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Duholm CS, Jensen S, Rask CU, Thomsen PH, Ivarsson T, Skarphedinsson G, Torp NC, Weidle B, Nissen JB, Højgaard DRMA. Specific Contamination Symptoms are Associated with Experiencing a Limited Response of Cognitive-Behavioral Therapy in Pediatric Patients with OCD. Child Psychiatry Hum Dev 2024; 55:1135-1145. [PMID: 36510026 DOI: 10.1007/s10578-022-01480-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/05/2022] [Indexed: 12/14/2022]
Abstract
A recent study identified three distinct treatment-response trajectories in pediatric OCD where higher levels of contamination symptoms predicted a limited response to cognitive-behavioral therapy (CBT). This study extends these findings by examining which specific symptoms characterize limited CBT response from baseline to 3-year follow-up, with an emphasis on contamination symptoms. The study sample comprised 269 pediatric patients with OCD, all receiving stepped-care treatment with manualized CBT. Differences in single item-reporting between the three trajectory groups were examined using linear mixed-effect modeling. Limited responders displayed a higher symptom load across all OCD symptom categories at 3-year follow-up, dominated by contamination symptoms. Five of these (obsessions about dirt and germs, about bodily fluids, about the feeling of contamination and compulsions regarding handwashing and showering) showed persistence from baseline to 3-year follow-up. The results indicate that presence of specific contamination symptoms may influence long-term symptom severity trajectories in young patients with OCD.
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Affiliation(s)
- Charlotte Steen Duholm
- Department of Child and Adolescent Psychiatry, Aarhus University Hospital, Psychiatry, Denmark.
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.
- Aarhus University Hospital, Psychiatry, Palle Juul-Jensens Boulevard 175, Entrance K, 8200, Aarhus, Denmark.
| | - Sanne Jensen
- Department of Child and Adolescent Psychiatry, Aarhus University Hospital, Psychiatry, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Charlotte Ulrikka Rask
- Department of Child and Adolescent Psychiatry, Aarhus University Hospital, Psychiatry, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Per Hove Thomsen
- Department of Child and Adolescent Psychiatry, Aarhus University Hospital, Psychiatry, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Tord Ivarsson
- Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | | | - Nor Christian Torp
- Division of Mental Health and Addiction, Vestre Viken Hospital, Drammen, Norway
- Akershus University Hospital, Oslo, Norway
| | - Bernhard Weidle
- Regional Centre for Child and Youth Mental Health and Child Welfare Central Norway, Norwegian University of Science and Technology, Trondheim, Norway
| | - Judith Becker Nissen
- Department of Child and Adolescent Psychiatry, Aarhus University Hospital, Psychiatry, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Davíð R M A Højgaard
- Department of Child and Adolescent Psychiatry, Aarhus University Hospital, Psychiatry, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
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Al Mohaddesin FR, Moghimi A, Fadardi JS. Disgust-reduction evaluative conditioning (DREC) and brain stimulation in patients with contamination-based obsessive-compulsive disorder: a protocol for a randomized control trial. Trials 2023; 24:750. [PMID: 38001473 PMCID: PMC10675853 DOI: 10.1186/s13063-023-07791-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2023] [Accepted: 11/08/2023] [Indexed: 11/26/2023] Open
Abstract
BACKGROUND The negative emotional valence of a stimulus can be altered if paired with a pleasant stimulus, a phenomenon referred to as evaluative conditioning. Disgust, as a central emotion in obsessive-compulsive disorder (OCD), particularly in the contamination subtype, may be an appropriate target for such a method. We know that disgust processing and OCD pathophysiology share in some brain areas, including the orbitofrontal cortex, as the neuromodulation techniques targeted in this area have been able to decrease OCD symptoms. We aim to conduct a randomized clinical trial to investigate the evaluative conditioning effect on disgust reduction in patients with contamination-based OCD when administered with or without neuromodulation targeted orbitofrontal cortex. METHOD In a single-blind randomized control trial (RCT), 55 patients with contamination-based OCD will be randomly assigned to four arms. In a factorial design, they will receive 10 sessions of evaluative conditioning training (either sham or real) plus cathodal transcranial direct current stimulation (tDCS) over the orbitofrontal cortex (either sham or real). The intensity of disgust experience and clinical symptoms will be investigated as primary outcomes and quantitative electroencephalogram and cognitive functions as secondary outcomes. The data will be collected at three assessment levels: baseline, after completing intervention sessions, and 2-month follow-up. DISCUSSION The present RCT is the first study that applies evaluative conditioning training in the OCD clinical sample. It will clarify the effect of the evaluative conditioning method alone and with tDCS on disgust reduction in patients with contamination-based OCD. It will provide initial evidence for such an emotion modulation method in the OCD population. The effect of this emotion-focused protocol on cognitive functions and electroencephalogram components is also of interest. TRIAL REGISTRATION ClinicalTrials.gov, NCT05907369. Registered on 16 June 2023. Retrospectively registered.
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Affiliation(s)
| | - Ali Moghimi
- Rayan Research Center for Neuroscience and Behavior, Department of Biology, Faculty of Science, Ferdowsi University of Mashhad, Mashhad, Iran.
| | - Javad Salehi Fadardi
- School of Community and Global Health, Claremont Graduate University, Claremont, USA
- Department of Psychology, Faculty of Education and Psychology, Ferdowsi University of Mashhad, Mashhad, Iran
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Chua J, Sündermann O. Attenuating experimentally acquired disgust: Comparing counterconditioning, exposure and unconditioned stimulus revaluation. J Behav Ther Exp Psychiatry 2023; 79:101813. [PMID: 36496272 DOI: 10.1016/j.jbtep.2022.101813] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2021] [Revised: 07/31/2022] [Accepted: 11/16/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND OBJECTIVES Disgust is implicated in the aetiology and maintenance of various psychopathologies such as anxiety disorders and obsessive-compulsive disorders. Despite its prominent role in psychopathology, little is known about how to effectively attenuate disgust. The study examined strategies to modify an experimentally acquired disgust response in a sample of undergraduate students. METHODS A conditioning paradigm was used where participants (N = 175) first underwent acquisition of disgust via repeated presentations of a neutral picture (functioning as conditioned stimulus + [CS+]) paired with a disgusting picture (functioning as unconditioned stimulus [US]). Participants were then randomly assigned to either an exposure (repeated presentation of CS-only trials), counterconditioning (pairing CS+ with pleasant pictures), US revaluation (pairing disgusting US with pleasant pictures) or a control (filler task) condition. We hypothesised that counterconditioning would attenuate evaluative learned disgust to the greatest extent, relative to exposure and US revaluation. Participants' evaluations of the pictures were attained with a disgust-pleasantness visual analogue scale. RESULTS Exposure, counterconditioning and US revaluation reduced disgusting US expectancies. However, experimental and control conditions did not differ in terms of attenuating disgust towards CS+. LIMITATIONS Measures of psychopathology and implicit evaluations of disgust were not collected. Modest power might have limited significance of the results. CONCLUSIONS No statistical support for the effectiveness of disgust attenuation following exposure nor counterconditioning were found. Findings for US revaluation are inconclusive. Implications for future research are discussed.
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Affiliation(s)
- Jiajie Chua
- Department of Psychology, National University of Singapore, Singapore.
| | - Oliver Sündermann
- Department of Psychology, National University of Singapore, Singapore
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Miegel F, Bücker L, Kühn S, Mostajeran F, Moritz S, Baumeister A, Lohse L, Blömer J, Grzella K, Jelinek L. Exposure and Response Prevention in Virtual Reality for Patients with Contamination-Related Obsessive-Compulsive Disorder: a Case Series. Psychiatr Q 2022; 93:861-882. [PMID: 35779165 DOI: 10.1007/s11126-022-09992-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/05/2022] [Indexed: 11/27/2022]
Abstract
Exposure therapy in virtual reality is successful in treating anxiety disorders. Studies on exposure and response prevention in virtual reality (VERP) in obsessive-compulsive disorder (OCD) are rare, and it is unclear whether distress associated with other emotions than anxiety (e.g., disgust) can be evoked. The present study aimed to investigate whether distress can be induced during VERP in patients with contamination-related OCD (C-OCD) and a primary feeling of disgust. We treated eight female patients with C-OCD with the primary emotion of disgust over six weeks with VERP and assessed their OC symptoms before and after the intervention period with the Y-BOCS. We measured subjective units of distress (SUD), heart rate and skin conductivity (arousal), sense of presence, and simulator sickness during four consecutive exposure sessions. VERP was able to induce distress and arousal. The qualitative feedback was heterogeneous and sense of presence moderate. Patients' OC symptoms reduced over the treatment period with medium to large effect sizes, but only two patients were considered responders; two patients discontinued treatment due to lack of treatment success. Although VERP was able to induce distress and arousal associated with disgust and evoked a moderate sense of presence, the low rate of symptom reduction diminishes the positive results. Possible reasons for the heterogeneous results and implications are discussed. Trial registration: German Registry for Clinical Studies (DRKS00016929), 10.04.2019.
