Anxiety disorders and control related beliefs: the exemplar of Obsessive–Compulsive Disorder (OCD)

Neural basis underlying the association between thought control ability and happiness: The moderating role of the amygdala

Thought control ability (TCA) plays an important role in individuals' health and happiness. Previous studies demonstrated that TCA was closely conceptually associated with happiness. However, empirical research supporting this relationship was limited. In addition, the neural basis underlying TCA and how this neural basis influences the relationship between TCA and happiness remain unexplored. In the present study, the voxel-based morphometry (VBM) method was adopted to investigate the neuroanatomical basis of TCA in 314 healthy subjects. The behavioral results revealed a significant positive association between TCA and happiness. On the neural level, there was a significant negative correlation between TCA and the gray matter density (GMD) of the bilateral amygdala. Split-half validation analysis revealed similar results, further confirming the stability of the VBM analysis findings. Furthermore, gray matter covariance network and graph theoretical analyses showed positive association between TCA and both the node degree and node strength of the amygdala. Moderation analysis revealed that the GMD of the amygdala moderated the relationship between TCA and happiness. Specifically, the positive association between TCA and self-perceived happiness was stronger in subjects with a lower GMD of the amygdala. The present study indicated the neural basis underlying the association between TCA and happiness and offered a method of improving individual well-being.

Beliefs about losing control and other OCD-related cognitions: An experimental investigation

BACKGROUND AND OBJECTIVES

Cognitive theories of obsessive-compulsive disorder (OCD) suggest that dysfunctional beliefs influence symptoms. However, well-established belief domains do not fully explain OCD symptomatology, suggesting other cognitive mechanisms may be involved. An additional belief domain which may play a role in OCD is beliefs about losing control. Indeed, these beliefs have been found to be associated with OCD symptoms. However, the relationships between beliefs about losing control and other OCD phenomena, including other relevant dysfunctional beliefs, is unclear. The aim of this study was to examine the relationships between beliefs about losing control and appraisals hypothesized to be relevant to OCD.

METHODS

A total of 163 participants completed the experimental protocol, wherein they received false (positive or negative) feedback regarding the likelihood they may lose control and completed a vignette task asking them to read hypothetical scenarios relevant to OCD concerns (checking, and aggressive thoughts). Vignettes were followed by questions and prompts used to measure OCD-relevant appraisals.

RESULTS

Based on MANOVAs, beliefs about losing control had a significant impact on appraisals in the checking, F (151) = 5.55, p = .001, and aggressive thoughts, F (151) = 2.898, p = .037, vignettes. However, planned comparison indicated that in the aggressive thoughts vignettes, this effect was in the opposite direction than was hypothesized.

LIMITATIONS

The losing control induction may have inadvertently influenced participants' beliefs about the utility of thought control.

CONCLUSIONS

Findings provide preliminary evidence for an association between beliefs about losing control and OCD-relevant appraisals.

Exploring the relationship between context and obsessions in individuals with obsessive-compulsive disorder symptoms: a narrative review

Obsessions in obsessive-compulsive disorder (OCD) have long been proposed to differ from intrusive thoughts in unaffected individuals based on appraisal of the thoughts. However, more recent research indicates that cognitive processes behind obsessions may differ significantly from those in healthy individuals concerning their contextual relationship. This narrative literature review summarizes current evidence for the role of context-relatedness for obsessions in OCD and intrusive thoughts in affected and unaffected individuals. The review encompasses a total of five studies, two of which include individuals diagnosed with OCD (one study also includes a group of unaffected control individuals), while the other three studies investigate the relationship between OCD symptoms and context in unaffected individuals. As assessed by mainly self-reports, the review examines the connection between thoughts and their context, shedding light on how the repetition and automaticity of thoughts, as well as their detachment from context over time contribute to defining obsessions in contrast to intrusive thoughts. However, the link with context depends on the content of the obsessions. We propose the term "decontextualization of thoughts" to describe the phenomenon that obsessions gradually lose their connection with external context during the development of OCD. Future research should investigate whether this hypothesis can be supported by experimental evidence and identify whether this shift might be more likely a cause or a consequence of the disorder.

What's control got to do with it? A systematic review of control beliefs in obsessive-compulsive disorder

Current conceptualizations of control-related beliefs in Obsessive-Compulsive Disorder (OCD) have largely been limited to beliefs about the need to control thoughts. Although growing evidence supports the notion of considering broader control-related constructs in this disorder, there has been limited research aimed at integrating findings across studies, making it difficult to determine how different control-related beliefs may influence OCD symptoms. The current review sought to systematically analyze findings from all studies investigating the relationship between control beliefs and OCD. The systematic search identified 157 eligible articles that assessed the relationship between control beliefs and OCD symptoms. Results suggested that certain control beliefs (e.g., importance of/need to control of thoughts, sense of control, beliefs about losing control) may be more closely associated with OCD than others (e.g., locus of control, and desire for control). In general, control beliefs were positively associated with OCD, with effect sizes ranging from small to large depending on the symptom domain. Based on limited studies, the only control belief which demonstrated specificity to OCD was ICT. Findings support the importance of integrating additional control beliefs in conceptualizations of OCD and provide evidence to support the benefits of targeting these beliefs in cognitive behavioural therapy.

The aversiveness of intrusiveness: Evidence from involuntary musical imagery

OBJECTIVE

Intrusive thoughts are characterized by a sense of intrusiveness of foreign entry into cognition. While not always consisting of negative content, intrusive thoughts are almost solely investigated in that context. Involuntary Musical Imagery (INMI) offers a promising alternative, as it is a type of involuntary cognition that can be used to evaluate intrusiveness without negative content.

