|
25
|
Katz DE, Rector NA, McCabe RE, Hawley LL, Rowa K, Richter MA, Ornstein T, Regev R, McKinnon M, Laposa JM. The effect of aerobic exercise alone and in combination with cognitive behavioural therapy on obsessive compulsive disorder: A randomized control study. J Anxiety Disord 2023; 98:102746. [PMID: 37494756 DOI: 10.1016/j.janxdis.2023.102746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 06/17/2023] [Accepted: 07/12/2023] [Indexed: 07/28/2023]
Abstract
PURPOSE Cognitive behavioural therapy (CBT) has been found to be an effective treatment for OCD, but there remains a significant proportion of individuals who fail to show a treatment response. Aerobic exercise has previously been associated with decreases in anxiety and depression, as well as improvements in OCD symptoms in small-scale studies. The purpose of the present research was to use a randomized control trial design to examine the effects of exercise alone and in combination with CBT, on OCD symptoms and secondary symptoms. METHOD 125 participants were randomly assigned to one of four treatment groups: waitlist control, exercise, CBT, and CBT with exercise. OCD symptom severity was measured at four points over the course of treatment, secondary outcome measures were gathered at three points over treatment. RESULTS CBT alone and combined with exercise was associated with significantly greater OCD symptom reduction than exercise alone or the control groups. Total exercise frequency predicted OCD symptom reduction in the groups in which exercise was measured. Group membership did not significantly predict reductions in secondary outcome measures. CONCLUSION Exercise frequency, rather than the presence or absence of exercise, appears to predict OCD symptom reduction, as did participation in CBT.
Collapse
Affiliation(s)
- Danielle E Katz
- Forest Hill Centre for Cognitive Behavioural Therapy, Toronto, Ontario, Canada
| | - Neil A Rector
- Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Department of Psychiatry, Toronto, Ontario, Canada; University of Toronto, Department of Psychiatry, Toronto, Ontario, Canada.
| | - Randi E McCabe
- McMaster University, Department of Psychology and Behavioural Neurosciences, Hamilton, Ontario, Canada; Anxiety Treatment and Research Clinic, St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada
| | - Lance L Hawley
- Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Department of Psychiatry, Toronto, Ontario, Canada; University of Toronto, Department of Psychiatry, Toronto, Ontario, Canada
| | - Karen Rowa
- McMaster University, Department of Psychology and Behavioural Neurosciences, Hamilton, Ontario, Canada; Anxiety Treatment and Research Clinic, St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada
| | - Margaret A Richter
- Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Department of Psychiatry, Toronto, Ontario, Canada; University of Toronto, Department of Psychiatry, Toronto, Ontario, Canada
| | - Tish Ornstein
- Department of Psychology, Toronto Metropolitan University, Toronto, Ontario, Canada
| | - Rotem Regev
- Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Department of Psychiatry, Toronto, Ontario, Canada
| | - Margaret McKinnon
- McMaster University, Department of Psychology and Behavioural Neurosciences, Hamilton, Ontario, Canada; Anxiety Treatment and Research Clinic, St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada
| | - Judith M Laposa
- University of Toronto, Department of Psychiatry, Toronto, Ontario, Canada; Campbell Family Mental Health Research Institute, Center for Addiction and Mental Health, Toronto, Ontario, Canada
| |
Collapse
|
26
|
Ouellet-Courtois C, Radomsky AS. Can immorality be contracted? Appraisals of moral disgust and contamination fear. Behav Res Ther 2023; 166:104336. [PMID: 37270955 DOI: 10.1016/j.brat.2023.104336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 04/05/2023] [Accepted: 05/19/2023] [Indexed: 06/06/2023]
Abstract
While extant research underlines the role of disgust in obsessive-compulsive disorder (OCD) with contamination fear, less research attention has been devoted to moral disgust. This study endeavored to examine the types of appraisals that are elicited by moral disgust in comparison to core disgust, and to examine their associations with both contact and mental contamination symptoms. In a within-participants design, 148 undergraduate students were exposed to core disgust, moral disgust, and anxiety control elicitors via vignettes, and provided appraisal ratings of sympathetic magic, thought-action fusion and mental contamination, as well as compulsive urges. Measures of both contact and mental contamination symptoms were administered. Mixed modeling analyses indicated that core disgust and moral disgust elicitors both provoked greater appraisals of sympathetic magic and compulsive urges than anxiety control elicitors. Further, moral disgust elicitors elicited greater thought-action fusion and mental contamination appraisals than all other elicitors. Overall, these effects were greater in those with higher contamination fear. This study demonstrates how a range of contagion beliefs are evoked by the presence of 'moral contaminants', and that such beliefs are positively associated with contamination concerns. These results shed light on moral disgust as an important target in the treatment of contamination fear.