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Affiliation(s)
- Franziska Miegel
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany.
| | - Lara Bücker
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | - Simone Kühn
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
- Lise Meitner Group for Environmental Neuroscience, Max Planck Institute for Human Development, Lentzeallee 94, 14195, Berlin, Germany
| | - Fariba Mostajeran
- Department of Informatics, University of Hamburg, Vogt-Kölln-Strasse 30, 22527, Hamburg, Germany
| | - Steffen Moritz
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | - Anna Baumeister
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | - Luzie Lohse
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | - Jannik Blömer
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | - Karsten Grzella
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | - Lena Jelinek
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
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Krause S, Ouellet-Courtois C, Sandstrom A, Radomsky AS. Thinking About Disgust: Cognitive Processes Mediate the Associations Between Disgust Proneness and OCD Symptom Domains. Int J Cogn Ther 2022. [DOI: 10.1007/s41811-022-00138-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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6
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Wang J, Sun X, Becker B, Lei Y. Common and separable behavioral and neural mechanisms underlie the generalization of fear and disgust. Prog Neuropsychopharmacol Biol Psychiatry 2022; 116:110519. [PMID: 35101603 DOI: 10.1016/j.pnpbp.2022.110519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 01/21/2022] [Accepted: 01/22/2022] [Indexed: 11/29/2022]
Abstract
Generalization represents the transfer of a conditioned responses to stimuli that resemble the conditioned stimulus (CS). Previous studies on generalization of defensive avoidance responses have primarily focused on fear and have neglected disgust generalization, which represents a key pathological mechanism in some anxiety disorders. In the present study we examined common and distinct mechanisms of fear and disgust generalization by means of a fear or disgust multi-CS conditioning and generalization paradigm with concomitant event-related potential (ERPs) acquisition in n = 62 subjects. We demonstrate that compared to fear, disgust-relevant generalized stimuli (GS) elicited larger expectancy ratings and longer reaction times (RTs) reflecting stronger ratings of 'risk'. On the electrophysiological level, increased P2 amplitudes were found in response to conditioned CS+ versus CS- across both domains, possibly reflecting higher motivational and attentional salience of aversive conditioned stimuli per se. Contingent negative variation (CNV) amplitude was significantly larger for disgust-CS+ than disgust-CS-, reflecting a stronger preparation of the disgust US. Additionally, we found that the contingent negative variation (CNV) fear generalization gradient, and CNV amplitude were increased with similarity to CS+. In contrast the CNV to disgust-GS did not differ and did not reflect disgust generalization. Together this may indicate that the CNV represents a highly fear-specific index for generalization learning. This study provides the first neurobiological evidence for common and distinct generalization learning in fear versus disgust suggesting that dysregulations in separable defensive avoidance mechanisms may underly different anxiety disorder subtypes.
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Affiliation(s)
- Jinxia Wang
- Institute for Brain and Psychological Sciences, Sichuan Normal University, Chengdu 610066, China; Faculty of Education and Psychology, University of Jyvaskyla, Finland
| | - Xiaoying Sun
- Ningxia College of Construction, Ningxia 750021, China
| | - Benjamin Becker
- Clinical Hospital of Chengdu Brain Science Institute, MOE Key Laboratory for Neuroinformation, University of Electronic Science and Technology of China, Chengdu, China.
| | - Yi Lei
- Institute for Brain and Psychological Sciences, Sichuan Normal University, Chengdu 610066, China.
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Anti-Disgust Cognitive Behavioral Therapy for Contamination-Based Obsessive Compulsive Disorder: A Randomized Controlled Clinical Trial. J Clin Med 2022; 11:jcm11102875. [PMID: 35629000 PMCID: PMC9145879 DOI: 10.3390/jcm11102875] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2022] [Revised: 05/15/2022] [Accepted: 05/18/2022] [Indexed: 02/01/2023] Open
Abstract
Background: Disgust is a strong and persistent emotion that frequently occurs during exposure-based treatments for contamination-based obsessive compulsive disorder (C-OCD). This study aimed to examine the efficacy of augmenting cognitive behavioral therapy (CBT) with a novel type of anti-disgust cognitive intervention in reducing the severity of OCD, disgust propensity/sensitivity, and refusal rate of exposure and response prevention, while simultaneously increasing acceptance of disgust. Materials and Methods: Fifty-five individuals with C-OCD (mean age 28.1 years, SD = 3.52; 77% female) were randomly assigned to 15 weekly sessions of anti-disgust plus CBT (AD-CBT) or CBT alone. They were evaluated for outcomes four times (pretreatment, prior to exposure and response prevention (ERP) sessions, posttreatment, and three-month follow-up), and mixed-design ANOVAs were used to analyze the data. Results: The findings indicated that when compared to CBT alone, AD-CBT significantly reduced OCD severity, disgust propensity/sensitivity, and concurrently increased disgust acceptance (p < 0.001). Additionally, engaging in an anti-disgust cognitive intervention was associated with lower ERP refusal rate (4% vs. 16%). The superiority of AD-CBT over CBT persisted through the three-month follow-up period. Conclusions: The current study suggests that supplementing CBT for C-OCD with an anti-disgust cognitive intervention significantly increased acceptance of disgust and decreased the refusal rate of ERP, OCD severity, and disgust-related factors.
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8
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Jalal B, Chamberlain SR, Robbins TW, Sahakian BJ. Obsessive-compulsive disorder-contamination fears, features, and treatment: novel smartphone therapies in light of global mental health and pandemics (COVID-19). CNS Spectr 2022; 27:136-144. [PMID: 33081864 PMCID: PMC7691644 DOI: 10.1017/s1092852920001947] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Accepted: 10/04/2020] [Indexed: 02/06/2023]
Abstract
This review aims to shed light on the symptoms of obsessive-compulsive disorder (OCD) with a focus on contamination fears. In addition, we will briefly review the current therapies for OCD and detail what their limitations are. A key focus will be on discussing how smartphone solutions may provide approaches to novel treatments, especially when considering global mental health and the challenges imposed by rural environments and limited resources; as well as restrictions imposed by world-wide pandemics such as COVID-19. In brief, research that questions this review will seek to address include: (1) What are the symptoms of contamination-related OCD? (2) How effective are current OCD therapies and what are their limitations? (3) How can novel technologies help mitigate challenges imposed by global mental health and pandemics/COVID-19.
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Affiliation(s)
- Baland Jalal
- Department of Psychiatry, University of Cambridge School of Clinical Medicine, Cambridge, United Kingdom
- Behavioural and Clinical Neuroscience Institute, University of Cambridge, Cambridge, United Kingdom
| | - Samuel R. Chamberlain
- Department of Psychiatry, University of Cambridge School of Clinical Medicine, Cambridge, United Kingdom
- Department of Psychiatry, Faculty of Medicine, University of Southampton; and Southern Health NHS Foundation Trust, Cambridgeshire & Peterborough NHS Foundation Trust, United Kingdom
| | - Trevor W. Robbins
- Behavioural and Clinical Neuroscience Institute, University of Cambridge, Cambridge, United Kingdom
- Department of Psychology, University of Cambridge, Cambridge, United Kingdom
| | - Barbara J. Sahakian
- Department of Psychiatry, University of Cambridge School of Clinical Medicine, Cambridge, United Kingdom
- Behavioural and Clinical Neuroscience Institute, University of Cambridge, Cambridge, United Kingdom
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Visvalingam S, Crone C, Street S, Oar EL, Gilchrist P, Norberg MM. The causes and consequences of shame in obsessive-compulsive disorder. Behav Res Ther 2022; 151:104064. [DOI: 10.1016/j.brat.2022.104064] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 02/01/2022] [Accepted: 02/11/2022] [Indexed: 11/02/2022]
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10
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Schutter DJLG. The Cerebellum and Disorders of Emotion. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2022; 1378:273-283. [DOI: 10.1007/978-3-030-99550-8_17] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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11
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Zeng Q, Lv L, Zheng X. Is Acquired Disgust More Difficult to Extinguish Than Acquired Fear? an Event-Related Potential Study. Front Psychol 2021; 12:687779. [PMID: 34867581 PMCID: PMC8639492 DOI: 10.3389/fpsyg.2021.687779] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 10/11/2021] [Indexed: 11/13/2022] Open
Abstract
This study used the classical conditioned acquisition and extinction paradigm to compare which of the two emotions, acquired disgust and acquired fear, was more difficult to extinguish, based on behavioral assessments and the event-related potential (ERP) technique. Behavioral assessments revealed that, following successful conditioned extinction, acquired disgust was more difficult to extinguish. The ERP results showed that, at the early stage of P1, the amplitude of conditioned fear was significantly smaller than that of conditioned disgust, and both were significantly different from the amplitude under neutral conditions; at the middle stage of N2, the difference between the amplitudes of conditioned disgust and conditioned fear disappeared, but they were still significantly different from the amplitudes of conditioned neutral stimuli; at the late stage of P3, the difference between conditioned disgust and conditioned neutral stimuli disappeared, but the difference between conditioned fear and neutral stimuli remained, suggesting that acquired fear was more difficult to extinguish than acquired disgust in terms of how the brain works.
