Obsessions and compulsions in the lab: A meta-analysis of procedures to induce symptoms of obsessive-compulsive disorder

Conceptual-level disgust conditioning in contamination-based obsessive-compulsive disorder

Pavlovian fear conditioning and extinction represent learning mechanisms underlying exposure-based interventions. While increasing evidence indicates a pivotal role of disgust in the development of contamination-based obsessive-compulsive disorder (C-OCD), dysregulations in conditioned disgust acquisition and maintenance, in particular driven by higher-order conceptual processes, have not been examined. Here, we address this gap by exposing individuals with high (HCC, n = 41) or low (LCC, n = 41) contamination concern to a conceptual-level disgust conditioning and extinction paradigm. Conditioned stimuli (CS+) were images from one conceptual category partially reinforced by unconditioned disgust-eliciting stimuli (US), while images from another category served as non-reinforced conditioned stimuli (CS-). Skin conductance responses (SCRs), US expectancy and CS valence ratings served as primary outcomes to quantify conditioned disgust responses. Relative to LCC, HCC individuals exhibited increased US expectancy and CS+ disgust experience, but comparable SCR levels following disgust acquisition. Despite a decrease in conditioned responses from the acquisition phase to the extinction phase, both groups did not fully extinguish the learned disgust. Importantly, the extinction resilience of acquired disgust was more pronounced in HCC individuals. Together, our findings suggest that individuals with high self-reported contamination concern exhibit increased disgust acquisition and resistance to extinction. The findings provide preliminary evidence on how dysregulated disgust learning mechanism across semantically related concepts may contribute to C-OCD.

Symptom provocation in obsessive-compulsive disorder: Validation of the Braga Obsessive Compulsive image set (BOCIS)

Symptom provocation paradigms are paramount to understand a heterogeneous disorder as obsessive-compulsive disorder (OCD). The main aim of our work was to develop and validate an open-access set of OCD-related images comprising three main subtypes: washing, checking, and symmetry. Twenty-six OCD patients and 25 controls provided valence and arousal ratings for a set of OCD-related, aversive, and neutral images. Linear mixed model analyses were used to estimate the main effects of group, image category, and group-image category interaction in image ratings. All main effects were found to be significant for both arousal and valence ratings, except for the group in arousal ratings. Path analysis confirmed our hypothesis that the OCI-R subscales influenced the subjective ratings of the corresponding image categories, particularly among patients. Independent samples t-tests were performed for each OCD picture to compose the set. Arousal demonstrated a greater capacity to distinguish controls and patients, thus sustaining our choice of using these ratings for the final Braga Obsessive-Compulsive Image Set (BOCIS). Our study demonstrated that the stimuli of the BOCIS reliably portray OCD-like triggers for washing, checking and symmetry subtypes. Its open-access availability will facilitate significant progress in both clinical and research settings.

Effects of acceptance-based strategies on psychological responses to disorder-relevant stimuli in inpatients with obsessive-compulsive disorder: An experimental study

BACKGROUND AND OBJECTIVES

Preliminary findings suggest that acceptance and commitment therapy-informed exposure therapy may be an effective treatment for obsessive-compulsive disorder (OCD). However, there is a lack of experimental studies that have examined immediate effects of acceptance-based strategies during exposure to disorder-relevant stimuli in persons with OCD.

METHODS

Fifty-three inpatients (64% female) with OCD participated in an experimental study during which they were exposed to obsessive-compulsive washing-relevant pictures and were instructed to either passively view these pictures for 5 s (neutral condition), to accept their feelings (acceptance condition) or to intensify their feelings (exposure condition) for 90 s each.

RESULTS

The acceptance condition led to higher acceptance and lower unpleasantness of patients' current feelings compared to the neutral condition and to lower strength of obsessions and urge to perform compulsions but only when compared to the exposure condition. Higher self-reported OCD symptom severity related to higher unpleasantness and strength of obsessions, particularly in the neutral condition.

LIMITATIONS

Future studies need to test whether the current findings translate to other stimuli and other forms of obsessions and compulsions. Due to the short duration, the exposure condition might have only mimicked the early phase of exposure and response prevention.

CONCLUSIONS

Acceptance-based strategies during cue exposure immediately increase acceptance of and reduce unpleasant feelings. In line with the rationale of acceptance-based treatment approaches, which do not aim at immediate disorder-specific symptom reductions, effects on obsessions and compulsions may be more delayed or require repeated training sessions.