Collapse
Affiliation(s)
- Catherine Ouellet-Courtois
- Concordia University, Department of Psychology, 7141 Rue Sherbrooke Ouest, Montreal, Quebec, H4B 1R6, Canada
| | - Adam S Radomsky
- Concordia University, Department of Psychology, 7141 Rue Sherbrooke Ouest, Montreal, Quebec, H4B 1R6, Canada.
| |
Collapse
|
27
|
ÖZDEMİR E, HACIÖMEROĞLU AB. Transdiagnostic Approach and Obsessive Compulsive Disorder. PSIKIYATRIDE GUNCEL YAKLASIMLAR - CURRENT APPROACHES IN PSYCHIATRY 2023. [DOI: 10.18863/pgy.1110989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/27/2023]
Abstract
The categorical approach of traditional psychiatric nosology has been a forceful approach for a very long time for explaining psychological disorders which are defined by symptom based diagnostic categories. However, in recent years, the importance of the "transdiagnostic" approach which is a new classification system is increasing. The transdiagnostic approach aims to examine dimensionally the common cognitive, behavioral, interpersonal and biological processes underlying many psychopathologies away from the categorical approach that classifies psychopathologies according to observable symptoms. This approach intends to treat the disorders through the common underlying processes and risk factors, thus heterogeneous and comorbid symptoms are better addressed and diagnostic categories that may change during treatment are avoided. In this review study, the current problems in diagnosing based on classification and gaps in the field were examined, and the approach itself was proposed as a solution. RDoC (Research Domain Criteria) which is a new classification system for psychiatric disorders within the scope of the approach, has created a new structure using modern research approaches in genetics, neuroscience and behavioral sciences. In the present study, the definition and emergence of the transdiagnostic approach, obsessive compulsive disorder and RDoC in the context of transdiagnostic approach and transdiagnostic treatment are explained. This review is intended to be a resource for both basic psychopathology research and the development of treatment methods within the framework of a transdiagnostic approach.
Collapse
|
28
|
Krause S, Radomsky AS. An Experimental Investigation of Moral Self-Violation and Mental Contamination. COGNITIVE THERAPY AND RESEARCH 2023; 47:1-11. [PMID: 37363745 PMCID: PMC10199425 DOI: 10.1007/s10608-023-10388-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/09/2023] [Indexed: 06/28/2023]
Abstract
Purpose Cognitive models of mental contamination (feelings of dirtiness/washing behaviour that arise without direct contact with a contaminant) highlight the central role of perceptions of violation in the onset and maintenance of these feelings. Little research has been done to clarify violation-specific appraisals relevant to mental contamination. Perceptions of violation of one's moral self-concept may represent one such appraisal domain. This experiment aimed to examine the impact of these appraisals on feelings of mental contamination. Methods One hundred and fifty participants received false feedback that they scored high on a morality subscale of a bogus personality test. They then completed a writing task wherein their degree of moral self-violation was manipulated. They received a writing prompt corresponding to one of three randomly assigned conditions (violated self (VS), bolstered self (BS), general negative (GN)). Finally, participants completed measures of mental contamination. Results The manipulation was effective at violating participants' moral self-concept. Those in the VS condition reported significantly higher levels of feelings of mental contamination than those in the BS or GN conditions. There were no significant differences between conditions regarding urges to wash. Conclusions Findings highlight the relevance of moral self-violation in the understanding and treatment of mental contamination.
Collapse
Affiliation(s)
- Sandra Krause
- Department of Psychology, Concordia University, 7141 Rue Sherbrooke Ouest, Montreal, QC H4B 1R6 Canada
| | - Adam S. Radomsky
- Department of Psychology, Concordia University, 7141 Rue Sherbrooke Ouest, Montreal, QC H4B 1R6 Canada
| |
Collapse
|
29
|
Fernandez SJ, Daffern M, Moulding R, Nedeljkovic M. Exploring predictors of aggressive intrusive thoughts and aggressive scripts: Similarities and differences in phenomenology. Aggress Behav 2023; 49:141-153. [PMID: 36408970 PMCID: PMC10100145 DOI: 10.1002/ab.22061] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Revised: 10/27/2022] [Accepted: 11/07/2022] [Indexed: 11/23/2022]
Abstract
Experiencing a thought about harming or injuring another person is commonly reported by the general population. Aggressive intrusive thoughts (AITs) and aggressive scripts are two constructs commonly used to define the experience of thinking about harming another person. However, they are generally investigated separately and with two significantly different population groups; respectively, individuals with obsessive-compulsive disorder and people with a history of violent behavior. AITs and aggressive scripts are assumed to have very different implications for violence risk assessment, but conceptual overlap and an absence of empirical research renders this assumption premature. Using a battery of self-report measures, this study aimed to investigate the differential predictors of AITs and aggressive script rehearsal in a nonclinical sample. Additionally, using regression analyses, the predictors of self-reported aggressive behavior were explored in a sample of 412 adults (73% females; Mage = 31.96 years, SD = 11.02). Violence-supportive beliefs and frequency of anger rumination predicted the frequency of aggressive script rehearsal, and aggressive script rehearsal, anger rumination, and violence-supportive beliefs predicted a history of aggressive behavior. In contrast, obsessive beliefs were predictive of AITs, and only AITs were related to ego-dystonicity. Both AITs and aggressive script rehearsal were related to the use of thought control strategies. These findings support the contributions that maladaptive beliefs have in the experience of aggressive scripts and AITs. Beliefs about violence, a history of aggressive behavior, and ego-dystonicity appear to differentiate aggressive scripts from AITs.
