Obsessive–compulsive tendencies may be associated with attenuated access to internal states: Evidence from a biofeedback-aided muscle tensing task

An investigation of the experience of control through the sense of agency in people with obsessive-compulsive disorder: a review and meta-analysis

The construct of sense of agency (SoA) has proven useful for understanding mechanisms underlying obsessive-compulsive disorder (OCD) phenomenology, especially in explaining the apparent dissociation in OCD between actual and perceived control over one's actions. Paradoxically, people with OCD appear to experience both diminished SoA (feeling unable to control their actions) and inflated SoA (having "magical" control over events). The present review investigated the extent to which the SoA is distorted in OCD, in terms of both implicit (ie, inferred from correlates and outcomes of voluntary actions) and explicit (ie, subjective judgment of one's control over an outcome) measures of SoA. Our search resulted in 15 studies that met the criteria for inclusion in a meta-analysis, where we also examined the potential moderating effects of the type of measure (explicit versus implicit) and of the actual control participants had over the outcome. We found that participants with OCD or with high levels of OCD symptoms show lower implicit measures of SoA and at the same time tend to overestimate their control in situations where they do not actually have it. Together, these findings support the hypothesized dissociation in OCD between actual and perceived control over one's actions.

The Seeking Proxies for Internal States (SPIS) Model of OCD - A Comprehensive Review of Current Findings and Implications for Future Directions

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.

Obsessive-Compulsive Disorder: The Underlying Role of Diminished Access to Internal States

We suggest that individuals with obsessive-compulsive disorder (OCD) experience difficulty accessing their internal states, including their feelings, emotions, preferences, and motivations. Instead, they rely on proxies to inform them of these states—that is, discernible substitutes in the form of fixed rules and rituals, observable behavior, and indexes. The Seeking Proxies for Internal States (SPIS) model of OCD proposes that compulsions, obsessions, indecision, and doubt result from seeking and using such proxies. The SPIS model not only accounts for these OCD symptoms but also sheds new light on normal processes of action control, metacognition, decision-making, and introspection.

Are people with obsessive-compulsive disorder under-confident in their memory and perception? A review and meta-analysis

People with obsessive-compulsive disorder (OCD) tend to distrust their memory, perception, and other cognitive functions, and many OCD symptoms can be traced to diminished confidence in one's cognitive processes. For example, poor confidence in recall accuracy can cause doubt about one's memory and motivate repeated checking. At the same time, people with OCD also display performance deficits in a variety of cognitive tasks, so their reduced confidence must be evaluated in relation to their actual performance. To that end, we conducted an exhaustive review and meta-analysis of studies in which OCD participants and non-clinical control participants performed cognitive tasks and reported their confidence in their performance. Our search resulted in 19 studies that met criteria for inclusion in the quantitative analysis, with all studies addressing either memory or perception. We found that both performance and reported confidence were lower in OCD than in control participants. Importantly, however, confidence was more impaired than performance in participants with OCD. These findings suggest that people with OCD are less confident in their memory and perception than they should be, indicating a genuine under-confidence in this population. We discuss potential mechanisms that might account for this finding and suggest avenues for further research into under-confidence and related meta-cognitive characteristics of OCD.

Attenuated Access to Emotions in Obsessive-Compulsive Disorder

The Seeking Proxies for Internal States (SPIS) model of obsessive-compulsive disorder (OCD) posits that OCD is associated with attenuated access to internal states. Here we explored the implications of this model in the realm of emotions. Participants with OCD, anxiety disorders, and nonclinical control participants completed the Mayer-Salovey-Caruso Emotional Intelligence Test (MSCEIT), assessing two domains of emotional intelligence: Experiential emotional intelligence (EI), reflecting the ability to perceive and feel emotions accurately, and Strategic EI, reflecting the ability to understand and manage emotions correctly. As only Experiential EI requires accurate perception of one's emotions for adequate performance, we predicted an interaction between group and EI area. Specifically, we predicted that compared to both anxiety disorders and healthy control participants, OCD participants would show a larger deficit in Experiential area of the MSCEIT relative to the Strategic area. Results were fully in line with this prediction. Moreover, supporting the specificity of the hypothesized deficit to OCD, participants with anxiety disorders did not differ from nonclinical control participants in their performance, and findings were not attributable to anxiety or depression levels. These results replicate and extend previous findings obtained with analogue samples and suggest that OCD is associated with attenuated access to emotional states, which may be partially compensated for by reliance on semantic knowledge of emotion.

