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Lee SW, Jang TY, Kim S, Lee SJ. Heightened but Inefficient Thought-Action Fusion in Obsessive-Compulsive Disorder: New Insight From a Multiple Trial Version of the Classic Thought-Action Fusion Experiment. Psychiatry Investig 2023; 20:120-129. [PMID: 36891596 PMCID: PMC9996149 DOI: 10.30773/pi.2022.0262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Accepted: 11/13/2022] [Indexed: 02/25/2023] Open
Abstract
OBJECTIVE Thought-action fusion (TAF), which is a tendency to make the relationship between one's thoughts and external consequences, is a dysfunctional belief linked to obsessive-compulsive disorder (OCD). While the TAF is commonly evaluated using the Thought-Action Fusion Scale (TAFS), it cannot fully reflect the actual experience of experimentally evoked TAF. In the present study, we applied a multiple-trial version of the classic TAF experiment and evaluate two variables, reaction time (RT) and emotional intensity (EI). METHODS Ninety-three patients with OCD and 45 healthy controls (HCs) were recruited. The participants were asked to read the name of a close or neutral person embedded in different positive (PS) or negative (NS) TAF statements. During the experiments, RT and EI were gathered. RESULTS The OCD patients presented with longer RT and lower EI in the NS condition than HCs. In each group, the HCs showed a significant relationship between RT in the NS condition and TAFS scores, whereas the patients did not, although they had higher TAFS scores than the HCs. In contrast, the patients showed a trend toward a correlation between RT in the NS condition and guilt. CONCLUSION These findings may indicate our multiple-trial version of the classical TAF showed reliable results of the two new variables, especially RT, in the task and allow to newly identify paradoxical patterns in which the TAFS scores are high but actual performance is impaired, that is, the inefficient activation of TAF in OCD.
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Affiliation(s)
- Sang Won Lee
- Department of Psychiatry, Kyungpook National University Chilgok Hospital, Daegu, Republic of Korea.,Department of Psychiatry, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Tae Yang Jang
- Department of Psychiatry, School of Medicine, Kyungpook National University, Daegu, Republic of Korea.,Department of Psychiatry, Kyungpook National University Hospital, Daegu, Republic of Korea
| | - Seungho Kim
- Department of Medical & Biological Engineering, Kyungpook National University, Daegu, Republic of Korea
| | - Seung Jae Lee
- Department of Psychiatry, School of Medicine, Kyungpook National University, Daegu, Republic of Korea.,Department of Psychiatry, Kyungpook National University Hospital, Daegu, Republic of Korea
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Fite RE, Magee JC. The Role of Magical Thinking, Sensitivity, and Thought Content in Thought-Action Fusion. JOURNAL OF SOCIAL AND CLINICAL PSYCHOLOGY 2022. [DOI: 10.1521/jscp.2022.41.2.128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Introduction: Cognitive models of obsessive-compulsive disorder (OCD) posit that maladaptive beliefs about intrusive thinking contribute to the disorder's development and maintenance. However, the findings concerning one notable belief, thought-action fusion (TAF), have been inconsistent. Current conceptualizations of TAF may conflate constructs such as magical thinking, sensitivity, and thought content that are already the subject of informative, interdisciplinary literatures. Methods: To tease apart these constructs, adult participants (N = 249) reported their trait levels of sensitivity and magical thinking, and were randomly assigned to engage with an intrusive thought in one of three content areas. We hypothesized that morality-related content would lead to heightened maladaptive outcomes, but only in combination with higher trait levels of sensitivity and magical thinking. Results: Results indicated that morality-related content, along with sensitivity to morality, played more of a prominent role in maladaptive outcomes, with magical thinking being implicated in general outcomes like worry. Discussion: These findings suggest that the link between TAF and maladaptive outcomes may depend on which TAF elements are present for an individual. Sensitivity, in tandem with other TAF elements (e.g., morality-related content, magical thinking) is predictive of divergent outcomes (e.g., worrying, urges to neutralize) and thus may be an important target of future interventions aimed at reducing TAF, worrying, and/or OC symptoms.