Collapse
Affiliation(s)
- Stephanie J Fernandez
- Department of Psychological Sciences, Swinburne University of Technology, Hawthorn, Melbourne, Australia.,Centre for Forensic Behavioural Science, Swinburne University of Technology, Alphington, Melbourne, Australia
| | - Michael Daffern
- Department of Psychological Sciences, Swinburne University of Technology, Hawthorn, Melbourne, Australia.,Centre for Forensic Behavioural Science, Swinburne University of Technology, Alphington, Melbourne, Australia
| | | | - Maja Nedeljkovic
- Department of Psychological Sciences, Swinburne University of Technology, Hawthorn, Melbourne, Australia
| |
Collapse
|
30
|
Brewin CR. Identity - A critical but neglected construct in cognitive-behaviour therapy. J Behav Ther Exp Psychiatry 2023; 78:101808. [PMID: 36435550 DOI: 10.1016/j.jbtep.2022.101808] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 10/26/2022] [Accepted: 11/12/2022] [Indexed: 11/24/2022]
Abstract
In cognitive-behaviour therapy attention paid to the self and identity has primarily involved self-representations (the Me-Self) rather than how the self is experienced (the I-Self). Within the I-Self experiences vary on a continuum from pre-reflective consciousness (raw experienced perceptions and states of being) to self-awareness (permitting reflection on and evaluation of subjective experience). There is considerable evidence that the I-Self is affected in many if not all disorders, and I review illustrative studies of OCD, eating disorders, body dysmorphic disorder, PTSD, and personality disorder. These indicate that patients often experience themselves as being defective in various ways, or as having an unstable or contradictory I-Self. Recognition of this neglected aspect of patients' experience has major implications for assessment and treatment. For example, acknowledgment that their sense of self may fluctuate dramatically from moment to moment, may be fragmented, or may consist of a sense of emptiness, may help to build a more empathic therapeutic relationship. If frightening or distressing pre-reflective experiences are the cause of avoidance or other maladaptive coping strategies, conscious attention paid to them in therapy may help to better integrate the I-Self and Me-Self, restoring a sense of predictability and control.
Collapse
|
31
|
Dr. Jack Rachman's contributions to our understanding and treatment of obsessive-compulsive disorder. J Behav Ther Exp Psychiatry 2023; 78:101773. [PMID: 36194913 DOI: 10.1016/j.jbtep.2022.101773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Accepted: 08/09/2022] [Indexed: 11/22/2022]
Abstract
BACKGROUND AND OBJECTIVES This paper reviews the development of the cognitive-behavioural model of obsessive-compulsive disorder (OCD) through the work of Dr. Jack Rachman and the research his ideas inspired or shaped. METHODS A narrative review of Rachman's work and important developments in related areas was conducted. RESULTS Rachman was highly responsive to theoretical and empirical developments in the field, and continuously developed his model of OCD over the course of his career. Key developments in his thinking and of those in related areas are described. LIMITATIONS This is a narrative review that highlights important developments in the cognitive behavioural model of OCD only. CONCLUSIONS The CBT model of OCD has strong empirical support and CBT treatment is the most effective psychotherapy. Continued development in our understanding of attachment and in the persistence of compulsions is warranted.
Collapse
|
32
|
Alcolado GM, Rowa K, Milosevic I, McCabe RE. Do all obsessions contradict personal values to the same degree? A pilot investigation. Bull Menninger Clin 2023; 87:291-312. [PMID: 37695881 DOI: 10.1521/bumc.2023.87.3.291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/13/2023]
Abstract
Although much is known about how intrusive thoughts become obsessions, the factors that determine which particular thoughts do so is not. The degree to which intrusions are personally significant may be such a determinant. Obsessive-compulsive disorder (OCD) is heterogeneous; thus, it is possible that contradictions of personal values may play a varying role in the development of obsessions depending on which OCD symptoms manifest and may change differentially following treatment. Archival data were examined. Patients with a diagnosis of OCD (N = 62) reported their most upsetting obsession and the degree to which it violated values both pre- and postparticipation in group cognitive-behavioral therapy for OCD. At pretreatment, contradiction ratings differed across symptom domains, such that participants with primary symptoms of obsessions/checking exhibited contradiction ratings that were significantly greater than did participants with other primary symptoms. Contradiction ratings did not change posttreatment. Implications for the conceptualization of OCD are discussed.
Collapse
Affiliation(s)
- Gillian M Alcolado
- Assistant professor in the Department of Clinical Health Psychology, University of Manitoba, Winnipeg, Canada
| | - Karen Rowa
- Anxiety Treatment and Research Clinic, St. Joseph's Healthcare Hamilton, Hamilton, Canada
- Associate Professors in the Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Canada
| | - Irena Milosevic
- Anxiety Treatment and Research Clinic, St. Joseph's Healthcare Hamilton, Hamilton, Canada
- Associate Professors in the Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Canada
| | - Randi E McCabe
- Anxiety Treatment and Research Clinic, St. Joseph's Healthcare Hamilton, Hamilton, Canada
- Professor in the Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Canada
| |
Collapse
|
33
|
Radomsky AS. The fear of losing control. J Behav Ther Exp Psychiatry 2022; 77:101768. [PMID: 36113905 DOI: 10.1016/j.jbtep.2022.101768] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 07/14/2022] [Accepted: 07/16/2022] [Indexed: 12/01/2022]
Abstract
Although a great deal of research has focused on various aspects of control and their relations to psychopathology, new insights and therapeutic potential could be revealed through an examination and perhaps emphasis on fears of losing control. Although elements of control-related beliefs and phenomena have been highlighted in association with obsessive-compulsive disorder and social anxiety disorder, this paper will give a fresh perspective on fears and beliefs about losing control, with implications for understanding and perhaps treating a broad range of psychological problems including panic disorder, posttraumatic stress disorder (PTSD), and others. New research questions and hypotheses are proposed, along with potential implications for expanded research into this domain and for clinical applications within a cognitive-behavioural approach.
