Evaluative differential conditioning of disgust: a sticky form of relational learning that is resistant to extinction

Once in Contact, Forever Contaminated! Introducing a Clinically Validated Imagery- and Video-Based Chain of Contagion Task for the Measurement of Disgust and Contamination Change in Experimental Research and Clinical Practice

Tolin et al. (2004) developed the Chain of Contagion Task (CCT) to experimentally test the law of contagion and looming vulnerability (LV). In the CCT, contaminated pencils are brought into contact with clean pencils. The degree of contamination transferred to further new pencils refers to the level of biased contagious beliefs. Although this could be an important transdiagnostic tool, the usability of the original paradigm has been very laborious. Therefore, an imagery- and video-based CCT is introduced and validated in Study 1 in a nonclinical sample with 85 participants. In Study 2, the imagery-based CCT was validated in a clinical study with 15 participants diagnosed with contamination-related obsessive-compulsive disorder (C-OCD), 15 participants suffering from an anxiety disorder, and 15 nonclinical controls. The number of participants is consistent with those in Tolin's original sample and the statistical evaluation of Study 2 was preregistered. Both CCT could be validated and the results could be replicated. In the imagery-based CCT, the C-OCD group displayed significantly higher contamination ratings, avoidance tendencies and LV than the two control groups. We argue that this open access diagnostic instrument can be applied in research as well as in therapeutic practice (Download CCT videos and imagery: https://doi.org/10.5281/zenodo.7730459).

Proactive Personality and Caring Behavior of Clinical Nurses: A Moderated Mediation Model of Emotional Intelligence and Disgust Sensitivity

The aims of the research were to investigate the mediating effect of emotional intelligence and the moderating effect of disgust sensitivity on the relationship between proactive personality and caring behavior among clinical nurses. A cross-sectional design while adhering to STROBE guidelines was used for this study. Three hundred ninety-three purposely selected nurses from three tertiary general hospitals completed an online survey. Measures included proactive personality, emotional intelligence, disgust sensitivity, and caring behavior. The findings showed that proactive personality positively predicted nurses' caring behavior, and that emotional intelligence played a mediating role in the relationship between proactive personality and caring behavior. Disgust sensitivity indirectly and negatively moderated the impact of proactive personality on nurses' caring behavior mainly in the second half of this moderated relationship. The findings underscore that the nursing managers may consider incorporating emotional intelligence topic in practical nursing skills training and improving nurses' ability to control their disgust sensitivity can improve their professional behavior, thus to provide patients with high-quality nursing services.

Disgust-based approach-avoidance modification training for individuals suffering from elevated stress: A randomized controlled pilot study

Perceived stress, a global health problem associated with various mental disorders, is assumed to be influenced by dysfunctional beliefs. It can be hypothesized that these beliefs can be modified with the help of approach-avoidance modification trainings (AAMTs). In the present study (conducted 2020-2022), we aimed to clarify whether the efficacy of AAMTs can be enhanced by utilizing the expression of emotions to move AAMT stimuli. For this purpose, we tested the feasibility and acceptability of a new AAMT paradigm in which the expression of disgust is used to move stress-increasing beliefs away from oneself and the expression of positive emotions is used to move stress-reducing beliefs towards oneself (AAMT-DP). Additionally, we explored the therapeutic potential of the AAMT-DP intervention by comparing it to an inactive control condition and to a conventional AAMT in which stimuli are moved by swipe movements (n = 10 in each condition). The primary outcome was perceived stress 1 week after the training as assessed with the Perceived Stress Scale. Findings indicate sufficient feasibility and acceptability of the intervention and that the decrease in perceived stress in the AAMT-DP condition was greater than in the inactive control condition (g = 0.72 [0.10, 1.72]) and than in the swipe control condition (g = 0.64 [0.01, 1.41]). In sum, findings provide preliminary evidence for the feasibility, acceptability, and the therapeutic potential of the AAMT-DP intervention.

Trauma reminders and disgust: The roles of posttraumatic stress disorder symptom severity, trauma type, and reminder type

Disgust is a common emotional response to trauma but is studied less frequently than fear or other negative emotions. In laboratory settings, individuals with a history of sexual assault report more disgust following exposure to trauma reminders than those exposed to other trauma types, and people with more severe posttraumatic stress disorder (PTSD) symptoms typically report more disgust than those with lower symptom levels. It remains unknown whether this association is also present in ecological contexts and if these associations vary by trauma reminder type. The present sample included 80 trauma-exposed community members (PTSD: n = 39, no PTSD: n = 41) who completed up to 17 prompts per day for 3 days (2,158 total completed surveys). Multilevel models indicated that trauma reminders were associated with increased feelings of disgust, B = 0.16, SE = 0.06, p < .001, which was consistent across trauma reminder types, p < .001-p = .001. PTSD symptom severity moderated the association between trauma reminders and disgust such that it was stronger for participants with higher CAPS-5 scores, B = 0.02, SE = 0.01, p = .011. All trauma reminder types demonstrated the same pattern of moderation, ps = .003-.022, except flashbacks, p = .070. Trauma type was not a significant moderator of any trauma reminder type, ps = .193-.929. These findings suggest that trauma reminders encountered in daily life are associated with feelings of disgust. The results underscore the importance of exploring disgust as a trauma-related emotional experience among trauma survivors.

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.

Four studies yield limited evidence for prepared (disgust) learning via evaluative conditioning

Prepared learning accounts suggest that specialized learning mechanisms increase the retention of associations linked to ancestrally-prevalent threats. Few studies have investigated specialized aversion learning for pathogen threats. In four pre-registered studies (N's = 515, 495, 164, 175), we employed an evaluative conditioning procedure to test whether foods (versus non-foods) are more readily associated with negative content associated with pathogens than negative content not associated with pathogens. Participants saw negatively valenced (either pathogen-relevant or -irrelevant), neutral or positively-valenced stimuli paired with meats and plants (in Studies 1 and 2) and with meats and abstract shapes (in Studies 3 and 4). They then evaluated each stimulus explicitly via self-reports (Studies 1-4) and implicitly via an Affect Misattribution Procedure (Studies 3 and 4). Linear mixed models revealed general evaluative conditioning effects, but inconsistent evidence for specialized (implicit or explicit) learning for a food-pathogen association. However, results from a mega-analysis across studies revealed stronger conditioning effects for meats paired with pathogen-relevant negative stimuli than pathogen-irrelevant negative stimuli.