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Affiliation(s)
- Qing Zeng
- School of Marxism, Jinan University, Guangzhou, China
| | - Lishan Lv
- School of Foreign Studies, South China Agricultural University, Guangzhou, China
| | - Xifu Zheng
- School of Psychology, South China Normal University, Guangzhou, China
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12
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Alhujaili N, Alghamdi A, Abo Talib T, Alhaqbani M, Alfelali M, Alghamdi W. The Impact of COVID-19 Pandemic on Obsession and Compulsion Symptoms in Saudi Arabia. Cureus 2021; 13:e20021. [PMID: 34987909 PMCID: PMC8716747 DOI: 10.7759/cureus.20021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/29/2021] [Indexed: 12/23/2022] Open
Abstract
Background Obsessive-compulsive disorder (OCD) is a common condition that has a significant impact on people’s lives. COVID-19 pandemic imposed a challenging situation for the general population with new precautionary measures. All that can have serious implications for those who already have intense concerns about cleanliness and hygiene and those diagnosed with OCD. The aim of this study was to examine the impact of the coronavirus disease 2019 (COVID-19) pandemic on the emergence and severity of obsession and compulsion symptoms in Saudi Arabia. Methods This was a cross-sectional study with 1,190 participants who completed an online three-part questionnaire that included sociodemographic data, the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) checklist, and (Y-BOCS) severity scale. On account of the fact that OCD requires a clinical evaluation to confirm the diagnosis, screening positive for OCD was defined based on criteria A of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), which is selecting at least one of either obsession or compulsion symptoms or both. Screening positive for obsession was defined as selecting at least one of the obsessional symptoms while screening positive for compulsion was defined as selecting at least one of the compulsion symptoms. Results Overall, OCD screening was positive in 82% of participants. Previous diagnosis of OCD was reported by 2.6% (N=36) of the participants and 55.2% of them reported that their symptoms did not change during the pandemic, while 41.1% reported that their symptoms increased. Positive OCD screening was significantly higher in participants who reported previous psychological illness (87.6% vs. 80.9%), those who followed news related to COVID-19 on a daily basis (88.7% vs. 76.1%), and participants who had not acquired the infection (82.9%) compared to those who were infected with COVID-19 (72.3%). Conclusion The aim of this study was to determine the impact of the pandemic on OCD screening and symptoms. New OCD symptoms were reported in a high proportion of the participants. The results of this study can provide guidance for psychiatrists and psychologists in the clinical approach and management of patients with OCD. Further focused research on the factors affecting the emergence or severity of OCD symptoms needs to be conducted in the future.
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Affiliation(s)
- Naseem Alhujaili
- Department of Medicine, Division of Psychiatry, Faculty of Medicine in Rabigh, King Abdulaziz University, Jeddah, SAU
| | - Abdulaziz Alghamdi
- Department of Medicine, Division of Psychiatry, Faculty of Medicine in Rabigh, King Abdulaziz University, Jeddah, SAU
| | - Tariq Abo Talib
- Department of Medicine, Division of Psychiatry, Faculty of Medicine in Rabigh, King Abdulaziz University, Jeddah 22252, Saudi Arabia., Jeddah, SAU
| | - Muhammad Alhaqbani
- Department of Medicine, Division of Psychiatry, Faculty of Medicine in Rabigh, King Abdulaziz University, Jeddah, SAU
| | - Mohammad Alfelali
- Department of Family and Community Medicine, Faculty of Medicine in Rabigh, King Abdulaziz University, Jeddah, SAU
| | - Waleed Alghamdi
- Department of Psychiatry, King Abdulaziz University, Jeddah, SAU
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13
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Üzümcü E, Evliyaoğlu ES, Inozu M. The role of gender, fear of self and disgust propensity in mental contamination: A model test using mental contamination induction. CURRENT PSYCHOLOGY 2021. [DOI: 10.1007/s12144-021-02285-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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14
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Sookman D, Phillips KA, Anholt GE, Bhar S, Bream V, Challacombe FL, Coughtrey A, Craske MG, Foa E, Gagné JP, Huppert JD, Jacobi D, Lovell K, McLean CP, Neziroglu F, Pedley R, Perrin S, Pinto A, Pollard CA, Radomsky AS, Riemann BC, Shafran R, Simos G, Söchting I, Summerfeldt LJ, Szymanski J, Treanor M, Van Noppen B, van Oppen P, Whittal M, Williams MT, Williams T, Yadin E, Veale D. Knowledge and competency standards for specialized cognitive behavior therapy for adult obsessive-compulsive disorder. Psychiatry Res 2021; 303:113752. [PMID: 34273818 DOI: 10.1016/j.psychres.2021.113752] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Accepted: 01/21/2021] [Indexed: 12/19/2022]
Abstract
Obsessive-Compulsive Disorder (OCD) is a leading cause of disability world-wide (World Health Organization, 2008). Treatment of OCD is a specialized field whose aim is recovery from illness for as many patients as possible. The evidence-based psychotherapeutic treatment for OCD is specialized cognitive behavior therapy (CBT, NICE, 2005, Koran and Simpson, 2013). However, these treatments are not accessible to many sufferers around the world. Currently available guidelines for care are deemed to be essential but insufficient because of highly variable clinician knowledge and competencies specific to OCD. The phase two mandate of the 14 nation International OCD Accreditation Task Force (ATF) created by the Canadian Institute for Obsessive Compulsive Disorders is development of knowledge and competency standards for specialized treatments for OCD through the lifespan deemed by experts to be foundational to transformative change in this field. This paper presents knowledge and competency standards for specialized CBT for adult OCD developed to inform, advance, and offer a model for clinical practice and training for OCD. During upcoming ATF phases three and four criteria and processes for training in specialized treatments for OCD through the lifespan for certification (individuals) and accreditation (sites) will be developed based on the ATF standards.
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Affiliation(s)
- Debbie Sookman
- Department of Psychology, McGill University Health Center, 1025 Pine Ave W, Montreal, Quebec, H3A 1A1, Canada; Department of Psychiatry, McGill University, 845 Sherbrooke St W, Montreal, Quebec, H3A 0G4, Canada.
| | - Katharine A Phillips
- Department of Psychiatry, Weill Cornell Medicine, 1300 York Ave, New York, NY 10065, United States.
| | - Gideon E Anholt
- Department of Psychology, Marcus Family Campus, Ben-Gurion University of the Negev, Beer Sheva, P.O.B. 653 Beer-Sheva, 8410501, Israel.
| | - Sunil Bhar
- Department of Psychological Sciences, Faculty of Health, Arts and Design, Swinburne University of Technology, 1 John St, Hawthorn, Victoria, 3122, Australia.
| | - Victoria Bream
- Oxford Health Specialist Psychological Interventions Clinic and Oxford Cognitive Therapy Centre, Warneford Hospital, Oxford, OX3 7JX, United Kingdom.
| | - Fiona L Challacombe
- Institute of Psychiatry, Psychology and Neuroscience, Kings College London, De Crespigny Park, London, SE5 8AF, United Kingdom.
| | - Anna Coughtrey
- Great Ormond Street Hospital for Children, London WC1N 3JH, United Kingdom; UCL Great Ormond Street Institute of Child Health, 30 Guilford St, Holborn, London, WC1N 1EH, United Kingdom.
| | - Michelle G Craske
- Anxiety and Depression Research Center, Depression Grant Challenge, Innovative Treatment Network, Staglin Family Music Center for Behavioral and Brain Health, UCLA Department of Psychology and Department of Psychiatry and Biobehavioral Sciences, Box 951563, 1285 Franz Hall, Los Angeles, CA, United States.
| | - Edna Foa
- Center for the Treatment and Study of Anxiety, University of Pennsylvania Perelman SOM, 3535 Market Street, Philadelphia, PA 19104, United States.
| | - Jean-Philippe Gagné
- Department of Psychology, Concordia University, 7141 Sherbrooke St, West, Montreal, Quebec H4B 1R6, Canada.
| | - Jonathan D Huppert
- Department of Psychology, The Hebrew University of Jerusalem, Mt. Scopus, Jerusalem, 91905, Israel.
| | - David Jacobi
- Rogers Behavioral Health, 34700 Valley Road, Oconomowoc, WI, 53066, United States.
| | - Karina Lovell
- Division of Nursing, Midwifery and Social Work, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Oxford Rd, Manchester, M13 9PL, United Kingdom; Manchester Academic Health Science Centre, Greater Manchester Mental Health NHS Foundation Trust, Manchester, M13 9PL, United Kingdom.
| | - Carmen P McLean
- National Center for PTSD, Dissemination and Training Division, VA Palo Alto Healthcare System, 795 Willow Road, Menlo Park, CA, 94025, United States; Department of Psychiatry and Behavioral Sciences, Stanford University, 450 Serra Mall, Stanford, CA, 94305, United States.
| | - Fugen Neziroglu
- Bio-Behavioral Institute, 935 Northern Boulevard, Suite 102, Great Neck, NY, 11021, United States.
| | - Rebecca Pedley
- Division of Nursing, Midwifery and Social Work, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, M13 9PL, United Kingdom.
| | - Sean Perrin
- Department of Psychology, Lund University, Box 213, 22100, Lund, Sweden.
| | - Anthony Pinto
- Zucker School of Medicine at Hofstra/Northwell, Zucker Hillside Hospital - Northwell Health, 265-16 74th Avenue, Glen Oaks, NY, 11004, United States.
| | - C Alec Pollard
- Center for OCD and Anxiety-Related Disorders, Saint Louis Behavioral Medicine Institute, 1129 Macklind Ave, St. Louis, MO, 63110, United States; Department of Family and Community Medicine, Saint Louis University School of Medicine, Saint Louis, MO, 63110, United States.
| | - Adam S Radomsky
- Department of Psychology, Concordia University, 7141 Sherbrooke St, West, Montreal, Quebec H4B 1R6, Canada.
| | - Bradley C Riemann
- 34700 Valley Road, Rogers Behavioral Health, Oconomowoc, WI, 53066, United States.
| | - Roz Shafran
- Population, Policy and Practice Research and Teaching Department, UCL Great Ormond Street Hospital Institute of Child Health, Holborn, London, WC1N 1EH, United Kingdom.
| | - Gregoris Simos
- Department of Educational and Social Policy, University of Macedonia, 156 Egnatia Street, 54636 Thessaloniki, Greece.