Collapse
Affiliation(s)
- Adam S Radomsky
- Department of Psychology, Concordia University, 7141 Sherbrooke St. W, Montreal, QC, H4B 1R6, Canada.
| |
Collapse
|
34
|
Alcolado GM, Radomsky AS. The Beliefs About Memory Inventory (BAMI) and Its Ability to Predict Compulsive Checking. COGNITIVE THERAPY AND RESEARCH 2022. [DOI: 10.1007/s10608-022-10340-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
|
35
|
A Cognitive-Behavioural Approach to Targeting Sensation-Based and Intrusion-Based Misinterpretations in Health Anxiety: A Single-Case Experimental Study. BEHAVIOUR CHANGE 2022. [DOI: 10.1017/bec.2022.22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Abstract
Health anxiety (HA) is common in psychiatric and medical settings. Cognitive models of HA highlight the role of misinterpreting physical sensations as dangerous. This report presents the case of a 31-year-old man and the use of a cognitive-behavioural approach to treat his HA which also considers the role of misinterpreting intrusions as abnormal, by drawing on theoretical accounts of obsessive-compulsive disorder (OCD). A single-case experimental design demonstrated reliable improvements in symptom measures of HA and general distress. Distinguishing sensation-based versus intrusion-based appraisals in HA has implications for interventions in health settings and for refining cognitive theory.
Collapse
|
36
|
Olofsdotter Lauri K, Aspvall K, Bagøien Hustad I, Malmqvist K, Serlachius E, Mataix‐Cols D, Rück C, Ivanov V, Andersson E. Initial evaluation of a therapist-supported online cognitive therapy self-help for patients with taboo obsessions. BRITISH JOURNAL OF CLINICAL PSYCHOLOGY 2022; 61:964-982. [PMID: 35429005 PMCID: PMC9790335 DOI: 10.1111/bjc.12369] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Accepted: 03/23/2022] [Indexed: 12/30/2022]
Abstract
OBJECTIVES The current study evaluated the feasibility of an internet-delivered cognitive therapy (I-CT) in a self-help format with minimal therapist support for patients with obsessive-compulsive disorder (OCD) with primary taboo obsessions. Specifically, the aims were to investigate (1) whether participants were able to grasp and apply the internet-delivered cognitive framework to their own situation; (2) whether they had clinically meaningful reductions of OCD symptom severity; and (3) whether reduced negative appraisals (hypothesized mechanism of change in CT) preceded reductions in OCD symptom severity. METHOD Nineteen OCD patients with primary taboo obsessions, recruited from an OCD clinic or self-referrals, received the I-CT intervention for 10 weeks. I-CT did not contain any systematic exposure or response prevention. RESULTS Adherence and engagement with the intervention was high. Most participants (n = 13, 68%) understood and successfully applied the cognitive model to their own situation. Within-group analyses showed large reductions in OCD symptom severity at post-treatment (bootstrapped within group d = 1.67 [95% CI; 0.67 to 2.66]) measured with the Yale-Brown Obsessive-Compulsive Scale. The gains were maintained at the 6-month follow-up. Post-hoc analyses revealed that the large reductions in OCD symptom severity were driven by the participants who understood the cognitive model. Reductions in negative appraisals predicted subsequent reductions in OCD symptom severity during treatment. CONCLUSION It is possible to adapt a purely cognitive intervention to a digital guided self-help format and to achieve both cognitive change and meaningful symptom reduction. The results require confirmation in a randomized clinical trial.