The psychological costs of behavioral immunity following COVID-19 diagnosis

Prior COVID-19 infection may elevate activity of the behavioral immune system-the psychological mechanisms that foster avoidance of infection cues-to protect the individual from contracting the infection in the future. Such "adaptive behavioral immunity" may come with psychological costs, such as exacerbating the global pandemic's disruption of social and emotional processes (i.e., pandemic disruption). To investigate that idea, we tested a mediational pathway linking prior COVID infection and pandemic disruption through behavioral immunity markers, assessed with subjective emotional ratings. This was tested in a sample of 734 Mechanical Turk workers who completed study procedures online during the global pandemic (September 2021-January 2022). Behavioral immunity markers were estimated with an affective image rating paradigm. Here, participants reported experienced disgust/fear and appraisals of sickness/harm risk to images varying in emotional content. Participants self-reported on their previous COVID-19 diagnosis history and level of pandemic disruption. The findings support the proposed mediational pathway and suggest that a prior COVID-19 infection is associated with broadly elevated threat emotionality, even to neutral stimuli that do not typically elicit threat emotions. This elevated threat emotionality was in turn related to disrupted socioemotional functioning within the pandemic context. These findings inform the psychological mechanisms that might predispose COVID survivors to mental health difficulties.

Neurocognitive mechanisms of mental imagery-based disgust learning

Disgust imagery represents a potential pathological mechanism for disgust-related disorders. However, it remains controversial as to whether disgust can be conditioned with disgust-evoking mental imagery serving as the unconditioned stimulus (US). Therefore, we examined this using a conditioned learning paradigm in combination with event-related potential (ERP) analysis in 35 healthy college students. The results indicated that the initial neutral face (conditioned stimulus, CS+) became more disgust-evoking, unpleasant, and arousing after pairing with disgust-evoking imagery (disgust CS+), compared to pairing with neutral (neutral CS+) and no (CS-) imagery. Moreover, we observed that mental imagery-based disgust conditioning was resistant to extinction. While the disgust CS + evoked larger P3 and late positive potential amplitudes than CS- during acquisition, no significant differences were found between disgust CS+ and neutral CS+, indicating a dissociation between self-reported and neurophysiological responses. Future studies may additionally acquire facial EMG as an implicit index of conditioned disgust. This study provides the first neurobiological evidence that associative disgust learning can occur without aversive physical stimuli, with implications for understanding how disgust-related disorders may manifest or deteriorate without external perceptual aversive experiences, such as in obsessive-compulsive disorder (OCD).

Repeated exposure to body-related memories in women with high body-related self-disgust: Impact on disgust, avoidance, and acceptance

Disgust-based body image concerns can bias autobiographical memory towards the recall and avoidant processing of disgust-related memories of the own body. Repeated exposure to such memories may help breaking avoidance and promote the habituation of disgust, thereby lowering body concerns. Using a pre-post within-participant experimental design, we tested if repeatedly exposing women with high self-disgust (N = 61) to disgust-focused body memories vs. neutral memories led to changes in disgust, body acceptance, and reactive avoidance. Contrary to expectations, state disgust towards the body itself only decreased following exposure to neutral memories. Yet, disgust elicited by body-related memories decreased following both repeated exposure to neutral and body memories. Although acceptance was not found to significantly change in either exposure session, pre-post decreases in state disgust were associated with increases in acceptance following the disgust-focused exposure. In contrast to expectations, reactive avoidance increased from pre to post in the disgust-focused exposure. Overall, the results indicate that repeated exposure to disgust-focused body memories may help reduce disgust elicited by these memories and promote body acceptance. Yet, the effect of this repeated exposure to body memories did not extend to changing state disgust towards the body, possibly due to reactive avoidance.

Is disgust more resistant to extinction than fear? A meta-analytic review of laboratory paradigms

Disgust can be acquired via evaluative conditioning; a process by which a neutral stimulus (conditioned stimulus; CS) comes to be evaluated as disgusting due to its pairing with an inherently disgusting stimulus (unconditioned stimulus; US). Research has shown that conditioned disgust responses are resistant to extinction which may have implications for disorders (i.e., contamination-based obsessive-compulsive disorder, specific phobias, and post-traumatic stress disorder) in which heightened disgust has been implicated. Importantly, extinction is the primary mechanism by which exposure therapies are thought to achieve symptom reduction for these disorders. Exposure therapies were originally modeled on fear extinction, whereas disgust extinction was largely overlooked until recently. Accordingly, differences in the degree to which learned disgust and fear can be attenuated via extinction learning remains unclear. The present investigation was a meta-analysis directly comparing the degree of extinction of conditioned disgust (n = 14) and conditioned fear (n = 14) in laboratory paradigms. Extinction was operationalized as the standardized mean difference (SMD) in evaluative ratings between the CS+ (the CS paired with the US) and CS- (the unpaired CS) after extinction training. Results of a subgroup analysis indicated that disgust (SMD = 0.52) was significantly more resistant to extinction than fear (SMD = 0.37). Additionally, a series of meta-regression analyses indicated that extinction was not influenced by important study characteristics (e.g., sex, age, number of conditioning and extinction trials). The findings suggest that extinction-based approaches may be less effective at attenuating learned disgust and research is needed to better optimize treatments for disgust-related disorders.

Obsessive-Compulsive Symptomatology and Disgust Propensity in Disordered Eating Behaviors of Adolescents with Celiac Disease

BACKGROUND

Considering the importance of underlying psychopathological mechanisms that mediate maladaptive eating behaviors in celiac disease (CD) in the determination of cognitive-behavioral therapeutic approaches, we investigated the impact of obsessive-compulsive symptomatology and disgust propensity on disordered eating attitudes (DEA) and poor gluten-free diet (GFD) compliance in adolescents with CD.

METHOD

Adolescents with biopsy-proven CD (n = 148, aged 12-18 years) were compared with age- and sex-matched controls (n = 104) in terms of eating attitudes/behaviors, obsessive-compulsive symptoms, and disgust propensity, as well as depression and anxiety to rule out depression- and anxiety-related covariates. The clinical implications associated with poor GFD compliance were determined using between-subgroup analysis. Multivariate linear regression and multiple logistic regression were used to identify predictors of DEA and GFD noncompliance, respectively.

RESULTS

In adolescents with CD, DEA was remarkably associated with obsessive-compulsive symptom severity and disgust propensity, especially in contamination and core disgust sub-dimensions. Obsessionality and disgust propensity were independent predictors of DEA, of which the obsessive-compulsive symptom severity was the most decisive predictor of DEA. Higher DEA severity and lower body mass index were independent predictors of poor GFD compliance.

CONCLUSION

Higher obsessionality, accompanied by disgust-related evaluative conditioning processes, may contribute to constructing a cognitive network consisting of hypervigilance and catastrophic interpretations towards benign somatic stimulations, food-related preoccupations, and avoidant behaviors in the disordered eating of adolescents with CD. The reciprocal relationship between lifelong GFD and DEA, mediated by obsessionality and disgust propensity, was supported by current findings that could guide clinicians in the management of maladaptive eating behaviors in adolescents with CD.

