A Prospective Test of Cognitive Vulnerability to Obsessive-compulsive Disorder

Interpersonal attachment, early family environment, and trauma in hoarding: A systematic review

The formation of intense emotional attachments to objects, difficulty parting with possessions, and the extreme accumulation of clutter are key features of Hoarding Disorder (HD). Although substantial literature implicates processes such as dysfunctional beliefs and maladaptive emotional cycles in HD, little is known about the vulnerability factors that lead to their development and hoarding symptomatology. The current review sought to systematically collate and integrate findings from studies investigating the relationship between hoarding symptoms and three proposed vulnerability factors: i) interpersonal attachment, ii) early family environment, and iii) traumatic or adverse life events. A comprehensive search of the databases PsycInfo, PubMed, and Scopus identified a total of 39 studies for inclusion. The results presented a complex pattern that supported the presence of relationships between insecure attachment, cold and controlling family experiences, and exposure to adverse life events with increased hoarding severity. However, the specificity of these factors to HD over other clinical groups remains unclear and findings are limited by the heterogenous and small number of studies. We conclude by discussing the clinical implications and limitations of these findings and propose new directions for future research.

Can selective attention and inhibition (interactively) predict future obsessive compulsive symptoms? A prospective study

BACKGROUND AND OBJECTIVES

The current study set out to investigate whether obsessive beliefs, selective attention, inhibition, and the interaction between selective attention and inhibition can prospectively predict contamination obsessive compulsive (OC) symptoms.

METHODS

Obsessive beliefs, inhibition, and selective attention were assessed in a student sample (n = 89) during a baseline session in the beginning of the first semester. Their predictive value was examined by assessing symptoms after an OC symptom induction in the lab and by assessing OC symptoms during a period of increased stress (the examination period) 68-80 days after baseline.

RESULTS

Results showed that obsessive beliefs did not consistently predict OC symptoms and there was no predictive effect of attentional bias, attentional bias variability, and inhibition in isolation. However, attentional bias variability and inhibition in the context of contamination-related stimuli interacted, in which only the combination of poor inhibition and large attentional bias variability predicted contamination OC symptoms during the examination period.

LIMITATIONS

Future research should investigate whether similar results are found in clinical populations, as the current sample consisted of a convenience sample of undergraduate students.

CONCLUSION

These results support the notion that information processing biases interact in predicting contamination OC symptoms.

Internet-based cognitive bias modification for obsessive compulsive disorder: study protocol for a randomized controlled trial

Background

Cognitive bias modification (CBM) interventions have demonstrated efficacy in augmenting core biases implicated in psychopathology. The current randomized controlled trial (RCT) will evaluate the efficacy of an internet-delivered positive imagery cognitive bias modification intervention for obsessive compulsive disorder (OCD) when compared to a control condition.

Methods/Design

Patients meeting diagnostic criteria for a current or lifetime diagnosis of OCD will be recruited via the research arm of a not-for-profit clinical and research unit in Australia. The minimum sample size for each group (alpha set at 0.05, power at .80) was identified as 29, but increased to 35 to allow for 20% attrition. We will measure the impact of CBM on interpretations bias using the OC Bias Measure (The Ambiguous Scenarios Test for OCD ;AST-OCD) and OC-beliefs (The Obsessive Beliefs Questionnaire-TRIP; OBQ-TRIP). Secondary outcome measures include the Dimensional Obsessive-Compulsive Scale (DOCS), the Patient Health Questionnaire (PHQ-9), The Kessler Psychological Distress Scale (K10), and the Word Sentence Association Test for OCD (WSAO). Change in diagnostic status will be indexed using the OCD Mini International Neuropsychiatric Interview (M.I.N.I) Module at baseline and follow-up. Intent-to-treat (ITT) marginal and mixed-effect models using restricted maximum likelihood (REML) estimation will be used to evaluate the primary hypotheses. Stability of bias change will be assessed at 1-month follow-up.

Discussion

A limitation of the online nature of the study is the inability to include a behavioral outcome measure.

