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Harkin B, Davies LE, Yates A. Contamination-Focussed Vignettes as an Analogue of Infectious Pandemics: An Experimental Validation using the State Disgust and Anxiety Responses in OCD. Psychol Rep 2024:332941241238208. [PMID: 38462961 DOI: 10.1177/00332941241238208] [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: 03/12/2024]
Abstract
Despite infectious pandemics proving particularly detrimental to those with Obsessive-Compulsive Disorder (OCD), the investigation of analogous experimental paradigms is lacking. To address this gap, we conducted two studies employing vignettes that depicted contamination-related situations commonly experienced during a pandemic (e.g., Coughing into hands and failing to use hand sanitizer). We manipulated the salience of these vignettes across three levels: high contamination, low contamination, and a neutral control condition. Our examination of state anxiety and disgust responses in all participants revealed the successful manipulation of the vignettes' impact. Specifically, individuals with more severe OCD symptoms reported significantly higher levels of state disgust and anxiety for both high and low contamination vignettes, in contrast to the group with lower symptom severity. No significant differences were observed in the neutral vignette condition between the high- and low-scoring groups. Interestingly, for those with higher OCD symptoms, high salience contamination-focused vignettes resulted in similarly elevated state disgust and anxiety, regardless of whether the vignettes were situated in public (Study 1) or domestic (Study 2) settings. This suggests that the heightened sensitivity to contamination-related scenarios observed in individuals with OCD symptoms in the present study is not confined to a specific context. These findings support the use of contamination-focused vignettes as analogues for studying infectious pandemics and provide valuable insights into OCD models, interventions, and future research.
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Affiliation(s)
- Ben Harkin
- Department of Psychology, Manchester Metropolitan University, Manchester, UK
| | - Lucy E Davies
- Department of Psychology, Manchester Metropolitan University, Manchester, UK
| | - Alan Yates
- Department of Psychology, Manchester Metropolitan University, Manchester, UK
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2
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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 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.
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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
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3
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Basel D, Magen M, Lazarov A. Increased attention allocation to stimuli reflecting end-states of compulsive behaviors among obsessive compulsive individuals. Sci Rep 2023; 13:12190. [PMID: 37500711 PMCID: PMC10374647 DOI: 10.1038/s41598-023-39459-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 07/25/2023] [Indexed: 07/29/2023] Open
Abstract
Attentional research in OCD has focused solely on threat stimuli, assumed to provoke related obsessions and ensuing compulsions. OCD-related stimuli depicting the completion of compulsive acts ("end-states") have yet to be examined. Past research also neglected to explore the reliability of tasks used. Here, attention allocation to both stimuli types was examined. Participants with high (HOC) and low (LOC) levels of obsessive-compulsive symptoms freely viewed three blocks of 30 two-by-two picture matrices, each including two OCD-related (cleaning\checking\ordering) and two neutral pictures, presented for eight seconds, while their gaze was recorded. Participants completed two task versions - one with traditional threat stimuli and one with novel stimuli signaling compulsions end-states. Only the end-state version yielded significant results, showing that HOC participants, compared to LOC participants, spent significantly more time fixating on OCD-related stimuli. Results remained significant after controlling for anxiety, stress, and depression. Task reliability was high. OCD-related stimuli signaling end-states of compulsive behavior should be incorporated in attentional research in OCD.
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Affiliation(s)
- Dana Basel
- School of Psychological Sciences, Tel Aviv University, 69978, Tel Aviv, Israel
| | - Moriah Magen
- School of Psychological Sciences, Tel Aviv University, 69978, Tel Aviv, Israel
| | - Amit Lazarov
- School of Psychological Sciences, Tel Aviv University, 69978, Tel Aviv, Israel.
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4
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Soffer-Dudek N. Obsessive-compulsive symptoms and dissociative experiences: Suggested underlying mechanisms and implications for science and practice. Front Psychol 2023; 14:1132800. [PMID: 37051604 PMCID: PMC10084853 DOI: 10.3389/fpsyg.2023.1132800] [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: 12/27/2022] [Accepted: 03/03/2023] [Indexed: 03/29/2023] Open
Abstract
A strong and specific link between obsessive-compulsive disorder or symptoms (OCD/S) and a tendency for dissociative experiences (e.g., depersonalization-derealization, absorption and imaginative involvement) cannot be explained by trauma and is poorly understood. The present theoretical formulation proposes five different models conceptualizing the relationship. According to Model 1, dissociative experiences result from OCD/S through inward-focused attention and repetition. According to Model 2, dissociative absorption causally brings about both OCD/S and associated cognitive risk factors, such as thought-action fusion, partly through impoverished sense of agency. The remaining models highlight common underlying causal mechanisms: temporo-parietal abnormalities impairing embodiment and sensory integration (Model 3); sleep alterations causing sleepiness and dreamlike thought or mixed sleep-wake states (Model 4); and a hyperactive, intrusive imagery system with a tendency for pictorial thinking (Model 5). The latter model relates to Maladaptive Daydreaming, a suggested dissociative syndrome with strong ties to the obsessive-compulsive spectrum. These five models point to potential directions for future research, as these theoretical accounts may aid the two fields in interacting with each other, to the benefit of both. Finally, several dissociation-informed paths for further developing clinical intervention in OCD are identified.
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Affiliation(s)
- Nirit Soffer-Dudek
- The Consciousness and Psychopathology Laboratory, Department of Psychology, Ben-Gurion University of the Negev, Be’er Sheva, Israel
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5
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Black SR, Wood MM, Choi J, Jackson BS, Evans TZ. Adult Age Differences in Sensitivity to Semantic Satiation. Exp Aging Res 2023; 49:152-172. [PMID: 35287550 DOI: 10.1080/0361073x.2022.2048585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE In this study, we investigated age differences in sensitivity to semantic satiation.Semantic satiation was conceptualized as occurring within a semantic activation framework. METHOD A prime or to-be-satiated word (e.g., ANIMAL) was presented repeatedly for an average of 2.5, 12.5, or 22.5 times. Afterward, a word triad comprised of two related words (e.g., PURPLE, YELLOW) and one unrelated word (e.g., DOG) was presented. The two related words were designated as nontargets or context words in the display and the unrelated word was the target. Participants were instructed to indicate as quickly and as accurately as possible which of the words in the triad was the unrelated word by pressing a key which was spatially compatible to the position of the stimulus on the CRt. RESULTS For young but not older adults, there was an attenuation of priming effects in the response latency data as repetition of the prime increased. CONCLUSION These results were interpreted as evidence that older adults are less sensitive to the semantic satiation phenomenon than young adults.
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Affiliation(s)
- Sheila R Black
- Department of Psychology, University of Alabama, Tuscaloosa, AL, USA
| | - Meagan M Wood
- Department of Psychological Science, Valdosta State University, Valdosta, GA, USA
| | - Jaimie Choi
- Department of Psychology, University of Alabama, Tuscaloosa, AL, USA
| | | | - Teairra Z Evans
- Department of Psychology, University of Alabama, Tuscaloosa, AL, USA
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6
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Dar R, Lazarov A, Liberman N. Seeking proxies for internal states (SPIS): Towards a novel model of obsessive-compulsive disorder. Behav Res Ther 2021; 147:103987. [PMID: 34688103 DOI: 10.1016/j.brat.2021.103987] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 10/04/2021] [Accepted: 10/07/2021] [Indexed: 12/17/2022]
Abstract
The Seeking Proxies for Internal States (SPIS) model of obsessive-compulsive disorder (OCD) proposes an account of OCD symptoms in terms of two core components: attenuation of access to internal states and seeking proxies for internal states. Specifically, the SPIS model posits that OCD is associated with difficulty in accessing various internal states, including feelings, preferences, memories, and even physiological states. This difficulty drives obsessive-compulsive individuals seek and rely on compensatory proxies, or substitutes, for their internal states. These proxies are perceived by the individual with OCD to be more easily discernible or less ambiguous compared to the internal states for which they substitute, and can take the form of fixed rules, rituals, or reliance on external sources of information. In the present article we first provide a detailed explanation of the SPIS model, and then review empirical studies that examined the model in a variety of domains, including bodily states, emotions, and decision-making. Next, we elaborate on the SPIS model's novel account of compulsive rituals, obsessions and doubt and relate them to extant theoretical accounts of OCD. To conclude, we highlight open questions that can guide future research and discuss the model's clinical implications.