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Berman NC, Hezel DM, Wilhelm S. Is my patient too sad to approach their fear? Depression severity and imaginal exposure outcomes for patients with OCD. J Behav Ther Exp Psychiatry 2021; 70:101615. [PMID: 32937237 DOI: 10.1016/j.jbtep.2020.101615] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Revised: 07/21/2020] [Accepted: 09/03/2020] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND OBJECTIVES There is conflicting research on how comorbid depression impacts the treatment of obsessive compulsive disorder (OCD) with exposure with response prevention. To better understand this relationship, the current study tests theoretical claims that greater depression limits motivation to engage in exposures, restricts habituation, and interferes with adaptive learning. METHODS Fifty-one individuals with OCD completed a diagnostic interview and self-report questionnaires assessing depression symptom severity and then participated in a standardized imaginal exposure protocol, in which they repeatedly approached an idiosyncratic fear deemed "moderately anxiety-provoking." RESULTS Contrary to expectations, linear regression models indicated that depression symptom severity was not independently associated with motivation, subjective or objective within-session habituation or adaptive learning outcomes. However, the perceived likelihood of the best-case scenario occurring as a result of the exposure moderated the relationship between depression severity and motivation to engage in the exposure exercise. LIMITATIONS Use of a one-session exposure protocol precludes conclusions regarding how depression is associated with outcomes in a full ERP treatment. CONCLUSIONS Depression symptom severity was not independently associated with motivation, habituation, or adaptive learning. The observed non-significant effects suggest that degree of depression, on its own, is not a meaningful indicator of how patients with OCD will fare an exposure intervention.
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Affiliation(s)
- Noah Chase Berman
- Department of Psychiatry, Massachusetts General Hospital/Harvard Medical School, OCD and Related Disorders, 185 Cambridge Street, Suite 2000, Boston, MA, 02114, USA; Psychology Department, College of the Holy Cross, 1 College St., Beaven Hall, PO Box 38A, Worcester, MA, 01610, USA.
| | - Dianne M Hezel
- Center for Obsessive-Compulsive Treatment and Related Disorders, New York State Psychiatric Institute, Department of Psychiatry, Columbia University, 1051 Riverside Drive, Unit #69, New York, NY, 10032, USA
| | - Sabine Wilhelm
- Department of Psychiatry, Massachusetts General Hospital/Harvard Medical School, OCD and Related Disorders, 185 Cambridge Street, Suite 2000, Boston, MA, 02114, USA
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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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Symptom-Specific Threat Perception Mediates the Relationship Between Obsessive Beliefs and OCD Symptoms. COGNITIVE THERAPY AND RESEARCH 2019. [DOI: 10.1007/s10608-019-10004-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Narayanaswamy JC, Jose D, Agarwal SM, Kalmady SV, Baruah U, Shivakumar V, Prasad C, Viswanath B, Rao NP, Venkatasubramanian G, Janardhan Reddy YC. Neuro-hemodynamic endophenotypes of emotional interference in OCD: fMRI study using emotion counting stroop task. Asian J Psychiatr 2019; 39:35-41. [PMID: 30528906 DOI: 10.1016/j.ajp.2018.11.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Revised: 11/14/2018] [Accepted: 11/24/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND We sought to examine the endophenotype pattern of neuro-hemodynamic substrates of emotion counting Stroop (ecStroop) paradigm in patients with OCD, their unaffected siblings [first degree relatives-FDR] and healthy controls (HC). METHODS OCD patients (medication naïve)[N = 16], their unaffected siblings(FDR)[N = 16] and HC [N = 24] were compared using an established ecStroop paradigm in a 3-Tesla fMRI. The relative BOLD signals corresponding to the three types of conditions (neural words-N, words with negative emotional salience-E and words with salience for OCD-O) were examined in the apriori hypothesized brain regions. RESULTS Both in O minus N contrast and O minus E contrast, the groups demonstrated significant differential activation of right insula (BA 13). The post-hoc analyses showed in patients and FDRs relative to HC the following: significant hyperactivation of insula in O minus E contrast; significant hyperactivation of right insula and right DLPFC (BA 9) in O minus N contrast. CONCLUSIONS The neuro-hemodynamic responses corresponding to the obsessive words in insula and DLPFC could be potential endophenotypes. "Threat relatedness" might thus have a vulnerability meaning in the pathogenesis and neurobiological basis of OCD.