An Experimental Investigation of Moral Self-Violation and Mental Contamination

Purpose

Cognitive models of mental contamination (feelings of dirtiness/washing behaviour that arise without direct contact with a contaminant) highlight the central role of perceptions of violation in the onset and maintenance of these feelings. Little research has been done to clarify violation-specific appraisals relevant to mental contamination. Perceptions of violation of one's moral self-concept may represent one such appraisal domain. This experiment aimed to examine the impact of these appraisals on feelings of mental contamination.

Methods

One hundred and fifty participants received false feedback that they scored high on a morality subscale of a bogus personality test. They then completed a writing task wherein their degree of moral self-violation was manipulated. They received a writing prompt corresponding to one of three randomly assigned conditions (violated self (VS), bolstered self (BS), general negative (GN)). Finally, participants completed measures of mental contamination.

Results

The manipulation was effective at violating participants' moral self-concept. Those in the VS condition reported significantly higher levels of feelings of mental contamination than those in the BS or GN conditions. There were no significant differences between conditions regarding urges to wash.

Conclusions

Findings highlight the relevance of moral self-violation in the understanding and treatment of mental contamination.

[Paranormal Experience and Mental Disorders]

Paranormal experiences such as superstition, perception of the supernatural and magical thinking have accompanied human history into the so-called modern world and play a major role in developmental psychology. Yet this area has remained unclear in its terminology, in its phenomenal scope, but also in its relation to reality in literature and everyday practice. The attempt is here undertaken clarify the significance of paranormal experience on a theoretical level in the sense of a "unsure experience of reality", but also to present its importance for diagnostics and therapy of psychiatric conditions in the context of e. g., psychotic, dissociative or OCD-related symptomatology.

Exam-related unwanted intrusive thoughts and related neutralizing behaviors: Analogues to obsessions and compulsions

Exam-related unwanted intrusive thoughts (UITs) and related neutralizing behaviors are common experiences among students. The present study investigated in what ways these UITs and behaviors are analogues to clinical obsessions and compulsions. Twenty-nine students completed three ecological momentary assessment surveys per day over 7 consecutive days, assessing the severity of exam-related UITs and related neutralizing behaviors, obsessive-compulsive (OC) symptoms, anxiety, distress, urge to neutralize, depressed mood, and stress in the week immediately before an exam period. Multilevel analysis demonstrated that the severity of exam-related UITs and related neutralizing behaviors was positively associated with OC symptoms, anxiety, distress, urge to neutralize, and stress but was not related to depressed mood. During the study period, the exam-related UITs occurred on average 7 times, and the related neutralizing behaviors on average 6 times. Overall, they were experienced with mild severity, low distress, and low urge to neutralize. Findings indicate that some aspects of exam-related UITs and related neutralizing behaviors (e.g., association with distress and urge to neutralize) might be analogous to OC symptoms but not all (e.g., no relation to depressed mood). We discuss how research on obsessive-compulsive disorder could benefit from considering exam-related UITs and related behaviors.

Just let me check: The role of individual differences in self-reported anxiety and obsessive-compulsive features on subjective, behavioural, and physiological indices during a checking task

Checking behaviour has been described as a form of preventative behaviour used by an individual to establish control over the environment and avoid future misfortune. However, when compulsive, checking behaviours can become disabling and distressing and have been linked to the maintenance of anxiety and obsessive-compulsive disorders. Despite this, there is limited literature across the field that has assessed the impact of dimensional measures of anxiety and obsessive-compulsive features (i.e., negative affect, uncertainty, and perfectionism) in driving checking behaviour. As such, the present study examined the impact of individual differences in self-reported anxiety and obsessive-compulsive features on subjective, behavioural, and physiological indices during a visual discrimination and checking task (n = 87). Higher self-reported anxiety and obsessive-compulsive features were associated with higher subjective ratings of unpleasantness and the urge to check during the task. Moreover, higher self-reported anxiety and obsessive-compulsive features related to general negative affect, uncertainty, and perfectionism were associated with greater checking frequency during the task. Lastly, stronger obsessional beliefs about perfectionism and the need for certainty were found to predict poorer accuracy, slower reaction times, and higher engagement of the corrugator supercilii during the task. In sum, these findings demonstrate how different anxiety and obsessive-compulsive features, in particular perfectionism and the need for certainty, may relate to and maintain checking behaviour in low threat contexts, which likely has implications for models of excessive and persistent checking in anxiety and obsessive-compulsive disorders.

