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Wahl K, Kollárik M, Lieb R. Does responsibility for potential harm attenuate the effects of repeated checking on metamemory and automatization? J Behav Ther Exp Psychiatry 2024; 85:101977. [PMID: 38972176 DOI: 10.1016/j.jbtep.2024.101977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Revised: 03/15/2024] [Accepted: 06/22/2024] [Indexed: 07/09/2024]
Abstract
BACKGROUND AND OBJECTIVES Repeated checking results in large reductions in metamemory variables (confidence, details, and vividness). It has been suggested that the underlying mechanism is gradual automatization. At the same time, individuals with obsessive-compulsive disorder (OCD) are reluctant to automatize routine processes. The aim was to investigate whether high responsibility for potential harm, typical of OCD, would attenuate the effects of repeated checking on metamemory variables and automatization. METHODS One hundred seventy-five participants were initially provided with a cover story that put the subsequent virtual checking task in a context of potential harm for not checking properly. Participants were randomly allocated to four experimental groups (varying high and low responsibility, relevant and irrelevant checking) and performed a virtual checking task repeatedly, using either identical stimuli (relevant checking) or different stimuli (irrelevant checking) between the first and final checking trial. Metamemory variables were rated on visual analogue scales, and response latencies were assessed to establish automatization. RESULTS Larger reductions in metamemory variables following relevant checking compared to irrelevant checking replicated previous findings. High responsibility did not affect these results. Large reductions in response latencies across the checking trials (automatization) were also independent of the perceived responsibility. LIMITATIONS We did not include individuals with OCD. CONCLUSIONS Since responsibility did not influence the effects of repeated checking on metamemory variables, findings are consistent with the idea that automatization remains a plausible explanation of the effects of repeated checking on metamemory variables in individuals with OCD.
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Affiliation(s)
- Karina Wahl
- Department of Psychology, Division of Clinical Psychology and Epidemiology, University of Basel, Switzerland.
| | - Martin Kollárik
- Department of Psychology, Division of Clinical Psychology and Epidemiology, University of Basel, Switzerland
| | - Roselind Lieb
- Department of Psychology, Division of Clinical Psychology and Epidemiology, University of Basel, Switzerland
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2
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Irak M, Topçuoğlu V, Duman TN, Akyurt S, Yılmaz İ, Pala İY. Investigating Retrospective and Prospective Metamemory Judgments During Episodic Memory in Patients With Obsessive-Compulsive Disorders. Behav Ther 2024; 55:277-291. [PMID: 38418040 DOI: 10.1016/j.beth.2023.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 06/25/2023] [Accepted: 07/03/2023] [Indexed: 03/01/2024]
Abstract
It is clear evidence that individuals diagnosed with obsessive-compulsive disorder (OCD) lack confidence in their memory and have low metamemory performance (judgment and accuracy). However, it is still unclear whether low metamemory performance is specific to first, domain general or domain specific, and second, to stimulus domain. To address these issues, we compared individuals diagnosed with OCD and healthy controls (HCs) on recognition, retrospective (judgments of learning [JOL]) and prospective (feeling of knowing [FOK]) metamemory judgments and under three different episodic memory tasks, which consisted of symptom-free, familiar and unfamiliar stimuli (word, scene, and face photo). OCD patients showed lower recognition performance, JOL and FOK judgments, and accuracy in all tasks than HCs. Also, OCD patients were slower than HCs during all cognitive performances. In both groups, metamemory performances were lower in familiar items than unfamiliar items. However, recognition performances were not affected by stimulus type. Our results support the idea of general episodic memory and a metamemory deficit in OCD. Moreover, metamemory deficits in OCD are domain general.