Collapse
Affiliation(s)
- Klara Olofsdotter Lauri
- Department of Clinical Neuroscience, Division of PsychologyKarolinska InstitutetStockholmSweden,Stockholm Health Care Services, Region StockholmStockholmSweden
| | - Kristina Aspvall
- Department of Clinical Neuroscience, Division of PsychologyKarolinska InstitutetStockholmSweden,Stockholm Health Care Services, Region StockholmStockholmSweden
| | | | - Karin Malmqvist
- Stockholm Health Care Services, Region StockholmStockholmSweden
| | - Eva Serlachius
- Department of Clinical Neuroscience, Division of PsychologyKarolinska InstitutetStockholmSweden,Stockholm Health Care Services, Region StockholmStockholmSweden
| | - David Mataix‐Cols
- Department of Clinical Neuroscience, Division of PsychologyKarolinska InstitutetStockholmSweden,Stockholm Health Care Services, Region StockholmStockholmSweden
| | - Christian Rück
- Stockholm Health Care Services, Region StockholmStockholmSweden
| | - Volen Ivanov
- Department of Clinical Neuroscience, Division of PsychologyKarolinska InstitutetStockholmSweden,Stockholm Health Care Services, Region StockholmStockholmSweden
| | - Erik Andersson
- Department of Clinical Neuroscience, Division of PsychologyKarolinska InstitutetStockholmSweden
| |
Collapse
|
37
|
Pampaloni I, Marriott S, Pessina E, Fisher C, Govender A, Mohamed H, Chandler A, Tyagi H, Morris L, Pallanti S. The global assessment of OCD. Compr Psychiatry 2022; 118:152342. [PMID: 36007341 DOI: 10.1016/j.comppsych.2022.152342] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Revised: 06/24/2022] [Accepted: 08/02/2022] [Indexed: 11/03/2022] Open
Abstract
Obsessive Compulsive Disorder (OCD) is a common mental disorder that often causes great sufferance, with substantial impairment in social functioning and quality of life and affects family and significant relationships. Notwithstanding its severity, OCD is often not adequately diagnosed, or it is diagnosed with delay, leading often to a long latency between onset of the OCD symptoms and the start of adequate treatments. Several factors contribute to the complexity of OCD's clinical picture: early age of onset, chronic course, heterogeneity of symptoms, high rate of comorbidity with other psychiatric disorders, slow or partial response to therapy. Therefore, it is of primary importance for clinicians involved in diagnosing OCD, to assess all aspects of the disorder. This narrative review focuses on the global assessment of OCD, highlighting crucial areas to explore, pointing out the clinical features which are relevant for the treatment of the disorder, and giving an overview of the psychometric tools that can be useful during the screening procedure.
Collapse
Affiliation(s)
- Ilenia Pampaloni
- South West London and St Georges Mental Health Trust, London, UK.
| | - Sabina Marriott
- South West London and St Georges Mental Health Trust, London, UK
| | | | - Claire Fisher
- South West London and St Georges Mental Health Trust, London, UK
| | - Anusha Govender
- South West London and St Georges Mental Health Trust, London, UK
| | - Heba Mohamed
- South West London and St Georges Mental Health Trust, London, UK
| | - Augusta Chandler
- South West London and St Georges Mental Health Trust, London, UK
| | - Himanshu Tyagi
- University College London Hospital NHS foundation Trust, London, UK
| | - Lucy Morris
- South West London and St Georges Mental Health Trust, London, UK
| | - Stefano Pallanti
- Albert Einstein Institute, New York, USA; Istututo di Neuroscienze, Firenze, Italy
| |
Collapse
|
38
|
Heapy C, Emerson LM, Carroll D. Are failures to suppress obsessive-intrusive thoughts associated with working memory? J Behav Ther Exp Psychiatry 2022; 76:101724. [PMID: 35149276 DOI: 10.1016/j.jbtep.2022.101724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2020] [Revised: 01/03/2022] [Accepted: 01/24/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND AND OBJECTIVES Obsessive compulsive disorder (OCD) is characterised by repeated attempts to suppress obsessive-intrusive thoughts (OITs). Nonclinical individuals also regularly engage in thought suppression. Attempts to suppress OITs are often unsuccessful and there is wide variation in suppression abilities across nonclinical and clinical samples. Understanding the mechanisms that explain variations in suppression abilities could enhance our understanding of OCD. This study aimed to investigate one potential mechanism - working memory - using a comprehensive thought suppression task. METHODS Eighty-three nonclinical participants completed a computerized thought dismissibility task (in which they replaced an obsessive-intrusive thought with a neutral thought), and a computerized working memory task. Participants also completed measures of OCD and negative mood. RESULTS None of the suppression variables (OIT frequency, mean OIT duration, mean latency to return, total OIT duration) were correlated with working memory capacity. Obsessive-compulsive symptoms were correlated with total OIT duration, but the relationship was not significant after controlling for negative mood. LIMITATIONS The thought dismissibility task does not account for differences in motivation to suppress OITs. The sample was non-clinical and mostly female. CONCLUSION An individual's ability to suppress OITs is not associated with their working memory capacity, suggesting poor working memory does not explain persistent OITs in individuals with OCD.
Collapse
Affiliation(s)
- Connor Heapy
- Department of Psychology, University of Sheffield, Cathedral Court, Sheffield, S1 2GN, UK.