Trial registration

The trial was registered on 10 October 2013 with the Australian New Zealand Clinical Trials Registry (ACTRN12613001130752)

Intolerance of uncertainty and obsessive-compulsive symptom expression

BACKGROUND AND OBJECTIVES

Research suggests a relationship between intolerance of uncertainty (IU) and obsessive-compulsive disorder (OCD), though this has been limited to self-report measures of OCD symptoms. The current investigation examined the relationship between IU and multiple symptom domains of OCD using self-report and in vivo assessments of OC symptoms.

METHODS

Five separate studies are presented in which undergraduate students (N=603) were administered a self-report measure of IU and tasks related to either ordering and arranging, checking, washing, contamination avoidance, or neutralization.

RESULTS

Intolerance of uncertainty was found to be significantly related to each self-report measure of the OCD symptom domains (ps < .01). Further, IU was predictive of performance on all in vivo tasks (ps < .05) except one concerning neutralizing/harm-related obsessions.

LIMITATIONS

This study relied on an unselected sample and was correlational in design.

CONCLUSIONS

The current study demonstrates that IU is related to multiple OC symptom dimensions. Future experimental research is warranted to evaluate the causal role of IU in OCD.

Letter to the Editor: Recent advances in research on cognition and emotion in OCD: a review

Cognitive theories of obsessive-compulsive disorder (OCD) ascertain that catastrophic (mis)interpretations of normally occurring intrusive thoughts are causal to the onset and maintenance of OCD. Recently, Calkins, Berman and Wilhelm have highlighted research validating the cognitive model. However, the current comment article stresses various findings that challenge basic premises of the cognitive theory. Moreover, a review of clinical studies investigating cognitive and behavioral therapies for OCD questions the added value of cognitive interventions over and above behavior therapy consisting of exposure and response prevention for this disorder. We suggest an alternative, potentially more useful route of investigation, stressing executive (dis)functions as the cause of OCD patients to (automatically) act on internal and external stimuli. We further suggest that dysfunctional beliefs proposed as paramount in the pathogenesis of OCD according to the cognitive model may be less important and specific than formerly believed.

Dysfunctional Belief Domains Related to Obsessive-Compulsive Disorder: A Further Examination of their Dimensionality and Specificity

International consensus has been achieved on the existence of several dysfunctional beliefs underlying the development and/or maintenance of the Obsessive-Compulsive Disorder (OCD). Nevertheless, questions such as the dimensionality of the belief domains and the existence of OCD-specific dysfunctional beliefs still remain inconclusive. The present paper addresses these topics through two different studies. Study 1: A series of confirmatory factor analyses (N= 573 non-clinical subjects) were carried out on the Obsessive Beliefs Spanish Inventory-Revised (OBSI-R), designed to assess dysfunctional beliefs hypothetically related to OCD. An eight-factor model emerged as the best factorial solution: responsibility, over-importance of thoughts, thought-action fusion-likelihood, thought action fusion-morality, importance of thought control, overestimation of threat, intolerance of uncertainty and perfectionism. Study 2: The OBSI-R and other symptom measures were administered to 75 OCD patients, 22 depressed patients, and 25 non-OCD anxious patients. Results indicated that, although OCD patients differed from their non-clinical counterparts on all of the OBSI-R subscales, no evidence of OCD-specificity emerged for any of the belief domains measured, as the OCD subjects did not differ from the other two clinical groups of patients.

Core OCD symptoms: exploration of specificity and relations with psychopathology

Obsessive-compulsive disorder (OCD) is a heterogeneous condition, comprised of multiple symptom domains. This study used aggregate composite scales representing three core OCD dimensions (Checking, Cleaning, and Rituals), as well as Hoarding, to examine the discriminant validity, diagnostic specificity, and predictive ability of OCD symptom scales. The core OCD scales demonstrated strong patterns of convergent and discriminant validity - suggesting that these dimensions are distinct from other self-reported symptoms - whereas hoarding symptoms correlated just as strongly with OCD and non-OCD symptoms in most analyses. Across analyses, our results indicated that Checking is a particularly strong, specific marker of OCD diagnosis, whereas the specificity of Cleaning and Hoarding to OCD was less strong. Finally, the OCD Checking scale was the only significant predictor of OCD diagnosis in logistic regression analyses. Results are discussed with regard to the importance of assessing OCD symptom dimensions separately and implications for classification.