Seeking proxies for internal states (SPIS): Towards a novel model of obsessive-compulsive disorder

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.

Protocol for a mixed-method cohort study investigating the prevalence and impact of obsessive-compulsive disorder (OCD) in chronic pain rehabilitation

INTRODUCTION

While there is considerable and growing research in the individual fields of obsessive-compulsive disorder (OCD) and chronic pain, focused research into their potential association remains limited. By exploring this potential association, better theoretical understanding of and better therapeutic approaches to chronic pain management could be developed. The study's aim is to explore the prevalence and impact of obsessions-compulsions on the experience and rehabilitation of chronic pain among individuals attending different branches of a New Zealand pain service.

METHODS AND ANALYSIS

This is a cohort study using well-validated questionnaires and semistructured interviews. Participants will be recruited through community pain services from a private rehabilitation-focused company with branches across New Zealand. Participants will complete an OCD screening measure (Obsessive-Compulsive Inventory-Revised (OCI-R)). These results will be used to compare results from the specialist pain services benchmarking electronic Persistent Pain Outcomes Collaboration measure sets, at both participant intake and completion of each Pain Service Programme. Prevalence rates of OCD caseness from the OCI-R will be estimated with 95% CI. Generalised linear regression models will be used to explore differences in pain baseline and outcome factors between those with high and low obsessive-compulsive symptoms. Semistructured interviews, assessed through interpretative phenomenological analysis (IPA), will be used to provide information on lived experiences of individuals with comorbid chronic pain and OCD. This will be supported through the administration of an Obsessive Beliefs Questionnaire 44.

ETHICS AND DISSEMINATION

Ethical approval has been obtained from the Health and Disability Ethics Committee (HDEC20/CEN/82). Study results will be disseminated at professional conferences and in peer-reviewed journals. A lay summary of findings will be provided to requesting participants or through attendance at a local hui (gathering).

TRIAL REGISTRATION NUMBER

Australian New Zealand Clinical Trials Registry (ACTRN12621000758808).

Reduced interoceptive accuracy in patients with obsessive-compulsive disorder: A case-control study

According to traditional and recent literature, one of the core features of obsessive-compulsive disorder (OCD) is pathological doubt, defined as a lack of certitude or confidence in one's memory, attention, intuition, and perceptions. Recent studies have shown that uncertainty, amongst other cognitive and emotional processes, might be linked to an impairment in interoceptive abilities. Here we aimed to assess Interoceptive Accuracy (IA) in a population of OCD patients, and to determine whether alexithymia and symptoms of depression and anxiety would be associated with IA. We recruited 18 patients with OCD and 18 healthy controls (HC). Interoceptive accuracy was tested with the Heartbeat Counting Task. Participants also underwent a psychometric assessment for Obsessions and Compulsions (Y-BOCS), Alexithymia (TAS-20), Impulsivity (BIS-11), Anxiety and Depression (HAM-A and HAM-D). OCD patients had lower Interoceptive Accuracy than HC (p = 0.016) and presented more anxiety and depressive symptoms, along with more alexithymic features than HC. However, these psychological elements were not associated with the reduced IA. This study replicates previous findings and fits with the current literature investigating interoceptive abilities in patients with OCD, which might be used to design specific therapeutic interventions focused on internal bodily signals.

Obsessive-compulsive symptoms are related to reduced awareness of emotional valence

BACKGROUND

The Seeking Proxies for Internal States (SPIS) model of OCD asserts that obsessive-compulsive (OC) tendencies are associated with attenuated access to internal states. Here we explore the implications of this model for awareness of emotional valence.

METHODS

In Study 1, participants with high and low OC tendencies (n = 30 in each group) rated how they felt while viewing different pictures with positive, neutral, or negative valence taken from the International Affective Picture System. Study 2 replicated Study 1 among non-selected participants (n = 99) that rated positive and negative pictures chosen from the recently developed Basic-Emotions Nencki Affective Picture System. In both studies, mean deviation from norm ratings (of each picture system) served as the primary outcome measure.