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3
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Abbasi Jondani J, Yazdkhasti F, Abedi A. Memory confidence and memory accuracy deterioration following repeated checking: A systematic review and meta-analysis. J Behav Ther Exp Psychiatry 2023; 81:101855. [PMID: 37001246 DOI: 10.1016/j.jbtep.2023.101855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 03/09/2023] [Accepted: 03/21/2023] [Indexed: 06/19/2023]
Abstract
BACKGROUND AND OBJECTIVES Rachman (2002) proposed a reciprocal detrimental relationship between repeated checking and memory confidence. Many experimental studies have indicated that repeated checking causes memory confidence deterioration while having no or little impact on memory accuracy. Thus, our main objective was to carry out a comprehensive meta-analysis to synthesize the existing research. Investigating the potential heterogeneity across studies using several moderator variables was also of interest. METHODS The comprehensive search of several databases yielded 29 studies comprising 67 substudies (N = 2180). Considering the substantial heterogeneity across these (sub)studies, data were analyzed using a random-effects meta-analytic approach. Subgroup analyses and meta-regressions were also carried out to explain some of the heterogeneity across studies. RESULTS The pooled effect size (Hedges' g) was equal to 0.870 (95% CI = 0.712-1.027, p < 0.001) for memory confidence and 0.213 (95% CI = 0.118-0.307, p < 0.001) for memory accuracy. However, we found evidence of publication bias in the literature. For both outcome variables, the effect was larger in studies inducing high responsibility or using real stimuli. A greater number of repeated checks was only associated with memory confidence decline. LIMITATIONS Results obtained from the analogue samples may have lower generalizability to people with OCD. CONCLUSIONS Repeated checking considerably deteriorates memory confidence while having a minor effect on memory accuracy. It is not clear whether memory accuracy contributes to memory confidence deterioration, particularly because memory accuracy declines were moderate in studies inducing high responsibility or using real objects.
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Affiliation(s)
- Javad Abbasi Jondani
- Department of Psychology, Faculty of Education and Psychology, University of Isfahan, Isfahan, Iran.
| | - Fariba Yazdkhasti
- Department of Psychology, Faculty of Education and Psychology, University of Isfahan, Isfahan, Iran.
| | - Ahmad Abedi
- Department of Psychology and Education of Children with Special Needs, Faculty of Education and Psychology, University of Isfahan, Isfahan, Iran.
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Picon EL, Wardell V, Palombo DJ, Todd RM, Aziz B, Bedi S, Silverberg ND. Factors perpetuating functional cognitive symptoms after mild traumatic brain injury. J Clin Exp Neuropsychol 2023; 45:988-1002. [PMID: 37602857 DOI: 10.1080/13803395.2023.2247601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 08/08/2023] [Indexed: 08/22/2023]
Abstract
INTRODUCTION Self-reported memory difficulties (forgetting familiar names, misplacing objects) often persist long after a mild traumatic brain injury (mTBI), despite normal neuropsychological test performance. This clinical presentation may be a manifestation of a functional cognitive disorder (FCD). Several mechanisms underlying FCD have been proposed, including metacognitive impairment, memory perfectionism, and misdirected attention, as well as depression or anxiety-related explanations. This study aims to explore these candidate perpetuating factors in mTBI, to advance our understanding of why memory symptoms frequently persist following mTBI. METHODS A cross-sectional study of 67 adults (n = 39 with mTBI mean = 25 months ago and n = 28 healthy controls). Participants completed standardized questionnaires (including the Functional Memory Disorder Inventory), a metacognitive task (to quantify discrepancies between their trial-by-trial accuracy and confidence), and a brief neuropsychological test battery. We assessed candidate mechanisms in two ways: (1) between-groups, comparing participants with mTBI to healthy controls, and (2) within-group, examining their associations with functional memory symptom severity (FMDI) in the mTBI group. RESULTS Participants with mTBI performed similarly to controls on objective measures of memory ability but reported experiencing much more frequent memory lapses in daily life. Contrary to expectations, metacognitive efficiency did not differentiate the mTBI and control groups and was not associated with functional memory symptoms. Memory perfectionism was strongly associated with greater functional memory symptoms among participants with mTBI but did not differ between groups when accounting for age. Depression and checking behaviors produced consistent results across between-groups and within-group analyses: these factors were greater in the mTBI group compared to the control group and were associated with greater functional memory symptoms within the mTBI group. CONCLUSIONS This study highlights promising (e.g., depression, checking behaviors) and unlikely (e.g., metacognitive impairment) mechanisms underlying functional memory symptoms after mTBI, to guide future research and treatment.