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Affiliation(s)
- Janardhanan C Narayanaswamy
- Obsessive-Compulsive Disorder Clinic, Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, India; Translational Psychiatry Laboratory, Neurobiology Research Centre, National Institute of Mental Health and Neurosciences, Bangalore, India.
| | - Dania Jose
- Obsessive-Compulsive Disorder Clinic, Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, India; Translational Psychiatry Laboratory, Neurobiology Research Centre, National Institute of Mental Health and Neurosciences, Bangalore, India
| | | | - Sunil V Kalmady
- Department of Psychiatry, University of Alberta, Edmonton, Alberta, Canada
| | - Upasana Baruah
- Obsessive-Compulsive Disorder Clinic, Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, India; Translational Psychiatry Laboratory, Neurobiology Research Centre, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Venkataram Shivakumar
- Obsessive-Compulsive Disorder Clinic, Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, India; Translational Psychiatry Laboratory, Neurobiology Research Centre, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Chandrajit Prasad
- Department of Neuroimaging & Interventional Radiology, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Biju Viswanath
- Obsessive-Compulsive Disorder Clinic, Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Naren P Rao
- Obsessive-Compulsive Disorder Clinic, Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Ganesan Venkatasubramanian
- Obsessive-Compulsive Disorder Clinic, Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, India; Translational Psychiatry Laboratory, Neurobiology Research Centre, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Y C Janardhan Reddy
- Obsessive-Compulsive Disorder Clinic, Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, India; Translational Psychiatry Laboratory, Neurobiology Research Centre, National Institute of Mental Health and Neurosciences, Bangalore, India
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Catastrophic Thinking: A Transdiagnostic Process Across Psychiatric Disorders. COGNITIVE THERAPY AND RESEARCH 2016. [DOI: 10.1007/s10608-016-9763-3] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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Andersson E, Ljótsson B, Hedman E, Hesser H, Enander J, Kaldo V, Andersson G, Lindefors N, Rück C. Testing the Mediating Effects of Obsessive Beliefs in Internet-Based Cognitive Behaviour Therapy for Obsessive-Compulsive Disorder: Results from a Randomized Controlled Trial. Clin Psychol Psychother 2014; 22:722-32. [PMID: 25418575 DOI: 10.1002/cpp.1931] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2014] [Revised: 10/21/2014] [Accepted: 10/22/2014] [Indexed: 11/05/2022]
Abstract
UNLABELLED Although cognitive interventions for obsessive-compulsive disorder (OCD) have been tested in randomized trials, there are few trials that have tested the specific mechanisms of cognitive interventions, i.e. how they achieve their effects. In this study, we aimed to investigate the mediating effects of a short cognitive intervention in the treatment of OCD and used data from a recently conducted randomized controlled trial where 101 participants were allocated to either Internet-based CBT (ICBT) or to a control condition. Obsessive beliefs were measured at pre-treatment, at the time they had received the cognitive intervention, and also at post-treatment. Weekly OCD symptoms were measured throughout the 10 weeks of treatment. We hypothesized that (1) the ICBT group would have greater reductions in obsessive beliefs (controlling for change in OCD symptoms) after completing the cognitive intervention, and that (2) this reduction would, in turn, predict greater OCD symptom reduction throughout the rest of the treatment period. Contrary to our expectations, the longitudinal mediation analysis indicated that (1) being randomized to ICBT actually increased the degree of obsessive beliefs after receiving the cognitive intervention at weeks 1-3, and (2) increase in obsessive beliefs predicted better outcome later in treatment. However, when repeating the analysis using cross-sectional data at post-treatment, the results were in line with the initial hypotheses. Results were replicated when the control condition received ICBT. We conclude that, although obsessive beliefs were significantly reduced at post-treatment for the ICBT group, early increase rather than decrease in obsessive beliefs predicted favourable outcome. KEY PRACTITIONER MESSAGE This study investigated the impact of cognitive interventions on obsessive beliefs for patients with obsessive-compulsive disorder. Results showed that a sudden increase in obsessive beliefs is not an indicator of worse treatment response. On the contrary, it is more likely that the patient is better off when having this sudden increase. Clinicians should not be alarmed if the patient has a sudden increase in obsessive beliefs, but we do recommend the clinician to investigate the reasons for this further.