RESULTS

Study 1 showed that high OC participants' mean deviation score was significantly higher, compared with low OC participants, across positive, neutral, and negative pictures (p=.01). Follow-up analyses revealed that while no group difference emerged for mean valence rating (p=.16), groups differed on the mean standard deviation of ratings within each valence category (p=.002). In Study 2, only OC tendencies, not depressive or anxiety symptoms, were positively correlated with mean deviation from norm ratings (p=.026). Dividing the sample to high and low OC groups based on an OC cutoff score yielded similar group differences to those observed in Study 1 (p<.001).

LIMITATIONS

Analog samples and a relative small sample size (Study 1).

CONCLUSIONS

This study suggests that OC symptoms are associated with reduced awareness of emotional valence, possibly emanating from a noisier emotional perception.

Attenuation of access to internal states in high obsessive-compulsive individuals might increase susceptibility to false feedback: Evidence from a visuo-motor hand-reaching task

BACKGROUND AND OBJECTIVES

The Seeking Proxies for Internal States (SPIS) model of obsessive-compulsive disorder (OCD) posits that obsessive-compulsive (OC) individuals have attenuated access to their internal states. Hence, they seek and rely on proxies, or discernible substitutes for these internal states. In previous studies, participants with high OC tendencies and OCD patients, compared to controls, showed increased reliance on external proxies and were more influenced by false feedback when judging their internal states. This study is the first to examine the effects of false feedback on performance of hand movements in participants with high and low OC tendencies.

METHOD

Thirty-four participants with high OC tendencies and 34 participants with low OC tendencies were asked to perform accurate hand reaches without visual feedback in two separate sessions of a computerized hand-reaching task: once after valid feedback training of their hand location and once with false-rotated feedback. We assessed the accuracy and directional adaptation of participants' reaches.

RESULTS

As predicted, high OC participants evidenced a larger decrease in their hand positioning accuracy after training with false feedback compared to low OC participants.

LIMITATIONS

The generalization of our findings to OCD requires replication with a clinical sample.

CONCLUSIONS

These results suggest that in addition to self-perceptions, motor performance of OC individuals is prone to be overly influenced by false feedback, possibly due to attenuated access to proprioceptive cues. These findings may be particularly relevant to understanding the distorted sense of agency in OCD.

Hoarding and obsessive-compulsive behaviours in frontotemporal dementia: Clinical and neuroanatomic associations

BACKGROUND

Hoarding and obsessive-compulsive behaviours (OCB) are well documented symptoms in frontotemporal dementia (FTD). While contemporary models consider hoarding and obsessive-compulsive disorder distinct, the related behaviours have not been separately examined in patients with FTD, and the neuroanatomical correlates of hoarding in patients with FTD have not been previously examined (American Psychiatric Association, 2013; Grisham and Baldwin, 2015; Mataix-Cols et al., 2010).

METHODS

Patients with FTD who were evaluated between 2004 and 2018 at our centre were included. Cortical thickness and subcortical volumetric analyses were completed on available T1 high resolution anatomic scans using FreeSurfer.

RESULTS

Eighty-seven patients met inclusion criteria, and 49 had scans available for quantitative MRI volumetric analysis. New hoarding behaviours were present in 29% of patients and were more common in the semantic variant subtype of FTD, while 49% of individuals had new or increased OCB. Hoarding behaviours were associated with decreased thickness in a factor comprised of left temporal, insular and anterior cingulate cortices. The presence of OCB was predicted by reduced cortical thickness and volumes in a factor comprised of the anterior cingulate and subcortical volumes in the bilateral amygdala and hippocampus. OCB were associated with greater right temporal cortical thickness in comparison to patients with hoarding.

DISCUSSION

The association of the semantic variant with hoarding, together with the observed associations between left temporal atrophy and hoarding indicate that degeneration of the left temporal lobe has a role in the emergence of hoarding in FTD. As in current models of Hoarding disorder and Obsessive-Compulsive disorder, our results suggest that in patients with FTD, hoarding and OCB are clinically and anatomically partially dissociable phenomenon. The results may also help to further elucidate the cognitive processes and neural networks contributing to Hoarding disorder and Obsessive-Compulsive disorder in persons without dementia.

Searchlight classification based on Amplitude of Low Frequency Fluctuation and functional connectivity in individuals with obsessive-compulsive symptoms

INTRODUCTION

Investigating obsessive-compulsive symptoms in subclinical populations provides a useful framework for understanding the early development of obsessive-compulsive spectrum disorders. The present study aimed to apply searchlight classification analysis on resting-state functional magnetic resonance imaging data to identify potential brain markers in subclinical individuals with obsessive-compulsive symptoms.