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Affiliation(s)
- Edwina L Picon
- Department of Psychology, University of British Columbia, Vancouver, Canada
| | - Victoria Wardell
- Department of Psychology, University of British Columbia, Vancouver, Canada
| | - Daniela J Palombo
- Department of Psychology, University of British Columbia, Vancouver, Canada
- Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Rebecca M Todd
- Department of Psychology, University of British Columbia, Vancouver, Canada
- Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Bilal Aziz
- Department of Psychology, University of British Columbia, Vancouver, Canada
| | - Sanjana Bedi
- Department of Psychology, University of British Columbia, Vancouver, Canada
| | - Noah D Silverberg
- Department of Psychology, University of British Columbia, Vancouver, Canada
- Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, British Columbia, Canada
- Rehabilitation Research Program, Centre for Aging SMART, Vancouver Coastal Health Research Institute, Vancouver, Canada
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5
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Alcolado GM, Radomsky AS. The Beliefs About Memory Inventory (BAMI) and Its Ability to Predict Compulsive Checking. COGNITIVE THERAPY AND RESEARCH 2022. [DOI: 10.1007/s10608-022-10340-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Radomsky AS, Alcolado GM, Dugas MJ, Lavoie SL. Responsibility, probability, and severity of harm: An experimental investigation of cognitive factors associated with checking-related OCD. Behav Res Ther 2022; 150:104034. [DOI: 10.1016/j.brat.2022.104034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 11/12/2021] [Accepted: 01/05/2022] [Indexed: 11/02/2022]
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Sookman D, Phillips KA, Anholt GE, Bhar S, Bream V, Challacombe FL, Coughtrey A, Craske MG, Foa E, Gagné JP, Huppert JD, Jacobi D, Lovell K, McLean CP, Neziroglu F, Pedley R, Perrin S, Pinto A, Pollard CA, Radomsky AS, Riemann BC, Shafran R, Simos G, Söchting I, Summerfeldt LJ, Szymanski J, Treanor M, Van Noppen B, van Oppen P, Whittal M, Williams MT, Williams T, Yadin E, Veale D. Knowledge and competency standards for specialized cognitive behavior therapy for adult obsessive-compulsive disorder. Psychiatry Res 2021; 303:113752. [PMID: 34273818 DOI: 10.1016/j.psychres.2021.113752] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Accepted: 01/21/2021] [Indexed: 12/19/2022]
Abstract
Obsessive-Compulsive Disorder (OCD) is a leading cause of disability world-wide (World Health Organization, 2008). Treatment of OCD is a specialized field whose aim is recovery from illness for as many patients as possible. The evidence-based psychotherapeutic treatment for OCD is specialized cognitive behavior therapy (CBT, NICE, 2005, Koran and Simpson, 2013). However, these treatments are not accessible to many sufferers around the world. Currently available guidelines for care are deemed to be essential but insufficient because of highly variable clinician knowledge and competencies specific to OCD. The phase two mandate of the 14 nation International OCD Accreditation Task Force (ATF) created by the Canadian Institute for Obsessive Compulsive Disorders is development of knowledge and competency standards for specialized treatments for OCD through the lifespan deemed by experts to be foundational to transformative change in this field. This paper presents knowledge and competency standards for specialized CBT for adult OCD developed to inform, advance, and offer a model for clinical practice and training for OCD. During upcoming ATF phases three and four criteria and processes for training in specialized treatments for OCD through the lifespan for certification (individuals) and accreditation (sites) will be developed based on the ATF standards.