The Role of Magical Thinking, Sensitivity, and Thought Content in Thought-Action Fusion

Introduction: Cognitive models of obsessive-compulsive disorder (OCD) posit that maladaptive beliefs about intrusive thinking contribute to the disorder's development and maintenance. However, the findings concerning one notable belief, thought-action fusion (TAF), have been inconsistent. Current conceptualizations of TAF may conflate constructs such as magical thinking, sensitivity, and thought content that are already the subject of informative, interdisciplinary literatures. Methods: To tease apart these constructs, adult participants (N = 249) reported their trait levels of sensitivity and magical thinking, and were randomly assigned to engage with an intrusive thought in one of three content areas. We hypothesized that morality-related content would lead to heightened maladaptive outcomes, but only in combination with higher trait levels of sensitivity and magical thinking. Results: Results indicated that morality-related content, along with sensitivity to morality, played more of a prominent role in maladaptive outcomes, with magical thinking being implicated in general outcomes like worry. Discussion: These findings suggest that the link between TAF and maladaptive outcomes may depend on which TAF elements are present for an individual. Sensitivity, in tandem with other TAF elements (e.g., morality-related content, magical thinking) is predictive of divergent outcomes (e.g., worrying, urges to neutralize) and thus may be an important target of future interventions aimed at reducing TAF, worrying, and/or OC symptoms.

Symptom provocation in obsessive-compulsive disorder: A voxel-based meta-analysis and meta-analytic connectivity modeling

BACKGROUND

Obsessive-compulsive disorder (OCD) is a heterogeneous psychiatric illness with a complex array of symptoms and potentially distinct neural underpinnings. We employed meta-analysis and connectivity modeling of symptom dimensions to delineate the circuit mechanisms of OCD.

METHODS

With the activation likelihood estimation (ALE) algorithm we performed meta-analysis of whole-brain functional magnetic resonance imaging (fMRI) studies of symptom provocation. We contrasted all OCD patients and controls in a primary analysis and divided the studies according to clinical symptoms in secondary meta-analyses. Finally, we employed meta-analytic connectivity modeling analyses (MACMs) to examine co-activation patterns of the brain regions revealed in the primary meta-analysis.

RESULTS

A total of 14 experiments from 12 eligible studies with a total of 238 OCD patients (124 men) and 219 healthy controls (120 men) were included in the primary analysis. OCD patients showed higher activation in the right caudate body/putamen/insula and lower activation in the left orbitofrontal cortex (OFC), left inferior frontal gyrus (IFG), left caudate body/middle cingulate cortex (MCC), right middle temporal gyrus (MTG), middle occipital gyrus (MOG) and right lateral occipital gyrus (LOG). MACMs revealed significant co-activation between left IFG and left caudate body/MCC, left MOG and right LOG, right LOG and MTG. In the secondary meta-analyses, the washing subgroup showed higher activation in the right OFC, bilateral ACC, left MOG and right caudate body.

CONCLUSION

OCD patients showed elevated dorsal striatal activation during symptom provocation. In contrast, the washing subgroup engaged higher activation in frontal, temporal and posterior cortical structures as well as right caudate body. Broadly consistent with the proposition of cortico-striatal-thalamic-cortical circuit dysfunction, these findings highlight potentially distinct neural circuits that may underlie the symptoms and potentially etiological subtypes of OCD.

Symptom provocation for treatment of obsessive-compulsive disorder using transcranial magnetic stimulation: A step-by-step guide for professional training

Transcranial Magnetic Stimulation (TMS) is a non-invasive brain stimulation technique that was cleared by the Food and Drug Administration (FDA) for the treatment of Obsessive-Compulsive Disorder (OCD) in 2018. The approved protocol includes individualized symptom provocation before each stimulation session, to elicit a moderate level of obsessional distress. Although symptom provocation can be a delicate, demanding, and uncomfortable procedure, structured training methods for those who are going to apply it are not available. Here, we describe a model for training in symptom provocation for TMS technicians, developed at the Champalimaud Clinical Centre in Lisbon, Portugal. Our programme includes two-sessions dedicated to clinical communication and symptom provocation techniques from a theoretical and practical perspective. Additionally, supervision meetings are conducted during treatment of patients, allowing regular case discussion and redefinition of symptom provocation hierarchy, as needed. In addition to having a strong practical component, our training program is short and pragmatic, allowing for easy implementation and fluid transition to clinical practice. By sharing our experience, we hope to contribute to systematize training procedures required for symptom provocation in the context of TMS, and to qualitatively describe a methodology that can be used for implementation of TMS programmes for the treatment of OCD.