METHODS

In this observational study, 40 college students with high obsessive-compulsive symptom scores and 40 with low obsessive-compulsive symptom scores were recruited from universities in China. We conducted searchlight classification and comparison analysis between the two groups based on Amplitude of Low Frequency Fluctuation (ALFF), fraction ALFF (fALFF) and resting-state functional connectivity using searchlight classification.

RESULTS

We found that the highest accuracy rate in differentiating between the two groups was 85.00%. Significant discriminating features included the ALFF of the left medial superior frontal gyrus and the functional connectivity between the right thalamus and the bilateral medial superior frontal gyrus, and the right putamen, as well as the functional connectivity between the left caudate and the right insula.

CONCLUSIONS

These findings highlight the specific and distinguishing brain functional abnormalities associated with obsessive-compulsive symptoms.

Functional neural mechanisms of sensory phenomena in obsessive-compulsive disorder

Sensory phenomena (SP) are aversive or uncomfortable sensations that accompany and/or drive repetitive behaviors in obsessive-compulsive disorder (OCD). Although SP are associated with significant distress and may respond less well to standard treatments than harm-related obsessions, little is known about their underlying neurobiology. The present study used functional magnetic resonance imaging (fMRI) to measure brain functioning related to severity of SP during a "body-focused" videos task designed to elicit activation in sensorimotor brain regions. Regression analysis examined the relationship between severity of SP and activation during task using permutation analysis, cluster-level corrected for multiple comparisons (family-wise error rate p < 0.05). The distribution of SP severity was not significantly different from normal, with both high- and low-severity scores represented in the OCD sample. Severity of SP was not correlated with other clinical symptoms in OCD including general anxiety, depression, or harm avoidance. When viewing body-focused videos, patients with greater severity of SP showed increased activity in the mid-posterior insula, a relationship that remained significant when controlling for other clinical symptoms, medication status, and comorbidities. At uncorrected thresholds, SP severity was also positively related to somatosensory, mid orbitofrontal, and lateral prefrontal cortical activity. These data suggest that SP in OCD are dissociable from other symptoms in the disorder and related to hyperactivation of the insula. Future work examining neural mechanisms of SP across different disorders (tics, trichotillomania) as well as with other imaging modalities will be needed to further understand the neurobiology of these impairing symptoms.

Obsessive-compulsive tendencies are related to seeking proxies for internal states in everyday life

BACKGROUND AND OBJECTIVES

In recent years we have proposed and investigated the Seeking Proxies for Internal States (SPIS) model of obsessive-compulsive disorder (OCD), which postulates that deficient access to internal states is a key feature of the disorder. According to this model, rules and rituals that often characterize people with OCD can be understood as proxies for deficiently accessible internal states. Here we compliment this earlier experimental work by examining whether reliance on proxies for internal states in everyday life is associated with OCD.

METHODS

We developed an inventory for assessing reliance on proxies in everyday life and examined its relationship with obsessive-compulsive tendencies in two internet panel studies. The internal states included hunger, enjoyment, interpersonal liking, preferences, a sense of understanding, and intuitions about correct solutions to problems. The proxies included one's own behavior, the opinion of others, and objective indices such as grades and elapsed time since eating.

RESULTS

In both studies, participants with obsessive-compulsive tendencies reported relying more on external, discernible proxies for a variety of internal states. These results remained significant after controlling for concurrent anxiety and depression.

LIMITATIONS

Our inventory is by necessity limited in its sampling of internal states and proxies and further correlational and experimental studies will be needed to examine additional areas of application, such as decision making and interpersonal liking.

CONCLUSIONS

These results are consistent with and expand the Seeking Proxies for Internal States (SPIS) model and may have implications for understanding and treating individual with OCD.

High obsessive-compulsive individuals may have attenuated access to internal cues associated with active movement: Evidence from a head repositioning study

BACKGROUND AND OBJECTIVES

The Seeking Proxies for Internal States model of OCD posits that obsessive-compulsive (OC) individuals have attenuated access to their internal states. Consequently, they seek and rely on discernible substitutes for these internal states. Previous research has supported these conjectures. Other studies, using a variety of measures, reported a reduced sense of agency (SoA) in OCD. The current study aimed to connect these two bodies of research by focusing on internal signals associated with active movement, which are related to the SoA. We hypothesized that the performance accuracy of high OC participants would be similar for active and passive movements, while that of low OC participants would be higher when the movement is acquired actively.