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Affiliation(s)
- Erik Andersson
- Department of Clinical Neuroscience, Division of Psychiatry, Karolinska Institutet, Stockholm, Sweden.,Department of Clinical Neuroscience, Division of Psychology, Karolinska Institutet, Stockholm, Sweden
| | - Brjánn Ljótsson
- Department of Clinical Neuroscience, Division of Psychology, Karolinska Institutet, Stockholm, Sweden
| | - Erik Hedman
- Department of Clinical Neuroscience, Division of Psychology, Karolinska Institutet, Stockholm, Sweden.,Osher Center for Integrative Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Hugo Hesser
- Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden
| | - Jesper Enander
- Department of Clinical Neuroscience, Division of Psychiatry, Karolinska Institutet, Stockholm, Sweden
| | - Viktor Kaldo
- Department of Clinical Neuroscience, Division of Psychiatry, Karolinska Institutet, Stockholm, Sweden
| | - Gerhard Andersson
- Department of Clinical Neuroscience, Division of Psychiatry, Karolinska Institutet, Stockholm, Sweden.,Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden
| | - Nils Lindefors
- Department of Clinical Neuroscience, Division of Psychiatry, Karolinska Institutet, Stockholm, Sweden
| | - Christian Rück
- Department of Clinical Neuroscience, Division of Psychiatry, Karolinska Institutet, Stockholm, Sweden
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Abstract
The cognitive model of OCD suggests that misinterpreting intrusive thoughts as unacceptable leads to increased anxiety and attempts to suppress or ignore the thoughts through avoidance or compulsive rituals. An insidious negative feedback loop develops as one's attention focuses on these thoughts and in turn the unwanted thoughts do not respond to efforts to avoid or suppress. This article is a current review of the research on cognitive processes in obsessive-compulsive disorder (OCD). We review research that has (1) empirically validated the theoretical underpinnings of the cognitive model, (2) altered maladaptive cognitive processes through state-of-the-art experimental procedures, (3) refined our understanding of the relationship between obsessive beliefs and OC symptoms and (4) examined how underlying traits (e.g., anxiety and disgust sensitivity) relate to the development and maintenance of OCD. We discuss the clinical implications of this research.
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Thompson-Hollands J, Farchione TJ, Barlow DH. Thought-action fusion across anxiety disorder diagnoses: specificity and treatment effects. J Nerv Ment Dis 2013; 201:407-13. [PMID: 23595095 PMCID: PMC3645350 DOI: 10.1097/nmd.0b013e31828e102c] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Thought-action fusion (TAF) is a cognitive error that has been frequently investigated within the context of obsessive-compulsive disorder (OCD). However, evidence suggests that this error may also be present in disorders other than OCD, indicating that TAF is related to higher order factors rather than a specific diagnosis. We explored TAF in a sample of patients with mixed diagnoses undergoing treatment with a transdiagnostic CBT protocol. Elevated TAF levels at baseline were not specific to patients with OCD. However, the presence of any generalized anxiety disorder (GAD) diagnosis was unexpectedly the strongest predictor of likelihood TAF. Likelihood TAF, a particular component of TAF, was reduced after transdiagnostic treatment, and this reduction was not affected by the presence of a GAD diagnosis. Results indicate that TAF is responsive to treatment and should be assessed and, perhaps, treated in disorders beyond OCD.
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Cougle JR, Fitch KE, Jacobson S, Lee HJ. A multi-method examination of the role of incompleteness in compulsive checking. J Anxiety Disord 2013; 27:231-9. [PMID: 23511304 DOI: 10.1016/j.janxdis.2013.02.003] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2012] [Revised: 01/14/2013] [Accepted: 02/16/2013] [Indexed: 01/22/2023]
Abstract
Emerging evidence implicates an important relationship between feelings of incompleteness and compulsive checking. To date, this work has relied mostly on self-report measures and correlational research designs. We explored the relationship in three different studies using in vivo tasks. In Study 1, we found checking symptoms to be uniquely associated with negative affective response to a pile of clutter (an incompleteness induction). In Study 2, two different measures of incompleteness were predictive of urge to check following a stove checking task. In Study 3, following a stove checking task, participants were randomized to incompleteness induction or control conditions, and urge to check was assessed afterwards. Among those with elevated checking symptoms and dispositional incompleteness, the incompleteness induction led to greater urge to check than the control condition. No effect of condition was found among those low in checking symptoms and dispositional incompleteness. Together, these studies provide novel data in support of an important role for incompleteness in checking compulsions.
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Affiliation(s)
- Jesse R Cougle
- Department of Psychology, Florida State University, United States.
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Berman NC, Wheaton MG, Abramowitz JS. The “Arnold Schwarzenegger Effect”: Is strength of the “victim” related to misinterpretations of harm intrusions? Behav Res Ther 2012; 50:761-6. [DOI: 10.1016/j.brat.2012.09.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2012] [Revised: 09/07/2012] [Accepted: 09/14/2012] [Indexed: 11/27/2022]
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