WITHDRAWN: Four studies Yield limited evidence for prepared (disgust) learning via evaluative conditioning

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Frontal lobe-related cognition in the context of self-disgust

Self- disgust is an adverse self-conscious emotion that plays an important role in psychopathology and well-being. However, self-disgust has received little attention in the emotion literature, therefore our understanding of the processes underlying the experience of self-disgust is relatively scarce, although neuropsychological and neuroimaging studies support the idea that this emotion may heavily rely on frontal lobe-related cognition. To test this hypothesis, in two studies we investigated the relationship between state and trait levels of self-disgust, cognition and emotion regulation in healthy adults. Specifically, in Study 1 we tested the hypothesis that emotion regulation strategies (avoidance, suppression, and cognitive reappraisal) mediate the relationship between inhibition ability and state and trait levels of self-disgust. In Study 2, we followed a more comprehensive approach to test the hypothesis that frontal lobe-related cognitive processes (updating, Theory of Mind-ToM-, and self-attention) are closely related to the experience of self-disgust in healthy adults. Overall, across these studies, we found evidence to support the idea that inhibition ability and ToM may play a role in the experience of state and trait self-disgust, respectively. However, we did not find consistent evidence across the two studies to support the notion held in the literature that the experience of self- conscious emotions, in this case self-disgust, is heavily dependent on frontal lobe-related cognition.

Conscious knowledge of CS-UCS contingency information affects extinction retrieval of conditioned disgust responses: Findings from an online de novo disgust conditioning task

Objective

The present study aimed to establish and develop an online de novo conditioning paradigm for the measurement of conditioned disgust responses. We further explored the effects of explicit instructions about the CS-UCS contingency on extinction learning and retrieval of conditioned disgust responses.

Method

The study included a sample of 115 healthy participants. Geometric figures served as conditioned stimuli (CS) and disgust-evoking pictures as unconditioned stimuli (UCS). During disgust conditioning, the CS+ was paired with the UCS (66% reinforcement) and the CS- remained unpaired; during extinction and retrieval, no UCS was presented. Half of the participants (n = 54) received instructions prior to the disgust extinction stating that the UCS will not be presented anymore. 1-2 days or 7-8 days later participants performed a retrieval test. CS-UCS contingency, disgust and valence ratings were used as dependent measures.

Results

Successful acquisition of conditioned disgust response was observed on the level of CS-UCS contingency, disgust and valence ratings. While some decline in valence and disgust ratings during the extinction stage was observed, contingency instructions did not significantly affect extinction performance. Retrieval one week later revealed that contingency instructions increased the discrimination of the CSs.

Conclusions

Extinction of conditioned disgust responses is not affected by explicit knowledge of the CS-UCS contingencies. However, contingency instructions prior to extinction seem to have a detrimental effect on long-term extinction retrieval.

Attenuating experimentally acquired disgust: Comparing counterconditioning, exposure and unconditioned stimulus revaluation

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.

Disgust and fear reactions uniquely affect intrusions and posttraumatic stress symptoms

Disgust reactions commonly occur during/following trauma and predict posttraumatic stress (PTS) symptoms. Yet, disgust is not mentioned in DSM-5 PTSD criteria. To investigate disgust's clinical significance in PTSD, we measured the relationship between disgust (and fear) reactions to a personal trauma, and problematic intrusion characteristics (e.g., distress) and intrusion symptom severity. We focused on intrusions because they are a transdiagnostic PTSD symptom, though we also measured overall PTS symptoms to replicate prior work. Participants (N = 471) recalled their most traumatic/stressful event from the past six months. They then rated disgust and fear reactions to this event and completed the Posttraumatic Stress Disorder Checklist-5. Participants who had experienced intrusions about their event in the past month (n = 261) rated these intrusions on several characteristics (e.g., distress, vividness). We found stronger traumatic event-related disgust reactions were associated with more problematic intrusion characteristics, higher intrusion symptom severity, and higher overall PTS symptom severity. Notably, disgust reactions uniquely predicted these variables after statistically controlling for fear reactions. We conclude disgust reactions to trauma may be similarly pathological to fear reactions for intrusion and broader PTS symptoms. Therefore, PTSD diagnostic manuals and treatments should recognize disgust as a trauma-relevant emotion.

Negative body image and avoidant retrieval of body-related autobiographical memories

People with a negative body image may be more likely to recall negative memories of their body, but also be motivated to avoid retrieving specific memories to prevent triggering aversive emotions (e.g., disgust). Such inclination to retain at a global level of memory recall may hamper the correction of their negative body image. In previous research using Autobiographical Memory Tests (AMTs) with minimal instructions, we failed to find an overgeneral memory bias specific to individuals with a negative body image but observed low specificity overall in response to body cue words. In the present study (N = 153), we included the traditional AMT next to a minimal instructions AMT and explored the idea that sensory reliving may be relevant to avoidance by assessing sensory reliving ratings next to memory specificity. A negative body image was associated with more negative body memories. In both AMTs, the findings failed to support our prediction that a more negative body image would be associated with lower specificity or sensory reliving. The findings are consistent with the view that autobiographical memories might be an important factor in defining one's body image, yet cast doubt on the relevance of avoidant retrieval of body-related memories in non-clinical samples.

Treatment of disgust in specific emotional disorders

Although conditioning approaches have highlighted potential characteristics of disgust in anxiety disorders, obsessive-compulsive disorder (OCD), and posttraumatic stress disorder (PTSD), these findings have yet to be translated into evidence-based treatments. Examination of the literature suggests various indicators of disgust that predict treatment outcome in these disorders. However, mechanisms remain unclear because studies examining disgust during the course of treatment are limited. Increasingly, the field has moved toward experimental investigation of strategies that reduce disgust. While cognitive reappraisal and imagery techniques appear promising, such techniques have yet to be examined as anxiety disorder treatments in large-scale randomized clinical trials. The literature also points to novel approaches to treating disgust, ranging from an inhibitory-informed approach to exposure therapy to transcranial direct current stimulation. However, the development of novel treatment approaches will require more rigorous experimental psychopathology approaches that can further elucidate processes that contribute to the etiology and/or maintenance of disorders of disgust.

Subjective disgust and facial electromyography responses towards unedited and morphed overweight self-pictures in women with varying levels of eating disorder symptomatology

Individuals with an eating disorder (ED) often report to be disgusted by their body. Body-related self-disgust could play an important role in the development and maintenance of EDs. We investigated if women with relatively high ED symptom scores indeed respond with disgust upon exposure to their body as indexed by facial electromyography (fEMG) of the m. levator labii superioris and self-report. Given that one's self-disgust may increase/decrease depending on the relative distance of the own body to the thin ideal, we also assessed women's disgust for overweight- and thin-morphs of their body. Female undergraduate students (N = 104) were photographed and presented with their (morphed) body pictures, next to disgust-relevant and overweight body control pictures. Higher levels of ED symptoms were associated with stronger self-reported disgust to unedited body-pictures and overweight-morphs. Disgust to thin-morphs was unrelated to ED symptoms. Participants generally showed heightened facial disgust towards overweight morphs, yet the strength of facial disgust was unrelated to ED symptoms. Thus, the findings provide evidence for the involvement of heightened body-related self-disgust in ED symptomatology, albeit only on the basis of self-report.