METHOD

Participants with high vs. low OC tendencies were asked to reposition their head to a target angle that was acquired actively or passively. This was repeated with eyes blindfolded to evaluate reliance on visual information. Accuracy of repositioning was measured with a cervical range-of-motion device.

RESULTS

As predicted, while low OC participants presented a significant decrease in their accuracy after passive (compared to active) acquisition, high OC participants' accuracy did not differ between acquisition types. Contrary to our predictions, reliance on vision was similar across groups.

LIMITATIONS

The generalization of our findings to OCD requires replication with a clinical sample.

CONCLUSIONS

This study implies that high OC individuals have a deficient access to internal cues involved in active movement. This might contribute to their doubt regarding their actions and to their reduced SoA.

Obsessive-Compulsive Tendencies Are Related to a Maximization Strategy in Making Decisions

The present studies were motivated by the hypothesis that attenuated access to internal states in obsessive-compulsive (OC) individuals, which leads to extensive reliance on external proxies, may manifest in a maximizing decision making style, i.e., to seeking the best option through an exhaustive search of all existing alternatives. Following previous research, we aimed to explore the possible relationships between OC tendencies, seeking proxies for internal states, indecisiveness and maximization. In Study 1, we measured levels of OC tendencies, seeking proxies for internal states, indecisiveness, maximization, depression and anxiety in an online Hebrew speaking sample (N = 201). In Study 2, we administrated the same questionnaires to an online English speaking sample (N = 240) and in addition, examined participants' decision making strategies in a hypothetical situation. The participants in both studies were unscreened adults. Correlational and linear regressions analyses indicated that OC tendencies are related to maximization, even when levels of indecisiveness, depression and anxiety are controlled for. Moreover, the findings suggested that reliance on external proxies may partially account for the aforementioned association. Possible implications and future directions are discussed.

Distrust of the senses and its association with obsessive-compulsive symptoms

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.

Individuals with high obsessive-compulsive tendencies or undermined confidence rely more on external proxies to access their internal states

BACKGROUND AND OBJECTIVES

The Seeking Proxies for Internal States (SPIS) hypothesis predicts that obsessive-compulsive disorder (OCD) is associated with a deficit in subjective convictions, which may lead to a reliance on external substitutes for the perceptions of an individual's internal states. Two well-designed studies were performed for the present work that adopted a false bio-feedback procedure in a muscle tension task to examine the SPIS hypothesis.

METHODS

The false bio-feedback paradigm was used to investigate our hypothesis. NeXus-10 Mark II hardware and V2011 BioTrace + software (Mind Media B.V., Herten, Netherlands) were utilized to measure the muscle tension of the flexor carpiulnaris muscle, which characterized the target's internal state. In addition, false EMG changes were recorded and displayed on a computer monitor and were considered external proxies.

RESULTS

Study 1 demonstrated that the participants with high obsessive-compulsive (OC) tendencies were more affected by the false bio-feedback and exhibited lower confidence in their judgments regarding their muscle tension compared with the participants with low OC tendencies. These findings indicate that subjects with high OC tendencies were more influenced by self-perception effects. In contrast, the subjects in the undermined confidence group in Study 2 were more easily influenced by the false bio-feedback compared with the control group, which suggests that the subjects in the undermined confidence group were more affected by self-perception effects.

LIMITATIONS

We did not combine the undermined confidence with OC tendencies or OCD symptoms in our paradigm to investigate their joint effects on self-perception.

CONCLUSIONS

Our findings provide further evidence that supports the SPIS hypothesis, which indicates that OC tendencies and the confidence in an individual's recognition of internal states appear to have similar effects on the assessment of internal states and reliance on proxies.

The doubt-certainty continuum in psychopathology, lay thinking, and science

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.

How can I know what I'm feeling? Obsessive-compulsive tendencies and induced doubt are related to reduced access to emotional states

BACKGROUND AND OBJECTIVE

People's feelings are not always accessible to them, and this might be especially the case for some individuals and in some situations. Based on our model of obsessive-compulsive disorder, we predicted that obsessive-compulsive (OC) tendencies and situationally induced doubt would be associated with decreased access to one's own emotions.

METHODS

In the first two studies we examined the relationships between OC tendencies and performance on the Mayer-Salovey-Caruso Emotional Intelligence Test (MSCEIT). In Study 3 we undermined participants' confidence in their ability to accurately assess their own emotions and assessed the effect of this manipulation on MSCEIT performance.