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Affiliation(s)
- Reuven Dar
- School of Psychological Sciences, Tel Aviv University, Israel.
| | - Amit Lazarov
- School of Psychological Sciences, Tel Aviv University, Israel
| | - Nira Liberman
- School of Psychological Sciences, Tel Aviv University, Israel
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7
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Sookman D, Phillips KA, Anholt GE, Bhar S, Bream V, Challacombe FL, Coughtrey A, Craske MG, Foa E, Gagné JP, Huppert JD, Jacobi D, Lovell K, McLean CP, Neziroglu F, Pedley R, Perrin S, Pinto A, Pollard CA, Radomsky AS, Riemann BC, Shafran R, Simos G, Söchting I, Summerfeldt LJ, Szymanski J, Treanor M, Van Noppen B, van Oppen P, Whittal M, Williams MT, Williams T, Yadin E, Veale D. Knowledge and competency standards for specialized cognitive behavior therapy for adult obsessive-compulsive disorder. Psychiatry Res 2021; 303:113752. [PMID: 34273818 DOI: 10.1016/j.psychres.2021.113752] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Accepted: 01/21/2021] [Indexed: 12/19/2022]
Abstract
Obsessive-Compulsive Disorder (OCD) is a leading cause of disability world-wide (World Health Organization, 2008). Treatment of OCD is a specialized field whose aim is recovery from illness for as many patients as possible. The evidence-based psychotherapeutic treatment for OCD is specialized cognitive behavior therapy (CBT, NICE, 2005, Koran and Simpson, 2013). However, these treatments are not accessible to many sufferers around the world. Currently available guidelines for care are deemed to be essential but insufficient because of highly variable clinician knowledge and competencies specific to OCD. The phase two mandate of the 14 nation International OCD Accreditation Task Force (ATF) created by the Canadian Institute for Obsessive Compulsive Disorders is development of knowledge and competency standards for specialized treatments for OCD through the lifespan deemed by experts to be foundational to transformative change in this field. This paper presents knowledge and competency standards for specialized CBT for adult OCD developed to inform, advance, and offer a model for clinical practice and training for OCD. During upcoming ATF phases three and four criteria and processes for training in specialized treatments for OCD through the lifespan for certification (individuals) and accreditation (sites) will be developed based on the ATF standards.
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Affiliation(s)
- Debbie Sookman
- Department of Psychology, McGill University Health Center, 1025 Pine Ave W, Montreal, Quebec, H3A 1A1, Canada; Department of Psychiatry, McGill University, 845 Sherbrooke St W, Montreal, Quebec, H3A 0G4, Canada.
| | - Katharine A Phillips
- Department of Psychiatry, Weill Cornell Medicine, 1300 York Ave, New York, NY 10065, United States.
| | - Gideon E Anholt
- Department of Psychology, Marcus Family Campus, Ben-Gurion University of the Negev, Beer Sheva, P.O.B. 653 Beer-Sheva, 8410501, Israel.
| | - Sunil Bhar
- Department of Psychological Sciences, Faculty of Health, Arts and Design, Swinburne University of Technology, 1 John St, Hawthorn, Victoria, 3122, Australia.
| | - Victoria Bream
- Oxford Health Specialist Psychological Interventions Clinic and Oxford Cognitive Therapy Centre, Warneford Hospital, Oxford, OX3 7JX, United Kingdom.
| | - Fiona L Challacombe
- Institute of Psychiatry, Psychology and Neuroscience, Kings College London, De Crespigny Park, London, SE5 8AF, United Kingdom.
| | - Anna Coughtrey
- Great Ormond Street Hospital for Children, London WC1N 3JH, United Kingdom; UCL Great Ormond Street Institute of Child Health, 30 Guilford St, Holborn, London, WC1N 1EH, United Kingdom.
| | - Michelle G Craske
- Anxiety and Depression Research Center, Depression Grant Challenge, Innovative Treatment Network, Staglin Family Music Center for Behavioral and Brain Health, UCLA Department of Psychology and Department of Psychiatry and Biobehavioral Sciences, Box 951563, 1285 Franz Hall, Los Angeles, CA, United States.
| | - Edna Foa
- Center for the Treatment and Study of Anxiety, University of Pennsylvania Perelman SOM, 3535 Market Street, Philadelphia, PA 19104, United States.
| | - Jean-Philippe Gagné
- Department of Psychology, Concordia University, 7141 Sherbrooke St, West, Montreal, Quebec H4B 1R6, Canada.
| | - Jonathan D Huppert
- Department of Psychology, The Hebrew University of Jerusalem, Mt. Scopus, Jerusalem, 91905, Israel.
| | - David Jacobi
- Rogers Behavioral Health, 34700 Valley Road, Oconomowoc, WI, 53066, United States.
| | - Karina Lovell
- Division of Nursing, Midwifery and Social Work, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Oxford Rd, Manchester, M13 9PL, United Kingdom; Manchester Academic Health Science Centre, Greater Manchester Mental Health NHS Foundation Trust, Manchester, M13 9PL, United Kingdom.
| | - Carmen P McLean
- National Center for PTSD, Dissemination and Training Division, VA Palo Alto Healthcare System, 795 Willow Road, Menlo Park, CA, 94025, United States; Department of Psychiatry and Behavioral Sciences, Stanford University, 450 Serra Mall, Stanford, CA, 94305, United States.
| | - Fugen Neziroglu
- Bio-Behavioral Institute, 935 Northern Boulevard, Suite 102, Great Neck, NY, 11021, United States.
| | - Rebecca Pedley
- Division of Nursing, Midwifery and Social Work, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, M13 9PL, United Kingdom.
| | - Sean Perrin
- Department of Psychology, Lund University, Box 213, 22100, Lund, Sweden.
| | - Anthony Pinto
- Zucker School of Medicine at Hofstra/Northwell, Zucker Hillside Hospital - Northwell Health, 265-16 74th Avenue, Glen Oaks, NY, 11004, United States.
| | - C Alec Pollard
- Center for OCD and Anxiety-Related Disorders, Saint Louis Behavioral Medicine Institute, 1129 Macklind Ave, St. Louis, MO, 63110, United States; Department of Family and Community Medicine, Saint Louis University School of Medicine, Saint Louis, MO, 63110, United States.
| | - Adam S Radomsky
- Department of Psychology, Concordia University, 7141 Sherbrooke St, West, Montreal, Quebec H4B 1R6, Canada.
| | - Bradley C Riemann
- 34700 Valley Road, Rogers Behavioral Health, Oconomowoc, WI, 53066, United States.
| | - Roz Shafran
- Population, Policy and Practice Research and Teaching Department, UCL Great Ormond Street Hospital Institute of Child Health, Holborn, London, WC1N 1EH, United Kingdom.
| | - Gregoris Simos
- Department of Educational and Social Policy, University of Macedonia, 156 Egnatia Street, 54636 Thessaloniki, Greece.
| | - Ingrid Söchting
- Departments of Psychology, University of British Columbia, 2136 West Mall, Vancouver, British Columbia, V6T 1Z4, Canada.
| | - Laura J Summerfeldt
- Department of Psychology, Trent University, 1600 West Bank Drive, Peterborough, K9L 0G2 Ontario, Canada.
| | - Jeff Szymanski
- International OCD Foundation, 18 Tremont Street, #308, Boston MA, 02108, United States.
| | - Michael Treanor
- Anxiety and Depression Research Center, University of California, Los Angeles, Box 951563, 1285 Franz Hall, Los Angeles, CA, United States.
| | - Barbara Van Noppen
- Clinical Psychiatry and Behavioral Sciences, OCD Southern California, 2514 Jamacha Road Ste, 502-35 El Cajon, CA, 92019, United States; Department of Psychiatry and Behavioral Sciences, Keck School of Medicine, University of Southern California, 2250 Alcazar Street, Suite 2200, Los Angeles, CA, 90033, United States.
| | - Patricia van Oppen
- Department of Psychiatry, Amsterdam UMC, location VUmc, Netherlands; Amsterdam Public Health Research Institute - Mental Health, Netherlands; GGZ inGeest Specialized Mental Health Care, Netherlands.
| | - Maureen Whittal
- Vancouver CBT Centre, 302-1765 W8th Avenue, Vancouver, British Columbia, V6J5C6, Canada; Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada.
| | - Monnica T Williams
- School of Psychology, University of Ottawa, 136 Jean-Jacques Lussier Pvt, Ottawa, K1N 6N5, Ontario, Canada.
| | - Timothy Williams
- Department of Psychology, University of Reading, PO Box 217, Reading, Berkshire, RG6 6AH, United Kingdom.
| | - Elna Yadin
- Department of Psychiatry, University of Pennsylvania, 3535 Market Street, 2nd Floor, Philadelphia, PA 19104, United States.
| | - David Veale
- South London and the Maudsley NHS Foundation Trust & King's College London, Denmark Hill, London, SE5 8 AZ, United Kingdom.
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Vannikov-Lugassi M, Shalev H, Soffer-Dudek N. From brooding to detachment: Rumination longitudinally predicts an increase in depersonalization and derealisation. Psychol Psychother 2021; 94 Suppl 2:321-338. [PMID: 32333727 DOI: 10.1111/papt.12279] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2019] [Revised: 03/31/2020] [Indexed: 01/29/2023]
Abstract
OBJECTIVES Depersonalization-derealization (DEP-DER) is a dissociative experience which is related to psychopathology and distress. Yet, the aetiological factors leading to DEP-DER are not sufficiently clear. In this study, we suggest rumination as one possible antecedent. Thus, the goal of the study was to explore the longitudinal relationship between rumination and DEP-DER. DESIGN Longitudinal self-report study; mixed clinical and community sample. METHODS The study was conducted on 98 participants, 49 of them were diagnosed with depression, anxiety disorders, or obsessive-compulsive disorder, and the other 49 were healthy, matched community controls. The participants underwent a structured clinical interview and completed a battery of questionnaires. Then, the participants completed the same battery again once a month, for five additional assessment points (6 months in total). The data were analysed using multilevel linear modelling with time-lag analysis. RESULTS We found that levels of rumination and DEP-DER increased and decreased simultaneously, meaning that on assessments in which people reported that they tended to ruminate, they also reported higher levels of DEP-DER symptoms. In addition, we found support for a unidirectional association, consistent with our theoretical hypothesis. Specifically, rumination levels on a certain month longitudinally predicted a higher likeliness for reporting DEP-DER on the following month, even when controlling for the contemporaneous relationship. Conversely, DEP-DER symptoms did not longitudinally predict increased rumination. CONCLUSIONS These findings suggest that rumination may be an antecedent of DEP-DER, but not vice versa. Possible mechanisms to explain this link are discussed. PRACTITIONER POINTS Rumination and DEP-DER oscillate together over time; additionally, rumination predicts a longitudinal increase in DEP-DER. Clinicians noticing ruminative thought followed by decreased emotionality should distinguish between an authentic decrease of distress versus detachment. The findings provide one possible explanation for the frequency of DEP-DER symptoms in anxiety and depressive disorders. Poor sleep quality and emotion regulation difficulties should be explored as potential mediators explaining this link.