METHODS

In Study 1, 200 participants completed self-report questionnaires to assess several aspects of intrusiveness: meta-awareness, control, repetitiveness, frequency, and subjective experience of INMI. In Study 2, 203 participants completed self-report questionnaires to explore the clinical characteristics (depression, stress, anxiety, and rumination) which might mediate the connection between INMI frequency and INMI negative experience.

RESULTS

Study 1 revealed, through exploratory factor analysis, that intrusiveness shares variance with the negative experience of INMI but not with INMI frequency. In Study 2, ruminative thinking was found to mediate the relationship between frequent INMI and the negative experience of INMI.

CONCLUSION

These results suggest that INMI might be used to investigate intrusiveness in the lab without the potential confound of negative emotions. In addition, the results suggest that neither the content nor the frequency of intrusive thoughts can solely explain why these thoughts are aversive to some but not others. Ruminative style might be the missing link to explain how and why these intrusive thoughts become aversive and obsessive. In other words, we suggest that the cause for intrusiveness lies not in the thought or repetitiveness, but in the thinker.

At the mercy of myself: A thematic analysis of beliefs about losing control

PURPOSE

Concerns about the likelihood, consequences, and meaning of losing control are commonplace across anxiety-related disorders. However, several experimental studies have suggested that individuals without a diagnosis of a mental disorder also believe that they can and will lose control under the right circumstances. Understanding the range of beliefs about the nature and consequences of losing control can help us to better understand the continuum of negative beliefs about losing control.

METHODS

The present study used thematic analysis to identify common beliefs about losing control in an unselected sample. Twenty-one participants, half of whom met criteria for at least one anxiety-related disorder, were interviewed about their beliefs about losing control.

RESULTS

All 21 participants reported that losing control was possible. Losses of control were defined as multifaceted cognitive-behavioural processes and were seen as negative considering the perceived consequences of the losses. Commonly described consequences were harm to oneself or others, powerlessness, and unpleasant emotions during (e.g., sadness, frustration, and anxiety) and following (e.g., regret, shame, and humiliation) a loss of control.

CONCLUSIONS

These results suggest that perceived losses of control are common and that negative beliefs about losing may only become problematic when the losses are personally significant. Further, they offer important insight into what is common among clinical and non-clinical beliefs about losing control and inform how these beliefs might be worth targeting in cognitive and behavioural interventions.

Family accommodation in PTSD: Proposed considerations and distinctions from the established transdiagnostic literature

Accommodation is widely documented and studied among internalizing disorders; however, the conceptualization and study of accommodation in the context of posttraumatic stress disorder (PTSD) is relatively nascent. PTSD entails many diagnostic criteria-including exposure to a distinct Criterion A event, emotional numbing, and anger-that may uniquely influence accommodation and merit special consideration. Our aim was to review the impact of accommodation in PTSD, compare and contrast accommodation in PTSD to other disorders with a strong empirical evidence base regarding accommodation, and highlight considerations unique to PTSD and associated implications for accommodation. We conclude by providing considerations for future research and practice.

How health beliefs and sense of control predict adherence to COVID-19 prevention guidelines among young adults in South Korea

This study defined adherence to COVID-19 prevention guidelines as health behavior and examined whether the two constructs of the health belief model (i.e., perceived susceptibility and perceived severity) and sense of control predict the level of adherence among young adults in South Korea. An online survey (N = 200) conducted in June 2021, showed that perceived susceptibility, perceived severity, and sense of control positively predict adherence behavior. Sense of control significantly moderated the relationship between perceived susceptibility and adherence even after controlling for depression and perceived health status. Specifically, individuals with a lower level of perceived susceptibility still adhered to COVID-19 prevention guidelines if they had a higher level of sense of control. The finding demonstrates the key role of sense of control in promoting adherence to COVID-19 prevention guidelines and the relationship between sense of control and two constructs of the health belief model. Implication for public messaging targeted at young adults during pandemic situations is also discussed.

The fear of losing control

Although a great deal of research has focused on various aspects of control and their relations to psychopathology, new insights and therapeutic potential could be revealed through an examination and perhaps emphasis on fears of losing control. Although elements of control-related beliefs and phenomena have been highlighted in association with obsessive-compulsive disorder and social anxiety disorder, this paper will give a fresh perspective on fears and beliefs about losing control, with implications for understanding and perhaps treating a broad range of psychological problems including panic disorder, posttraumatic stress disorder (PTSD), and others. New research questions and hypotheses are proposed, along with potential implications for expanded research into this domain and for clinical applications within a cognitive-behavioural approach.

Effects of predictable behavioral patterns on anxiety dynamics

People face stressors that are beyond their control and that maladaptively perpetuate anxiety. In these contexts, rituals emerge as a natural coping strategy helping decrease excessive anxiety. However, mechanisms facilitating these purported effects have rarely been studied. We hypothesized that repetitive and rigid ritual sequences help the human cognitive-behavioral system to return to low-entropy states and assuage anxiety. This study reports a pre-registered test of this hypothesis using a Czech student sample (n = 268). Participants were exposed to an anxiety induction and then randomly assigned to perform one of three actions: ritualized, control, and neutral (no-activity). We assessed the effects of this manipulation on cognitive and physiological anxiety, finding that ritualized action positively affected anxiety decrease, but this decrease was only slightly larger than in the other two conditions. Nevertheless, the between-condition differences in the reduction of physiological anxiety were well-estimated in participants more susceptible to anxiety induction.