Lifetime Exposure to Adverse Events and Reinforcement Sensitivity in Obsessive–Compulsive Prone Individuals

A diathesis-stress perspective of obsessive–compulsive symptoms (OCS) predicts that exposure to adverse events and personality dispositions jointly influence OCS. Gray and McNaughton's (2000) model of personality posits that, faced with challenging circumstances, individuals with a high sensitivity to punishment (SP) will be more prone to OCS because they cannot avoid the downward spiral into anxiety. The current study investigates OCS severity in relation to lifetime exposure to adverse events (AE), SP, and sensitivity to reward (SR) in 122 nonclinical adults. The results indicate that OCS severity is predicted by AE, SP and SR. Interestingly, the impact of adverse experiences is moderated by SR and not SP. These findings suggest that: (1) exposure to adverse events and SP are independent OCS risk factors, and (2) exposure to adverse events is more critical for reward dependent people. This is discussed in light of responsibility and ‘not just right experiences’ in OCS, along with the role of impulsivity in the obsessive-compulsive disorder spectrum.

Distress tolerance and obsessions: an integrative analysis

BACKGROUND

Recent research implicates a potential relationship between poor distress tolerance (DT) and obsessive-compulsive disorder (OCD) and obsessions in particular, though this evidence has been largely indirect. We sought to examine the incremental and specific associations between DT and obsessions using multiple methodologies.

METHODS

We conducted three separate studies using independent nonclinical samples (total N=558) that involved cross-sectional (Study 1) and prospective self-report designs (Study 2), as well as the use of an in vivo neutralization task (Study 3).

RESULTS

Poor DT was specifically associated with obsessing but not other OCD symptoms, even when covarying for several theoretically relevant constructs. Further, poor DT was predictive of residual change in obsessing symptoms 1-month later. Poor DT was also associated with neutralization in response to an OCD-like intrusion and postneutralization period anxiety.

CONCLUSIONS

These consistent findings provide support for an important relationship between DT and obsessions and suggest that interventions targeting DT may have special benefit for the treatment of obsessions.

Cognitive bias modification for anxiety: current evidence and future directions

Cognitive bias modification (CBM) is an innovative approach to modifying cognitive biases that confer vulnerability to anxiety. CBM interventions are designed to directly modify attention and interpretation biases via repeated practice on cognitive tasks. Analogue studies have demonstrated that CBM affects cognitive biases and anxiety in a number of anxiety conditions. Multisession CBM treatments have shown preliminary efficacy for generalized social phobia and generalized anxiety disorder, with effect sizes comparable to existing treatments. However, with any newly developing field, there are a number of important limitations of the existing data that need to be addressed before making firm conclusions regarding CBM's efficacy for anxiety disorders. This article focuses on the theoretical rationale for CBM and the current evidence from analogue and clinical samples.

Vulnerability factors in OCD symptoms: cross-cultural comparisons between Turkish and Canadian samples

Recent findings have suggested some potential psychological vulnerability factors for development of obsessive-compulsive (OC) symptoms, including cognitive factors of appraisal and thought control, religiosity, self-esteem and personality characteristics such as neuroticism. Studies demonstrating these associations usually come from Western cultures, but there may be cultural differences relevant to these vulnerability factors and OC symptoms. The present study examined the relationship between putative vulnerability factors and OC symptoms by comparing non-clinical samples from Turkey and Canada, two countries with quite different cultural characteristics. The findings revealed some common correlates such as neuroticism and certain types of metacognition, including appraisals of responsibility/threat estimation and perfectionism/need for certainty, as well as thought-action fusion. However, culture-specific factors were also indicated in the type of thought control participants used. For OC disorder symptoms, Turkish participants were more likely to utilize worry and thought suppression, while Canadian participants tended to use self-punishment more frequently. The association with common factors supports the cross-cultural validity of some factors, whereas unique factors suggest cultural features that may be operative in cognitive processes relevant to OC symptoms.