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Affiliation(s)
| | - Hadar Shalev
- Ben-Gurion University of the Negev, Be'er-Sheva, Israel.,Soroka Medical Center, Be'er Sheva, Israel
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9
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Gazing rituals in body dysmorphic disorder. J Behav Ther Exp Psychiatry 2020; 68:101522. [PMID: 31877406 DOI: 10.1016/j.jbtep.2019.101522] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Revised: 08/11/2019] [Accepted: 10/17/2019] [Indexed: 11/21/2022]
Abstract
BACKGROUND AND OBJECTIVES Gazing rituals and selective attention to perceived flaws during gazing are considered as maintaining factors in cognitive-behavioral models for body dysmorphic disorder (BDD). This study investigated different durations of BDD-like gazing at different facial stimuli (an unfamiliar face, the participant's own face, and the participant's own reflection in the mirror) with regard to effects on dissociation, attractiveness evaluations and perceptual uncertainty. The aim of this study was to examine the hypothesized causal effects of gazing rituals on appearance preoccupation. METHODS We asked 115 females to complete a face gazing paradigm with three different facial stimuli and, depending on the condition, different gazing durations. We also examined the influence of BDD symptom severity on the reactions to different facial stimuli. RESULTS Five minutes of gazing significantly increased dissociation. Participants rated the attractiveness of self-relevant stimuli, especially the own photographed face, below average and lower than the unfamiliar face. LIMITATIONS Limitations with regard to sample characteristics and experimental design are discussed. CONCLUSIONS Our findings support cognitive-behavioral models for BDD and indicate that therapists may extend therapeutic interventions like mirror retraining by specific perceptual retraining with photographs of the patients.
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10
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Wilson S, Aardema F, O'Connor K. What do I look like? Perceptual confidence in bulimia nervosa. Eat Weight Disord 2020; 25:177-183. [PMID: 30019261 DOI: 10.1007/s40519-018-0542-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Accepted: 07/06/2018] [Indexed: 10/28/2022] Open
Abstract
Cognitive confidence, a type of metacognition referring to confidence in one's cognitive abilities (e.g., memory, perception, etc.), has been identified as relevant to eating disorders (EDs) using self-report measures. Repeated checking has been found to elicit decreases in perceptual confidence in obsessive compulsive disorder (OCD). The purpose of the present study was to experimentally investigate perceptual confidence, a type of cognitive confidence, in EDs. Specifically, this construct was investigated in the context of body checking, a behaviour with similarities to compulsive checking as observed in OCD. Women with bulimia nervosa (BN; n = 21) and healthy controls (HC; n = 24) participated in the study. There were no group differences with regards to perceptual confidence at baseline F(1, 43) = 0.5, p = 0.48, ηp2 = 0.01, but a significant difference was observed post-checking F(1, 43) = 7.79, p = 0.008, ηp2 = 0.15, which was accounted for by significant decreases in perceptual confidence in the BN group F(1, 43) = 13.31, p < 0.001, ηp2 = 0.24. Similar to compulsive checking in OCD, body checking may paradoxically decrease confidence regarding one's appearance. LEVEL OF EVIDENCE: Level I, experimental study.
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Affiliation(s)
- Samantha Wilson
- Research Center, Montréal Mental Health University Institute, 7331 Hochelaga, Montreal, QC, H1N 3V2, Canada. .,Department of Psychology, Université de Montréal, 90 Vincent d'Indy, Montreal, QC, H2V 2S9, Canada.
| | - Frederick Aardema
- Research Center, Montréal Mental Health University Institute, 7331 Hochelaga, Montreal, QC, H1N 3V2, Canada.,Department of Psychiatry, Université de Montréal, 2900 Édouard-Montpetit, Montreal, QC, H3T 1J4, Canada
| | - Kieron O'Connor
- Research Center, Montréal Mental Health University Institute, 7331 Hochelaga, Montreal, QC, H1N 3V2, Canada.,Department of Psychiatry, Université de Montréal, 2900 Édouard-Montpetit, Montreal, QC, H3T 1J4, Canada
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11
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Choice Blindness, Confabulatory Introspection, and Obsessive–Compulsive Symptoms: Investigation in a Clinical Sample. COGNITIVE THERAPY AND RESEARCH 2019. [DOI: 10.1007/s10608-019-10066-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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12
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Giacomantonio M, Salvati M, Mancini F. Am I guilty or not? Deontological guilt, uncertainty, and checking behavior. APPLIED COGNITIVE PSYCHOLOGY 2019. [DOI: 10.1002/acp.3600] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Mauro Giacomantonio
- Department of Social and Developmental PsychologySapienza University of Rome Rome Italy
| | - Marco Salvati
- Department of Social and Developmental PsychologySapienza University of Rome Rome Italy
| | - Francesco Mancini
- Associazione di Psicologia Cognitiva APC and Scuola di Psicoterapia Cognitiva SPC Rome Italy
- Department of Human SciencesGuglielmo Marconi University Rome Italy
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13
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Gazing at facial features increases dissociation and decreases attractiveness ratings in non-clinical females - A potential explanation for a common ritual in body dysmorphic disorder. PLoS One 2019; 14:e0219791. [PMID: 31344065 PMCID: PMC6657848 DOI: 10.1371/journal.pone.0219791] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Accepted: 07/01/2019] [Indexed: 12/01/2022] Open
Abstract
Rituals, such as gazing at faces, are common in body dysmorphic disorder (BDD) and appear in cognitive-behavioral models as a maintaining factor. Rituals are also common in obsessive-compulsive disorder (OCD). In contrast to OCD, the proposed associations between rituals and intrusive thoughts/appearance preoccupation have not been empirically investigated for BDD. We examined if the assumed effect of gazing rituals on attractiveness ratings exists and if it is associated with dissociation. In an experiment, we asked N = 65 non-clinical females to focus on the nose of a photographed face at pre- and post-test. In between, participants gazed at the nose of either the same (relevant gazing) or another face (irrelevant gazing). We found increasing dissociation after gazing in both conditions and a differentially stronger decrease of attractiveness ratings in the relevant gazing condition. Our findings support the hypothesized effect of gazing rituals on attractiveness evaluation in cognitive-behavioral models for BDD.
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Schultchen D, Zaudig M, Krauseneck T, Berberich G, Pollatos O. Interoceptive deficits in patients with obsessive-compulsive disorder in the time course of cognitive-behavioral therapy. PLoS One 2019; 14:e0217237. [PMID: 31125377 PMCID: PMC6534313 DOI: 10.1371/journal.pone.0217237] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Accepted: 05/07/2019] [Indexed: 01/07/2023] Open
Abstract
Interoception is impaired in different psychiatric disorders and is also associated with emotions. Only one study could show a higher interoceptive accuracy (IAcc) in patients with obsessive-compulsive disorder (OCD). Based on the predictive coding system we assume contrary results, indicating a decreased IAcc in patients with OCD. So far, there is no study investigating the effect of cognitive-behavioral therapy on IAcc in patients with OCD. Therefore, we hypothesize that patients with OCD improve their IAcc during the time course of therapy compared to healthy controls. Twenty-six patients with OCD from the Psychosomatic Clinic in Windach were examined in the time course of cognitive-behavioral therapy. They were compared to 26 matched healthy controls. IAcc via the heartbeat perception task as well as questionnaire data (OCD-, depression- and anxiety symptoms) were assessed. Results showed that IAcc, OCD-, depression- and anxiety symptoms were attenuated in patients with OCD. Patients recovered in the time course of therapy regarding OCD-, depression- and anxiety symptoms. Interoceptive deficits did not change in the time course of cognitive-behavioral therapy. We demonstrated that IAcc is affected in patients with OCD and this deficit does not change during the time course of a standardized therapy. Future studies should investigate, whether an inaccuracy in perceiving one's bodily signals constitutes a risk factor for relapse. Further, it could be examined if IAcc can be increased via self- and body focus interventions in patients with OCD.