Always Saying the Wrong Thing: Negative Beliefs About Losing Control Cause Symptoms of Social Anxiety

Background

Individuals with social anxiety disorder (SAD) often report a fear that they will lose control of their emotions or report intense, unpleasant thoughts or images of uncontrollably humiliating themselves in social situations. These fears and associated beliefs that one is likely to lose control may underlie the anxiety and/or cognitive biases (e.g., self-focused attention and negative post-event processing) experienced during and following social situations. The present experiment examined whether manipulating beliefs about losing control would cause changes in symptoms of SAD.

Methods

One hundred and twenty-six undergraduate psychology students were given false feedback that they were either at high or low risk of losing control, and then completed a social interaction task with an actor. Participants rated their anxiety before and during the interaction and completed a post-event processing questionnaire 24-hours later.

Results

Participants in the high beliefs about losing control (HLC) condition reported significantly greater subjective anxiety than those in the low beliefs about losing control (LLC) condition leading up to the social interaction task, and significantly more negative post-event processing.

Conclusion

Results suggest beliefs about losing control may play a causal role in the development and maintenance of SAD. These beliefs may represent a novel domain to be targeted in CBT.

Supplementary Information

The online version contains supplementary material available at 10.1007/s10608-022-10325-w.

A Possible Anti-anxiety Effect of Appetitive Aggression and a Possible Link to the Work of Donald Winnicott

Various pleasant sensations that give a particularly intense pleasure are able to improve anxiety. In the present study I consider the possibility that their anti-anxiety action depends on the strong pleasure they provide, and I propose a possible mechanism of this action. According to some studies, also appetitive aggression (an aggression that provokes a strong pleasure and that is performed only for the pleasure it provides) can improve anxiety, and in this article I consider the possibility that the pleasure of appetitive aggression is able to reduce anxiety by the same mechanism I have proposed for other intense pleasurable sensations. The aggression performed by a child against the mother or against a substitute for the mother in the first period of life (a period in which this aggression is not dangerous) is a recurring theme throughout the work of of Donald Winnicott. Winnicott stresses that this aggression is necessary for the normal development of the child, and that the child must be free to practise it. According to Winnicott, this aggression is highly pleasurable and is not a response to unpleasant or hostile external situations. For these characteristics it seems to correspond to appetitive aggression in the adult that has been found to be able to reduce anxiety. Consequently, aggression performed by the child in the first period of life may also relieve anxiety, in the same way that appetitive aggression helps against anxiety in the adult. In his writings, Winnicott returns several times to an unthinkable or archaic anxiety that children experience when they feel abandoned by their mother for a period that is too long for them, and all children, according to Winnicott, live on the brink of this anxiety. In this study I propose the hypothesis that aggression in the early period of life may be necessary for children because the intense pleasure it provides may help them against this continuously impending anxiety.

Intact capacity for implicit learning in obsessive-compulsive disorder

BACKGROUND AND OBJECTIVES

Individuals with OCD tend to rely on explicit processing when performing implicit learning tasks. However, it is unclear whether this tendency reflects impaired capacity for implicit processing or a preference toward explicit processing. We sought to use a psychometrically valid task to examine the hypothesis that individuals with OCD have intact capacity for implicit learning.

METHODS

Twenty-four participants with OCD and 24 non-psychiatric controls completed a modified artificial grammar learning task where acquisition and retrieval of the underlying grammatical rules are considered strictly implicit. In an exploratory condition designed to examine the effect of nudging participants toward controlled processing, 12 participants in each group were told that the stimuli presented at acquisition were composed according to grammatical rules and were encouraged to identify these rules.

RESULTS

As predicted, participants with OCD acquired and expressed knowledge of the grammatical rule, demonstrating intact capacity for implicit learning, with no differences found between the OCD and controls on the extent of implicit learning. The exploratory intentional learning instructions had no effect, as participants in this condition were unable to adhere to the instructions, supporting the robust implicit nature of the artificial grammar learning task.

LIMITATIONS

The relatively small sample size did not allow comparisons between OCD symptom subtypes.

CONCLUSIONS

Our results provide evidence for intact implicit learning in OCD, and challenge previous studies suggesting a general deficiency in implicit learning in OCD.

Validating the Diathesis–Stress Model Based Case Conceptualization Procedure in Cognitive Behavioral Therapies: The LIBET (Life Themes and Semi-Adaptive Plans—Implications of Biased Beliefs, Elicitation and Treatment) Procedure

Cognitive behavioral therapy (CBT) approaches use case formulation procedures based on the diathesis–stress conceptualization model, arranged in two dimensions: emotional vulnerability (present in a patient’s consciousness in terms of core beliefs) and coping strategies. Nevertheless, despite its pivotal role, there are a limited number of validation studies for this model. Life themes and semi-adaptive plans: Implications of biased beliefs, elicitation and treatment (LIBET) is a CBT case formulation method grounded on the CBT diathesis–stress model that aims to help validate the CBT case formulation model, and, in particular, its bidimensional arrangement. In LIBET, the two classic CBT dimensions are called “life themes,” which are mental states of focused attention to emotional sensitivities represented as core beliefs in consciousness, and “semi-adaptive plans,” which are the rigid management strategies of “life themes” implemented by adopting coping strategies such as anxious safety behaviors, compulsive controls and aggressive or rewarding strategies. The study uses quantitative textual analysis to validate the LIBET procedure in a clinical sample. The investigation discusses the extent to which the results can be considered a validation of the arrangement of the general CBT diathesis–stress model in the two dimensions of core beliefs and coping strategies.