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Affiliation(s)
- Debbie Sookman
- Department of Psychology, McGill University Health Center, 1025 Pine Ave W, Montreal, Quebec, H3A 1A1, Canada; Department of Psychiatry, McGill University, 845 Sherbrooke St W, Montreal, Quebec, H3A 0G4, Canada.
| | - Katharine A Phillips
- Department of Psychiatry, Weill Cornell Medicine, 1300 York Ave, New York, NY 10065, United States.
| | - Gideon E Anholt
- Department of Psychology, Marcus Family Campus, Ben-Gurion University of the Negev, Beer Sheva, P.O.B. 653 Beer-Sheva, 8410501, Israel.
| | - Sunil Bhar
- Department of Psychological Sciences, Faculty of Health, Arts and Design, Swinburne University of Technology, 1 John St, Hawthorn, Victoria, 3122, Australia.
| | - Victoria Bream
- Oxford Health Specialist Psychological Interventions Clinic and Oxford Cognitive Therapy Centre, Warneford Hospital, Oxford, OX3 7JX, United Kingdom.
| | - Fiona L Challacombe
- Institute of Psychiatry, Psychology and Neuroscience, Kings College London, De Crespigny Park, London, SE5 8AF, United Kingdom.
| | - Anna Coughtrey
- Great Ormond Street Hospital for Children, London WC1N 3JH, United Kingdom; UCL Great Ormond Street Institute of Child Health, 30 Guilford St, Holborn, London, WC1N 1EH, United Kingdom.
| | - Michelle G Craske
- Anxiety and Depression Research Center, Depression Grant Challenge, Innovative Treatment Network, Staglin Family Music Center for Behavioral and Brain Health, UCLA Department of Psychology and Department of Psychiatry and Biobehavioral Sciences, Box 951563, 1285 Franz Hall, Los Angeles, CA, United States.
| | - Edna Foa
- Center for the Treatment and Study of Anxiety, University of Pennsylvania Perelman SOM, 3535 Market Street, Philadelphia, PA 19104, United States.
| | - Jean-Philippe Gagné
- Department of Psychology, Concordia University, 7141 Sherbrooke St, West, Montreal, Quebec H4B 1R6, Canada.
| | - Jonathan D Huppert
- Department of Psychology, The Hebrew University of Jerusalem, Mt. Scopus, Jerusalem, 91905, Israel.
| | - David Jacobi
- Rogers Behavioral Health, 34700 Valley Road, Oconomowoc, WI, 53066, United States.
| | - Karina Lovell
- Division of Nursing, Midwifery and Social Work, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Oxford Rd, Manchester, M13 9PL, United Kingdom; Manchester Academic Health Science Centre, Greater Manchester Mental Health NHS Foundation Trust, Manchester, M13 9PL, United Kingdom.
| | - Carmen P McLean
- National Center for PTSD, Dissemination and Training Division, VA Palo Alto Healthcare System, 795 Willow Road, Menlo Park, CA, 94025, United States; Department of Psychiatry and Behavioral Sciences, Stanford University, 450 Serra Mall, Stanford, CA, 94305, United States.
| | - Fugen Neziroglu
- Bio-Behavioral Institute, 935 Northern Boulevard, Suite 102, Great Neck, NY, 11021, United States.
| | - Rebecca Pedley
- Division of Nursing, Midwifery and Social Work, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, M13 9PL, United Kingdom.
| | - Sean Perrin
- Department of Psychology, Lund University, Box 213, 22100, Lund, Sweden.
| | - Anthony Pinto
- Zucker School of Medicine at Hofstra/Northwell, Zucker Hillside Hospital - Northwell Health, 265-16 74th Avenue, Glen Oaks, NY, 11004, United States.
| | - C Alec Pollard
- Center for OCD and Anxiety-Related Disorders, Saint Louis Behavioral Medicine Institute, 1129 Macklind Ave, St. Louis, MO, 63110, United States; Department of Family and Community Medicine, Saint Louis University School of Medicine, Saint Louis, MO, 63110, United States.
| | - Adam S Radomsky
- Department of Psychology, Concordia University, 7141 Sherbrooke St, West, Montreal, Quebec H4B 1R6, Canada.
| | - Bradley C Riemann
- 34700 Valley Road, Rogers Behavioral Health, Oconomowoc, WI, 53066, United States.
| | - Roz Shafran
- Population, Policy and Practice Research and Teaching Department, UCL Great Ormond Street Hospital Institute of Child Health, Holborn, London, WC1N 1EH, United Kingdom.