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Affiliation(s)
- Dana Schultchen
- Department of Clinical and Health Psychology, Institute of Psychology and Education, Ulm University, Ulm, Germany
- * E-mail:
| | | | | | | | - Olga Pollatos
- Department of Clinical and Health Psychology, Institute of Psychology and Education, Ulm University, Ulm, Germany
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Ouimet AJ, Ashbaugh AR, Radomsky AS. Hoping for more: How cognitive science has and hasn't been helpful to the OCD clinician. Clin Psychol Rev 2019; 69:14-29. [DOI: 10.1016/j.cpr.2018.04.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Revised: 04/09/2018] [Accepted: 04/10/2018] [Indexed: 12/19/2022]
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16
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Soref A, Liberman N, Abramovitch A, Dar R. Explicit instructions facilitate performance of OCD participants but impair performance of non-OCD participants on a serial reaction time task. J Anxiety Disord 2018; 55:56-62. [PMID: 29500079 DOI: 10.1016/j.janxdis.2018.02.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Revised: 02/09/2018] [Accepted: 02/21/2018] [Indexed: 11/29/2022]
Abstract
Previous studies have shown that individuals diagnosed with OCD tend to rely on explicit processing while performing implicit learning tasks. We sought to investigate whether individuals with OCD are capable of implicit learning, but would demonstrate improved performance when explicit processing strategies are enhanced. Twenty-four participants with OCD and 24 non-psychiatric control (NPC) participants performed an implicit learning task in which they responded to a single target stimulus that successively appears at one of four locations according to an underlying sequence. We manipulated the learning strategy by informing half of the participants that the target stimulus location was determined by an underlying sequence, which they should identify (intentional learning). The other half of the participants was not informed of the existence of the underlying sequence, and was expected to learn the sequence implicitly (standard learning). We predicted that OCD participants will exhibit inferior performance compared to NPC participants in the standard learning condition, and that intentional learning instructions would impair the performance of NPC participants, but enhance the performance of OCD participants. The results supported these predictions and suggest that individuals with OCD prefer controlled to automatic processing. We discuss the implications of this conclusion to our understanding of OCD.
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Affiliation(s)
- Assaf Soref
- School of Psychological Sciences, Tel-Aviv University, Israel.
| | - Nira Liberman
- School of Psychological Sciences, Tel-Aviv University, Israel
| | | | - Reuven Dar
- School of Psychological Sciences, Tel-Aviv University, Israel
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17
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Tapancı Z, Yıldırım A, Boysan M. Neurological soft signs, dissociation and alexithymia in patients with obsessive-compulsive disorder (OCD) and healthy subjects. Psychiatry Res 2018; 260:90-97. [PMID: 29175504 DOI: 10.1016/j.psychres.2017.11.058] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2017] [Revised: 11/09/2017] [Accepted: 11/18/2017] [Indexed: 10/18/2022]
Abstract
A body of evidence has supported that patients with obsessive-compulsive disorder (OCD) have increased rates of various neurological soft signs (NSS) compared to controls. Various lines of research has documented robust relationships between OCD and dissociative symptomatology. The study aimed to examine the associations between obsessive-compulsive symptoms, dissociative experiences alexithymia, and NSS. The study included thirty OCD patients and thirty healthy controls, matched for age, marital status, education, and income. The Neurological Evaluation Scale (NES), Padua Inventory-Revised (PI-R), Dissociative Experiences Scale (DES) and Toronto Alexithymia Scale (TAS-20) were administered. In comparison to healthy controls, patients with OCD had difficulty sequencing for complex motor acts and greater absorption/ imaginative involvement. Using latent class analysis, the study sample was classified into two homogenous subsets as mild NSS (n = 45) and severe NSS (n = 15). Majority of the participants who were grouped into severe NSS latent class were OCD patient (n = 14, 93.3%). Furthermore, those with severe NSS reported greater levels of alexithymia and more severe obsessive-compulsive symptoms, particularly precision. We concluded that relationships between OCD severity and NSS appear to be of crucial importance. Our data along with accumulated evidence suggest that OCD associated with pronounced NSS may represent a specific subtype of the disorder.
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Affiliation(s)
- Zafer Tapancı
- Department of Psychiatry, Yüzüncü Yıl University School of Medicine, Van, Turkey.
| | - Abdullah Yıldırım
- Department of Psychiatry, Yüzüncü Yıl University School of Medicine, Van, Turkey.
| | - Murat Boysan
- Department of Psychology, Yüzüncü Yıl University Faculty of Social Sciences, Van, Turkey.
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18
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Soffer-Dudek N, Somer E. Trapped in a Daydream: Daily Elevations in Maladaptive Daydreaming Are Associated With Daily Psychopathological Symptoms. Front Psychiatry 2018; 9:194. [PMID: 29867613 PMCID: PMC5962718 DOI: 10.3389/fpsyt.2018.00194] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Accepted: 04/25/2018] [Indexed: 01/22/2023] Open
Abstract
Background: Maladaptive Daydreaming (MD) characterizes individuals who engage in vivid, fanciful daydreaming for hours on end, neglecting real-life relationships and responsibilities, resulting in clinical distress and functional impairment. Sufferers have embraced the term MD in cyber-communities devoted to this problem because it seemed to uniquely fit their experience and since existing diagnostic labels and their therapies seemed inadequate. However, scientific research in the field has been scarce, relying on cross-sectional or case study designs. Existing knowledge on MD suggests the involvement of dissociative and obsessive-compulsive symptoms, as well as positive reinforcement comparable to processes in addiction disorders. The present study aimed to rigorously explore factors that accompany MD employing a longitudinal daily-diary design, hypothesizing that temporal increases in MD will associate concurrently with, and will temporally precede, other symptoms and emotional changes. In addition, we aimed to explore which symptoms may act as precursors to increases in MD, in order to identify possible mechanisms bringing about daydreaming in these individuals. Methods: In a sample of 77 self-diagnosed individuals with MD we assessed relevant daily symptoms for 14 days, including MD, depression, general anxiety, social anxiety, obsessive-compulsive symptoms, and dissociation, as well as positive and negative emotion. Results: Increases in MD were strongly related to concurrent increases in all other symptoms and negative emotion, and to decreased positive emotion. Obsessive-compulsive symptoms, dissociation, and negative emotion also temporally followed MD. Obsessive-compulsive symptoms were the only consistent temporal antecedent of MD. Conclusions: MD and obsessive-compulsive symptoms coincided in what seems to be a vicious cycle; understanding possible shared mechanisms between these symptoms may inform our understanding of the etiology of MD. For example, Serotonin levels may possibly be involved in the development or maintenance of this condition. The findings may also provide clues as to potentially beneficial interventions for treating MD. For example, perhaps utilizing response prevention techniques may be useful for curbing or intercepting unwanted daydreaming. Future studies on MD should address its compulsory nature.
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Affiliation(s)
- Nirit Soffer-Dudek
- The Consciousness and Psychopathology Laboratory, Department of Psychology, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Eli Somer
- School of Social Work, University of Haifa, Haifa, Israel
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Wong SF, Williams AD, Grisham JR. Distrust of the senses and its association with obsessive-compulsive symptoms. J Behav Ther Exp Psychiatry 2017. [PMID: 28628809 DOI: 10.1016/j.jbtep.2017.06.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND AND OBJECTIVES Leading cognitive theories of OCD suggests that despite prevalent and persistent doubt, individuals with OCD do not have perceptual deficits. An alternate cognitive theory, the Seeking Proxies for Internal States hypothesis (SPIS), proposes that sensory distrust in OCD stems from actual deficits in accessing internal states. Consistent with the SPIS, previous research has found that high-OC individuals were less accurate than low-OC individuals in producing target levels of muscle tension in a biofeedback task and that OC symptoms were positively associated with reliance on an external proxy. METHODS The current study aimed to replicate and extend the SPIS hypothesis in two experiments using a modified version of the biofeedback-aided muscle tensing task using grip strength as the sensory input and a distance perception task. We contrasted the performance of undergraduate students self-reporting high- and low-OC symptoms. RESULTS Overall, our findings failed to substantially support the SPIS hypothesis such that OC symptoms were not associated with deficient access to internal states of grip strength and distance perception or increased reliance on feedback. LIMITATIONS As this study was conducted in a non-clinical sample, we were unable to generalise our findings to a clinical population. CONCLUSIONS Findings are commensurate with the wider OCD literature suggesting the absence of cognitive and perceptual deficits in OCD individuals.
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Affiliation(s)
- Shiu F Wong
- School of Psychology, The University of New South Wales, Kensington, NSW, Australia.
| | - Alishia D Williams
- Department of Clinical and Health Psychology, Utrecht University, Utrecht, The Netherlands
| | - Jessica R Grisham
- School of Psychology, The University of New South Wales, Kensington, NSW, Australia
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20
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Bottesi G, Ghisi M, Sica C, Freeston MH. Intolerance of uncertainty, not just right experiences, and compulsive checking: Test of a moderated mediation model on a non-clinical sample. Compr Psychiatry 2017; 73:111-119. [PMID: 27939647 DOI: 10.1016/j.comppsych.2016.11.014] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2016] [Revised: 11/28/2016] [Accepted: 11/28/2016] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVE Intolerance of uncertainty (IU) and not just right experiences (NJREs) have been claimed putative vulnerability factors for obsessive-compulsive disorder (OCD). The aim of the present study was to test whether IU could represent a trans-diagnostic construct accountable for OC checking behaviors and whether NJREs could embody an OCD-specific criterion through which IU operates. METHOD One hundred and eighty-eight Italian community individuals completed self-report measures of IU, NJREs, OC symptoms, worry, anxiety, and depression. Mediation and moderated mediation models were tested using a bootstrapping approach, wherein IU was included as the independent variable as well as the moderator; checking behaviors were entered as the dependent variable; and NJRE severity was included as a mediator. RESULTS The main findings highlighted that NJREs were a mediator of the relationship between IU and checking behaviors; nonetheless, in connection with medium levels of IU, NJREs no longer mediated the path. Furthermore, IU did not emerge to moderate the mediation. CONCLUSION Despite their preliminary nature, the present results might be a hint for future research, as theoretical integration may represent a way to go for better understanding OCD etiology and phenomenology.