How health anxiety affected obsessive-compulsive symptoms during the COVID-19 pandemic in China: The mediation of difficulties in emotion regulation and the moderation of pathological personality traits

Health anxiety (HA) was/is a common negative emotional problem during the COVID-19 pandemic. According to the cognitive model of HA, individuals with HA continued to adopt a series of maladaptive and repetitive behaviors which were associated with obsessive-compulsive symptoms (OCS; including over-washing, over-checking, obsessing, and metal neutralizing). The priority of the present study was to explore how HA specifically affected OCS and whether difficulties in emotion regulation (DER) and pathological personality traits (PPT) affected the relationship between the HA and OCS. We distributed an online survey from February 1 to February 17 in 2020 (N = 1546, with average age of 25.8, and 32.7% of males) from 219 cities in China. Results showed that only four dimensions (i.e., Nonacceptance, Impulse, Non-clarity and Non-awareness) of the DER scale mediated in the predictive path of HA on OCS, which constituted a multiple mediating model. The other moderated mediation model further showed that, with higher PPT, the more significant the impact of HA was on DER, revealing PPT's moderator role between HA and OCS.

Personality correlates of eating pathology severity and subtypes in The National Comorbidity Survey Adolescent Supplement

OBJECTIVE

We examined how personality traits are associated with eating pathology (EP) across a range of severities and symptom subtypes.

METHOD

The National Comorbidity Survey Adolescent Supplement (N = 10,148) was used to compare personality across severities (i.e., clinical Eating Disorders [EDs], subclinical disordered eating, preclinical weight concerns, or no weight/EP [no W/EP]), subclinical subtypes (i.e., Binge Eating Only, Binge-Purge, Binge-Restrict, Restrict-Purge, or no W/EP), and clinical subtypes (i.e., Anorexia Nervosa [AN]), Bulimia Nervosa [BN], Binge Eating Disorder [BED], internalizing disorders, or no ED or internalizing disorder) of EP.

RESULTS

More severe EP was associated with more extreme personality trait endorsements. Impulsivity-related traits did not consistently distinguish binge eating/purging from restricting subtypes, although behavioral disinhibition differentiated adolescents with BN or BED from AN.

CONCLUSION

Personality traits related to affectivity and impulsivity were more consistently associated with severity rather than subtype of EP.

For the Greater Good? The Devastating Ripple Effects of the Covid-19 Crisis

As the crisis around Covid-19 evolves, it becomes clear that there are numerous negative side-effects of the lockdown strategies implemented by many countries. Currently, more evidence becomes available that the lockdowns may have more negative effects than positive effects. For instance, many measures taken in a lockdown aimed at protecting human life may compromise the immune system, and purpose in life, especially of vulnerable groups. This leads to the paradoxical situation of compromising the immune system and physical and mental health of many people, including the ones we aim to protect. Also, it is expected that hundreds of millions of people will die from hunger and postponed medical treatments. Other side effects include financial insecurity of billions of people, physical and mental health problems, and increased inequalities. The economic and health repercussions of the crisis will be falling disproportionately on young workers, low-income families and women, and thus exacerbate existing inequalities. As the virus outbreak and media coverage spread fear and anxiety, superstition, cognitive dissonance reduction and conspiracy theories are ways to find meaning and reduce anxiety. These behavioral aspects may play a role in the continuance of lockdown decisions. Based on theories regarding agnotology (i.e., the ways ignorance or doubt about certain topics is created by means of withholding or presenting information in a certain way), social influence, superstition and stress and coping, I seek to explain the social and behavioral aspects of human behavior in times of crises. Both the Covid-19 crisis itself as well as the resulting economic and (mental) health crisis are global problems that may require global solutions. I present a model of drivers and outcomes of lockdown behaviors and offer suggestions and a tool to counteract the negative psychological effects by means of online life crafting therapeutic writing interventions.

Operational method of reliability and content-validity analysis: Taking "trait-symptoms" screening of individuals at high-risk for OCD as an example

A well-designed self-reported scale is highly applicable to current clinical and research practices. However, the problems with the scale method, such as quantitative analysis of content validity and test-retest reliability analysis of state-like variables are yet to be resolved. The main purpose of this paper is to propose an operational method for solving these problems. Additionally, it aims to enhance understanding of the research paradigm for the scale method (excluding criterion-related validity). This paper used a study that involved screening of high-risk groups for OCD (Obsessive-Compulsive Disorder), conducted 5 rounds of tests, and developed scales, reliability, and validity analysis (using sample sizes of 496, 610, 600, 600 and 990). The operational method we propose is practical, feasible, and can be used to develop and validate a scale.

Do you believe in magical thinking? Examining magical thinking as a mediator between obsessive-compulsive belief domains and symptoms

BACKGROUND

Despite substantial research attention on obsessive beliefs, more research is needed to understand how these beliefs serve as aetiological or maintaining factors for obsessive-compulsive (OC) symptoms. Magical thinking may allow individuals to gain a sense of control when experiencing intrusive thoughts and corresponding obsessive beliefs, potentially accounting for why OC belief domains are often related to OC symptoms.

AIMS

This study examines magical thinking as a mediating variable in the relationship between OC belief domains and symptoms.

METHOD

Undergraduate students (n = 284) reported their obsessive beliefs, magical thinking, and OC symptoms.

RESULTS

As expected, there were significant indirect effects for the belief domain of inflated responsibility and over-estimation of threat on OC symptoms via magical thinking. There was also an indirect effect for the belief domain of importance and control of thoughts on OC symptoms via magical thinking. Unexpectedly, there was no indirect effect involving the belief domain of perfectionism and intolerance of uncertainty.