| | - Gregoris Simos
- Department of Educational and Social Policy, University of Macedonia, 156 Egnatia Street, 54636 Thessaloniki, Greece.
| | - Ingrid Söchting
- Departments of Psychology, University of British Columbia, 2136 West Mall, Vancouver, British Columbia, V6T 1Z4, Canada.
| | - Laura J Summerfeldt
- Department of Psychology, Trent University, 1600 West Bank Drive, Peterborough, K9L 0G2 Ontario, Canada.
| | - Jeff Szymanski
- International OCD Foundation, 18 Tremont Street, #308, Boston MA, 02108, United States.
| | - Michael Treanor
- Anxiety and Depression Research Center, University of California, Los Angeles, Box 951563, 1285 Franz Hall, Los Angeles, CA, United States.
| | - Barbara Van Noppen
- Clinical Psychiatry and Behavioral Sciences, OCD Southern California, 2514 Jamacha Road Ste, 502-35 El Cajon, CA, 92019, United States; Department of Psychiatry and Behavioral Sciences, Keck School of Medicine, University of Southern California, 2250 Alcazar Street, Suite 2200, Los Angeles, CA, 90033, United States.
| | - Patricia van Oppen
- Department of Psychiatry, Amsterdam UMC, location VUmc, Netherlands; Amsterdam Public Health Research Institute - Mental Health, Netherlands; GGZ inGeest Specialized Mental Health Care, Netherlands.
| | - Maureen Whittal
- Vancouver CBT Centre, 302-1765 W8th Avenue, Vancouver, British Columbia, V6J5C6, Canada; Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada.
| | - Monnica T Williams
- School of Psychology, University of Ottawa, 136 Jean-Jacques Lussier Pvt, Ottawa, K1N 6N5, Ontario, Canada.
| | - Timothy Williams
- Department of Psychology, University of Reading, PO Box 217, Reading, Berkshire, RG6 6AH, United Kingdom.
| | - Elna Yadin
- Department of Psychiatry, University of Pennsylvania, 3535 Market Street, 2nd Floor, Philadelphia, PA 19104, United States.
| | - David Veale
- South London and the Maudsley NHS Foundation Trust & King's College London, Denmark Hill, London, SE5 8 AZ, United Kingdom.
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Not all checking decreases memory confidence: Implications for obsessive-compulsive disorder. J Behav Ther Exp Psychiatry 2020; 69:101573. [PMID: 32470684 DOI: 10.1016/j.jbtep.2020.101573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Revised: 03/17/2020] [Accepted: 04/27/2020] [Indexed: 11/21/2022]
Abstract
BACKGROUND AND OBJECTIVES Repetitive checking, a frequently reported compulsive behavior associated with obsessive-compulsive disorder (OCD), may, at least in part, result from a lack of memory confidence. Surprisingly, numerous studies have shown that when participants repeatedly perform an action and check that they performed it correctly, memory confidence decreases across repetitions, suggesting that repeated checking produces memory distrust. It is not clear, however, whether the checking component of each trial is critical for the decrease in confidence to occur. Five experiments tested whether the checking component is either necessary or sufficient to produce memory distrust. METHODS Participants repeatedly turned on and off virtual stove burners, with some conditions checking that the burners were off on each trial. Memory for the specific burners turned on and off was tested on the first and last trials, along with memory confidence. RESULTS Confidence decreased across trials even when the checking component was eliminated. However, increasing the number of times each person checked on each trial did not decrease confidence. LIMITATIONS A sample of individuals formally diagnosed with OCD was not tested. Also, our results only speak to massed (within-trial) checking, not spaced checking occurring over longer time intervals. CONCLUSIONS Whereas we consistently replicated the increase in memory distrust across repeated trials that is typically found with the stove-checking task, the checking component of each trial is neither necessary nor sufficient for the accrual of memory distrust. The build-up of proactive interference across repeated trials may cause the memory distrust.