| | - Ingrid Söchting
- Departments of Psychology, University of British Columbia, 2136 West Mall, Vancouver, British Columbia, V6T 1Z4, Canada.
| | - Laura J Summerfeldt
- Department of Psychology, Trent University, 1600 West Bank Drive, Peterborough, K9L 0G2 Ontario, Canada.
| | - Jeff Szymanski
- International OCD Foundation, 18 Tremont Street, #308, Boston MA, 02108, United States.
| | - Michael Treanor
- Anxiety and Depression Research Center, University of California, Los Angeles, Box 951563, 1285 Franz Hall, Los Angeles, CA, United States.
| | - Barbara Van Noppen
- Clinical Psychiatry and Behavioral Sciences, OCD Southern California, 2514 Jamacha Road Ste, 502-35 El Cajon, CA, 92019, United States; Department of Psychiatry and Behavioral Sciences, Keck School of Medicine, University of Southern California, 2250 Alcazar Street, Suite 2200, Los Angeles, CA, 90033, United States.
| | - Patricia van Oppen
- Department of Psychiatry, Amsterdam UMC, location VUmc, Netherlands; Amsterdam Public Health Research Institute - Mental Health, Netherlands; GGZ inGeest Specialized Mental Health Care, Netherlands.
| | - Maureen Whittal
- Vancouver CBT Centre, 302-1765 W8th Avenue, Vancouver, British Columbia, V6J5C6, Canada; Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada.
| | - Monnica T Williams
- School of Psychology, University of Ottawa, 136 Jean-Jacques Lussier Pvt, Ottawa, K1N 6N5, Ontario, Canada.
| | - Timothy Williams
- Department of Psychology, University of Reading, PO Box 217, Reading, Berkshire, RG6 6AH, United Kingdom.
| | - Elna Yadin
- Department of Psychiatry, University of Pennsylvania, 3535 Market Street, 2nd Floor, Philadelphia, PA 19104, United States.
| | - David Veale
- South London and the Maudsley NHS Foundation Trust & King's College London, Denmark Hill, London, SE5 8 AZ, United Kingdom.
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15
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Novara C, Lebrun C, Macgregor A, Vivet B, Thérouanne P, Capdevielle D, Raffard S. Acquisition and maintenance of disgust reactions in an OCD analogue sample: Efficiency of extinction strategies through a counter-conditioning procedure. PLoS One 2021; 16:e0254592. [PMID: 34260646 PMCID: PMC8279387 DOI: 10.1371/journal.pone.0254592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 06/30/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Obsessive-compulsive disorder (OCD) has long been considered as an anxiety disorder, disgust is the dominant emotion in contamination-based OCD. However, disgust seems resistant to exposure with response prevention partly due to the fact that disgust is acquired through evaluative conditioning. AIMS The present research investigates a counter-conditioning intervention in treating disgust-related emotional responses in two groups of individuals with high (High contamination concerns, HCC, n = 24) and low (Low contamination concerns LCC, n = 23) contamination concerns. METHODS The two groups completed a differential associative learning task in which neutral images were followed by disgusting images (conditioned stimulus; CS+), or not (CS-). Following this acquisition phase, there was a counter-conditioning procedure in which CS+ was followed by a very pleasant unconditional stimulus while CS- remained unreinforced. RESULTS Following counter-conditioning, both groups reported significant reduction in their expectancy of US occurrence and reported less disgust with CS+. For both expectancy and disgust, reduction was lower in the HCC group than in the LCC group. Disgust sensitivity was highly correlated with both acquisition and maintenance of the response acquired, while US expectation was predicted by anxiety. CONCLUSION Counter-conditioning procedure reduces both expectations and conditioned disgust.
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Affiliation(s)
- Caroline Novara
- Univ Paul Valéry Montpellier 3, Univ. Montpellier, EPSYLON EA 4556, Montpellier, France
- Groupe Ramsay Gds, Clinique RECH, Montpellier, France
| | - Cindy Lebrun
- Univ Paul Valéry Montpellier 3, Univ. Montpellier, EPSYLON EA 4556, Montpellier, France
| | - Alexandra Macgregor
- Service Universitaire de Psychiatrie Adulte, CHU Montpellier, Montpellier, France
| | - Bruno Vivet
- Groupe Ramsay Gds, Clinique RECH, Montpellier, France
| | | | - Delphine Capdevielle
- Service Universitaire de Psychiatrie Adulte, CHU Montpellier, Montpellier, France
| | - Stephane Raffard
- Univ Paul Valéry Montpellier 3, Univ. Montpellier, EPSYLON EA 4556, Montpellier, France
- Service Universitaire de Psychiatrie Adulte, CHU Montpellier, Montpellier, France
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Mancusi L, McKay D. Behavioral avoidance tasks for eliciting disgust and anxiety in contamination fear: An examination of a test for a combined disgust and fear reaction. J Anxiety Disord 2021; 78:102366. [PMID: 33578215 DOI: 10.1016/j.janxdis.2021.102366] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 01/21/2021] [Accepted: 01/26/2021] [Indexed: 11/28/2022]
Abstract
While research supports the role of disgust in contamination OCD, there is also an overlap with fear in motivating avoidance. The "heebie-jeebies" is an emotional response associated with fear and disgust that motivates avoidance of contact with skin-transmitted pathogens (e.g., parasites). This motivation aligns with characteristics of contamination OCD. From a screening of undergraduate students (N = 188), contamination fearful (n = 14), high trait-anxious (n = 14), and low trait-anxious (n = 18) groups were created. Participants engaged in disgust, fear, and "heebie-jeebies" behavioral avoidance tasks. Participants rated "heebie-jeebies" emotion, physical sensations, and behavioral urges. Duration or refusal of task was recorded. A significant interaction effect was found for disgust and anxiety. Participants with higher disgust reported higher "heebie-jeebies" emotion at high, but not low, levels of anxiety. Exploratory analyses revealed that many contamination fearful and high trait-anxious participants refused to complete the task. The interaction of disgust and anxiety significantly predicted the probability of refusal. Participants with higher disgust and anxiety were more likely to refuse to complete the task. Results suggest that the "heebie-jeebies" motivates avoidance of skin-transmitted pathogens. Future research is warranted to further investigate the "heebie-jeebies" and how it relates to contamination concerns.
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17
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The Role of Disgust and Threat in Contamination-Related Obsessive–Compulsive Disorder. BEHAVIOUR CHANGE 2021. [DOI: 10.1017/bec.2021.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AbstractTheoretical models suggest that the emotion disgust or threat overestimates are important in the aetiology and maintenance of contamination-based obsessive–compulsive disorder. In the current study, both threat and disgust were manipulated and 115 non-clinical participants (mean age 20.46 years, 94 females) were randomly allocated to one of four conditions: high-disgust/low-threat (n = 29), high-disgust/high-threat (n = 29), low-disgust/low-threat (n = 27), and low-disgust/high-threat (n = 30). Participants completed a hierarchical Behavioural Avoidance Task (BAT). Those in the high-threat and high-disgust conditions completed less BAT steps and showed more latency to begin each step than those in the low-threat and low-disgust conditions. A significant interaction effect was observed for the high-disgust/high-threat condition as significantly more task avoidance was found. However, handwashing duration was not significantly different between the high and low-disgust conditions or the high and low-threat conditions. The overall low mean washing duration of 30 s possibly due to the testing conditions and/or the ethnic heterogeneity of the sample may account for these results. There were also no significant differences in the level of anxiety for participants in the high-threat compared with the low-threat conditions. It is possible that anxiety remained relatively low across conditions as a result of the graduated BAT. Future research and theoretical and clinical implications are discussed.
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18
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The role of disgust proneness and contamination-related thought-action fusion in mental contamination-related washing urges. CURRENT PSYCHOLOGY 2021. [DOI: 10.1007/s12144-021-01401-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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19
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Cervin M, Perrin S. Incompleteness and Disgust Predict Treatment Outcome in Pediatric Obsessive-Compulsive Disorder. Behav Ther 2021; 52:53-63. [PMID: 33483124 DOI: 10.1016/j.beth.2020.01.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2019] [Revised: 01/06/2020] [Accepted: 01/28/2020] [Indexed: 01/09/2023]
Abstract
Increasing evidence suggests that pediatric obsessive-compulsive disorder (OCD) is motivated not only by fear but also by feelings of incompleteness and disgust. However, it is currently unclear whether emotion involvement in OCD symptoms is associated with treatment response in youth with OCD. The present study examined whether treatment outcome for youth with OCD was predicted by the degree to which fear, disgust, and incompleteness were involved in baseline OCD symptoms. Children and adolescents with OCD entering treatment for this condition (N = 111) were administered standardized OCD symptom measures and an interview designed to assess the degree of fear, incompleteness, and disgust experienced during current OCD symptoms. Follow-up assessments occurred on average 13 months after baseline with each participant coded for outcome according to internationally acknowledged change criteria for pediatric OCD. Higher levels of incompleteness and disgust as part of baseline OCD symptoms predicted poorer outcome. The degree of fear during baseline OCD symptoms did not predict outcome. If replicated under controlled conditions, these results suggest that incompleteness and disgust may act as barriers to improvement in pediatric OCD and that treatment modifications that target these emotion-related motivators may improve outcome for a subset of youth.
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Affiliation(s)
- Matti Cervin
- Lund University and Skåne Child and Adolescent Psychiatry.