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Affiliation(s)
- Gioia Bottesi
- Department of General Psychology, University of Padova, via Venezia 8, 35131 Padova, Italy.
| | - Marta Ghisi
- Department of General Psychology, University of Padova, via Venezia 8, 35131 Padova, Italy.
| | - Claudio Sica
- Department of Health Sciences, University of Firenze, via di San Salvi 12, Complesso di San Salvi Padiglione 26, 50135 Firenze, Italy.
| | - Mark H Freeston
- Institute of Neuroscience, (Ridley Building, 4th Floor), Faculty of Medical Sciences, University of Newcastle, Newcastle upon Tyne, Tyne and Wear NE1 7RU, United Kingdom.
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21
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Bucarelli B, Purdon C. Stove checking behaviour in people with OCD vs. anxious controls. J Behav Ther Exp Psychiatry 2016; 53:17-24. [PMID: 27664817 DOI: 10.1016/j.jbtep.2016.03.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2015] [Revised: 11/06/2015] [Accepted: 03/10/2016] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND OBJECTIVES A growing body of research suggests that the repetition of an action degrades memory for that action, as well as confidence that is has been done correctly. This has important implications for understanding the compulsive repetition of actions characteristic of obsessive compulsive disorder (OCD). At this time, though, much of the research has been conducted on analogue or nonclinical OCD samples in comparison to healthy controls and often using virtual, as opposed to actual, threat stimuli. Furthermore, although it has been argued that people with OCD are overly attentive to threat stimuli, the research on actual attention to threat is scant. METHODS People with a principal diagnosis of OCD (n = 30) and people with a clinically significant diagnosis of an anxiety disorder, but no OCD (n = 18) completed measures of memory confidence and responsibility and then underwent a stove-checking task in a functioning kitchen while wearing a portable eye tracking device. Pre- and post-task ratings of harm and responsibility were taken, along with post-task ratings of memory and certainty. RESULTS People with OCD did not exhibit poorer memory confidence than the anxious control (AC) group, but did report greater trait and state responsibility for harm. The OCD group checked longer than did the AC group and check duration predicted post-task ratings of harm, but to the same extent in both groups. People with OCD attended to threat items less than did the AC group. Greater visual attention to the stove during the checking period was associated with greater post-task ratings of responsibility and harm and with less certainty in and memory for the check - but only for the AC group. LIMITATIONS The sample size was modest, women were over-represented and problems with the eye tracking device reduced the amount of reliable data available for analysis. CONCLUSIONS Compulsions are complex actions that are mediated by many trait, state and contextual factors. People with OCD may be able to circumvent self-perpetuating checking processes under certain circumstances. Future research should explore the factors that determine whether or not self-perpetuating mechanisms are activated.
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Affiliation(s)
- Bianca Bucarelli
- Department of Psychology, University of Waterloo, Waterloo, ON N2G 3L1, Canada.
| | - Christine Purdon
- Department of Psychology, University of Waterloo, Waterloo, ON N2G 3L1, Canada.
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22
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The doubt-certainty continuum in psychopathology, lay thinking, and science. J Behav Ther Exp Psychiatry 2016; 53:68-74. [PMID: 26299890 DOI: 10.1016/j.jbtep.2015.08.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2015] [Revised: 08/10/2015] [Accepted: 08/11/2015] [Indexed: 11/23/2022]
Abstract
This paper presents a theoretical model suggesting that doubt and certainty are two extremes of a continuum. Different people can be located in different locations on this continuum, according to how much they tend to seek refutation vs. confirmation. In both ends of the continuum lay mental disorders, which can be seen as extreme deviations from the usual relatively stable equilibrium between the two thinking processes. One end is defined by excessive skepticism and manifested as obsessive compulsive disorder (OCD), a disorder characterized by incessant doubt. The other end is defined by excessive certainty and lack of doubt, manifested as delusional disorders. Throughout this article, we demonstrate that the differences between normative thoughts and delusional thoughts are relatively vague, and that in general, the human default tendency is to prefer certainty over doubt. This preference is reflected in the confirmation bias as well as in other cognitive constructs such as overconfidence and stereotypes. Recent perspectives on these biases suggest that the human preference for confirmation can be explained in evolutionary terms as adaptive and rational. A parallel view of the scientific enterprise suggests that it also requires a certain equilibrium between skepticism and confirmation. We conclude by discussing the importance of the dialectic relationship between confirmation and refutation in both lay thinking and scientific thought.
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23
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Giele CL, van den Hout MA, Engelhard IM, Dek ECP, Toffolo MBJ, Cath DC. Perseveration induces dissociative uncertainty in obsessive-compulsive disorder. J Behav Ther Exp Psychiatry 2016; 52:1-10. [PMID: 26901818 DOI: 10.1016/j.jbtep.2016.02.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2015] [Revised: 02/04/2016] [Accepted: 02/05/2016] [Indexed: 11/18/2022]
Abstract
BACKGROUND AND OBJECTIVES Obsessive compulsive (OC)-like perseveration paradoxically increases feelings of uncertainty. We studied whether the underlying mechanism between perseveration and uncertainty is a reduced accessibility of meaning ('semantic satiation'). METHODS OCD patients (n = 24) and matched non-clinical controls (n = 24) repeated words 2 (non-perseveration) or 20 times (perseveration). They decided whether this word was related to another target word. Speed of relatedness judgments and feelings of dissociative uncertainty were measured. The effects of real-life perseveration on dissociative uncertainty were tested in a smaller subsample of the OCD group (n = 9). RESULTS Speed of relatedness judgments was not affected by perseveration. However, both groups reported more dissociative uncertainty after perseveration compared to non-perseveration, which was higher in OCD patients. Patients reported more dissociative uncertainty after 'clinical' perseveration compared to non-perseveration.. LIMITATIONS Both parts of this study are limited by some methodological issues and a small sample size. CONCLUSIONS Although the mechanism behind 'perseveration → uncertainty' is still unclear, results suggest that the effects of perseveration are counterproductive.
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Affiliation(s)
- Catharina L Giele
- Department of Clinical and Health Psychology, Utrecht University, Utrecht, The Netherlands.
| | - Marcel A van den Hout
- Department of Clinical and Health Psychology, Utrecht University, Utrecht, The Netherlands
| | - Iris M Engelhard
- Department of Clinical and Health Psychology, Utrecht University, Utrecht, The Netherlands; Altrecht Academic Anxiety Centre, Utrecht, The Netherlands
| | - Eliane C P Dek
- Department of Clinical and Health Psychology, Utrecht University, Utrecht, The Netherlands
| | - Marieke B J Toffolo
- Department of Clinical and Health Psychology, Utrecht University, Utrecht, The Netherlands
| | - Danielle C Cath
- Department of Clinical and Health Psychology, Utrecht University, Utrecht, The Netherlands; Altrecht Academic Anxiety Centre, Utrecht, The Netherlands
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Banca P, Harrison NA, Voon V. Compulsivity Across the Pathological Misuse of Drug and Non-Drug Rewards. Front Behav Neurosci 2016; 10:154. [PMID: 27536223 PMCID: PMC4971057 DOI: 10.3389/fnbeh.2016.00154] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2016] [Accepted: 07/19/2016] [Indexed: 11/13/2022] Open
Abstract
Behavioral adaptation is required for the successful navigation of a constantly changing environment. Impairments in behavioral flexibility are commonly observed in psychiatric disorders including those of addiction. This study investigates two distinct facets of compulsivity, namely reversal learning and attentional set shifting, implicating orbitofrontal and lateral prefrontal regions respectively, across disorders of primary and secondary rewards. Obese subjects with and without binge eating disorder (BED), individuals with compulsive sexual behaviors (CSB), alcohol dependence (AD) and pathological video-gaming (VG) were tested with two computerized tasks: the probabilistic reversal task (trials to criterion and win-stay/lose-shift errors) and the intra/extra-dimensional set shift task (IED). Individuals with AD and pathological VG were slower at reversal learning irrespective of valence, with AD subjects more likely to perseverate after losses. Compared to obese subjects without BED, BED subjects were worse at reversal learning to wins but better at losses highlighting valence effects as a function of binge eating. CSB subjects demonstrated enhanced sensitivity to reward outcomes with faster acquisition and greater perseveration with higher magnitude rewards. We further show an impairment in attentional set shifting in individuals with BED and AD relative to healthy volunteers (HV). This study provides evidence for commonalities and differences in two distinct dimensions of behavioral inflexibility across disorders of compulsivity. We summarize studies on compulsivity subtypes within this same patient population. We emphasize commonalities in AD and BED with impairments across a range of compulsivity indices, perhaps supporting pathological binge eating as a form of behavioral addiction. We further emphasize commonalities in reversal learning across disorders and the crucial role of valence effects. These findings highlight the role of behavioral inflexibility and compulsivity as a relevant domain in defining dimensional psychiatry and the identification of relevant cognitive endophenotypes as targets for therapeutic modulation.