Stopping a Response When You Really Care about the Action: Considerations from a Clinical Perspective

Response inhibition, whether reactive or proactive, is mostly investigated in a narrow cognitive framework. We argue that it be viewed within a broader frame than the action being inhibited, i.e., in the context of emotion and motivation of the individual at large. This is particularly important in the clinical domain, where the motivational strength of an action can be driven by threat avoidance or reward seeking. The cognitive response inhibition literature has focused on stopping reactively with responses in anticipation of clearly delineated external signals, or proactively in limited contexts, largely independent of clinical phenomena. Moreover, the focus has often been on stopping efficiency and its correlates rather than on inhibition failures. Currently, the cognitive and clinical perspectives are incommensurable. A broader context may explain the apparent paradox where individuals with disorders characterised by maladaptive action control have difficulty inhibiting their actions only in specific circumstances. Using Obsessive Compulsive Disorder as a case study, clinical theorising has focused largely on compulsions as failures of inhibition in relation to specific internal or external triggers. We propose that the concept of action tendencies may constitute a useful common denominator bridging research into motor, emotional, motivational, and contextual aspects of action control failure. The success of action control may depend on the interaction between the strength of action tendencies, the ability to withhold urges, and contextual factors.

"Was I asking for it?": An experimental investigation of perceived responsibility, mental contamination and workplace sexual harassment

BACKGROUND AND OBJECTIVES

Mental contamination (i.e., contamination concerns that arise in the absence of direct contact with a contaminant) is a common symptom in obsessive-compulsive disorder (OCD). Cognitive theories suggest that it results from individuals' misinterpretations of perceived violations. Cognitive theories of OCD also highlight the importance of appraisals of inflated responsibility in the maintenance of other OCD symptoms. However, the role of responsibility in mental contamination has not yet been examined experimentally. The present study examined the role of perceived responsibility and violation in the relationship between workplace sexual harassment imagery and subsequent mental contamination.

METHODS

One hundred and forty-nine participants listened to a workplace sexual harassment imagery task, wherein responsibility was manipulated. Participants were randomly assigned to one of three conditions (high responsibility (HR), low responsibility (LR), no responsibility (NR)). Participants completed questionnaires assessing mental contamination and completed a hand washing task.

RESULTS

Those in the NR condition reported significantly lower levels of responsibility than those in the LR or HR conditions. Accordingly, those in the NR condition also reported significantly lower levels of anxiety and dirtiness than in the LR condition. There were no significant differences between the LR and HR condition on variables of interest.

LIMITATIONS

The nature of the victim blaming used for the responsibility induction may have elicited compensatory responses from participants.

CONCLUSIONS

Findings may highlight the central role of perceptions of violation in the understanding and treatment of mental contamination.

Gazing rituals in body dysmorphic disorder

BACKGROUND AND OBJECTIVES

Gazing rituals and selective attention to perceived flaws during gazing are considered as maintaining factors in cognitive-behavioral models for body dysmorphic disorder (BDD). This study investigated different durations of BDD-like gazing at different facial stimuli (an unfamiliar face, the participant's own face, and the participant's own reflection in the mirror) with regard to effects on dissociation, attractiveness evaluations and perceptual uncertainty. The aim of this study was to examine the hypothesized causal effects of gazing rituals on appearance preoccupation.

METHODS

We asked 115 females to complete a face gazing paradigm with three different facial stimuli and, depending on the condition, different gazing durations. We also examined the influence of BDD symptom severity on the reactions to different facial stimuli.

RESULTS

Five minutes of gazing significantly increased dissociation. Participants rated the attractiveness of self-relevant stimuli, especially the own photographed face, below average and lower than the unfamiliar face.

LIMITATIONS

Limitations with regard to sample characteristics and experimental design are discussed.

CONCLUSIONS

Our findings support cognitive-behavioral models for BDD and indicate that therapists may extend therapeutic interventions like mirror retraining by specific perceptual retraining with photographs of the patients.

Examining the functional activity of different obsessive-compulsive symptom dimensions in Tourette syndrome

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Patients with Tourette Syndrome completed an obsessive–compulsive provocation task.

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Patients reported higher anxiety for the provocation conditions than did controls.

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Group differences found in the insula, sensorimotor cortex and supramarginal gyri.

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Obsessive–compulsive severity associated with frontal and parietal lobe activity.

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Tic severity associated with anterior cingulate activity for the symmetry condition.

Objectives

Tourette syndrome (TS) is commonly comorbid with obsessive–compulsive disorder (OCD) and many phenomenological similarities exist between tics and obsessive–compulsive symptoms (OCS). Therefore, due to the clinical importance of comorbid OCD, the goal of this study was to investigate the neural substrates of OCS in TS using functional magnetic resonance imaging.

Methods

Forty patients with TS and 20 healthy controls underwent functional magnetic resonance imaging while viewing blocks of OCS-provoking pictures relating to washing, checking and symmetry symptoms, as well as generally disgusting and neutral scenes. Statistical comparisons were made between patients with moderate/severe OCS, absent/mild OCS and healthy controls. As well, within the entire TS patient group, significant associations with clinical measures were assessed for each of the provocation conditions.