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20
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Taboas W, McKay D. Inducing and manipulating sensations of incompleteness. Bull Menninger Clin 2020; 84:237-263. [PMID: 33000964 DOI: 10.1521/bumc.2020.84.3.237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Incompleteness (INC) and Harm Avoidance (HA) are known core dimensions of obsessive-compulsive disorder (OCD). Emotional processing and inhibitory learning (IL) have both been proposed as viable mechanisms of exposure for the alleviation of HA, yet the relationship with INC remains unclear. This study evaluated differential manipulation responses to induced INC. The authors specifically tested whether targeting the key component of IL, expectancy violation generated by the discrepancy between an articulated prediction and the actual exposure experience, would lead to improved outcomes. A sample of undergraduates (N = 68) completed a series of behavioral tasks to induce INC, followed by manipulations (exposure with or without articulated predictions) to reduce INC reactions. Results show that modest changes were observed following reduction manipulations following INC induction. Furthermore, heightened HA predicted the changes of induced sensations. Mediation tests showed that articulation of predicted sensations mediated pre- to postreduction ratings. Clinical and research implications are discussed.
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Affiliation(s)
- William Taboas
- Postdoctoral Research Fellow at the Center for Understanding and Treating Anxiety (CUTA), San Diego State University, San Diego, California
| | - Dean McKay
- Professor and Fordham-Columbia Research Fellow in the Department of Psychology, Fordham University, Bronx, New York
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21
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Hyde MK, Masser BM. Eligible blood donors' decisions about donating stool for fecal microbiota transplantation: Does ambivalence play a role? Transfusion 2020; 61:474-483. [PMID: 33006187 DOI: 10.1111/trf.16109] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 09/11/2020] [Accepted: 09/11/2020] [Indexed: 12/22/2022]
Abstract
Blood collection agencies (BCAs) are expanding core business by inviting blood donors to donate stool for fecal microbiota transplantation (FMT). However, whether blood donors also want to donate stool is unclear since, despite its benefits, stool donation is viewed by many as unpleasant. This study examined the prevalence, contributors to, and role of these mixed feelings (ambivalence) in stool donation intentions. STUDY DESIGN AND METHODS This cross-sectional study surveyed Australian residents aged 18 years or more who believed themselves eligible to donate blood and met broad criteria for prescreening as a stool donor (eg, healthy, not taking medication). Survey questions assessed attitude, norms, self-efficacy, motives, disgust, ambivalence, and intentions to donate stool. RESULTS A total of 382 eligible blood donors aged not more than 50 years (mean, 28.71 years; 48% female, 62% "healthy" body mass index) participated. Six percent indicated no ambivalence about donating stool. In regression, significant determinants of ambivalence were less awareness of FMT, lower self-efficacy, motivated by ensuring that stool is available for loved ones, and more disgust about stool donation. Higher ambivalence contributed to decreased donation intention. Self-efficacy and disgust differentiated participants with moderate ambivalence, a group likely responsive to intervention, from those with low or high ambivalence. CONCLUSION Ambivalence about donating stool was common among eligible blood donors. BCAs should raise awareness about stool donation and FMT before requesting donation. BCAs may increase cost savings and donor retention by giving clear guidance about donation requirements and implementing processes that build confidence. Early screening of potential donors for ambivalence and disgust will enable BCAs to provide decision support.
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Affiliation(s)
- Melissa K Hyde
- School of Psychology, The University of Queensland, Brisbane, Queensland, Australia
| | - Barbara M Masser
- School of Psychology, The University of Queensland, Brisbane, Queensland, Australia.,Clinical Services and Research, Australian Red Cross Lifeblood, Sydney, New South Wales, Australia
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22
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PASCAL SA, PODINA IR, NEDELCEA C. A Meta-Analysis on the Efficacy of Exposure-Based Treatment in Anxiety Disorders: Implications for Disgust. JOURNAL OF EVIDENCE-BASED PSYCHOTHERAPIES 2020. [DOI: 10.24193/jebp.2020.2.10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Despite of several meta-analyses indicating that exposure-based treatments (EBT) are successful in addressing anxiety and fear symptoms, less is known whether this is also the case for disgust, which also accompanies anxiety disorders. Therefore, the aim of the current meta-analysis was to compare the efficacy of EBT on disgust and anxiety (emotional distress), against control condition. This meta-analysis included a total of eight studies. Overall, there was a medium effect size (g = .57, 95% CI: .26 to .88, p < .001) for emotional distress; a medium effect size for anxiety (g = .79, 95% CI: .24 to 1.34, p = .005), yet a small effect size for disgust (g = .36, 95% CI: .05 to .68, p = .024). These findings prompt that current EBT are not tailored to address disgust symptoms accompanying many forms of anxiety disorders, although literature points more and more to a need in this respect. We also examined potential moderator variables (the year of publication, the number of exposure sessions, age of the sample, and gender composition). Additionally, we discussed several strengths and limitations, one of the most important being the small number of studies regarding the subject and their heterogeneity.
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Affiliation(s)
- Simona A. PASCAL
- "Laboratory of Cognitive Clinical Sciences, Department of Psychology, University of Bucharest, Bucharest, Romania."
| | - Ioana R. PODINA
- Department of Psychology, University of Bucharest, Bucharest, Romania
| | - Cătălin NEDELCEA
- Department of Psychology, University of Bucharest, Bucharest, Romania
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23
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Fong ZH, Sündermann O. Modulating disgust in mental contamination: Experimental evidence for the role of disgust. J Behav Ther Exp Psychiatry 2020; 68:101567. [PMID: 32197134 DOI: 10.1016/j.jbtep.2020.101567] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Revised: 02/14/2020] [Accepted: 03/01/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND AND OBJECTIVES Disgust has been associated with mental contamination (MC), although the evidence has hitherto been nonexperimental. Furthermore, strategies that can target both disgust and MC have not been well explored. We investigated the role of disgust in MC by inducing disgust via olfaction within the "dirty kiss" paradigm and conversely, to see if pairing pleasant olfactory stimulus during re-exposure, based on counterconditioning, can reduce MC. We also examined whether disgust constructs (propensity and sensitivity) and trait MC are associated with state MC arising from the "dirty kiss". METHODS MC was first evoked using the "dirty kiss" paradigm, in which participants (N = 90) visualized receiving a non-consensual kiss from a physically dirty man (time 1). After a break, participants repeated the "dirty kiss" task in a room that was scented to smell either disgusting, pleasant or neutral (time 2). Participants completed measures of disgust and trait MC after the experiment. RESULTS Participants in the disgust condition reported increased feelings of dirtiness at time 2. Disgust propensity predicted feelings of dirtiness at time 1. Disgust sensitivity and trait MC were not associated with state MC indices. LIMITATIONS The use of a non-clinical female sample, extraneous factors during the break and contextual factors arising from room change at time 2 are some potential limitations. CONCLUSIONS Induced disgust within a MC paradigm resulted in increased feelings of dirtiness, suggestive of disgust-based emotional reasoning. Pairing pleasant olfactory stimulus was not effective at attenuating MC or disgust.
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Affiliation(s)
- Zhi Hui Fong
- Department of Psychology, National University of Singapore, Singapore
| | - Oliver Sündermann
- Department of Psychology, National University of Singapore, Singapore.
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24
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Fink-Lamotte J, Widmann A, Fader J, Exner C. Interpretation bias and contamination-based obsessive-compulsive symptoms influence emotional intensity related to disgust and fear. PLoS One 2020; 15:e0232362. [PMID: 32353055 PMCID: PMC7192464 DOI: 10.1371/journal.pone.0232362] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Accepted: 04/13/2020] [Indexed: 11/25/2022] Open
Abstract
Biased processing of disgust-related stimuli is increasingly discussed in addition to fear-related processing as a maintenance factor for contamination-based obsessive-compulsive disorder (C-OCD). However, the differential impact of fear and disgust on biased processing in C-OCD is not yet completely understood. Because it is difficult to distinguish the two emotions in self-report assessment by directly addressing the specific emotions, a text paragraph-based interpretation bias paradigm was applied to more implicitly assess emotions. For the text-based interpretation bias paradigm, disgust-related, fear-related, disgust-fear-ambiguous and neutral text paragraphs describing everyday life situations were developed and validated in a pre-study (N = 205). Fifty-nine healthy participants watched either disgust- or fear-inducing movies and afterwards rated their experienced emotional response to the text paragraphs. The results show that fear and disgust components of an emotional response to mixed-emotional situations are strongly influenced by the situational context, and across the levels of trait contamination fear people did not differ in their fear experiences to everyday situations (which was overall strong), but in their disgust experiences. These findings highlight the strength of situational context on interpretation bias for mixed-emotional disorders and the important role of disgust for C-OCD.
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Affiliation(s)
- Jakob Fink-Lamotte
- Clinical Psychology and Psychotherapy, University of Leipzig, Leipzig, Germany
- * E-mail:
| | - Andreas Widmann
- Cognitive and Biological Psychology, University of Leipzig, Leipzig, Germany
- Leibniz Institute for Neurobiology, Magdeburg, Germany
| | - Judith Fader
- Clinical Psychology and Psychotherapy, University of Leipzig, Leipzig, Germany
| | - Cornelia Exner
- Clinical Psychology and Psychotherapy, University of Leipzig, Leipzig, Germany
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25
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Keller NE, Hennings AC, Dunsmoor JE. Behavioral and neural processes in counterconditioning: Past and future directions. Behav Res Ther 2020; 125:103532. [PMID: 31881357 PMCID: PMC6983350 DOI: 10.1016/j.brat.2019.103532] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Revised: 12/06/2019] [Accepted: 12/11/2019] [Indexed: 02/07/2023]
Abstract
Counterconditioning refers both to the technique and putative process by which behavior is modified through a new association with a stimulus of an opposite valence. Similar to extinction, counterconditioning is considered a form of inhibition that interferes with the expression of the originally learned response without erasing it. But whereas interest in extinction continues to rise, counterconditioning has received far less attention. Here, we provide an in-depth review of counterconditioning research and detail whether counterconditioning is any more effective than extinction at preventing relapse of the originally learned behavior. We consider the clinical implications of counterconditioning, describe recent neurobiological and neuroimaging research in this area, and consider future avenues in need of further investigation.