| | - Lisa-Marie Emerson
- Department of Psychology, University of Sheffield, Cathedral Court, Sheffield, S1 2GN, UK
| | - Dan Carroll
- Department of Psychology, University of Sheffield, Cathedral Court, Sheffield, S1 2GN, UK
| |
Collapse
|
39
|
Krause S, Ouellet-Courtois C, Sandstrom A, Radomsky AS. Thinking About Disgust: Cognitive Processes Mediate the Associations Between Disgust Proneness and OCD Symptom Domains. Int J Cogn Ther 2022. [DOI: 10.1007/s41811-022-00138-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
40
|
Core dysfunctional beliefs in patients with obsessive–compulsive disorder are shared with patients with anxiety disorder according to the revised Beliefs Questionnaire. CURRENT PSYCHOLOGY 2022. [DOI: 10.1007/s12144-022-03464-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
|
41
|
Kollárik M, Heinzel CV, Miché M, Lieb R, Wahl K. Exam-related unwanted intrusive thoughts and related neutralizing behaviors: Analogues to obsessions and compulsions. PLoS One 2022; 17:e0270692. [PMID: 35789213 PMCID: PMC9255742 DOI: 10.1371/journal.pone.0270692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 06/15/2022] [Indexed: 12/05/2022] Open
Abstract
Exam-related unwanted intrusive thoughts (UITs) and related neutralizing behaviors are common experiences among students. The present study investigated in what ways these UITs and behaviors are analogues to clinical obsessions and compulsions. Twenty-nine students completed three ecological momentary assessment surveys per day over 7 consecutive days, assessing the severity of exam-related UITs and related neutralizing behaviors, obsessive-compulsive (OC) symptoms, anxiety, distress, urge to neutralize, depressed mood, and stress in the week immediately before an exam period. Multilevel analysis demonstrated that the severity of exam-related UITs and related neutralizing behaviors was positively associated with OC symptoms, anxiety, distress, urge to neutralize, and stress but was not related to depressed mood. During the study period, the exam-related UITs occurred on average 7 times, and the related neutralizing behaviors on average 6 times. Overall, they were experienced with mild severity, low distress, and low urge to neutralize. Findings indicate that some aspects of exam-related UITs and related neutralizing behaviors (e.g., association with distress and urge to neutralize) might be analogous to OC symptoms but not all (e.g., no relation to depressed mood). We discuss how research on obsessive-compulsive disorder could benefit from considering exam-related UITs and related behaviors.
Collapse
Affiliation(s)
- Martin Kollárik
- Department of Psychology, Division of Clinical Psychology and Epidemiology, University of Basel, Basel, Switzerland
| | - Carlotta V. Heinzel
- Department of Psychology, Division of Clinical Psychology and Epidemiology, University of Basel, Basel, Switzerland
| | - Marcel Miché
- Department of Psychology, Division of Clinical Psychology and Epidemiology, University of Basel, Basel, Switzerland
| | - Roselind Lieb
- Department of Psychology, Division of Clinical Psychology and Epidemiology, University of Basel, Basel, Switzerland
| | - Karina Wahl
- Department of Psychology, Division of Clinical Psychology and Epidemiology, University of Basel, Basel, Switzerland
- * E-mail:
| |
Collapse
|
42
|
Cognitive-Behavioral Treatment of Obsessive-Compulsive Disorder: The Results of a Naturalistic Outcomes Study. J Clin Med 2022; 11:jcm11102762. [PMID: 35628888 PMCID: PMC9145175 DOI: 10.3390/jcm11102762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 05/10/2022] [Accepted: 05/12/2022] [Indexed: 12/10/2022] Open
Abstract
Cognitive−behavioral therapy is a well-established treatment for obsessive−compulsive disorder (OCD). There are a variety of cognitive and behavioral strategies, and it is necessary to analyze the outcomes of the treatments. The aim of the present study is to verify the effectiveness of a treatment that combines evidence-based procedures and specific cognitive interventions highlighting the issue of acceptance. Forty patients with OCD were recruited and underwent a specific treatment procedure. All patients had a psychodiagnostic assessment for OCD using the Y−BOCS (Yale−Brown obsessive−compulsive scale) performed twice: before treatment (t0) and after nine months (t1). Data analysis showed a decrease in the scores between t0 and t1 according to the Y−BOCS in terms of the interference, severity, and impairment of obsessive−compulsive symptoms. A repeated-measures ANOVA showed a significant reduction in symptoms after treatment, with values of F (1, 39) = 137.56, p < 0.001, and η2 = 0.78. The ANOVA results were corroborated by a Wilcoxon signed-rank test. A reliable change index analysis indicated that 33 participants reported improvements in symptoms, of which 23 were clinically significant. The results showed clinical relevance for OCD treatment and highlighted how this cognitive procedure favored positive outcomes.
Collapse
|
43
|
Testing the Two-Factor Model of Musical Obsessions: Can They Be Predicted by the Interaction Between Frequency and Dysfunctional Interpretations of Common Earworms? Int J Cogn Ther 2022. [DOI: 10.1007/s41811-022-00136-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Abstract
Musical obsessions can be conceptualized as a severe form of intrusive musical imagery (IMI). The two-factor model of musical obsessions proposes that musical obsessions result from the interaction of the frequency of IMI and dysfunctional interpretations of IMI. The aim of this study was to evaluate the predictions of the two-factor model. A total of 372 participants (291 without a known diagnosis of obsessive–compulsive disorder [OCD] and 81 with a lifetime diagnosis of OCD) completed online questionnaires about the frequency of IMI, their dysfunctional interpretations, and their severity. We specified a model with severity of IMI as outcome and interpretations and frequency as predictors and controlled for the type of sample. The interaction between frequency and dysfunctional interpretations predicted severity of IMI, however in another direction than suggested. Future studies should include experimental and longitudinal designs and pay particular attention to low-frequency IMI and their role in musical obsessions.