Pavlovian Disgust Conditioning and Generalization: Specificity and Associations With Individual Differences

Although studies have identified differences between fear and disgust conditioning, much less is known about the generalization of conditioned disgust. This is an important gap in the literature given that overgeneralization of conditioned disgust to neutral stimuli may have clinical implications. To address this knowledge gap, female participants (n = 80) completed a Pavlovian conditioning procedure in which one neutral food item (conditioned stimulus; CS+) was followed by disgusting videos of individuals vomiting (unconditioned stimulus; US) and another neutral food item (CS-) was not reinforced with the disgusting video. Following this acquisition phase, there was an extinction phase in which both CSs were presented unreinforced. Importantly, participants also evaluated generalization stimuli (GS+, GS-) that resembled, but were distinct from, the CS after each conditioning phase. As predicted, the CS+ was rated as significantly more disgusting and fear inducing than the CS- after acquisition and this pattern persisted after extinction. However, disgust ratings of the CS+ after acquisition were significantly larger than fear ratings. Participants also rated the GS+ as significantly more disgusting, but not fear inducing, than the GS- after acquisition. However, this effect was not observed after extinction. Disgust proneness did predict a greater increase in disgust and fear ratings of the CS+ relative to the CS- after acquisition and extinction. In contrast, trait anxiety predicted only higher fear ratings to the CS+ relative to the CS- after acquisition and extinction. Disgust proneness nor trait anxiety predicted the greater increase in disgust to the GS+ relative to the GS- after acquisition. These findings suggest that while conditioned disgust can generalize, individual difference variables that predict generalization remain unclear. The implications of these findings for disorders of disgust are discussed.

Visible skin disease symptoms of another person reduce automatic imitation of their hand movements

Imitation is an important mechanism for social interaction and learning, and humans tend to imitate others automatically. While imitating others is often useful, it can backfire when imitation is incongruent with one's goals. For example, in forced-choice reaction time tasks, this tendency results in a reliable slowing of reactions if the observed and self-initiated actions are incompatible (compatibility effect). While imitation is commonly explained as a social phenomenon, previous results on the compatibility effect's dependence on social cues are inconsistent. However, in many previous studies, the associated social cues were easy to ignore by the participants. To make the social modifier more salient, the current study manipulated emotionally relevant aspects of the model hand itself in an imitation inhibition task by using models displaying skin disease symptoms which we expected to elicit (1) perceptions of dissimilarity and (2) disgust in participants. As predicted, participants' (n = 63) reaction times were influenced more by the incompatible actions of the symptom-free than the symptomatic model hand. However, both levels of self-reported disgust toward and self-other overlap with symptomatic hands were low and did not account for the observed effect on automatic imitation. Our findings show that automatic imitation depends on social factors if these are an integral part of the model and processed quickly, presumably due to their affective salience or the salience of the self-other distinction. Whether this effect is driven by emotional reactions to the model remains an open question.

More than just fear: Development and psychometric evaluation of the Spider Distress Scale to assess spider fear and spider-related disgust

Spider fear is an excellent model to experimentally study processes in the maintenance and treatment of long-lasting fears. A valid, reliable, and practical tool to assess spider-related distress dimensionally, and to differentiate between spider-related fear and disgust in a time-sensitive manner, may help to better understand individual differences in these two emotions and to tailor treatments accordingly. We developed a concise self-report questionnaire, the Spider Distress Scale (SDS), that combines the strengths of established spider fear questionnaires and addresses their shortcomings. We explored (study 1 and 2) and confirmed (study 3) a two-factor structure of the SDS in samples from the general population (n = 370; n = 360; n = 423), recruited online via Prolific Academic from the United Kingdom, the Netherlands, and the United States. The fear and disgust factors of the SDS are highly internally consistent and the SDS has excellent test-retest reliability. We found good convergent and discriminant validity, based on self-report measures and spider behavioural approach tasks, and the SDS successfully differentiated between individuals with and without spider fear (study 4, n = 75). Our series of studies suggests that fear and disgust are functionally related, but that disgust towards spiders can be differentially assessed when focussing on unique elements of disgust-related information.

Common and separable behavioral and neural mechanisms underlie the generalization of fear and disgust

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.

Exploring the role of disgust sensitivity and propensity in selective eating

While disgust is a clinically and theoretically relevant construct for selective eating, limited research has examined how different aspects of disgust relate to selective eating severity in adults. Thus, the present study sought to 1) compare disgust propensity (how easily people are disgusted) and disgust sensitivity (how unpleasant disgust is) across a spectrum of selective eaters, 2) explore the specificity of the associations between disgust sensitivity/propensity and selective eating across selective eating and related phenotypes, and 3) explore whether the relationship between selective eating and disgust is food-specific. Participants were 554 adults recruited on Amazon's Mechanical Turk who completed cross-sectional surveys on study constructs. The sample was recruited to over-represent individuals with high levels of selective eating. Results support that disgust propensity, but not sensitivity, was elevated in the impaired selective eating group compared to non-impaired selective eaters and non-selective eaters. Only the selective eating phenotype was independently associated with both disgust sensitivity and propensity. Correlation results supported that the associations between selective eating and disgust were specific to the disgust elicited by food (i.e., animal protein, fruits, vegetables). Overall, results support that disgust propensity and disgust sensitivity play a role in selective eating. Results imply that disgust sensitivity associated with selective eating appears limited to the food domain and may be more specific to disgust eliciting food itself, rather than signs of food contamination or spoilage.

Is Acquired Disgust More Difficult to Extinguish Than Acquired Fear? an Event-Related Potential Study

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.

A comprehensive group-based cognitive behavioural treatment for blood-injection-injury phobia

OBJECTIVES

A key feature of blood-injection-injury (BII) phobia is activation of disgust responses, in addition to fear. Yet, standard treatments have largely neglected addressing disgust responses. The disorder is further complicated by fainting in 75% of sufferers. Moreover, treatments have been traditionally delivered in an individual format, which may not be as efficient as group treatment. The aim of this study was to develop a group-based programme for BII phobia, with components targeting fear, disgust, and fainting, to determine feasibility and effectiveness of such an intervention.

METHODS

Participants took part in an 8-session, group-based Cognitive Behavioural Therapy (CBT) programme for BII phobia (N = 40). The key outcome measure was the Multidimensional Blood/Injury Phobia Inventory, which assesses a range of phobic stimuli and responses (including fear, disgust, and fainting).