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Affiliation(s)
- Nicole E Keller
- University of Texas at Austin, Institute for Neuroscience, Austin, TX, 78712, USA
| | - Augustin C Hennings
- University of Texas at Austin, Institute for Neuroscience, Austin, TX, 78712, USA
| | - Joseph E Dunsmoor
- University of Texas at Austin, Institute for Neuroscience, Austin, TX, 78712, USA; University of Texas at Austin, Department of Psychiatry, Austin, TX, 78712, USA.
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26
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Jalal B, McNally RJ, Elias JA, Potluri S, Ramachandran VS. "Fake it till You Make it"! Contaminating Rubber Hands ("Multisensory Stimulation Therapy") to Treat Obsessive-Compulsive Disorder. Front Hum Neurosci 2020; 13:414. [PMID: 31998095 PMCID: PMC6962184 DOI: 10.3389/fnhum.2019.00414] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Accepted: 11/07/2019] [Indexed: 12/22/2022] Open
Abstract
Obsessive-compulsive disorder (OCD) is a deeply enigmatic psychiatric condition associated with immense suffering worldwide. Efficacious therapies for OCD, like exposure and response prevention (ERP), are sometimes poorly tolerated by patients. As many as 25% of patients refuse to initiate ERP mainly because they are too anxious to follow exposure procedures. Accordingly, we proposed a simple and tolerable (immersive yet indirect) low-cost technique for treating OCD that we call “multisensory stimulation therapy.” This method involves contaminating a rubber hand during the so-called “rubber hand illusion” (RHI) in which tactile sensations may be perceived as arising from a fake hand. Notably, Jalal et al. (2015) showed that such fake hand contamination during the RHI provokes powerful disgust reactions in healthy volunteers. In the current study, we explored the therapeutic potential of this novel approach. OCD patients (n = 29) watched as their hidden real hand was being stroked together with a visible fake hand; either synchronously (inducing the RHI; i.e., the experimental condition; n = 16) or asynchronously (i.e., the control condition; n = 13). After 5 min of tactile stimulation, the rubber hand was contaminated with fake feces, simulating conventional exposure therapy. Intriguingly, results suggested sensory assimilation of contamination sensations into the body image via the RHI: patients undergoing synchronous stimulation did not report greater contamination sensations when the fake hand was initially contaminated relative to asynchronous stroking. But contrary to expectations, they did so after the rubber hand had been contaminated for 5 min, as assessed via disgust facial expressions (a secondary outcome) and in vivo exposure (upon discontinuing the illusion). Further, to our surprise, synchronous and asynchronous stroking induced an equally vivid and fast-emerging illusion, which helps explain why both conditions initially (5 min after initiating tactile stimulation) provoked contamination reactions of equal magnitude. This study is the first to suggest heightened malleability of body image in OCD. Importantly, it may pave the way for a tolerable technique for the treatment of OCD—highly suitable for poorly resourced and emergency settings, including low-income and developing countries with minimal access to high-tech solutions like virtual reality.
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Affiliation(s)
- Baland Jalal
- Department of Psychiatry, Behavioural and Clinical Neuroscience Institute, University of Cambridge School of Clinical Medicine, Cambridge, United Kingdom.,Department of Psychology, Harvard University, Cambridge, MA, United States
| | - Richard J McNally
- Department of Psychology, Harvard University, Cambridge, MA, United States
| | - Jason A Elias
- Obsessive-Compulsive Disorder Institute, McLean Hospital, Belmont, MA, United States.,Department of Psychiatry, Harvard Medical School, Boston, MA, United States
| | - Sriramya Potluri
- Obsessive-Compulsive Disorder Institute, McLean Hospital, Belmont, MA, United States.,Department of Psychiatry, Harvard Medical School, Boston, MA, United States
| | - Vilayanur S Ramachandran
- Center for Brain and Cognition, University of California, San Diego, San Diego, CA, United States
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27
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Kang S, Vervliet B, Engelhard IM, van Dis EA, Hagenaars MA. Reduced return of threat expectancy after counterconditioning versus extinction. Behav Res Ther 2018; 108:78-84. [DOI: 10.1016/j.brat.2018.06.009] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Revised: 05/10/2018] [Accepted: 06/25/2018] [Indexed: 10/28/2022]
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28
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Nitta H, Tomita H, Zhang Y, Zhou X, Yamada Y. Disgust and the rubber hand illusion: a registered replication report of Jalal, Krishnakumar, and Ramachandran (2015). COGNITIVE RESEARCH-PRINCIPLES AND IMPLICATIONS 2018; 3:15. [PMID: 29780877 PMCID: PMC5954052 DOI: 10.1186/s41235-018-0101-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/21/2016] [Accepted: 04/05/2018] [Indexed: 02/05/2023]
Abstract
Heightened experience of disgust is a feature of obsessive-compulsive disorder (OCD), particularly contamination-related OCD (C-OCD). Previous studies of the rubber hand illusion (RHI) reported that the sense of body ownership is related to the interaction between vision, touch, and proprioception. One recent study demonstrated a link between the RHI and disgust, suggesting that there is an interaction between these three perceptual modalities and disgust (Jalal et al., PLOS ONE 10:e0139159, 2015). However, there have been no direct replications of this initial study. We therefore performed a direct replication of Jalal et al.'s (PLOS ONE 10:e0139159, 2015) study. We examined 133 participants (based on a power analysis) to determine whether placing contamination-related stimuli on a rubber hand causes OCD-like disgust among healthy participants experiencing the RHI. That is, we tested whether Japanese participants experience more intense disgust when the rubber hand and the participant's hidden hand are stroked synchronously than when stroked asynchronously, in order to replicate and examine the cross-cultural validity of this effect. The main finding of the original study by Jalal and colleagues was successfully replicated in a large sample. Some inconsistencies in one of the control procedures exploring coldness sensations during the RHI were found, which could possibly be due to cross-cultural differences or the improved statistical power of the present study. Based on the present replication study, we conclude that an intervention using the RHI as proposed by Jalal et al. (PLOS ONE 10:e0139159, 2015) might potentially be useful for the treatment of OCD following replications in clinical OCD populations. Preregistration details: This study was preregistered with Cognitive Research: Principles and Implications. The Authors' protocol received in-principle acceptance on 31 March 2017. The preregistered protocol is available here: 10.6084/m9.figshare.6217295.
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Affiliation(s)
- Hiroshi Nitta
- 1Graduate School of Human-Environment Studies, Kyushu University, 6-19-1 Hakozaki, Higashi-ku, Fukuoka, 812-8581 Japan
| | - Haruto Tomita
- 1Graduate School of Human-Environment Studies, Kyushu University, 6-19-1 Hakozaki, Higashi-ku, Fukuoka, 812-8581 Japan
| | - Yi Zhang
- 1Graduate School of Human-Environment Studies, Kyushu University, 6-19-1 Hakozaki, Higashi-ku, Fukuoka, 812-8581 Japan
| | - Xinxin Zhou
- 1Graduate School of Human-Environment Studies, Kyushu University, 6-19-1 Hakozaki, Higashi-ku, Fukuoka, 812-8581 Japan
| | - Yuki Yamada
- 2Faculty of Arts and Science, Kyushu University, Fukuoka, Japan
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Ching THW, Williams MT, Siev J, Olatunji BO. Responsibility/Threat Overestimation Moderates the Relationship Between Contamination-Based Disgust and Obsessive-Compulsive Concerns About Sexual Orientation. ARCHIVES OF SEXUAL BEHAVIOR 2018; 47:1109-1117. [PMID: 29476409 DOI: 10.1007/s10508-018-1165-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/30/2016] [Revised: 06/03/2017] [Accepted: 01/29/2018] [Indexed: 06/08/2023]
Abstract
Disgust has been shown to perform a "disease-avoidance" function in contamination fears. However, no studies have examined the relevance of disgust to obsessive-compulsive (OC) concerns about sexual orientation (e.g., fear of one's sexual orientation transforming against one's will, and compulsive avoidance of same-sex and/or gay or lesbian individuals to prevent that from happening). Therefore, we investigated whether the specific domain of contamination-based disgust (i.e., evoked by the perceived threat of transmission of essences between individuals) predicted OC concerns about sexual orientation, and whether this effect was moderated/amplified by obsessive beliefs, in evaluation of a "sexual orientation transformation-avoidance" function. We recruited 283 self-identified heterosexual college students (152 females, 131 males; mean age = 20.88 years, SD = 3.19) who completed three measures assessing disgust, obsessive beliefs, and OC concerns about sexual orientation. Results showed that contamination-based disgust (β = .17), responsibility/threat overestimation beliefs (β = .15), and their interaction (β = .17) each uniquely predicted OC concerns about sexual orientation, ts = 2.22, 2.50, and 2.90, ps < .05. Post hoc probing indicated that high contamination-based disgust accompanied by strong responsibility/threat overestimation beliefs predicted more severe OC concerns about sexual orientation, β = .48, t = 3.24, p < .001. The present study, therefore, provided preliminary evidence for a "sexual orientation transformation-avoidance" process underlying OC concerns about sexual orientation in heterosexual college students, which is facilitated by contamination-based disgust, and exacerbated by responsibility/threat overestimation beliefs. Treatment for OC concerns about sexual orientation should target such beliefs.