Collapse
|
44
|
Nelson J, Kelly JM, Wadsworth L, Maloney E. Co-occurring OCD and Panic Disorder: A Review of Their Etiology and Treatment. J Cogn Psychother 2022; 36:JCP-2021-0009.R2. [PMID: 35470149 DOI: 10.1891/jcp-2021-0009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Estimated rates of co-occurrence between obsessive and compulsive disorder (OCD) and panic disorder (PD) are notable, but vary considerably, with rates from epidemiological and clinical studies ranging from 1.8% to 22% (Rector et al., 2017). We reviewed the current empirical literature on the etiology, treatment, diagnostic assessment, and differential diagnosis of co-occurring OCD/PD. Best practices for cognitive-behavioral treatment, including identifying and addressing treatment barriers are also addressed. Although it is acknowledged in current literature that co-occurring OCD and PD levels may be clinically significant, there remains a need to thoroughly examine the possible consequences and future research directions of this overlap. Future research must continue to elucidate the biological and environmental causes of OCD/PD co-occurrence.
Collapse
|
45
|
Fite RE, Magee JC. The Role of Magical Thinking, Sensitivity, and Thought Content in Thought-Action Fusion. JOURNAL OF SOCIAL AND CLINICAL PSYCHOLOGY 2022. [DOI: 10.1521/jscp.2022.41.2.128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Introduction: Cognitive models of obsessive-compulsive disorder (OCD) posit that maladaptive beliefs about intrusive thinking contribute to the disorder's development and maintenance. However, the findings concerning one notable belief, thought-action fusion (TAF), have been inconsistent. Current conceptualizations of TAF may conflate constructs such as magical thinking, sensitivity, and thought content that are already the subject of informative, interdisciplinary literatures. Methods: To tease apart these constructs, adult participants (N = 249) reported their trait levels of sensitivity and magical thinking, and were randomly assigned to engage with an intrusive thought in one of three content areas. We hypothesized that morality-related content would lead to heightened maladaptive outcomes, but only in combination with higher trait levels of sensitivity and magical thinking. Results: Results indicated that morality-related content, along with sensitivity to morality, played more of a prominent role in maladaptive outcomes, with magical thinking being implicated in general outcomes like worry. Discussion: These findings suggest that the link between TAF and maladaptive outcomes may depend on which TAF elements are present for an individual. Sensitivity, in tandem with other TAF elements (e.g., morality-related content, magical thinking) is predictive of divergent outcomes (e.g., worrying, urges to neutralize) and thus may be an important target of future interventions aimed at reducing TAF, worrying, and/or OC symptoms.
Collapse
|
46
|
Cervin M, McNeel MM, Wilhelm S, McGuire JF, Murphy TK, Small BJ, Geller DA, Storch EA. Cognitive Beliefs Across the Symptom Dimensions of Pediatric Obsessive-Compulsive Disorder: Type of Symptom Matters. Behav Ther 2022; 53:240-254. [PMID: 35227401 PMCID: PMC9397538 DOI: 10.1016/j.beth.2021.08.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 08/06/2021] [Accepted: 08/12/2021] [Indexed: 02/03/2023]
Abstract
The cognitive model of obsessive-compulsive disorder (OCD) posits that dysfunctional cognitive beliefs are crucial to the onset and maintenance of OCD; however, the relationship between these cognitive beliefs and the heterogeneity of OCD symptoms in children and adolescents remains unknown. We examined how the major belief domains of the cognitive model (inflated responsibility/threat estimation, perfectionism/intolerance of uncertainty, importance/control of thoughts) and dysfunctional metacognitions were related to OCD symptoms across the following dimensions: doubting/checking, obsessing, hoarding, washing, ordering, and neutralization. Self-report ratings from 137 treatment-seeking youth with OCD were analyzed. When cognitive beliefs and symptom dimensions were analyzed in tandem, inflated responsibility/threat estimation and dysfunctional metacognitions were uniquely related to doubting/checking, obsessing, and hoarding and perfectionism/intolerance of uncertainty to ordering. Cognitive beliefs explained a large proportion of variation in doubting/checking (61%) and obsessing (46%), but much less so in ordering (15%), hoarding (14%), neutralization (8%), and washing (3%). Similar relations between cognitive beliefs and symptom dimensions were present in children and adolescents. Cognitive beliefs appear to be relevant for pediatric OCD related to harm, responsibility, and checking, but they do not map clearly onto contamination and symmetry-related symptoms. Implications for OCD etiology and treatment are discussed.
Collapse
Affiliation(s)
| | | | - Sabine Wilhelm
- Massachusetts General Hospital and Harvard Medical School
| | | | | | | | | | | |
Collapse
|
47
|
The Impact of Modifying Interpretive Bias on Contamination-Related Obsessive–Compulsive Symptoms. JOURNAL OF PSYCHOPATHOLOGY AND BEHAVIORAL ASSESSMENT 2022. [DOI: 10.1007/s10862-022-09963-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
AbstractCognitive-behavioural models of obsessive–compulsive disorder (OCD) propose that a tendency to negatively interpret ambiguous thoughts and situations plays a key role in maintaining the disorder. Moreover, some researchers have proposed that negative interpretive biases may share a common processing mechanism with attentional biases, with changes in one predicted to lead to changes in the other. The current study examined whether training positive (i.e., adaptive) interpretive bias of contamination-related OCD concerns using a cognitive bias modification paradigm (CBM-I) would lead to reductions in contamination concerns, as well as changes in contamination-related attentional bias. Undergraduate students with high levels of contamination-related OCD symptoms were randomly assigned to receive either positive (n = 31) or neutral (n = 33) CBM-I training. Participants in the positive training condition, relative to the neutral training condition, showed a significantly greater increase in positive interpretive bias, significantly less within-session behavioural avoidance of contaminants, and significantly reduced contamination-related cognitions (at one-week follow-up). Contrary to expectations, CBM-I training did not differentially impact attentional bias nor self-reported contamination-related OCD symptoms. We discuss future directions in applying CBM-I to contamination-related OCD.