RESULTS

There were significant improvements, with large effect sizes, across symptoms over the course of treatment. Participants with higher disgust sensitivity reported higher pre-treatment symptom severity and greater life interference than those with lower disgust scores. Despite this, neither pre-treatment disgust sensitivity nor fainting history impacted on treatment response. For the first time, however, we showed that greater reductions in disgust to BII stimuli were associated with greater overall symptom reductions, highlighting the importance of disgust in the treatment of this disorder, and potentially others.

CONCLUSION

Despite the heterogeneous nature of BII phobia, this group-based, modified CBT intervention was effective in reducing a variety of phobic responses, including fear, disgust, and fainting.

PRACTITIONER POINTS

Disgust is a key maintaining factor in blood-injection-injury phobia, which clinicians should consider in their assessment and treatment of this disorder. There is little in the existing literature to guide clinicians in this regard. This study examined a novel group treatment for blood-injection-injury phobia which included strategies to target disgust, in addition to traditional CBT strategies to address fear and fainting. The treatment was feasible and acceptable. Symptoms of fear, disgust, and fainting reduced significantly over treatment. Changes in disgust symptoms were associated with overall symptom changes, however a control group is needed to determine the effects of individual treatment components and to make more robust conclusions about the benefits of this enhanced approach.

Lessons learned developing and testing family-based interoceptive exposure for adolescents with low-weight eating disorders

BACKGROUND

Anorexia nervosa (AN) usually develops in early adolescence and is characterized by high rates of morbidity and mortality. Family-based therapy (FBT) is the leading evidence-based treatment for adolescents with AN, but not all patients experience sufficient improvement. The purpose of this manuscript is to describe the development and subsequent experience with a Family-Based Interoceptive Exposure (FBT-IE) for adolescents with a broader form of low-weight eating disorders.

METHODS

The novel IE-based behavioral intervention is a six-session family-based treatment module designed to directly target and modify disgust by altering the prefrontal regulation of the insula response to aversive stimuli by decreasing visceral sensitivity (e.g., bloating). Each session teaches a new skill regarding tolerating distress to visceral sensations associated with disgust and an in-vivo "IE exercise," in which the family is provided with a meal replacement shake of unknown content and caloric density.

RESULTS

In this novel treatment, the patient learns to tolerate disgust in the context of a challenging food stimulus as a way to increase consumption of restricted foods outside of session.

CONCLUSION

We discuss successes and challenges executing this treatment with patients with low-weight eating disorders and propose future directions for the intervention.

Fear conditioning and extinction in obsessive-compulsive disorder: A systematic review

Laboratory experiments using fear conditioning and extinction protocols help lay the groundwork for designing, testing, and optimizing innovative treatments for anxiety-related disorders. Yet, there is limited basic research on fear conditioning and extinction in obsessive-compulsive disorder (OCD). This is surprising because exposure-based treatments based on associative learning principles are among the most popular and effective treatment options for OCD. Here, we systematically review and critically assess existing aversive conditioning and extinction studies of OCD. Across 12 studies, there was moderate evidence that OCD is associated with abnormal acquisition of conditioned responses that differ from comparison groups. There was relatively stronger evidence of OCD's association with impaired extinction processes. This included multiple studies finding elevated conditioned responses during extinction learning and poorer threat/safety discrimination during recall, although a minority of studies yielded results inconsistent with this conclusion. Overall, the conditioning model holds value for OCD research, but more work is necessary to clarify emerging patterns of results and increase clinical translational utility to the level seen in other anxiety-related disorders. We detail limitations in the literature and suggest next steps, including modeling OCD with more complex conditioning methodology (e.g., semantic/conceptual generalization, avoidance) and improving individual-differences assessment with dimensional techniques.

Deontological Guilt and Disgust Sensitivity Modulate Moral Behaviour

OBJECTIVE

Deontological Guilt (DG), and Altruistic Guilt (AG) emerge from the appraisal of violating an internalized rule or an altruistic principle, respectively. DG is strictly connected with Disgust Sensitivity and plays a key role in the development and maintenance of Obsessive-Compulsive Disorder (OCD). Previous studies investigated how DG affects responses to hypothetical moral dilemmas, however how DG and Disgust Sensitivity interact modulating moral behavior is still unknown.

METHODS

STUDY 1. 46 healthy participants performed an ecological paradigm in which people can spontaneously decide to lie to obtain a reward (egoistic lie) or give it away (altruistic lie) after three emotional inductions: DG, AG or neutral. Furthermore, OCD traits, Morality, Guilt Propensity and Disgust Sensitivity were assessed by means of questionnaires. STUDY 2. 27 participants from the original sample were retested during the COVID-19 lockdown in Italy to ascertain whether the pandemic modified traits related to morality, disgust, guilt or OCD symptoms and whether these changes modulated moral behavior (measured by a task in which cheating was associated to higher pay-offs).

RESULTS

STUDY 1. Compared to the neutral, after the DG induction participants produced less altruistic and more egoistic lies. This effect was stronger in participants with high Disgust Sensitivity. STUDY 2. During the COVID-19 lockdown participants became more sensitive to the Authority pillar of the Moral Foundations and more sensitive to Disgust: this increment in deontological morality affected (im) moral behavior depending on changes in Disgust Sensitivity.

CONCLUSIONS

Our data suggest that people with high Disgust Sensitivity are more affected by deontological inductions which translate to higher immorality, supposedly by lowering their moral self-image. These results might have important clinical implications as they suggest that addressing Disgust Sensitivity in therapy, might also decrease the effect of guilt on patients' behavior.

Does an unconditioned stimulus memory devaluation procedure decrease disgust memories and conditioned disgust? Results of two laboratory studies

Research has demonstrated that disgust can be installed through classical conditioning by pairing neutral conditioned stimuli (CSs) with disgusting unconditioned stimuli (USs). Disgust has been argued to play an important role in maintaining fear-related disorders. This maintaining role may be explained by conditioned disgust being less sensitive to extinction (i.e., experiencing the CS in the absence of the US). Promising alternatives to extinction training are procedures that focus on the devaluation of US memory representations. In the current study, we investigated whether such devaluation procedures can be successful to counter conditioned disgust. We conducted two laboratory studies (N = 120 and N = 51) in which disgust was conditioned using audio-visual USs. Memory representations of the USs were devalued by having participants recall these USs while they performed a taxing eye-movement task or executed one of several control tasks. The results showed successful conditioned disgust acquisition. However, no strong evidence was obtained that an US memory devaluation procedure modulates disgust memory and diminishes conditioned disgust as indicated by subjective, behavioral, or psychophysiological measures. We discuss the relevance of our results for methodological improvements regarding US memory devaluation procedures and disgust conditioning.