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Affiliation(s)
- Terence H W Ching
- Department of Psychological Sciences, University of Connecticut, Storrs, CT, 06269, USA.
| | - Monnica T Williams
- Department of Psychological Sciences, University of Connecticut, Storrs, CT, 06269, USA
| | - Jedidiah Siev
- Department of Psychology, Swarthmore College, Swarthmore, PA, USA
| | - Bunmi O Olatunji
- Department of Psychological Sciences, Vanderbilt University, Nashville, TN, USA
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Rouel M, Stevenson RJ, Smith E. Examination of Responses Involved in Contamination Aversion Based on Threat Type. JOURNAL OF SOCIAL AND CLINICAL PSYCHOLOGY 2018. [DOI: 10.1521/jscp.2018.37.2.83] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
There is evidence that different types of contaminants produce different responses and have different motivations for avoidance. Contaminants directly associated with disease (direct contaminants) are motivated by disgust avoidance, whereas contaminants indirectly associated with disease (indirect contaminants) and contaminants associated with harmful substances (harm contaminants) are motivated by harm avoidance and threat estimations. This study aims to confirm this distinction between contaminant types and examine the role of cognitive load, awareness and time on processing these threats. One hundred and four participants completed three chain of contagion tasks with direct, indirect, and harm contaminants. Cognitive load, awareness of contamination and time were manipulated during the tasks. Consistent with previous findings, direct contaminants produced stronger disgust responses, while harm and indirect contaminants produced stronger threat estimations. Increasing cognitive load did not impact processing of any type of contaminant. There was evidence that a time delay reduced the spread of contagion for all contaminants. This highlights the importance of time in altering the perception of contamination threat. Implications and future research directions are discussed.
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Preusser F, Margraf J, Zlomuzica A. Generalization of Extinguished Fear to Untreated Fear Stimuli after Exposure. Neuropsychopharmacology 2017; 42:2545-2552. [PMID: 28589965 PMCID: PMC5686487 DOI: 10.1038/npp.2017.119] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Revised: 04/26/2017] [Accepted: 06/01/2017] [Indexed: 11/09/2022]
Abstract
Exposure therapy is highly effective in treating excessive fear related to specific objects and/or situations. However, patients with anxiety disorders often display a generalization of fear responses toward conceptually and perceptually related stimuli and situations. It is unclear whether the beneficial effects of exposure on fear reduction toward treated fear stimuli can extend to untreated fear stimuli. Here, we investigated whether basic principles of extinction generalization apply to exposure. Spider-phobic participants were randomly assigned to either two sessions of exposure treatment (n=23) with spiders or no-treatment (n=24). Prior to and after treatment, behavioral approach tests (BATs) were conducted to examine avoidance, fear and disgust responses toward the treated phobic stimulus (spider as the extinction stimulus). Likewise, BATs with the untreated fear stimulus (cockroach) were conducted to dissect the generalization of treatment effects. Treatment was highly effective in increasing approach behavior toward both treated and untreated fear stimuli. Generalization of treatment effects were evident on the behavioral (approach distance during the BAT), subjective (fear levels during the BAT) and psychophysiological level (heart rate during the BAT). However, a stronger decline in disgust was only evident for the treated fear stimulus. Notably, the herein attained generalization effects were not context-dependent. Hence, exposure therapy for spider phobia was effective in reducing fear of untreated stimuli which share common fear-evoking characteristics with spiders but were never presented during the respective exposure treatment. These findings provide clinical evidence for extinction generalization across different fear-evoking stimuli mediated via exposure.
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Affiliation(s)
- Friederike Preusser
- Mental Health Research and Treatment Center, Ruhr-University Bochum, Bochum, Germany
| | - Jürgen Margraf
- Mental Health Research and Treatment Center, Ruhr-University Bochum, Bochum, Germany
| | - Armin Zlomuzica
- Mental Health Research and Treatment Center, Ruhr-University Bochum, Bochum, Germany
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Olatunji BO, Berg H, Cox RC, Billingsley A. The effects of cognitive reappraisal on conditioned disgust in contamination-based OCD: An analogue study. J Anxiety Disord 2017; 51:86-93. [PMID: 28705679 DOI: 10.1016/j.janxdis.2017.06.005] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Revised: 06/14/2017] [Accepted: 06/23/2017] [Indexed: 10/19/2022]
Abstract
Experimental research has shown that conditioned disgust is resistant to extinction, which may account for the slower habituation to disgust relative to fear in contamination-based obsessive-compulsive disorder (OCD). However, few studies have examined the efficacy of interventions that may attenuate conditioned disgust responses. Studies of cognitive reappraisal have demonstrated that reinterpreting a stimulus can alter emotional responding. This technique is based on cognitive theories which suggest that anxiety disorders arise from biased cognitions; therefore, changing a person's thoughts will elicit durable changes in emotional responses. Given the demonstrated effectiveness of cognitive reappraisal, the present study examined whether cognitive reappraisal would attenuate conditioned disgust responses. We conditioned participants high in contamination fear (n=55) using images of neutral food items (conditioned stimuli; CS) paired with videos of individuals vomiting (unconditioned stimuli; US) while we obtained subjective disgust reports. After conditioning, half of the participants were randomly assigned to cognitive reappraisal training aimed at decreasing their emotional response to the US and CS, while the other half received no such training. The findings showed that cognitive reappraisal participants demonstrated a reduction in learned disgust across sessions and further benefited from extinction. These findings suggest that cognitive reappraisal may be an effective strategy for attenuating learned disgust.
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Reilly EE, Anderson LM, Gorrell S, Schaumberg K, Anderson DA. Expanding exposure-based interventions for eating disorders. Int J Eat Disord 2017; 50:1137-1141. [PMID: 28815659 PMCID: PMC5814124 DOI: 10.1002/eat.22761] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2017] [Revised: 07/25/2017] [Accepted: 07/27/2017] [Indexed: 11/11/2022]
Abstract
Initial trials evaluating exposure-based interventions for eating disorders (EDs) in the 1980s demonstrated mixed results. Since that time, innovations in exposure therapy for anxiety disorders have yielded insights that can be used to refine and expand the approach to effectively target ED behaviors. This article provides a brief summary of relevant advances in exposure therapy for anxiety and outlines how these advances may be adapted and evaluated for use with ED samples. More specifically, we propose shifting to an inhibitory learning framework, considering treatment targets other than fear, and increasing variability in exposure techniques represent three important areas for future study. Overall, this article aims to provide professionals in the field with a framework for how to incorporate cutting-edge advances in exposure therapy into rigorous intervention research for EDs.
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Affiliation(s)
- Erin E. Reilly
- University at Albany, State University of New York, Albany, New York,University of California, San Diego, La Jolla, California
| | - Lisa M. Anderson
- University at Albany, State University of New York, Albany, New York,University of Minnesota, Minneapolis, Minnesota
| | - Sasha Gorrell
- University at Albany, State University of New York, Albany, New York
| | | | - Drew A. Anderson
- University at Albany, State University of New York, Albany, New York
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Bhikram T, Abi-Jaoude E, Sandor P. OCD: obsessive-compulsive … disgust? The role of disgust in obsessive-compulsive disorder. J Psychiatry Neurosci 2017; 42:300-306. [PMID: 28375077 PMCID: PMC5573572 DOI: 10.1503/jpn.160079] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Recent research has identified the important role of disgust in the symptomatology of obsessive-compulsive disorder (OCD). Exaggerated and inappropriate disgust reactions may drive some of the symptoms of OCD, and in some cases, may even eclipse feelings of anxiety. This paper reviews behavioural and neuroimaging research that recognizes the prominent role of disgust in contributing to OCD symptoms, especially contamination-based symptoms. We discuss how elevated behavioural and biological markers of disgust reported in OCD populations support the need for alternative clinical treatment strategies and theoretical models of OCD.
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Affiliation(s)
- Tracy Bhikram
- Correspondence to: T. Bhikram, University Health Network, Tourette Syndrome Neurodevelopmental Clinic, 399 Bathurst St, Toronto, ON M5T 2S8;
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Schröder AE, Vulink NC, van Loon AJ, Denys DA. Cognitive behavioral therapy is effective in misophonia: An open trial. J Affect Disord 2017; 217:289-294. [PMID: 28441620 DOI: 10.1016/j.jad.2017.04.017] [Citation(s) in RCA: 58] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Revised: 04/10/2017] [Accepted: 04/16/2017] [Indexed: 11/25/2022]
Abstract
BACKGROUND Misophonia is a psychiatric disorder in which ordinary human sounds like smacking or chewing provoke intense anger and disgust. Despite the high burden of this condition, to date there is no evidence-based treatment available. In this study we evaluated the efficacy of cognitive behavioral therapy (CBT) and investigated whether clinical or demographic characteristics predicted treatment response. METHODS Ninety patients with misophonia received eight bi-weekly group CBT sessions. Treatment response was defined as a Clinical Global Impression - Improvement Scale (CGI-I) score at endpoint of 1 or 2 (very much or much improved) and a 30% or greater reduction on the Amsterdam Misophonia Scale (A-MISO-S), a measure of the severity of misophonia symptoms. RESULTS Following treatment 48% (N=42) of the patients showed a significant reduction of misophonia symptoms. Severity of misophonia and the presence of disgust were positive predictors of treatment response. LIMITATIONS The A-MISO-S is not a validated scale. Furthermore, this was an open-label study with a waiting list control condition. CONCLUSIONS This is the first treatment study for misophonia. Our results suggest that CBT is effective in half of the patients.