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When it's at: An examination of when cognitive change occurs during cognitive therapy for compulsive checking in obsessive-compulsive disorder. J Behav Ther Exp Psychiatry 2020; 67:101442. [PMID: 30573211 DOI: 10.1016/j.jbtep.2018.12.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Revised: 11/12/2018] [Accepted: 12/04/2018] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND OBJECTIVES The cognitive theory of compulsive checking in OCD proposes that checking behaviour is maintained by maladaptive beliefs, including those related to inflated responsibility and those related to reduced memory confidence. This study examined whether and when specific interventions (as part of a new cognitive therapy for compulsive checking) addressing these cognitive targets changed feelings of responsibility and memory confidence. METHODS Participants were nine adults with a primary or secondary diagnosis of OCD who reported significant checking symptoms (at least one hour per day) on the Yale-Brown Obsessive-Compulsive Scale. A single-case multiple baseline design was used, after which participants received 12 sessions of cognitive therapy. From the start of the baseline period through to the 1 month post-treatment follow-up assessment session, participants completed daily monitoring of feelings of responsibility, memory confidence, and their time spent engaging in compulsive checking. RESULTS Results revealed that feelings of responsibility significantly reduced and memory confidence significantly increased from baseline to immediately post-treatment, with very high effect sizes. Multilevel modelling revealed significant linear changes in feelings of responsibility (i.e., reductions over time) and memory confidence (i.e., increases over time) occurred following the sessions when these were addressed. Finally, we found that improvements in these over the course of the treatment significantly predicted reduced time spent checking. LIMITATIONS The small sample size limits our ability to generalize our results. CONCLUSIONS Results are discussed in terms of a focus on the timing of change in cognitive therapy.
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Hoven M, Lebreton M, Engelmann JB, Denys D, Luigjes J, van Holst RJ. Abnormalities of confidence in psychiatry: an overview and future perspectives. Transl Psychiatry 2019; 9:268. [PMID: 31636252 PMCID: PMC6803712 DOI: 10.1038/s41398-019-0602-7] [Citation(s) in RCA: 60] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Revised: 07/03/2019] [Accepted: 07/30/2019] [Indexed: 01/11/2023] Open
Abstract
Our behavior is constantly accompanied by a sense of confidence and its' precision is critical for adequate adaptation and survival. Importantly, abnormal confidence judgments that do not reflect reality may play a crucial role in pathological decision-making typically seen in psychiatric disorders. In this review, we propose abnormalities of confidence as a new model of interpreting psychiatric symptoms. We hypothesize a dysfunction of confidence at the root of psychiatric symptoms either expressed subclinically in the general population or clinically in the patient population. Our review reveals a robust association between confidence abnormalities and psychiatric symptomatology. Confidence abnormalities are present in subclinical/prodromal phases of psychiatric disorders, show a positive relationship with symptom severity, and appear to normalize after recovery. In the reviewed literature, the strongest evidence was found for a decline in confidence in (sub)clinical OCD, and for a decrease in confidence discrimination in (sub)clinical schizophrenia. We found suggestive evidence for increased/decreased confidence in addiction and depression/anxiety, respectively. Confidence abnormalities may help to understand underlying psychopathological substrates across disorders, and should thus be considered transdiagnostically. This review provides clear evidence for confidence abnormalities in different psychiatric disorders, identifies current knowledge gaps and supplies suggestions for future avenues. As such, it may guide future translational research into the underlying processes governing these abnormalities, as well as future interventions to restore them.
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Affiliation(s)
- Monja Hoven
- Department of Psychiatry, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.