Results

Group differences in the insula, sensorimotor cortex, supramarginal gyrus and visual processing regions were common among the checking, washing and disgust conditions. In the patient group, negative associations between OCS severity and activity in the supramarginal gyrus, inferior frontal gyrus, sensorimotor cortex, precuneus and visual processing regions were common among the provocation conditions. Tic severity was only associated with activity in the anterior cingulate cortex for the symmetry condition.

Conclusion

Our findings implicate areas previously reported to be involved in OCD, as well as areas not typically implicated in OCD, suggesting that the neurobiological profile of TS+OCD is intermediate to pure TS and pure OCD.

Why check? A meta-analysis of checking in obsessive-compulsive disorder: Threat vs. distrust of senses

Compulsive checking is the most common ritual among individuals with obsessive-compulsive disorder (OCD). Yet, other than uncertainty, the variables prompting checking are not fully understood. Laboratory studies suggest that task conditions - whether threatening (anxiety-relevant) or neutral, and task type - whether requiring perceptual or reasoning decision-making - may be influential. The purpose of our meta-analysis was to compare OCD participants and healthy controls on experimental tasks involving uncertainty in which a behavioral measure of checking was obtained. Four databases were searched. Twenty-two studies met the inclusion criteria, including 43 conditions comparing 663 OCD participants to 614 healthy controls. Due to the dependent structure of the data a robust variance estimation analysis approach was used. Overall effects were similar for neutral and threatening conditions. However, OCD participants responded with greater checking compared to controls on perceptual tasks, but not on reasoning tasks. Results support previous reports suggesting that OCD checking can be observed in neutral conditions, possibly posing as a risk factor for a checking vicious cycle. In addition, our results support OCD models which focus on checking as stemming from interference with automatic processes and distrust of sensory modalities.

A Method to Provoke Obsessive Compulsive Symptoms for Basic Research and Clinical Interventions

The efficacy of deep repetitive transcranial magnetic stimulation (dTMS) for obsessive compulsive disorder (OCD) was recently confirmed in a Food and Drug Administration-regulated, multicenter, sham-controlled study. In this study, patients who failed pharmacotherapy underwent individually tailored provocations just prior to each stimulation session, in the attempt to activate the relevant circuitry and making it labile to change. The procedure that was developed reliably evoked moderate intensity symptoms, making it effective on the one hand and mild enough to allow the patient to continue with the dTMS session on the other. This methodology article describes in a detailed step wise fashion how to evaluate the patient's specific symptoms and design the individualized provocations. Additionally, the article explains how to instruct relevant personnel to administer the provocations, gauge their efficacy, and overcome possible obstacles. This method, apart from its ongoing role in the clinical treatment of OCD by dTMS, may be used for provocation of symptoms in basic studies [e.g., imaging with Electroencephalogram (EEG) or Functional magnetic resonance imaging fMRI] as well as other treatments.

Modelling OCD: a test of the inflated responsibility model

BACKGROUND

The Salkovskis (1999) model of obsessive compulsive disorder (OCD), which emphasizes the role of inflated responsibility, has proven highly influential in both the understanding and treatment of OCD.

AIMS

This study aimed to empirically test several core processes of this model.

METHOD

The individual components of the model were measured using multiple indicators in a sample of undergraduate students (n = 170), and confirmatory factor analyses were used to ascertain the most reliable, valid and theoretically consistent latent variables. Structural equation modelling was used to test proposed relations between latent constructs in the model.

RESULTS

The inflated responsibility model was a good fit for the data in the present sample. As predicted by the model, misinterpretations of intrusive thoughts as indicating personal responsibility fully mediated the relationships between responsibility beliefs and counterproductive safety strategies, neutralizing actions and mood changes.

CONCLUSIONS

The Salkovksis (1999) inflated responsibility model of OCD is empirically supported in the present sample of undergraduate students, lending support to the proposed mechanisms in the model and supporting prior evidence.

Mental Imagery and Brain Regulation-New Links Between Psychotherapy and Neuroscience

Mental imagery is a promising tool and mechanism of psychological interventions, particularly for mood and anxiety disorders. In parallel developments, neuromodulation techniques have shown promise as add-on therapies in psychiatry, particularly non-invasive brain stimulation for depression. However, these techniques have not yet been combined in a systematic manner. One novel technology that may be able to achieve this is neurofeedback, which entails the self-regulation of activation in specific brain areas or networks (or the self-modulation of distributed activation patterns) by the patients themselves, through real-time feedback of brain activation (for example, from functional magnetic resonance imaging). One of the key mechanisms by which patients learn such self-regulation is mental imagery. Here, we will first review the main mental imagery approaches in psychotherapy and the implicated brain networks. We will then discuss how these networks can be targeted with neuromodulation (neurofeedback or non-invasive or invasive brain stimulation). We will review the clinical evidence for neurofeedback and discuss possible ways of enhancing it through systematic combination with psychological interventions, with a focus on depression, anxiety disorders, and addiction. The overarching aim of this perspective paper will be to open a debate on new ways of developing neuropsychotherapies.