Collapse
|
48
|
Boosting exposure and response prevention with imagery-based techniques: a case study tackling sexual obsessions in an adolescent. COGNITIVE BEHAVIOUR THERAPIST 2022. [DOI: 10.1017/s1754470x22000058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Abstract
Sexual obsessions are common in adolescents with obsessive compulsive disorder (OCD), but how to address these obsessions in a developmentally sensitive manner remains under-explored. This report presents the case of an adolescent who experienced unwanted sexual imagery, undergoing conventional exposure and response prevention, which was subsequently augmented with imagery-based techniques. This approach was associated with remission in symptoms of OCD and marked improvements in symptoms of anxiety and depression. The imagery-based approach was well received and valued as key to treatment success by the adolescent. This raises the tantalising possibility that working directly with images can fuel treatment innovation in tackling sexual (and non-sexual) obsessions in youth OCD.
Key learning aims
(1)
Sexual obsessions are common in adolescent obsessive compulsive disorder (OCD).
(2)
Little guidance is available on how to conduct exposure and response prevention sensitively for sexual obsessions in adolescent OCD.
(3)
Imagery-based techniques can be used effectively for reducing sexual obsessions.
(4)
Imagery-based techniques delivered by videoconferencing can be acceptable for young people.
Collapse
|
49
|
Visvalingam S, Crone C, Street S, Oar EL, Gilchrist P, Norberg MM. The causes and consequences of shame in obsessive-compulsive disorder. Behav Res Ther 2022; 151:104064. [DOI: 10.1016/j.brat.2022.104064] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 02/01/2022] [Accepted: 02/11/2022] [Indexed: 11/02/2022]
|
50
|
Shan HD, Liu YF, Zhao Q, Wang Y, Wang YM, Cheung EF, Chan RC, Wang Z. Distinct clinical manifestations of obsessive-compulsive disorder are associated with cortical thickness alteration. Aust N Z J Psychiatry 2022; 56:186-196. [PMID: 33951944 DOI: 10.1177/00048674211009623] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
BACKGROUND Although brain structural changes have been reported in patients with obsessive-compulsive disorder (OCD), results from previous studies have been inconsistent. A growing number of studies have focused on obsessive beliefs and impulsivity which could be involved in the occurrence and maintenance of OCD symptoms. The present study aimed to examine whether there are distinct brain structural changes in patients with different OCD subgroups. METHODS Eighty-nine patients with OCD and 42 healthy controls were recruited to undergo structural magnetic resonance imaging brain scan. OCD patients were classified into subgroups according to scores of the Obsessive Belief Questionnaire (OBQ-44) and the Barratt Impulsiveness Scale (BIS-11) using cluster analysis. Group comparisons in cortical thickness and subcortical volumes between all OCD patients and healthy controls, as well as between subgroups of OCD patients and healthy controls, were carried out. RESULTS OCD patients with more obsessive beliefs and attentional impulsivity (OCD_OB_AT) had reduced cortical thickness at the inferior parietal gyrus, the superior and middle temporal gyrus and the insula compared with OCD patients with higher score on the non-planning impulsivity (OCD_NP, corrected p < 0.05). The whole group of OCD patients and both subgroups showed reduced cortical thickness at the superior parietal gyrus compared with controls (uncorrected p < 0.01, number of vertices > 100). CONCLUSION Our results suggest that apart from distinct phenomenology, there are distinct neural correlates of different OCD subgroups based on obsessive beliefs and impulsivity. These neural correlates may have clinical significance and should be considered in future research.
Collapse
Affiliation(s)
- Hai-di Shan
- Shanghai Mental Health Centre, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ya-Fei Liu
- Shanghai Mental Health Centre, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Qing Zhao
- Shanghai Mental Health Centre, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Centre, Shanghai, China
| | - Yi Wang
- Neuropsychology and Applied Cognitive Neuroscience Laboratory, CAS Key Laboratory of Mental Health, Institute of Psychology, Beijing, China.,Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Yong-Ming Wang
- Neuropsychology and Applied Cognitive Neuroscience Laboratory, CAS Key Laboratory of Mental Health, Institute of Psychology, Beijing, China.,Department of Psychology, University of Chinese Academy of Sciences, Beijing, China.,Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Eric F Cheung
- Castle Peak Hospital, Hong Kong Special Administration Region, China
| | - Raymond C Chan
- Shanghai Mental Health Centre, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Neuropsychology and Applied Cognitive Neuroscience Laboratory, CAS Key Laboratory of Mental Health, Institute of Psychology, Beijing, China.,Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Zhen Wang
- Shanghai Mental Health Centre, Shanghai Jiao Tong University School of Medicine, Shanghai, China.,Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Centre, Shanghai, China.,Institute of Psychological and Behavioral Science, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| |
Collapse
|