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Affiliation(s)
- Paula Banca
- Behavioral and Clinical Neuroscience Institute, University of CambridgeCambridge, UK
| | - Neil A. Harrison
- Brighton and Sussex Medical School, University of SussexBrighton, UK
| | - Valerie Voon
- Behavioral and Clinical Neuroscience Institute, University of CambridgeCambridge, UK
- Department of Psychiatry, University of CambridgeCambridge, UK
- Cambridgeshire and Peterborough NHS Foundation TrustCambridge, UK
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25
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Taylor J, Purdon C. Responsibility and hand washing behaviour. J Behav Ther Exp Psychiatry 2016; 51:43-50. [PMID: 26773341 DOI: 10.1016/j.jbtep.2015.12.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2015] [Revised: 12/19/2015] [Accepted: 12/21/2015] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND OBJECTIVES Recent research suggests that compulsions persist due to a self-perpetuating mechanism of poor memory confidence and repetition. However, most of this work has examined checking compulsions and findings may not generalize well to washing compulsions. This study examined the role of responsibility in the persistence of washing behaviour. METHODS Hand washing was examined in undergraduates (n = 80) high and low in contamination fears (CF) under conditions of high or low responsibility (RL). Wash duration and number of visits to objects/locations key to the wash (e.g., soap) were examined. RESULTS Overvalued responsibility predicted washing duration across groups. Neither wash duration nor number of visits was associated with memory for the wash. Wash duration predicted post-wash certainty that the wash had prevented harm, but only in the high CF group, and that effect varied according to RL: longer wash duration predicted greater certainty under conditions of low RL but predicted less certainty under conditions of high RL. Greater repetition predicted poorer sensory confidence, but only in the high CF group under high RL conditions. LIMITATIONS The data were collected in an analogue sample of modest size. Replication in a clinical sample is required. CONCLUSIONS Self-perpetuating mechanisms identified in perseverative checking seem to also be present in perseverative washing, but only under conditions of high responsibility. Sensory confidence may be more important to perseverative washing than memory confidence. More research is required to understand self-perpetuating mechanisms at play when washing to under conditions of high responsibility.
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Affiliation(s)
- Jasmine Taylor
- Department of Psychology University of Waterloo Waterloo, ON, N2L 3G1, Canada.
| | - Christine Purdon
- Department of Psychology University of Waterloo Waterloo, ON, N2L 3G1, Canada.
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26
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Lazarov A, Cohen T, Liberman N, Dar R. Can doubt attenuate access to internal states? Implications for obsessive-compulsive disorder. J Behav Ther Exp Psychiatry 2015; 49:150-156. [PMID: 25435333 DOI: 10.1016/j.jbtep.2014.11.003] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2014] [Revised: 10/12/2014] [Accepted: 11/04/2014] [Indexed: 10/24/2022]
Abstract
BACKGROUND AND OBJECTIVES We have previously reported that obsessive-compulsive individuals perform more poorly on tasks that require accurate perception of internal states. As these individuals are also characterized by elevated levels of doubt regarding internal states, the causal relationship between doubt and accurate perception remained unclear. The presented study examines whether undermining participants' confidence in their ability to accurately produce a specific internal state would affect their performance on a task that requires accurate perception of this state. METHODS Participants were trained to produce specific levels of forearm muscle tension and then required to produce various tension levels in four experimental phases. The first three alternated in terms of whether the participants viewed a biofeedback monitor while the fourth offered participants several times the choice to view the monitor. Prior to the task, half of the participants received instructions that undermined their confidence in their ability to accurately assess their own muscle tension. We measured participants' accuracy in producing the required muscle tension levels and the number of times they requested to view the monitor in the final phase. RESULTS Undermined confidence participants were less accurate in producing the required muscle tension levels in the absence of biofeedback, and were also more likely to request the monitor in the final phase. CONCLUSIONS Doubt can affect performance on tasks that require perceiving and experiencing internal states. This finding supports the possibility that access to internal states in OCD is attenuated due to elevated levels of doubt regarding these states.
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Gangemi A, Mancini F, Dar R. An experimental re-examination of the inferential confusion hypothesis of obsessive-compulsive doubt. J Behav Ther Exp Psychiatry 2015; 48:90-7. [PMID: 25775946 DOI: 10.1016/j.jbtep.2015.02.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2014] [Revised: 02/17/2015] [Accepted: 02/20/2015] [Indexed: 02/05/2023]
Abstract
BACKGROUND AND OBJECTIVES The inferential confusion hypothesis postulates that obsessive doubt is perpetuated by a subjective form of reasoning characterized primarily by a distrust of reality and an overreliance on imagined possibilities. However, experimental evidence for this hypothesis may be compromised by a potential confound between type of information (reality vs. possibility) and its valence (danger vs. safety). In the present study we aimed to untangle this potential confound. METHODS Forty OCD and 40 non-clinical participants underwent two versions of the Inferential Processes Task (Aardema, F., et al. (2009). The quantification of doubt in obsessive-compulsive disorder. International Journal of Cognitive Therapy, 2, 188-205). In the original version, the reality-based information is congruent with the safety hypothesis, whereas the possibility-based information is congruent with the danger hypothesis. In the modified version incorporated in the present study, the reality-based information is congruent with the danger hypothesis, whereas the possibility-based information is congruent with the safety hypothesis. RESULTS Our findings did not support the inferential confusion hypothesis: both OCD and control participants changed their estimations of the probability of unwanted events based on the type of information they received (whether it conveyed danger or safety) regardless of whether it was framed as reality or possibility. LIMITATIONS The design of the present study does not lend itself to examining alternative explanations for the persistence of doubt in OCD. CONCLUSIONS The hypothesized inferential confusion in OCD requires further validation. It is particularly important to demonstrate that findings do not reflect a prudential reasoning strategy.
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Affiliation(s)
- Amelia Gangemi
- Dipartimento di Scienze Cognitive, University of Messina, Via Concezione, 6/8, 98121 Messina, Italy.
| | - Francesco Mancini
- Scuola di Specializzazione in Psicoterapia Cognitiva, Associazione di Psicologia Cognitiva (APC) Viale Castro Pretorio, 116, 00185 Roma, Italy.
| | - Reuven Dar
- School of Psychological Sciences, Tel Aviv University, Tel Aviv 69978, Israel.
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28
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Perseveration causes automatization of checking behavior in obsessive-compulsive disorder. Behav Res Ther 2015; 71:1-9. [PMID: 25989162 DOI: 10.1016/j.brat.2015.05.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2014] [Revised: 04/29/2015] [Accepted: 05/09/2015] [Indexed: 11/20/2022]
Abstract
Repeated checking leads to reductions in meta-memory (i.e., memory confidence, vividness and detail), and automatization of checking behavior (Dek, van den Hout, Giele, & Engelhard, 2014, 2015). Dek et al. (2014) suggested that this is caused by increased familiarity with the checked stimuli. They predicted that defamiliarization of checking by modifying the perceptual characteristics of stimuli would cause de-automatization and attenuate the negative meta-memory effects of re-checking. However, their results were inconclusive. The present study investigated whether repeated checking leads to automatization of checking behavior, and if defamiliarization indeed leads to de-automatization and attenuation of meta-memory effects in patients with OCD and healthy controls. Participants performed a checking task, in which they activated, deactivated and checked threat-irrelevant stimuli. During a pre- and post-test checking trial, check duration was recorded and a reaction time task was simultaneously administered as dual-task to assess automatization. After the pre- and post-test checking trial, meta-memory was rated. Results showed that relevant checking led to automatization of checking behavior on the RT measure, and negative meta-memory effects for patients and controls. Defamiliarization led to de-automatization measured with the RT task, but did not attenuate the negative meta-memory effects of repeated checking. Clinical implications are discussed.
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Evidence accumulation in obsessive-compulsive disorder: the role of uncertainty and monetary reward on perceptual decision-making thresholds. Neuropsychopharmacology 2015; 40:1192-202. [PMID: 25425323 PMCID: PMC4349497 DOI: 10.1038/npp.2014.303] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2014] [Revised: 10/28/2014] [Accepted: 11/07/2014] [Indexed: 02/02/2023]
Abstract
The compulsive behaviour underlying obsessive-compulsive disorder (OCD) may be related to abnormalities in decision-making. The inability to commit to ultimate decisions, for example, patients unable to decide whether their hands are sufficiently clean, may reflect failures in accumulating sufficient evidence before a decision. Here we investigate the process of evidence accumulation in OCD in perceptual discrimination, hypothesizing enhanced evidence accumulation relative to healthy volunteers. Twenty-eight OCD patients and thirty-five controls were tested with a low-level visual perceptual task (random-dot-motion task, RDMT) and two response conflict control tasks. Regression analysis across different motion coherence levels and Hierarchical Drift Diffusion Modelling (HDDM) were used to characterize response strategies between groups in the RDMT. Patients required more evidence under high uncertainty perceptual contexts, as indexed by longer response time and higher decision boundaries. HDDM, which defines a decision when accumulated noisy evidence reaches a decision boundary, further showed slower drift rate towards the decision boundary reflecting poorer quality of evidence entering the decision process in patients under low uncertainty. With monetary incentives emphasizing speed and penalty for slower responses, patients decreased the decision thresholds relative to controls, accumulating less evidence in low uncertainty. These findings were unrelated to visual perceptual deficits and response conflict. This study provides evidence for impaired decision-formation processes in OCD, with a differential influence of high and low uncertainty contexts on evidence accumulation (decision threshold) and on the quality of evidence gathered (drift rates). It further emphasizes that OCD patients are sensitive to monetary incentives heightening speed in the speed-accuracy tradeoff, improving evidence accumulation.