Acquisition and maintenance of disgust reactions in an OCD analogue sample: Efficiency of extinction strategies through a counter-conditioning procedure

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.

Generalization gradients for fear and disgust in human associative learning

Previous research indicates that excessive fear is a critical feature in anxiety disorders; however, recent studies suggest that disgust may also contribute to the etiology and maintenance of some anxiety disorders. It remains unclear if differences exist between these two threat-related emotions in conditioning and generalization. Evaluating different patterns of fear and disgust learning would facilitate a deeper understanding of how anxiety disorders develop. In this study, 32 college students completed threat conditioning tasks, including conditioned stimuli paired with frightening or disgusting images. Fear and disgust were divided into two randomly ordered blocks to examine differences by recording subjective US expectancy ratings and eye movements in the conditioning and generalization process. During conditioning, differing US expectancy ratings (fear vs. disgust) were found only on CS-, which may demonstrated that fear is associated with inferior discrimination learning. During the generalization test, participants exhibited greater US expectancy ratings to fear-related GS1 (generalized stimulus) and GS2 relative to disgust GS1 and GS2. Fear led to longer reaction times than disgust in both phases, and the pupil size and fixation duration for fear stimuli were larger than for disgust stimuli, suggesting that disgust generalization has a steeper gradient than fear generalization. These findings provide preliminary evidence for differences between fear- and disgust-related stimuli in conditioning and generalization, and suggest insights into treatment for anxiety and other fear- or disgust-related disorders.

The revolting body: Self-disgust as a key factor in anorexia nervosa

In this article, we present a theoretical model that points to disgust-induced avoidance as a mechanism that can help explain the persistent and excessive food restriction in individuals with anorexia nervosa (AN). Disgust is characterized by intense negative feelings of revulsion and an overwhelming and irresistible urge to avoid potential disgust elicitors. When eating, or even the prospect of eating, elicits overwhelming feelings of disgust in individuals with AN, this could explain why food restriction persists even when someone is in a state of starvation. Following this model, disgust is elicited by the expected impact of food on the own body ("becoming fat") resulting in body-related self-disgust. We argue that limiting food intake may serve to avoid self-disgust. This implies that when self-disgust remains unchanged after treatment of AN, residual levels of self-disgust after treatment could make individuals vulnerable to relapse.

Individual differences in avoiding feelings of disgust: Development and construct validity of the disgust avoidance questionnaire

We developed and examined the construct validity of the Disgust Avoidance Questionnaire (DAQ) as a measure of people’s inclination to prevent experiencing disgust (disgust prevention) and to escape from the experience of disgust (disgust escape). In a stepwise item-reduction (Study 1; N = 417) using Exploratory Factor Analysis (EFA) based on a 4-subscale distinction (behavioral prevention, cognitive prevention, behavioral escape, cognitive escape), we selected 17 items from a pool of potential items. In order to incorporate the conceptual overlap between dimensions of disgust avoidance, focus (prevention vs. escape), and strategy (behavioral avoidance vs. cognitive avoidance), we specified an adapted model. In this model, we allowed each item to load on one type of dimension and one type of strategy, resulting in four overlapping factors (prevention, escape, behavioral avoidance, cognitive avoidance). Evaluation of this overlapping 4-factor model (Study 2; N = 513) using Exploratory Structural Equation Modeling (ESEM) and Confirmatory Factor Analysis (CFA) showed promising model fit indices, factor loadings, factor correlations, and reliability estimates for three of the four factors (prevention, behavioral avoidance, cognitive avoidance). Those three subscales also showed good convergent validity. In contrast, the results related to the escape factor may call the suitability of self-report to assess disgust escape into question. In light of the exploratory nature of the project, future examinations of the DAQ’s validity and applicability to more diverse samples are essential. A critical next step for future research would be to examine the DAQ’s criterion validity and the distinctive roles of the DAQ subscales in (clinical) psychological constructs and processes.

Regulation of emotions during experimental endotoxemia: A pilot study

Even though dysfunctional emotion regulation is prominent in depression and a link between depression and inflammation is well established, there is little knowledge about how inflammation affects the regulation of emotions. The aim of this pilot study was to explore the effect of experimentally induced inflammation on the cognitive reappraisal of emotions, and to assess domain specificity by comparing success in regulation of emotions towards two unpleasant stimuli classes (general negative stimuli and disgust stimuli). In a between-subject design, ten healthy participants were injected with an intravenous injection of lipopolysaccharide (2 ng/kg body weight) and eleven were injected with saline. Participants performed a cognitive reappraisal task, in which they had to down-regulate or up-regulate their emotions towards general negative stimuli and disgust stimuli, 5-6 h post-injection. Contrary to our hypotheses, participants injected with lipopolysaccharide reported greater success in down-regulating emotional responses towards unpleasant stimuli as compared to the saline group. In addition, both groups were poorer at down-regulating emotions towards disgust stimuli as compared to general negative stimuli. The current pilot study indicates that cognitive reappraisal of emotions is affected during experimental endotoxemia, and suggests that disgust stimuli might be difficult to reappraise.

Reappraisal of disgust: Self-report and behavioural assessment of individuals with moderate to high contamination fears

Previous research has linked certain psychological disorders, including obsessive-compulsive disorder (OCD), to the experience of disgust and how it is interpreted/appraised. Therefore, the present study examined whether targeting primary and secondary disgust appraisals (i.e., cognitive reappraisal) in individuals with moderate to high OCD-relevant contamination fears can effectively reduce disgust. Fifty-two participants were randomly assigned to one of three conditions; two of which involved reading a brief script modifying either a primary disgust appraisal (i.e., likelihood of a feared outcome) or a secondary disgust appraisal (i.e., the individual's ability to cope), and a third control condition with no reappraisal script. Following this experimental manipulation of disgust appraisal, participants completed two contamination-relevant behavioural approach tasks which involved 1) increasing proximity to, and eventually touching, a dead cockroach, and 2) drinking apple juice from an unused urine sample collection container. Results indicated that the interventions successfully modified their intended appraisal targets. Furthermore, on the second behavioural approach task, the secondary reappraisal condition demonstrated significantly less disgust-related avoidance relative to the control condition and reported significantly less disgust relative to the primary reappraisal condition. Our results incrementally add to the existing literature that emphasises the potential advantages of modifying disgust appraisals and specifically secondary disgust appraisals when treating disgust-based psychological disorders.

The Role of Disgust in Eating Disorders

PURPOSE OF REVIEW

In current review, we evaluate the current literature examining the role of disgust in eating disorders (EDs), and provide a theoretical model designed to inform the study and treatment of disgust-based symptoms in EDs.