Neural correlates of symptom provocation in pediatric obsessive-compulsive disorder

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Largest controlled pediatric OCD symptom provocation study.

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Novel standardized symptom provocation picture set for pediatric OCD.

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Behavioral group differences strongest for ‘Just Right’ factor.

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Temporal pole recruited by OCD group.

Obsessive-compulsive disorder

(OCD)-affected adults and children exhibit three to four symptom dimensions with distinct but overlapping neural correlates. No symptom provocation behavioural or imaging study has examined all symptom dimensions in a pediatric OCD sample.

Method

Clinically diagnosed pediatric OCD-affected participants (n = 25) as well as age, gender and Tanner pubertal stage-matched healthy controls (HCs; n = 24) (total sample: mean age = 14.77 ± 2.93 years; age range = 9–18 years; 35% male) viewed alternating blocks of OCD symptom provocation (Contamination, Bad Thoughts, and Just Right symptom dimensions), Fear, Neutral and Rest (i.e. fixation) conditions during functional magnetic resonance imaging. A region-of-interest analysis used seeds based upon results of an adult OCD meta-analysis

Results

OCD participants found OCD symptom-related stimuli bothersome, particularly when compared to controls in the “Just Right” symptom dimension. Pediatric OCD patients exhibited greater recruitment of the left superior temporal gyrus (STG) than healthy controls during combined symptom provocation versus neutral conditions.

Conclusion

Findings suggest involvement of the temporal poles rather than in classic cortico-striatal-thalamico-cortical circuits in pediatric OCD during symptom provocation.

Gazing at facial features increases dissociation and decreases attractiveness ratings in non-clinical females - A potential explanation for a common ritual in body dysmorphic disorder

Rituals, such as gazing at faces, are common in body dysmorphic disorder (BDD) and appear in cognitive-behavioral models as a maintaining factor. Rituals are also common in obsessive-compulsive disorder (OCD). In contrast to OCD, the proposed associations between rituals and intrusive thoughts/appearance preoccupation have not been empirically investigated for BDD. We examined if the assumed effect of gazing rituals on attractiveness ratings exists and if it is associated with dissociation. In an experiment, we asked N = 65 non-clinical females to focus on the nose of a photographed face at pre- and post-test. In between, participants gazed at the nose of either the same (relevant gazing) or another face (irrelevant gazing). We found increasing dissociation after gazing in both conditions and a differentially stronger decrease of attractiveness ratings in the relevant gazing condition. Our findings support the hypothesized effect of gazing rituals on attractiveness evaluation in cognitive-behavioral models for BDD.

Effects of induced appearance-related interpretation bias: A test of the cognitive-behavioral model of body dysmorphic disorder

BACKGROUND AND OBJECTIVES

Interpretation biases are hypothesized to maintain body dysmorphic disorder (BDD). Although their existence and malleability have been investigated in clinical studies, their causal status in the maintenance of BDD remains unclear. This study examined the effects of a single-session appearance-related interpretation bias training (CBM-I) on bias indices and stress reactivity (i.e., distress, appearance dissatisfaction, self-esteem, perceived physical attractiveness), exploring the causality predicted in cognitive-behavioral models.

METHODS

We used a modified version of the Word Sentence Association Paradigm (WSAP), assessing explicit (i.e., decision rates) and more implicit interpretation bias components (i.e., reaction times). Mentally healthy students (N = 112) were randomized to training conditions enhancing positive interpretation patterns (PT) vs. negative interpretation patterns (NT) vs. a no-feedback control condition (CC). Stress reactivity was assessed during the Cyberball Paradigm.

RESULTS

The PT showed a pre-post increase in adaptive bias patterns regarding decision and a differential pre-post decrease in reaction times for the rejection of negative interpretations, compared to the other groups. There were no condition-congruent post-training differences in stress reactivity. However, residual interpretation bias change was significantly correlated with state distress, self-esteem and appearance dissatisfaction during stressor exposure.

LIMITATIONS

Limitations pertaining to sample characteristics, training and assessment overlap, and stressor task design are discussed.