CONCLUSIONS

Magical thinking may be one mechanism through which certain OC beliefs lead to OC symptoms. It may be that magical thinking serves as a coping mechanism in response to elevated beliefs. Future studies should extend these findings across time and clinical samples.

Dispositional resilience in treatment-seeking patients with obsessive-compulsive disorder and its association with treatment outcome

There is a lack of research on the relation between obsessive-compulsive disorder (OCD) and resilience. Dispositional resilience, as described and defined in literature on hardiness, consists of three facets, namely beliefs about having control in everyday living, having a sense of purpose or commitment, and a positive attitude toward challenges. This study explores associations between dispositional resilience (measured with the Dispositional Resilience Scale (DRS-15-R)), symptom severity, and treatment outcome in a sample of 89 patients treated with concentrated exposure therapy (cET), and compares the findings with scores from two reference groups (students and soldiers). The patient group had significantly lower resilience scores than the two reference groups. Weak correlations were observed between dispositional resilience and OCD symptoms. Differences in dispositional resilience were weakly related to remission status at follow-up (odds ratio of 1.11). Furthermore, resilience improved from pre- to post-treatment (Cohen's d of 0.65). Our results imply that patients' initial resilience score does not hinder nor facilitate treatment effects to a great extent in this format of ERP treatment.

Politically-focused intrusive thoughts and associated ritualistic behaviors in a community sample

A significant proportion of the U.S. population report increased stress attributed to the political climate following the controversial 2016 United States (U.S.) Presidential election. The political stressors paired with the growth in news consumption and social media-use could be a potential trigger for obsessive-compulsive-like symptoms specific to politics in some individuals. This study aimed to elucidate the rate of Politically-focused Intrusive Thoughts and associated Ritualistic Behaviors (PITRB), their demographic and clinical correlates, and the degree of association with political ideology. Survey data were collected using the crowdsourcing platform Mechanical Turk. A total of N = 484 individuals completed the survey. Measures of politically-focused intrusive thoughts and ritualistic behaviors, general obsessive-compulsive symptoms, depression, anxiety, anxiety control, worry, and disability were administered, as well as a measure of social and economic conservative affiliation. Results showed that a quarter of the sample (25.2%) had at least one PITRB more than once a day. PITRB was associated with all measures of psychopathology and disability. Finally, anxiety control moderated the relationship between PITRB and both anxiety and depression. No differences in psychopathology were found between major party affiliations. The findings suggest that politically-focused intrusive thoughts and ritualistic behaviors are associated with psychopathology domains in a manner comparable to general obsessive-compulsive symptoms.

Explicit instructions facilitate performance of OCD participants but impair performance of non-OCD participants on a serial reaction time task

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.

Obsessive-Compulsive Disorder in Paediatric and Adult Samples: Nature, Treatment and Cognitive Processes. A Review of the Theoretical and Empirical Literature

The appraisal model of obsessive-compulsive disorder (OCD) suggests that six key appraisal domains contribute to the aetiology and maintenance of OCD symptoms. An accumulating body of evidence supports this notion and suggests that modifying cognitive appraisals may be beneficial in reducing obsessive-compulsive symptomatology. This literature review first summarises the nature of OCD and its treatment, followed by a summary of the existing correlational and experimental research on the role of cognitive appraisal processes in OCD across both adult and paediatric samples. While correlational data provide some support for the relationship between cognitive appraisal domains and OCD symptoms, results are inconclusive, and experimental methods are warranted to determine the precise causal relationship between specific cognitive appraisal domains and OCD symptoms.

Role of the Perigenual Anterior Cingulate and Orbitofrontal Cortex in Contingency Learning in the Marmoset

Two learning mechanisms contribute to decision-making: goal-directed actions and the "habit" system, by which action-outcome and stimulus-response associations are formed, respectively. Rodent lesion studies and human neuroimaging have implicated both the medial prefrontal cortex (mPFC) and the orbitofrontal cortex (OFC) in the neural basis of contingency learning, a critical component of goal-directed actions, though some published findings are conflicting. We sought to reconcile the existing literature by comparing the effects of excitotoxic lesions of the perigenual anterior cingulate cortex (pgACC), a region of the mPFC, and OFC on contingency learning in the marmoset monkey using a touchscreen-based paradigm, in which the contingent relationship between one of a pair of actions and its outcome was degraded selectively. Both the pgACC and OFC lesion groups were insensitive to the contingency degradation, whereas the control group demonstrated selectively higher performance of the nondegraded action when compared with the degraded action. These findings suggest the pgACC and OFC are both necessary for normal contingency learning and therefore goal-directed behavior.

Extending the Transdiagnostic Model of Attachment and Psychopathology

Research has suggested that high levels of attachment insecurities that are formed through interactions with significant others are associated with a general vulnerability to mental disorders. In the present paper, we extend Ein-Dor and Doron's (2015) transdiagnostic model linking attachment orientations with internalizing and externalizing symptoms, to include thought disorder spectrum symptoms. Specifically, we speculate on the processes that mediate the linkage between attachment insecurities and psychosis and obsessive compulsive disorder (OCD) symptoms, and indicate the different contexts that might set a trajectory of one individual to one set of symptoms while another individual to a different set of symptoms.