RECENT FINDINGS

Findings from this review suggest that aberrant disgust-conditioning processes represent promising but understudied mechanisms that may contribute to the risk and maintenance of core eating disorder (ED) psychopathology. In addition, preliminary evidence supports the use of interventions designed to target aversive disgust cues and disrupt maladaptive disgust-based conditioning that may maintain eating pathology. However, experimental studies designed to elucidate the role of disgust and aversive learning processes remain limited. Disgust is a promising risk and maintenance factor in EDs. Future systematic investigation is needed to examine disgust-based processes at a mechanistic level in order to better understand the links between disgust, avoidance behaviors, and EDs. Further investigation of the mechanistic role of disgust in EDs is warranted.

Conceptualizing eating disorder psychopathology using an anxiety disorders framework: Evidence and implications for exposure-based clinical research

Eating disorders (EDs) and anxiety disorders (ADs) evidence shared risk and significant comorbidity. Recent advances in understanding of anxiety-based disorders may have direct application to research and treatment efforts for EDs. The current review presents an up-to-date, behavioral conceptualization of the overlap between anxiety-based disorders and EDs. We identify ways in which anxiety presents in EDs, consider differences between EDs and ADs relevant to treatment adaptions, discuss how exposure-based strategies may be adapted for use in ED treatment, and outline directions for future mechanistic, translational, and clinical ED research from this perspective. Important research directions include: simultaneous examination of the extent to which EDs are characterized by aberrant avoidance-, reward-, and/or habit-based neurobiological and behavioral processes; improvement in understanding of how nutritional status interacts with neurobiological characteristics of EDs; incorporation of a growing knowledge of biobehavioral signatures in ED treatment planning; development of more comprehensive exposure-based treatment approaches for EDs; testing whether certain exposure interventions for AD are appropriate for EDs; and improvement in clinician self-efficacy and ability to use exposure therapy for EDs.

The effect of differential disgust conditioning and subsequent extinction versus counterconditioning procedures on women's sexual responses to erotic stimuli

Recent theoretical accounts point to disgust as an important factor in the development and persistence of sexual dysfunctions. This study tested if (i) contingent disgust experiences can render initially sexually arousing stimuli disgusting, and (ii) such acquired disgust responses could be best neutralized via a CS-only extinction or a counterconditioning procedure. Participants (N = 74) were exposed to a differential conditioning procedure that was followed by either a CS-only extinction or a counterconditioning procedure. Erotic films served as the CS+/CS-. A disgusting film served as the US. During the extinction procedure, the CS+ was no longer followed by the disgusting US. During counterconditioning the CS+ was paired with positive stimuli. After conditioning, the CS + elicited lower genital arousal and was rated as significantly more disgusting, less pleasant, and less sexually arousing than the CS-. These diminished genital and subjective sexual arousal responses to the CS+ were successfully restored after both the extinction and the counterconditioning procedure, whereas conditioned feelings of disgust and behavioral avoidance persisted. There was no evidence for differential effectiveness of either procedure. Thus, sexual responses can be attenuated by learned sex-disgust associations and restored by extinction and counterconditioning procedures, but conditioned feelings of disgust seem more resistant.

Effects of repeated exposure to fearful and disgusting stimuli on fear renewal in blood-injection-injury phobia

Although exposure is effective for blood-injection-injury (BII) phobia, fear often returns after treatment. While disgust has been implicated in BII phobia, its effects on fear renewal are unclear. To address this knowledge gap, the present study examined the effect of repeated video exposure to fearful and disgusting stimuli in multiple contexts on fear renewal in BII phobia. Individuals with BII phobia (N = 57) were randomized to Disgust-Specific Exposure (DSE) which included exposure to disgusting but threat-irrelevant stimuli (i.e., vomit), Fear-Specific Exposure (FSE) which included exposure to threat-relevant stimuli (i.e., injections), or General Negative Exposure (GNE) which included exposure designed to elicit negative affect (i.e., tornado) without being disgusting or threat-relevant. During session one, participants watched a pre- and post-exposure assessment injection video ("pre/post assessment"), and a novel injection video after exposure to assess renewal effects ("novel 1"). Participants came in one week later to rate the same videos, and a new injection video ("novel 2"). For week one outcomes, comparisons of covariate adjusted means indicated the fear-specific group reported significantly lower levels of anxiety than the general-negative group to the post-exposure and novel 1 stimulus. When presented with the post-exposure stimuli during week two, the disgust-specific and fear-specific groups reported significantly lower levels of anxiety than the general negative group. The fear-specific group also reported significantly lower levels of anxiety than the disgust-specific and general-negative groups when presented with novel 1 and novel 2 stimuli at week two. These findings suggest that repeated exposure to threat-relevant cues in multiple contexts does reduce the return of anxiety. However, repeated exposure to disgusting but threat irrelevant stimuli may also produce some therapeutic effects. The implications of the integration of disgust-relevant processes into exposure-based treatment of BII phobia are discussed.

Effects of "Dirty" Information on Disgust Responding to an Unknown Animal in Children: The Moderating Role of Maternal Disgust Proneness

Although research has shown that disgust facilitates avoidance of small animals among adults, much less is known about disgust appraisals of small animals in children as well as the predictors of such appraisals. To address this gap, children (ages 5-13) were exposed to dirt-related and cleanliness-related information about unknown animals. The extent to which these types of information influenced children's feelings of fear, disgust, positivity, and avoidance behavior in relation to the animals was examined. The present study then examined the extent to which child and maternal disgust proneness predicted feelings of disgust to the 'dirty' animal. The findings show that providing dirt-related information resulted in a significant increase in disgust, but not fear, responding to the animal. Dirt-related information also resulted in a significant decrease in positive feelings toward the animal. Conversely, providing cleanliness-related information resulted in a significant decrease in disgust, but not fear, responding to the animal. In addition, providing cleanliness-related information resulted in a significant increase in positive feelings toward the animal. Children also engage in more avoidance of the animal described as dirty compared to the animal described as clean. In addition, subsequent analysis revealed an interaction between child and maternal disgust propensity in predicting learned disgust to the dirty animal such that the highest levels of feelings of disgust to the dirty animal were observed among children with high disgust proneness who also have mothers with high disgust proneness. The implications of these findings for conceptualizing the role of disgust in animal phobias among youth will be discussed.

The Effect of Trait and State Disgust on Fear of God and Sin

There is a growing literature suggesting disgust plays a major role in religiosity. However, the relationships between specific domains of disgust sensitivity and general religious fundamentalism or religious scrupulosity remains unknown and a lack of experimental data prevents the drawing of causal inferences about the potential effects of disgust on religiosity. Two studies are reported that examined the relationship between specific types of disgust sensitivity (i.e., pathogen, sexual, and moral disgust) and specific religious beliefs (i.e., fear of sin and fear of God). In the first study it was found that sexual disgust and pathogen disgust were significantly correlated with fear of sin and fear of God, respectively. In the second study the experimental induction of disgust led to greater fear of sin but not to the fear of God. These findings suggest that pathogen and sexual disgust sensitivities may serve as effective mechanisms for inflated scrupulosity. Taken together the outcomes from both studies converge on a greater understanding of the ‘Human Behavioral Immune System’ model that can account for social behavior with the evolution of adaptive benefit and perhaps more importantly highlights the possible drivers of specific religious behavior.