RESULTS

As predicted, OC tendencies were associated with lower scores on the Experiential area of the MSCEIT, which relies on access to experienced emotions, but not on the Strategic area, which relies on semantic knowledge about emotions. Similarly, undermining participants' confidence in their own emotions reduced their scores on the Experiential, but not on the Strategic area of the MSCEIT.

LIMITATIONS

The findings should be replicated with a clinical OCD population and with other measures of emotional experience.

CONCLUSION

These studies suggest that impaired access to emotional states may be caused by doubting those states, that it characterizes people with high OC tendencies, and that it might be a manifestation of a more general difficulty in accessing internal states.

A Possible Link between Supra-Second Open-Ended Timing Sensitivity and Obsessive-Compulsive Tendencies

One of the main characteristics of obsessive-compulsive disorder (OCD) is the persistent feeling of uncertainty, affecting many domains of actions and feelings. It was recently hypothesized that OCD uncertainty is related to attenuated access to internal states. As supra-second timing is associated with bodily and interoceptive awareness, we examined whether supra-second timing would be associated with OC tendencies. We measured supra-second (~9 s) and sub-second (~450 ms) timing along with control non-temporal perceptual tasks in a group of 60 university students. Supra-second timing was measured either with fixed criterion tasks requiring to temporally discriminate between two predefined fixed interval durations (9 vs. 9.9 s), or with an open-ended task requiring to discriminate between 9 s and longer intervals which were of varying durations that were not a priori known to the participants. The open-ended task employed an adaptive Bayesian procedure that efficiently estimated the duration difference required to discriminate 9 s from longer intervals. We also assessed symptoms of OCD, depression, and anxiety. Open-ended supra-second temporal sensitivity was correlated with OC tendencies, as predicted (even after controlling for depression and anxiety), whereas the other tasks were not. Higher OC tendencies were associated with lower timing sensitivity to 9 s intervals such that participants with higher OC tendency scores required longer interval differences to discriminate 9 s from longer intervals. While these results need to be substantiated in future research, they suggest that open-ended timing tasks, as those encountered in real-life (e.g., estimating how long it would take to complete a task), might be adversely affected in OCD.

Things happen: Individuals with high obsessive-compulsive tendencies omit agency in their spoken language

The study examined the prediction that obsessive-compulsive tendencies are related to an attenuated sense of agency (SoA). As most explicit agency judgments are likely to reflect also motivation for and expectation of control, we examined agency in sentence production. Reduced agency can be expressed linguistically by omitting the agent or by using grammatical framings that detach the event from the entity that caused it. We examined the use of agentic language of participants with high vs. low scores on a measure of obsessive-compulsive (OC) symptoms, using structured linguistic tasks in which sentences are elicited in a conversation-like setting. As predicted, high OC individuals produced significantly more non-agentic sentences than low OC individuals, using various linguistic strategies. The results suggest that OC tendencies are related to attenuated SoA. We discuss the implications of these findings for explicating the SoA in OCD and the potential contribution of language analysis for understanding psychopathology.

Can doubt attenuate access to internal states? Implications for obsessive-compulsive disorder

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.

An experimental re-examination of the inferential confusion hypothesis of obsessive-compulsive doubt

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.

Right or flawed: relationship obsessions and sexual satisfaction

INTRODUCTION

Relationship obsessive-compulsive disorder (ROCD) is marked by the presence of obsessions and compulsions focusing on romantic relationships. ROCD symptoms were previously linked with decreased relationship quality and might interfere with sexual functioning.

AIM

The study aims to examine the association between ROCD symptoms and sexual satisfaction.

METHODS

Participants completed an online survey assessing ROCD symptoms and relationship and sexual satisfaction levels. Depression, general worry, obsessive-compulsive disorder (OCD) symptoms, and attachment orientation were also measured.

MAIN OUTCOME MEASURE

The main outcome measures were self reported relationship satisfaction and sexual satisfaction.

RESULTS

ROCD symptoms were associated with decreased sexual satisfaction over and above symptoms of depression, general worry, OCD, and attachment orientation. The link between ROCD symptoms and sexual satisfaction was mediated by relationship satisfaction.

CONCLUSIONS

Identifying and addressing ROCD symptoms may be important for treatment of sexual functioning.