Incremental specificity of disgust sensitivity in the prediction of obsessive-compulsive disorder symptoms: Cross-sectional and prospective approaches

The present study examines the association between disgust sensitivity (DS) and obsessive-compulsive disorder (OCD) symptoms in two non-clinical samples. Findings from Study 1 (n=270) revealed a significant association between DS and OCD symptoms even after controlling for negative affect and anxiety sensitivity. Subsequent analysis also revealed a specific association between DS and the washing subtype of OCD symptoms when controlling for other OCD symptom dimensions. DS did not significantly predict residual change in total symptoms of OCD over a 12-week period (n=300) when controlling for risk factors for anxiety disorder symptoms in general (e.g., negative affect, anxiety sensitivity) and OCD specifically (e.g., obsessive beliefs) in Study 2. However, exploratory analyses suggest that DS may be predictive of residual change in some OCD symptom subtypes but not others. Implications of these findings for future research on the role of disgust in OCD are discussed.

Obsessive-compulsive symptoms: the contribution of obsessional beliefs and experiential avoidance

Experiential (emotional) avoidance (EA), a core concept in acceptance and commitment therapy, involves an unwillingness to endure upsetting emotions, thoughts, memories, and other private experiences; and is hypothesized to play a role in obsessive-compulsive disorder (OCD). The present study examined how well EA, relative to traditional cognitive-behavioral theoretical constructs such as dysfunctional core beliefs about intrusive thoughts, predicts obsessive-compulsive (OC) symptoms. A sample of 353 non-clinical participants completed measures of EA, core "obsessive" beliefs, and OC symptoms. Individuals reporting greater levels of OC symptoms endorsed more obsessive beliefs and EA relative those with lower levels of OC symptoms, even when accounting for general levels of psychological distress. Among those with more OC symptoms, EA did not show relationships with obsessive beliefs. Moreover, EA did not add significantly to the prediction of OC symptom dimensions over and above the contribution of general distress and obsessive beliefs. Obsessive beliefs, meanwhile, contributed significantly to the prediction of OC checking and obsessing symptoms after accounting for EA. It appears the construct of EA is too general to explain OC symptoms over and above cognitive-behavioral constructs such as core obsessive beliefs, which are more specific.

Sagen dysfunktionale Kognitionen den Therapieerfolg voraus?

Zusammenfassung. Theoretischer Hintergrund: Dysfunktionale Kognitionen stellen den Kern des kognitiv-behavioralen Modells zur Erklärung psychischer Störungen dar. Fragestellung: In einer Längsschnittstudie wird geprüft, ob die Reduktion von Angst- und depressiver Symptomatik mit dem Ausmaß und der Reduktion dysfunktionaler Kognitionen zusammenhängt. Methode: N = 87 Patienten mit den Diagnosen Zwangsstörung, Major Depression und Panikstörung bzw. Agoraphobie beantworteten vor und nach einer kognitiven Verhaltenstherapie Fragebögen zu Symptomatik, dysfunktionalen Einstellungen, Sorgen und Grübeln. Ergebnisse: Die Patienten verbessern sich im Therapieverlauf hinsichtlich kognitiver Inhalte und Prozesse sowie der Belastung. Ausgeprägte Sorgen zu Therapiebeginn korrelieren mit weniger Besserung ängstlicher Symptomatik, Reflektion ist dagegen ein protektiver Faktor. Die Abnahme dysfunktionaler Einstellungen sagt die Reduktion der Ängstlichkeit, die Abnahme des Sorgens die Reduktion der Depressivität vorher. Schlussfolgerungen: Die Annahmen des kognitiv-behavioralen Modells werden gestützt.