CONCLUSIONS

Findings suggest that appearance-related interpretation bias is modifiable both explicitly and more implicitly via CBM-I in a mentally healthy sample. The causal status of interpretation bias in BDD maintenance warrants further investigation.

Can selective attention and inhibition (interactively) predict future obsessive compulsive symptoms? A prospective study

BACKGROUND AND OBJECTIVES

The current study set out to investigate whether obsessive beliefs, selective attention, inhibition, and the interaction between selective attention and inhibition can prospectively predict contamination obsessive compulsive (OC) symptoms.

METHODS

Obsessive beliefs, inhibition, and selective attention were assessed in a student sample (n = 89) during a baseline session in the beginning of the first semester. Their predictive value was examined by assessing symptoms after an OC symptom induction in the lab and by assessing OC symptoms during a period of increased stress (the examination period) 68-80 days after baseline.

RESULTS

Results showed that obsessive beliefs did not consistently predict OC symptoms and there was no predictive effect of attentional bias, attentional bias variability, and inhibition in isolation. However, attentional bias variability and inhibition in the context of contamination-related stimuli interacted, in which only the combination of poor inhibition and large attentional bias variability predicted contamination OC symptoms during the examination period.

LIMITATIONS

Future research should investigate whether similar results are found in clinical populations, as the current sample consisted of a convenience sample of undergraduate students.

CONCLUSION

These results support the notion that information processing biases interact in predicting contamination OC symptoms.

Metacognitive Beliefs Predict Greater Mental Contamination Severity After an Evoking Source

Mental contamination occurs when individuals experience feelings of internal dirtiness and distress in the absence of physical contact with a contaminant. Women who experience sexual trauma frequently report mental contamination. The self-regulatory executive function (S-REF) model proposes that metacognitive beliefs contribute to the appraisal and regulation of thinking, leading to expectations that metacognitive beliefs would predict greater mental contamination severity following an evoking source. Women who reported directly experiencing sexual trauma (N = 102) completed self-report measures of metacognitive beliefs and covariates during an online study session, and subsequently completed a task that evoked mental contamination during a follow-up in-person study session. Metacognitive beliefs surrounding the uncontrollability and danger of thoughts, cognitive confidence, and the need to control thoughts positively correlated with mental contamination severity following the evoking source. Metacognitive beliefs surrounding the uncontrollability and danger of thoughts predicted greater mental contamination severity following the evoking source in multivariate analyses that statistically controlled for baseline mental contamination severity, trait anxiety, and overlap among the metacognitive beliefs. The present results provide preliminary support for the S-REF model as a potential framework for conceptualizing mental contamination.

Free operant observing in humans: a translational approach to compulsive certainty seeking

Excessive checking is reported in non-clinical populations and is a pervasive symptom in obsessive compulsive disorder (OCD). We implemented a free-operant task in humans, previously used in rats, wherein participants can "check" to reduce uncertainty. Participants can press an observing key to ascertain which of two main keys will, if pressed, currently lead to rewards. Over a series of experiments, we found that punishment robustly increased observing in non-clinical participants and that observing persisted long after punishment was removed. Moreover, participants appeared insensitive to the initial costs of checking, and a threefold increase in the effort required to observe served to deter participants only to a limited degree. We also assessed observing in OCD patients with no known comorbidities. The patients observed more than control participants and were abnormally insensitive to the introduction of punishment. These findings support the translational value of the task, with similar behaviours in humans and rodents. This paradigm may serve as a unifying platform, promoting interaction between different approaches to analyse adaptive and maladaptive certainty seeking behaviours. Specifically, we demonstrate how seemingly disparate theoretical and empirical approaches can be reconciled synergistically to promote a combined behavioural and cognitive account of certainty seeking.

Aripiprazole as an adjuvant treatment for obsessive and compulsive symptoms in manic phase of bipolar disorder: A randomized, double-blind, placebo-controlled clinical trial

BACKGROUND AND OBJECTIVE

Our Objective is to study the effects of aripiprazole as an adjuvant treatment for obsessive and compulsive (OC) symptoms in patients with bipolar disorder (BD) type I, manic phase.

PATIENTS AND METHODS

In this 8-week, double-blind, placebo-controlled randomized clinical trial, 56 patients with BD who had OC symptoms were randomly allocated to receive aripiprazole or placebo plus their routine medication regimen (lithium + clonazepam). Yale Brown obsessive compulsive behavior scale (YBOCS) was administered to evaluate the outcomes. Adverse effects were also registered.