The Role of Magical Thinking, Religiosity and Thought-Control Strategies in Obsessive-Compulsive Symptoms in a Turkish Adult Sample

Background: It has been suggested that magical thinking is related to both obsessions and compulsions in obsessive-compulsive disorder (OCD). Recent studies have indicated the significant relationship between level of religiosity and beliefs about the importance and need to control unwanted thoughts in OCD. People also use diverse strategies to control their unwanted thoughts. Aims: The present study aimed to examine the interrelationships between magical thinking and worry and punishment as thought-control strategies in mediating the relationship between religiosity and obsessive-compulsive (OC) symptoms in a Turkish sample. Methods: The sample of the present study was comprised of 179 non-clinical, community-based participants who completed measures of OC symptoms (measured with the Obsessive Compulsive Inventory — Revised), magical thinking (measured with the Magical Ideation Scale), religiosity, and thought-control strategies (measured with the Thought Control Questionnaire). Results: Both worry and punishment as thought-control strategies and magical thinking mediated the links between religiosity and OC symptoms. Furthermore, the relationship between religiosity and OC symptoms was mediated by magical thinking through punishment and worry. Conclusions: Findings pointing out the mediating role of magical thinking through punishment and worry in the relationship between religiosity and OC symptoms are novel and need to be replicated in future studies.

Obsessive-Compulsive Symptomatology, Religiosity Levels and the Illusion-of-Control Paradigm in a Non-Clinical Undergraduate Sample

The present research employed the illusion-of-control paradigm to investigate the relationships between Obsessive-Compulsive disorder (OCD) symptoms, religiosity levels, and illusory sense of control (SC). An opportunistic sample of 60 undergraduate students was presented with a pre-programmed series of neutral visual stimuli (i.e. lines) and was expected to try to control the sequence through the use of keyboard presses. Participants assessed their perceived level of control twice throughout the computerised task. In addition, the study was interested at examining the relationship between religiosity and OC behaviour and the Santa Clara Strength of Religious Faith Questionnaire (SCSRF) was employed. In proportion to predictions, OCD symptoms were correlated with higher illusory SC; furthermore, religiosity levels were related to some degree to OCD symptoms. The essential role of mental control in OCD is discussed, particularly the significant clinical implications of such an association. Furthermore, the possible contribution of religious affiliations to the maintenance of OC behaviour is further discussed.

The Role of Cognitions and Beliefs in Trichotillomania: A Qualitative Study Using Interpretative Phenomenological Analysis

Trichotillomania (TTM) is characterised by the removal of one's hair, causing hair loss. Phenomenological research on TTM has investigated its associated behavioural and affective factors. Few studies have investigated the possible role of cognitions and beliefs, despite emerging support for cognitive therapies in treating this disorder. This study aimed to explore and describe the cognitions and beliefs that contribute to the onset and maintenance of hairpulling in TTM. Eight women with TTM participated in semi-structured, in-depth interviews to explore their experience of cognitions and beliefs before, during and after typical hairpulling episodes. Interviews were analysed using the qualitative method of Interpretative Phenomenological Analysis. Six superordinate themes of beliefs were identified as important: negative self-beliefs, control beliefs, beliefs about coping, beliefs about negative emotions, permission-giving beliefs, and perfectionism. These preliminary findings suggest that cognitions may play an important role in TTM phenomenology. Future quantitative research on the role of cognitions and beliefs in TTM in larger samples has the potential to advance cognitive-behavioural models and treatments of this poorly understood disorder.

Effects of Anxiety on Spontaneous Ritualized Behavior

Environmental uncertainty and uncontrollability cause psycho-physiological distress to organisms, often impeding normal functioning. A common response involves ritualization, that is, the limitation of behavioral expressions to predictable stereotypic and repetitive motor patterns. In humans, such behaviors are also symptomatic of psychopathologies like obsessive-compulsive disorder (OCD) and autism spectrum disorders (ASDs). Although these reactions might be mediated by different neural pathways, they serve to regain a sense of control over an uncertain situation by engaging in behavioral patterns characterized by redundancy (superfluous actions that exceed the functional requirements of a goal), repetitiveness (recurrent behaviors or utterances), and rigidity (emphasis on fidelity and invariance). We examined whether ritualized behavior will manifest spontaneously as a dominant behavioral strategy in anxiogenic situations. Manipulating anxiety, we used motion-capture technology to quantify various characteristics of hand movements. We found that induced anxiety led to an increase in repetitiveness and rigidity, but not redundancy. However, examination of both psychological and physiological pathways revealed that repetitiveness and rigidity were predicted by an increase in heart rate, while self-perceived anxiety was a marginally significant predictor of redundancy. We suggest that these findings are in accordance with an entropy model of uncertainty, in which anxiety motivates organisms to return to familiar low-entropy states in order to regain a sense of control. Our results might inform a better understanding of ritual behavior and psychiatric disorders whose symptoms include over-ritualization.

Family functioning in paediatric obsessive compulsive and related disorders

OBJECTIVE

Research among youths with obsessive compulsive disorder (OCD) has shown a significant relationship between illness severity, treatment outcome, and the family environment yet little work has been undertaken among the broader class of obsessive compulsive and related disorders (OCRDs) - Trichotillomania, body dysmorphic disorder (BDD), skin picking disorder (SPD), and hoarding. The aim of this study was to (1) review the family functioning literature among paediatric OCRDs, (2) address limitations to previous studies, and (3) highlight areas in need of further research.

METHODS

A review of the literature was conducted using several databases (i.e., Google Scholar, PubMed, ScienceDirect) and employing key search terms (e.g., 'family functioning', 'paediatric OCD'). The resultant articles examined several domains subsumed under the broader heading of family environment including parental mental health, parenting practices, family dynamics, family involvement with symptoms, and family emotional climate.