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Affiliation(s)
- Arjan E Schröder
- Department of Psychiatry, Academic Medical Center (AMC), University of Amsterdam, The Netherlands.
| | - Nienke C Vulink
- Department of Psychiatry, Academic Medical Center (AMC), University of Amsterdam, The Netherlands
| | - Arnoud J van Loon
- Department of Psychiatry, Academic Medical Center (AMC), University of Amsterdam, The Netherlands
| | - Damiaan A Denys
- Department of Psychiatry, Academic Medical Center (AMC), University of Amsterdam, The Netherlands; The Netherlands Institute for Neuroscience, an institute of the Royal Netherlands Academy of Arts and Sciences, Amsterdam, The Netherlands.
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Olatunji BO, Armstrong T, Elwood L. Is Disgust Proneness Associated With Anxiety and Related Disorders? A Qualitative Review and Meta-Analysis of Group Comparison and Correlational Studies. PERSPECTIVES ON PSYCHOLOGICAL SCIENCE 2017. [DOI: 10.1177/1745691616688879] [Citation(s) in RCA: 62] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Research suggests that disgust may be linked to the etiology of some anxiety-related disorders. The present investigation reviews this literature and employs separate meta-analyses of clinical group comparison and correlational studies to examine the association between disgust proneness and anxiety-related disorder symptoms. Meta-analysis of 43 group comparison studies revealed those high in anxiety disorder symptoms reported significantly more disgust proneness than those low in anxiety symptoms. Although this effect was not moderated by clinical versus analogue studies or type of disorder, larger group differences were observed for those high in anxiety symptoms associated with contagion concerns compared to those high in anxiety symptoms not associated with contagion concerns. Similarly, meta-analysis of correlational data across 83 samples revealed moderate associations between disgust proneness and anxiety-related disorder symptoms. Moderator analysis revealed that the association between disgust proneness and anxiety-related disorder symptoms was especially robust for anxiety symptoms associated with contagion concerns. After controlling for measures of negative affect, disgust proneness continued to be moderately correlated with anxiety-related disorder symptoms. However, negative affect was no longer significantly associated with symptoms of anxiety-related disorders when controlling for disgust proneness. The implications of these findings are discussed in the context of a novel transdiagnostic model.
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Factor Structure, Reliability, and Validity of the Japanese Version of the Disgust Propensity and Sensitivity Scale-Revised. PLoS One 2016; 11:e0164630. [PMID: 27732659 PMCID: PMC5061427 DOI: 10.1371/journal.pone.0164630] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2016] [Accepted: 09/28/2016] [Indexed: 11/19/2022] Open
Abstract
The Disgust Propensity and Sensitivity Scale-Revised is one of the most widely used measures of individual differences for the emotion of disgust. It consists of 2 subscales: disgust propensity and disgust sensitivity. This study examined the factor structure, reliability, and validity of the Japanese version of the revised Disgust Propensity and Sensitivity Scale. Japanese participants (N = 1067) completed the scale as well as the Padua Inventory, Anxiety Sensitivity Index, State-Trait Anxiety Inventory, and Positive and Negative Affective Schedule. The participants were divided into 3 samples: Sample 1 (n = 481, mean age = 23.05, 186 males and 295 females); Sample 2 (n = 492, mean age = 20.27, 243 males and 249 females); and Sample 3 (n = 94, mean age = 22.68, 35 males and 58 females). We combined Samples 1 and 2 (n = 973, mean age = 21.66, 429 males and 544 females), and then created 2 subsamples to ensure the mutual independence of the samples used for two different factor analyses: subsample 1 (n = 486, mean age = 21.86, 199 male and 287 female) for exploratory factor analysis and subsample 2 (n = 487, mean age = 21.40, 230 male and 257 female) for confirmatory factor analysis. We examined test-retest reliability using Sample 3, and construct validity using Samples 1, 2, and the combined sample. Exploratory and confirmatory factor analyses revealed that the item-factor structure of the Japanese Disgust Propensity and Sensitivity Scale-Revised was identical to the English version. Moreover, the scale showed good internal consistency, test-retest reliability, and construct validity for empirical support as provided by correlational analyses. Results revealed adequate psychometric properties of the scale. This study provided the first examples of empirical support for the DPSS-R-J.
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Widen SC, Olatunji BO. A Developmental Perspective on Disgust: Implications for Obsessive-Compulsive Disorder. Curr Behav Neurosci Rep 2016. [DOI: 10.1007/s40473-016-0087-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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39
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Duncko R, Veale D. Changes in disgust and heart rate during exposure for Obsessive Compulsive Disorder: A case series. J Behav Ther Exp Psychiatry 2016; 51:92-9. [PMID: 26803230 DOI: 10.1016/j.jbtep.2016.01.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2015] [Revised: 11/26/2015] [Accepted: 01/10/2016] [Indexed: 01/21/2023]
Abstract
BACKGROUND AND OBJECTIVES The emotion of disgust has been suggested as a factor contributing to a poor response to Cognitive Behaviour Therapy (CBT) in the treatment of Obsessive Compulsive Disorder (OCD). However, only limited information is available about the phenomenology of disgust in clinical OCD and the physiological mechanisms involved. This case series was designed to explore the phenomenology of OCD and the physiological activity associated with the emotion of disgust. METHODS State disgust and heart rate was measured in eleven participants attending treatment for OCD during exposure relevant to their individual formulation. RESULTS All participants with contamination and most patients with blood and injury related fears experienced a prominent increase in state disgust during exposure. These participants also had absent heart rate acceleration during exposure. Disgust response correlated with heart rate response (r = -0.63, p < 0.01) and Root Mean Square of Successive Differences (RMSSD) (r = 0.52, p < 0.01). LIMITATIONS The design using ecologically valid stimuli and the limited number of participants did not allow between subject comparisons or more detailed analysis of relationship between trait and state disgust and between disgust and severity of OCD. CONCLUSIONS Our findings show that a large proportion of our case series with OCD experience prominent disgust with signs of increased vagal tonus during their exposure. Such experiences differ from the concept of adrenergic activation used for psychoeducation in CBT and appraisals of harm and this may result in poorer therapeutic outcome.
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Affiliation(s)
- Roman Duncko
- South London and Maudsley NHS Foundation Trust, UK; Institute of Psychiatry, Psychology and Neuroscience, Kings College London, UK.
| | - David Veale
- South London and Maudsley NHS Foundation Trust, UK; Institute of Psychiatry, Psychology and Neuroscience, Kings College London, UK
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Wood J, Ahmari SE. A Framework for Understanding the Emerging Role of Corticolimbic-Ventral Striatal Networks in OCD-Associated Repetitive Behaviors. Front Syst Neurosci 2015; 9:171. [PMID: 26733823 PMCID: PMC4681810 DOI: 10.3389/fnsys.2015.00171] [Citation(s) in RCA: 57] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2015] [Accepted: 11/23/2015] [Indexed: 11/13/2022] Open
Abstract
Significant interest in the mechanistic underpinnings of obsessive-compulsive disorder (OCD) has fueled research on the neural origins of compulsive behaviors. Converging clinical and preclinical evidence suggests that abnormal repetitive behaviors are driven by dysfunction in cortico-striatal-thalamic-cortical (CSTC) circuits. These findings suggest that compulsive behaviors arise, in part, from aberrant communication between lateral orbitofrontal cortex (OFC) and dorsal striatum. An important body of work focused on the role of this network in OCD has been instrumental to progress in the field. Disease models focused primarily on these regions, however, fail to capture an important aspect of the disorder: affective dysregulation. High levels of anxiety are extremely prevalent in OCD, as is comorbidity with major depressive disorder. Furthermore, deficits in processing rewards and abnormalities in processing emotional stimuli are suggestive of aberrant encoding of affective information. Accordingly, OCD can be partially characterized as a disease in which behavioral selection is corrupted by exaggerated or dysregulated emotional states. This suggests that the networks producing OCD symptoms likely expand beyond traditional lateral OFC and dorsal striatum circuit models, and highlights the need to cast a wider net in our investigation of the circuits involved in generating and sustaining OCD symptoms. Here, we address the emerging role of medial OFC, amygdala, and ventral tegmental area projections to the ventral striatum (VS) in OCD pathophysiology. The VS receives strong innervation from these affect and reward processing regions, and is therefore poised to integrate information crucial to the generation of compulsive behaviors. Though it complements functions of dorsal striatum and lateral OFC, this corticolimbic-VS network is less commonly explored as a potential source of the pathology underlying OCD. In this review, we discuss this network's potential role as a locus of OCD pathology and effective treatment.
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Affiliation(s)
- Jesse Wood
- Translational Neuroscience Program, Department of Psychiatry, University of PittsburghPittsburgh, PA, USA
- Center for Neuroscience, University of PittsburghPittsburgh, PA, USA
| | - Susanne E. Ahmari
- Translational Neuroscience Program, Department of Psychiatry, University of PittsburghPittsburgh, PA, USA
- Center for Neuroscience, University of PittsburghPittsburgh, PA, USA
- Center for the Neural Basis of Cognition, University of PittsburghPittsburgh, PA, USA
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