RESULTS

Of 56 BD patients with OC symptoms which were randomly allocated in two groups of aripiprazole (n = 29) and placebo group (n = 27), 46 patients (23 in aripiprazole group and 23 in placebo group) completed the trial. Throughout the trial, the mean score of YBOCS in the aripiprazole group decreased from 21 ± 4.81 to 9.6 ± 2.2 (P < 0.001) and in the placebo group dropped from 20.46 ± 4.8 to 17.32 ± 3.7 (P < 0.001). At the end of the study, 21 (91.30%) patients in the aripiprazole group and 1 (4.34%) patient in the placebo group had >34% decline in YBOCS score (P < 0.01). No serious adverse effects were reported in any groups.

CONCLUSIONS

The results of our study revealed that aripiprazole can be used as an effective adjuvant agent for treatment of obsessive and compulsive symptoms in manic patients.

Tolerance of negative emotion moderates the amplification of mental contamination following an evoking task: A randomized experimental study

BACKGROUND AND OBJECTIVES

Contamination is a near universal feeling, with mental contamination representing a contamination feeling in the absence of direct physical contact with a source. Extant research indicates that tolerance of negative emotion is important for understanding emotional reactions to images, thoughts, and memories, all of which are common sources of mental contamination. Extending research linking distress tolerance to mental contamination, this study examined if individual differences in the tolerance of negative emotion moderates the amplification of mental contamination following an evoking task.

METHOD

Unselected participants completed a self-report measure of tolerance of negative emotion during an online session. They later attended an in-person session and were randomized to an experimental scenario group: betrayal (n = 49) or control (n = 49). Participants imagined themselves in a scenario, with the betrayal scenario designed to evoke mental contamination. Mental contamination was assessed by self-report before and after the scenario.

RESULTS

The betrayal, but not control, scenario caused an increase in mental contamination. Tolerance for negative emotion moderated the effect of group on mental contamination. Group differences in mental contamination evidenced at low, but not high, distress tolerance.

LIMITATIONS

A novel experimental manipulation and an unselected sample were used. Future research could assess tolerance of negative emotion using a behavioral task.

CONCLUSIONS

These results indicate that tolerance of negative emotion may be important for understanding when individuals experience mental contamination.

Emotional Processing in Obsessive-Compulsive Disorder: A Systematic Review and Meta-analysis of 25 Functional Neuroimaging Studies

BACKGROUND

Patients with obsessive-compulsive disorder (OCD) experience aversive emotions in response to obsessions, motivating avoidance and compulsive behaviors. However, there is considerable ambiguity regarding the brain circuitry involved in emotional processing in OCD, especially whether activation is altered in the amygdala.

METHODS

We conducted a systematic literature review and performed a meta-analysis-seed-based d mapping-of 25 whole-brain neuroimaging studies (including 571 patients and 564 healthy control subjects) using functional magnetic resonance imaging or positron emission tomography, comparing brain activation of patients with OCD and healthy control subjects during presentation of emotionally valenced versus neutral stimuli. Meta-regressions were employed to investigate possible moderators.

RESULTS

Patients with OCD, compared with healthy control subjects, showed increased activation in the bilateral amygdala, right putamen, orbitofrontal cortex extending into the anterior cingulate and ventromedial prefrontal cortex, and middle temporal and left inferior occipital cortices during emotional processing. Right amygdala hyperactivation was most pronounced in unmedicated patients. Symptom severity was related to increased activation in the orbitofrontal and anterior cingulate cortices and precuneus. Greater comorbidity with mood and anxiety disorders was associated with higher activation in the right amygdala, putamen, and insula as well as with lower activation in the left amygdala and right ventromedial prefrontal cortex.

CONCLUSIONS

Patients with OCD show increased emotional processing-related activation in limbic, frontal, and temporal regions. Previous mixed evidence regarding the role of the amygdala in OCD has likely been influenced by patient characteristics (such as medication status) and low statistical power.

Factor Structure and Further Validation of the 20-Item Short Form of the Obsessive Beliefs Questionnaire

A 44-item version of the Obsessive Beliefs Questionnaire (OBQ-44) put forward by the Obsessive Compulsive Cognitions Working Group remains the most widely used version of the OBQ, despite research casting doubt on its factorial validity and the existence of a short form (i.e., OBQ-20). In a large sample of undergraduate students ( n = 1,210), a bifactor model of the OBQ-20, consisting of a general factor and four specific factors (threat, responsibility, importance/control of thoughts, perfectionism/certainty), was supported as the best-fitting model. None of the examined OBQ-44 models provided adequate fit. The bifactor model of the OBQ-20 was retained in two independent samples ( n = 1,342 community adults, n = 319 undergraduate students). The incremental validity of the specific factors of the OBQ-20 beyond the general factor was evidenced across multiple criterion indices, including obsessive–compulsive symptom measures and reactions to a thought-induction task. Results further support use of the OBQ-20.