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Voon V, Dalley JW. Translatable and Back-Translatable Measurement of Impulsivity and Compulsivity: Convergent and Divergent Processes. Curr Top Behav Neurosci 2015; 28:53-91. [PMID: 27418067 DOI: 10.1007/7854_2015_5013] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Impulsivity and compulsivity have emerged as important dimensional constructs that challenge traditional psychiatric classification systems. Both are present in normal healthy populations where the need to act quickly and repeatedly without hesitation can be highly advantageous. However, when excessively expressed, impulsive and compulsive behavior can lead to adverse consequences and spectrum disorders exemplified by attention-deficit/hyperactivity disorder (ADHD), obsessive compulsive disorder (OCD), autism, and drug addiction. Impulsive individuals have difficulty in deferring gratification and are inclined to 'jump the gun' and respond prematurely before sufficient information is gathered. Compulsivity involves repetitive behavior often motivated by the need to reduce or prevent anxiety, thus leading to the maladaptive perseveration of behavior. Defined in this way, impulsivity and compulsivity could be viewed as separate entities or 'traits' but overwhelming evidence indicates that both may be present in the same disorder, either concurrently or even separately at different time points. Herein we discuss the neural and cognitive heterogeneity of impulsive and compulsive endophenotypes. These constructs map onto distinct fronto-striatal neural and neurochemical structures interacting both at nodal convergent points and as opponent processes highlighting both the heterogeneity and the commonalities of function. We focus on discoveries made using both translational research methodologies and studies exclusively in humans, and implications for treatment intervention in disorders in which impulsive and compulsive symptoms prevail. We emphasize the relevance of these constructs for understanding dimensional psychiatry.
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Affiliation(s)
- Valerie Voon
- Behavioral and Clinical Neuroscience Institute, University of Cambridge, Cambridge, CB2 3EB, UK.
- Department of Psychiatry, University of Cambridge, Addenbrooke's Hospital, Cambridge, CB2 2QQ, UK.
- Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK.
| | - Jeffrey W Dalley
- Behavioral and Clinical Neuroscience Institute, University of Cambridge, Cambridge, CB2 3EB, UK
- Department of Psychiatry, University of Cambridge, Addenbrooke's Hospital, Cambridge, CB2 2QQ, UK
- Department of Psychology, University of Cambridge, Downing Street, Cambridge, CB2 3EB, UK
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Visser HA, van Oppen P, van Megen HJ, Eikelenboom M, van Balkom AJ. Obsessive-compulsive disorder; chronic versus non-chronic symptoms. J Affect Disord 2014; 152-154:169-74. [PMID: 24084621 DOI: 10.1016/j.jad.2013.09.004] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2013] [Revised: 09/05/2013] [Accepted: 09/05/2013] [Indexed: 12/20/2022]
Abstract
OBJECTIVE Understanding chronicity in OCD is hampered by contradictory findings arising from dissimilar definitions of chronic OCD. The purpose of this study was to investigate the magnitude of chronicity in OCD and to examine if chronic OCD is critically different from non-chronic OCD, using a chronicity definition that reflects empirical findings. METHOD Baseline data of the Netherlands Obsessive Compulsive Disorder Association (NOCDA) study, in which 379 OCD patients participated, were analyzed. Chronic OCD was defined as "continuous presence of at least moderately severe OCD symptoms during at least two years", and was assessed retrospectively using a Life-Chart Interview. RESULTS Application of the chronicity criterion resulted in two groups with highly distinguishable course patterns. The majority of the sample (61.7%) reported a chronic course. Patients with a chronic course reported significantly more severe OCD symptoms, more illness burden, more comorbidity, an earlier OCD onset and more contamination and washing - and symmetry and ordering symptoms. Multivariable logistic regression analysis revealed that chronic OCD was independently associated with more OCD-subtypes (p<0.001), contamination and washing symptoms (p<0.001), earlier OCD onset (p=0.05) and higher severity of compulsions (p<.01). LIMITATIONS The findings are based on a cross-sectional survey. Furthermore course was assessed retrospectively, implying the possibility of overestimation of persistence and severity of symptoms. CONCLUSION Chronicity is the rule rather than the exception in OCD in clinical samples. Chronic OCD is critically different from non-chronic OCD. Further attempts to break down the heterogeneity of OCD in homogeneous course subtypes should be made to allow for a more precise determination of the pathogenesis of OCD and better treatment.
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Affiliation(s)
- Henny A Visser
- Innova Research Centre, Mental Health Care Institute GGZ Centraal, Ermelo, The Netherlands.
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Shafran R, Radomsky AS, Coughtrey A, Rachman S. Advances in the Cognitive Behavioural Treatment of Obsessive Compulsive Disorder. Cogn Behav Ther 2013; 42:265-74. [DOI: 10.1080/16506073.2013.773061] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Giele CL, van den Hout MA, Engelhard IM, Dek ECP, Hoogers EEP, de Wit K. Ironic effects of compulsive perseveration. Memory 2012; 21:417-22. [PMID: 23016554 DOI: 10.1080/09658211.2012.727006] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Individuals with obsessive-compulsive disorder (OCD) exhibit perseverative behaviours, like checking, to reduce uncertainty, but perseveration paradoxically enhances uncertainty. It is unclear what mechanism might be responsible. We hypothesised that perseverative OC-like behaviour produces "semantic satiation" and interferes with the accessibility of meaning. Healthy participants repeated 20 types of OC-like checking behaviour nonperseveratively (2 times) or perseveratively (20 times). Afterwards, they decided as quickly as possible whether a picture was semantically related to the checked object. The nonperseverative condition showed spreading of activation: Judgements were faster for related than for unrelated objects and pictures. The effect was blocked in the perseverative condition, where reaction times for related and unrelated items were similar. The results suggest that the ironic effects of compulsive perseveration are due to interference with spreading of activation.
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Affiliation(s)
- Catharina L Giele
- Department of Clinical and Health Psychology, Utrecht University, Utrecht, The Netherlands.
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Harkin B, Miellet S, Kessler K. What checkers actually check: an eye tracking study of inhibitory control and working memory. PLoS One 2012; 7:e44689. [PMID: 23049755 PMCID: PMC3458048 DOI: 10.1371/journal.pone.0044689] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2012] [Accepted: 08/06/2012] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Not only is compulsive checking the most common symptom in Obsessive Compulsive Disorder (OCD) with an estimated prevalence of 50-80% in patients, but approximately ∼15% of the general population reveal subclinical checking tendencies that impact negatively on their performance in daily activities. Therefore, it is critical to understand how checking affects attention and memory in clinical as well as subclinical checkers. Eye fixations are commonly used as indicators for the distribution of attention but research in OCD has revealed mixed results at best. METHODOLOGY/PRINCIPAL FINDING Here we report atypical eye movement patterns in subclinical checkers during an ecologically valid working memory (WM) manipulation. Our key manipulation was to present an intermediate probe during the delay period of the memory task, explicitly asking for the location of a letter, which, however, had not been part of the encoding set (i.e., misleading participants). Using eye movement measures we now provide evidence that high checkers' inhibitory impairments for misleading information results in them checking the contents of WM in an atypical manner. Checkers fixate more often and for longer when misleading information is presented than non-checkers. Specifically, checkers spend more time checking stimulus locations as well as locations that had actually been empty during encoding. CONCLUSIONS/SIGNIFICANCE We conclude that these atypical eye movement patterns directly reflect internal checking of memory contents and we discuss the implications of our findings for the interpretation of behavioural and neuropsychological data. In addition our results highlight the importance of ecologically valid methodology for revealing the impact of detrimental attention and memory checking on eye movement patterns.