Obsessive-compulsive symptom profiles in individuals exposed to interpersonal versus noninterpersonal trauma

Obsessive-compulsive (OC) symptoms have been associated with trauma exposure. Although no studies have specified relations between type of trauma and OC symptom presentations, this information may inform personalized care for this complex population. Thus, this study used profile analysis via multidimensional scaling to characterize typical OC symptom profiles in individuals exposed to interpersonal versus noninterpersonal traumas. Profiles were also correlated with self-reported disgust and mental contamination, which have been related to OC symptoms and interpersonal trauma in prior research. The interpersonal trauma group revealed two profiles: (1) Obsessing (high obsessing, low neutralizing), and (2) Ordering (high ordering, low obsessing). The noninterpersonal trauma group showed two profiles: (1) Hoarding/Ordering (high hoarding and ordering, low washing), and (2) Hoarding Only (high hoarding, low ordering). No significant correlations were found between OC profiles and disgust-related constructs. Clinical implications, limitations, and future directions are explored.

Linking Pavlovian Disgust Conditioning and Eating Disorder Symptoms: An Analogue Study

Although the experience of disgust is commonly endorsed among women with eating disorders, it remains unclear how to best model this emotion in relation to disordered eating. The present study sought to identify potential disgust conditioning abnormalities that may underlie the development of eating disorder symptoms. Individuals high and low in eating disorder symptoms (HED, n = 19; LED, n = 18) completed a Pavlovian conditioning procedure in which one neutral food item (conditioned stimulus; CS+) was followed by disgusting videos of individuals vomiting (unconditioned stimulus; US) and another neutral food item (CS-) was not reinforced with the disgusting video. Following this acquisition procedure, there was an extinction procedure in which both CSs were presented unreinforced. The results showed that ratings of disgust, fear, and willingness to eat the CS+ and CS- did not significantly vary as a function of the conditioning phase for the LED group. However, the HED group rated the CS+ as significantly more disgusting and fear inducing than the CS- after the acquisition phase and this pattern persisted after extinction. These conditioning effects were also observed to be significantly larger for disgust compared to fear. The HED group also reported being significantly less willing to eat the CS+ compared to the CS- after the acquisition phase and this pattern also persisted after extinction. In the full sample, only discriminant disgust responding after acquisition was associated with the amount of calorie consumption over the 24-hour period after conditioning. These findings suggest that eating disorder symptoms may result from a heightened proneness to associate disgusting outcomes with otherwise neutral food items. This pattern of disgust learning may reinforce food avoidance in eating disorders and appears to be difficult to fully unlearn.

The central role of disgust in disorders of food avoidance

BACKGROUND

Individuals with extreme food avoidance such as Avoidant Restrictive Food Intake Disorder (ARFID) experience impairing physical and mental health consequences from nutrition of insufficient variety or/and quantity. Identifying mechanisms contributing to food avoidance is essential to develop effective interventions. Anxiety figures prominently in theoretical models of food avoidance; however, there is limited evidence that repeated exposures to foods increases approach behavior in ARFID. Studying disgust, and relationships between disgust and anxiety, may offer novel insights, as disgust is functionally associated with avoidance of contamination from pathogens (as may occur via ingestion) and is largely resistant to extinction.

METHOD

This exploratory, cross-sectional study included data from 1,644 adults who completed an online questionnaire. Participant responses were used to measure ARFID classification, picky eating, sensory sensitivity, disgust, and anxiety. Structural equation modeling tested a measurement model of latent disgust and anxiety factors as measured by self-reported frequency of disgust and anxiety reactions. Mediational models were used to explore causal ordering.

RESULTS

A latent disgust factor was more strongly related to severity of picky eating (B ≈ 0.4) and ARFID classification (B ≈ 0.6) than the latent anxiety factor (B ≈ 0.1). Disgust partially mediated the association between anxiety and picky eating and fully mediated the association between anxiety and ARFID. Models testing the reverse causal ordering demonstrated poorer fit. Findings suggest anxiety may be associated with food avoidance in part due to increased disgust.

CONCLUSIONS

Disgust may play a prominent role in food avoidance. Findings may inform novel approaches to treatment.

Applying the disgust conditioning model of food avoidance: A case study of acceptance-based interoceptive exposure

OBJECTIVE

The current case report details the treatment of a 16-year-old adolescent with anorexia nervosa utilizing a novel adjunct, acceptance-based interoceptive exposure, prior to family-based treatment (FBT) for eating disorders.

METHOD

The exposure-based module focused particularly on the tolerance of disgust. For six sessions, the clinician taught the client skills that could be used to tolerate distress to visceral sensations associated with disgust. These skills were to be used during in- and between-session exposures. Each session included exposure to physical sensations that occurred while drinking a milkshake.

RESULTS

Across six sessions, the client reported improvement in symptoms in addition to gaining weight. Additionally, she consumed more calories of a test meal following the intervention. Within broader FBT, the client reached an established weight goal, was able to return to physical activity, and reported an increased ability to manage distress.

DISCUSSION

Given the client's improvement on the Eating Disorders Examination-Questionnaire (EDE-Q) within six sessions, we believe IE may be a useful adjunct to FBT. Interoceptive exposure may augment the efficacy of FBT for anorexia nervosa as it provides clients with skills to utilize during the refeeding phase of treatment.

Conceptualizing the role of disgust in avoidant/restrictive food intake disorder: Implications for the etiology and treatment of selective eating

Selective eating is a common presenting problem in Avoidant/Restrictive Food Intake Disorder (ARFID). Understanding the etiology of selective eating will lead to the creation of more effective treatments for this problem. Recent reports have linked disgust sensitivity to picky eating, and the field has yet to conceptualize the role that disgust might play in ARFID. Disgust has long been tied to formation of taste aversions and is considered at its core to be a food-related emotion. A brief review of the literature on disgust reveals that disgust has a unique psychophysiological profile compared to other emotions, like anxiety, and that disgust is resistant to extinction procedures. If disgust is implicated in the etiology of selective eating, its presence would have a significant impact on treatment approaches. This article provides an overview of the research on disgust and eating, a clinical example of the treatment challenges that disgust may pose, and an overview of the unique clinical features of disgust as they apply to psychopathology. We pose several research questions related to disgust and selective eating and discuss initial hypotheses for pursing this line of inquiry. Finally, we discuss the possible implications of this line of research for treatment.