RESULTS

The literature reviewed demonstrated a strong relationship between paediatric OCD and adverse family functioning (e.g., parental symptoms of anxiety and depression, family accommodation, family strain and stress, parental guilt and fear) in all identified domains. While family functioning research in paediatric HPD was relatively scant, research suggested similar familial dysfunction (e.g., limited independence, low family cohesion, family violence). Collectively, only 1 article, examining BDD, assessed family functioning within other OCRDs.

CONCLUSIONS

This review supports the need for further research in the OCRDs. Limitations to the available literature and targeted suggestions for future research are discussed.

PRACTITIONER POINTS

The domains of family environment in this study indicate specific family functioning deficits that may serve as aetiological and/or maintenance factors in paediatric OCRDs, possibly contributing to the understanding of these complex disorders. The recognition of family deficits in paediatric OCRDs may prove beneficial in developing or bolstering preventative and/or therapeutic interventions. Insufficient number of articles pertaining to family functioning in some paediatric OCRDs (i.e., hoarding, skin picking) inhibits formal conclusions. Magnitudes of family functioning effects were not calculated; therefore, future research should consider meta-analytic analyses.

Neural computations mediating one-shot learning in the human brain

Incremental learning, in which new knowledge is acquired gradually through trial and error, can be distinguished from one-shot learning, in which the brain learns rapidly from only a single pairing of a stimulus and a consequence. Very little is known about how the brain transitions between these two fundamentally different forms of learning. Here we test a computational hypothesis that uncertainty about the causal relationship between a stimulus and an outcome induces rapid changes in the rate of learning, which in turn mediates the transition between incremental and one-shot learning. By using a novel behavioral task in combination with functional magnetic resonance imaging (fMRI) data from human volunteers, we found evidence implicating the ventrolateral prefrontal cortex and hippocampus in this process. The hippocampus was selectively “switched” on when one-shot learning was predicted to occur, while the ventrolateral prefrontal cortex was found to encode uncertainty about the causal association, exhibiting increased coupling with the hippocampus for high-learning rates, suggesting this region may act as a “switch,” turning on and off one-shot learning as required.

A combination of neuroimaging and computational modeling suggests that a part of ventrolateral prefrontal cortex, in cooperation with the hippocampus, is responsible for switching between incremental and one-shot strategies for learning about causal relationships. Read the Synopsis.

There are at least two distinct learning strategies for identifying the relationship between a cause and its consequence: (1) incremental learning, in which we gradually acquire knowledge through trial and error, and (2) one-shot learning, in which we rapidly learn from only a single pairing of a potential cause and a consequence. Little is known about how the brain switches between these two forms of learning. In this study, we provide evidence that the amount of uncertainty about the relationship between cause and consequence mediates the transition between incremental and one-shot learning. Specifically, the more uncertainty there is about the causal relationship, the higher the learning rate that is assigned to that stimulus. By imaging the brain while participants were performing the learning task, we also found that uncertainty about the causal association is encoded in the ventrolateral prefrontal cortex and that the degree of coupling between this region and the hippocampus increases during one-shot learning. We speculate that this prefrontal region may act as a “switch,” turning on and off one-shot learning as required.

Obsessive-compulsive disorder patients have a reduced sense of control on the illusion of control task

There is disagreement regarding the role of perceived control in obsessive–compulsive disorder (OCD). The present study used a traditional illusion of control paradigm (Alloy and Abramson, 1979) to empirically test control estimation in OCD. Twenty-six OCD patients and 26 matched comparison subjects completed an illusion of control task wherein their goal was to attempt to exert control over a light bulb. The density of reinforcement (high, low) and the valence of trials (gain, loss) were experimentally manipulated within subjects. Unbeknownst to participants, the illumination of the light bulb was predetermined and irrespective of their behavior. OCD patients exhibited lower estimates of control compared with healthy comparison subjects. There were no interactions between group and outcome density or group and valence. We found that OCD patients endorse lower estimates of control than comparison subjects. This finding highlights a potential role for contingency learning in the disorder.

External error monitoring in subclinical obsessive-compulsive subjects: electrophysiological evidence from a Gambling Task

BACKGROUND

Feedback-related negativity (FRN) is believed to be an important electrophysiology index of "external" negative feedback processing. Previous studies on FRN in obsessive-compulsive (OC) individuals are scarce and controversial. In these studies, anxiety symptoms were not evaluated in detail. However, OC disorders have a number of radical differences from anxiety disorders. It is necessary to study FRN and its neuroanatomical correlates in OC individuals without anxious symptoms.

METHODS

A total of 628 undergraduate students completed an OC questionnaire. We chose 14 students who scored in the upper 10% and 14 students who scored in the lowest 10% without anxiety symptoms as a subclinical OC group (SOC) and a low obsessive-compulsive group (LOC). The students all performed the revised Iowa Gambling Task. We used the event-related potentials (ERP) and standardized low-resolution brain electromagnetic tomography (sLORETA) to track external negative feedback processing and its substrate in the brain.

RESULTS

Our study revealed poorer decision-making ability and greater FRN amplitudes in SOC subjects compared with LOC controls. The SOC subjects displayed anterior prefrontal cortex (aPFC) hyperactivation during the loss feedback condition. Specifically, we found an intercorrelation of current source density during the loss condition between the dorsal anterior cingulate cortex (dACC) and aPFC in the LOC subjects but not in the SOC group.