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Affiliation(s)
- Ben Harkin
- Institute of Neuroscience and Psychology, University of Glasgow, Glasgow, United Kingdom
| | | | - Klaus Kessler
- Institute of Neuroscience and Psychology, University of Glasgow, Glasgow, United Kingdom
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Lazarov A, Dar R, Liberman N, Oded Y. Obsessive–compulsive tendencies may be associated with attenuated access to internal states: Evidence from a biofeedback-aided muscle tensing task. Conscious Cogn 2012; 21:1401-9. [DOI: 10.1016/j.concog.2012.07.002] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2012] [Revised: 06/22/2012] [Accepted: 07/01/2012] [Indexed: 10/28/2022]
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Sarig S, Dar R, Liberman N. Obsessive-compulsive tendencies are related to indecisiveness and reliance on feedback in a neutral color judgment task. J Behav Ther Exp Psychiatry 2012; 43:692-7. [PMID: 21983353 DOI: 10.1016/j.jbtep.2011.09.012] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2011] [Revised: 09/12/2011] [Accepted: 09/12/2011] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND OBJECTIVES The present study was designed to test whether OC tendencies are associated with indecisiveness and increased need for objective feedback in vague decision situations. This hypothesis was tested using a neutral color judgment task that places minimal demands on working memory. METHODS Sixty-one participants completed several measures of OC symptoms and tendencies. Indecisiveness was tested on a novel computerized task in which participants can move along a continuum marked by two colors at the extreme ends and are instructed to choose the color they judge to be the exact mid-point on the continuum. RESULTS OC scores were positively correlated with indecisiveness on the task, as assessed by the amount of time it took participants to complete the task and the extent of their search through the color continuum. This association was most pronounced when feedback for performance was not routinely provided. Requests for feedback were also positively correlated with OC scores. OC scores were not associated with actual performance on the task (accuracy levels) or with confidence ratings. LIMITATIONS The study relies on non-clinical participants and the extent to which these results would extend to OCD patients in unknown. Some effects may be confounded by the fixed order in which the task phases were administered. CONCLUSIONS The findings support the hypothesis that OC tendencies are associated with general indecisiveness and reliance on external feedback.
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Affiliation(s)
- Shelly Sarig
- Department of Psychology, Tel Aviv University, Tel Aviv 69978, Israel
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Lazarov A, Dar R, Liberman N, Oded Y. Obsessive-compulsive tendencies and undermined confidence are related to reliance on proxies for internal states in a false feedback paradigm. J Behav Ther Exp Psychiatry 2012; 43:556-64. [PMID: 21835134 DOI: 10.1016/j.jbtep.2011.07.007] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2011] [Revised: 05/19/2011] [Accepted: 07/14/2011] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND OBJECTIVES We have previously hypothesized that obsessive-compulsive (OC) tendencies are associated with a general lack of subjective conviction regarding internal states, which leads to compensatory seeking of and reliance on more discernible substitutes (proxies) for these states (Lazarov, A., Dar, R., Oded, Y., & Liberman, N. (2010). Behaviour Research and Therapy, 48, 516-523). This article presents two studies designed to provide further support to this hypothesis by using false biofeedback as a proxy for internal states. METHODS In Study 1 we presented high and low OC participants with pre-programmed false feedback showing either increasing or decreasing levels of muscle tension. In Study 2 we presented similar false feedback on level of relaxation to non-selected participants, half of which received instructions that undermined their confidence in their ability to assess their own level of relaxation. RESULTS In Study 1, high OC participants were more affected by false biofeedback when judging their own level of muscle tension than were low OC participants. In Study 2, undermined confidence participants were more affected by false biofeedback when judging their own level of relaxation as compared to control participants. LIMITATIONS Our findings are based on a non-clinical, highly functioning, largely female student sample and their generalization to OCD requires replication with a sample of OCD patients. CONCLUSIONS These results provide converging evidence for our hypothesis by replicating and extending our previous findings. We discuss the implication of our hypothesis for the understanding and treatment of OCD and outline directions for future research.
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Affiliation(s)
- Amit Lazarov
- Department of Psychology, Tel Aviv University, Tel Aviv 69978, Israel
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Giele CL, van den Hout MA, Engelhard IM, Dek ECP, Hofmeijer FK. Obsessive-compulsive-like reasoning makes an unlikely catastrophe more credible. J Behav Ther Exp Psychiatry 2011; 42:293-7. [PMID: 21349245 DOI: 10.1016/j.jbtep.2010.12.012] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2010] [Revised: 12/20/2010] [Accepted: 12/23/2010] [Indexed: 11/26/2022]
Abstract
When obsessive-compulsive (OC) patients are confronted with disorder-relevant situations, they tend to reason in chains of small steps between the current situation and a highly improbable catastrophe. It was hypothesized that this type of "perseverative reasoning" would increase the subjective likelihood of the feared catastrophe. In an experiment with 63 healthy undergraduates, we tested whether OC-like perseverative reasoning induces feelings of uncertainty about a harmful outcome and makes this outcome more credible. Furthermore, we explored whether making multiple series of events increases these effects. Participants were administered a neutral situation with a catastrophic improbable outcome. In a pre- and post-test, they rated the credibility of this outcome and feelings of uncertainty about the outcome. In between, two experimental groups were instructed to generate respectively one or five series of intermediate steps between the situation and the harmful outcome, while a control group carried out a filler task. Consistent with the predictions, perseverative reasoning enhanced the credibility of a negative, improbable outcome. However, there were no differences between the two experimental conditions (one or five reasoning chains), and perseverative reasoning did not increase uncertainty about the outcome. The OC-like generation of small steps between an innocuous situation and a negative outcome increases the credibility of a feared outcome, potentially serving to maintain obsessive-compulsive disorder (OCD) problems.
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Affiliation(s)
- Catharina L Giele
- Clinical and Health Psychology, Utrecht University, PO Box 80140, 3508 TC Utrecht, The Netherlands.
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Coleman SL, Pietrefesa AS, Holaway RM, Coles ME, Heimberg RG. Content and correlates of checking related to symptoms of obsessive compulsive disorder and generalized anxiety disorder. J Anxiety Disord 2011; 25:293-301. [PMID: 21242055 DOI: 10.1016/j.janxdis.2010.09.014] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2009] [Revised: 08/19/2010] [Accepted: 09/10/2010] [Indexed: 01/26/2023]
Abstract
In addition to the central role of compulsive behaviors in obsessive compulsive disorder (OCD), recent data have documented the presence of compulsive behaviors in individuals with generalized anxiety disorder (GAD). However, there is a lack of information about potential similarities and differences with regard to the quality, or content, of checking associated with worry and obsessions. The two studies presented herein are an initial step towards gathering this information. Findings of Study 1, from a large unselected undergraduate sample, showed that symptoms of OCD and GAD were both significantly associated with checking behaviors. However, while OCD symptoms were associated with checking related to both objects and interpersonal situations, GAD symptoms were only significantly associated with interpersonal checking. Findings of Study 2, using a separate sample, suggest links between interpersonal checking and features characteristic of GAD, namely emotion regulation difficulties, and between object checking and a cognitive feature of OCD, namely thought-action fusion. In summary, the current studies add to a growing body of literature suggesting that checking may be important in numerous forms of psychopathology, while also suggesting that the nature and function of checking may differ for various symptom profiles.
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Affiliation(s)
- Shannon L Coleman
- Department of Psychology, Binghamton University (SUNY), Binghamton, NY 13902-6000, USA.
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Radomsky AS, Alcolado GM. Don't even think about checking: mental checking causes memory distrust. J Behav Ther Exp Psychiatry 2010; 41:345-51. [PMID: 20398893 DOI: 10.1016/j.jbtep.2010.03.005] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2009] [Revised: 03/15/2010] [Accepted: 03/16/2010] [Indexed: 11/16/2022]
Abstract
Compulsive checking occurs in both physical and mental forms and is a common symptom of obsessive-compulsive disorder (OCD). Though there has been much recent attention devoted to research on physical checking, mental checking has been largely neglected. Previous research has reliably found that repeated physical checking reduces memory confidence, vividness and detail, while memory accuracy remains relatively unaffected. The current study examined memory accuracy and meta-memory in (n=62) undergraduate students for both physical and mental checks after repeated physical or mental checking of a stove. We hypothesized that repeated physical checking would lead to reductions in meta-memory for previous physical checks and that repeated mental checking would lead to reductions in meta-memory for previous mental checks. Results were consistent with hypotheses, in that checking in each modality led to significant decreases in all meta-memory variables for that modality but not the other. Results also showed that checking in each modality led to slight but significant declines in memory accuracy for that modality. Findings are discussed in terms of cognitive-behavioural models of and treatments for compulsive checking in OCD.
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Affiliation(s)
- Adam S Radomsky
- Concordia University, Department of Psychology, 7141 Sherbrooke St. West, Montreal, QC H4B1R6, Canada.
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Helbig-Lang S, Petermann F. Tolerate or eliminate? A systematic review on the effects of safety behavior across anxiety disorders. ACTA ACUST UNITED AC 2010. [DOI: 10.1111/j.1468-2850.2010.01213.x] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Repeated checking causes distrust in memory but not in attention and perception. Behav Res Ther 2010; 48:580-7. [DOI: 10.1016/j.brat.2010.03.009] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2009] [Revised: 03/01/2010] [Accepted: 03/09/2010] [Indexed: 11/22/2022]
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Lazarov A, Dar R, Oded Y, Liberman N. Are obsessive–compulsive tendencies related to reliance on external proxies for internal states? Evidence from biofeedback-aided relaxation studies. Behav Res Ther 2010; 48:516-23. [PMID: 20303473 DOI: 10.1016/j.brat.2010.02.007] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2009] [Revised: 02/21/2010] [Accepted: 02/23/2010] [Indexed: 11/25/2022]
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Radomsky AS, Shafran R, Coughtrey A, Rachman S. Cognitive-Behavior Therapy for Compulsive Checking in OCD. COGNITIVE AND BEHAVIORAL PRACTICE 2010. [DOI: 10.1016/j.cbpra.2009.10.002] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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