CONCLUSIONS

Our results support the notion that overactive external feedback error processing may reflect a candidate endophenotype of OC. We also provide important information on the dysfunction in the interaction between aPFC and dACC in populations with OC. Nevertheless, the findings support that OC may be distinguished from other anxiety disorders using a new electrophysiology perspective.

Beliefs about control and the persistence of cleaning behaviour: an experimental analysis

BACKGROUND AND OBJECTIVES

Low perceived control (PC) and overestimations of controllability have each been related to obsessive compulsive (OC) symptoms and behaviour. OC beliefs and symptoms are also associated with a discrepancy between low perceived control (PC) and a high desire for control (DC). The present study sought to examine the influence of components of PC, low control-related self-efficacy (CSE) and high predicted controllability (PRC), on the persistence of cleaning behaviour and DC ratings.

METHODS

A cleaning task was used to observe cleaning time (in seconds) in undergraduate participants (n = 174) under two conditions of each of PRC (high versus low), and CSE (high versus low). DC ratings were taken prior to the cleaning task.

RESULTS

It was demonstrated that PRC and CSE manipulations had differential effects on cleaning times and DC ratings, where significantly longer cleaning times were observed in the high (versus low) PRC condition, and in association with higher DC ratings reported in the low (versus high) CSE condition. However, regression analyses demonstrated that DC, PRC and CSE each accounted for significant variance in observed cleaning times.

LIMITATIONS

Teasing apart predictability from controllability is a methodological challenge in the manipulation of perceived control.

CONCLUSIONS

Findings highlight the importance of considering components of PC along with DC in OC-phenomenology; these will be discussed in the context of current cognitive theories of and treatments for OCD.

Locus of Control in Obsessive-Compulsive (OC) and Depression Symptoms: The Moderating Effect of Externality on Obsessive-Related Control Beliefs in OC Symptoms

Although the role of excessive efforts to exert mental control over one's unwanted intrusive thoughts has been successfully explained and documented in the cognitive-behavioural models of obsessive–compulsive disorder (OCD), individual's beliefs regarding the controllability of events, that is, locus of control (LOC), have been largely ignored in recent cognitive formulations of OCD. The present study aimed to examine the relationship between these two control-related cognitions by comparing their roles in obsessive–compulsive (OC) and depression symptoms. Measures of LOC, obsessive-related beliefs, depression, anxiety and OCD symptoms were administered to a sample of 530 Turkish university students. Results showed that while external LOC was positively associated with depression symptoms, the relation was different for OC symptoms. The interaction of LOC with a high desire for thought control was significantly associated with general OC symptoms, particularly with checking symptoms. The findings suggest that beliefs regarding the controllability of events are critical factors in OC symptomatology, but only when there is also a high desire of thought control.

Dysfunctional forward model mechanisms and aberrant sense of agency in obsessive-compulsive disorder

BACKGROUND

Patients with obsessive-compulsive disorder (OCD) often lack the experience of action completion and have altered feelings of agency. This might depend on the integrity of predictions of action outcomes generated by forward models of the motor system. Such motor predictions are critical for inhibitory gating of actions and their consequences. Therefore, it was hypothesized that OCD patients show compromised forward model mechanisms.

METHODS

To test whether inhibitory gating based on motor predictions is altered in OCD, we used electroencephalography to measure suppression of the N1 component of the event-related potential during active generation and passive observation of visual feedback in 18 OCD patients and 18 healthy control subjects. Predictability of action feedback was manipulated on the basis of action and external cues, and simultaneous agency judgments were assessed.

RESULTS

OCD patients showed significantly reduced N1 suppression to actively generated feedback as compared with passively observed feedback. Moreover, in OCD patients, the N1 was not modulated by additional predictive motor cues as observed in control subjects. Patients also reported enhanced estimations of agency experience, which correlated with the strength of incompleteness feelings.

CONCLUSIONS

OCD patients fail to predict and suppress the sensory consequences of their own actions. The increased mismatch between expected and actual outcomes caused by this forward model dysfunction may explain persistent feelings of incompleteness even after properly executed actions and the augmented search for control in these patients.

The role of magical thinking in Obsessive-Compulsive Disorder symptoms and cognitions in an analogue sample

BACKGROUND AND OBJECTIVES

In addition to clinical observations exemplifying biased reasoning styles (e.g., overemphasis of thoughts) and particular ritualistic behaviors, it is also empirically supported that magical beliefs are also associated with Obsessive-Compulsive Disorder (OCD) symptoms and some cognitions. It should be noted, however, that most empirical studies have been carried out on the samples from Western cultures, even though these beliefs were culturally determined. Thus, more research is needed in order to understand their roles in the OCD symptoms in different cultural contexts. The present study aimed to examine the impact of magical beliefs in OCD symptoms, cognitions and thought control in a non-Western analogue sample from Turkey.

METHOD

The measures of paranormal beliefs, fusion of thoughts-actions, obsessive beliefs, strategies of thought control and OCD symptoms were administered to an undergraduate sample.

RESULT

Consistent with findings in the literature, the analyses of group comparisons, correlation and regression showed that even after controlling general negative affect, magical beliefs were still associated with OCD symptoms, some beliefs and control strategies, namely the symptoms of obsessional thoughts and checking, fusions of thoughts and actions in likelihood, faulty beliefs in perfectionism-certainty and punishment.

LIMITATIONS

Some methodological concerns such as cross-sectional nature, inclusion of only non-clinical sample were major restrictions of the present study.

CONCLUSION

Evidence that magical thinking is a critical factor in the OCD is supported once more in a different cultural context.