| | - Maël Lebreton
- 0000 0001 2322 4988grid.8591.5Swiss Center for Affective Science (CISA), University of Geneva (UNIGE), Geneva, Switzerland ,0000 0001 2322 4988grid.8591.5Neurology and Imaging of Cognition (LabNIC), Department of Basic Neurosciences, University of Geneva (UNIGE), Geneva, Switzerland
| | - Jan B. Engelmann
- 0000000084992262grid.7177.6CREED, Amsterdam School of Economics (ASE), University of Amsterdam, Amsterdam, The Netherlands ,0000000084992262grid.7177.6Amsterdam Brain and Cognition (ABC), University of Amsterdam, Amsterdam, The Netherlands ,0000 0001 2353 4804grid.438706.eThe Tinbergen Institute, Amsterdam, The Netherlands
| | - Damiaan Denys
- 0000000084992262grid.7177.6Department of Psychiatry, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands ,0000 0001 2171 8263grid.419918.cNeuromodulation & Behavior, Netherlands Institute for Neuroscience, KNAW, Amsterdam, The Netherlands
| | - Judy Luigjes
- 0000000084992262grid.7177.6Department of Psychiatry, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Ruth J. van Holst
- 0000000084992262grid.7177.6Department of Psychiatry, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
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Soref A, Liberman N, Abramovitch A, Dar R. Explicit instructions facilitate performance of OCD participants but impair performance of non-OCD participants on a serial reaction time task. J Anxiety Disord 2018; 55:56-62. [PMID: 29500079 DOI: 10.1016/j.janxdis.2018.02.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Revised: 02/09/2018] [Accepted: 02/21/2018] [Indexed: 11/29/2022]
Abstract
Previous studies have shown that individuals diagnosed with OCD tend to rely on explicit processing while performing implicit learning tasks. We sought to investigate whether individuals with OCD are capable of implicit learning, but would demonstrate improved performance when explicit processing strategies are enhanced. Twenty-four participants with OCD and 24 non-psychiatric control (NPC) participants performed an implicit learning task in which they responded to a single target stimulus that successively appears at one of four locations according to an underlying sequence. We manipulated the learning strategy by informing half of the participants that the target stimulus location was determined by an underlying sequence, which they should identify (intentional learning). The other half of the participants was not informed of the existence of the underlying sequence, and was expected to learn the sequence implicitly (standard learning). We predicted that OCD participants will exhibit inferior performance compared to NPC participants in the standard learning condition, and that intentional learning instructions would impair the performance of NPC participants, but enhance the performance of OCD participants. The results supported these predictions and suggest that individuals with OCD prefer controlled to automatic processing. We discuss the implications of this conclusion to our understanding of OCD.
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Affiliation(s)
- Assaf Soref
- School of Psychological Sciences, Tel-Aviv University, Israel.
| | - Nira Liberman
- School of Psychological Sciences, Tel-Aviv University, Israel
| | | | - Reuven Dar
- School of Psychological Sciences, Tel-Aviv University, Israel
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12
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Excessive Reassurance Seeking and Cognitive Confidence in Obsessive-Compulsive Disorder. Int J Cogn Ther 2018. [DOI: 10.1007/s41811-018-0008-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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13
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Bruce SL, Ching THW, Williams MT. Pedophilia-Themed Obsessive-Compulsive Disorder: Assessment, Differential Diagnosis, and Treatment with Exposure and Response Prevention. ARCHIVES OF SEXUAL BEHAVIOR 2018; 47:389-402. [PMID: 28822003 DOI: 10.1007/s10508-017-1031-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/02/2016] [Revised: 06/12/2017] [Accepted: 06/28/2017] [Indexed: 06/07/2023]
Abstract
Fears of sexually harming children are fairly common among clients suffering from obsessive-compulsive disorder (OCD), yet these symptoms are largely unrecognized and frequently misdiagnosed by mental health professionals. Specifically, clients with pedophilia-themed OCD (P-OCD) experience excessive worries and distressing intrusive thoughts about being sexually attracted to, and sexually violating, children. Expressing these concerns may provoke misjudgments from uninformed mental health professionals that a client is presenting instead with pedophilic disorder. This misdiagnosis and subsequent improper interventions can then contribute to increased fear, anxiety, and in many cases, depression, in affected clients. Therefore, it is imperative that mental health professionals first possess a good understanding of this common manifestation of OCD. As such, in this article, we described obsessions and compulsions typical of P-OCD, in order to inform the reader of the distinctive differences between P-OCD and pedophilic disorder. Information about how to assess for P-OCD symptoms is then provided, followed by suggestions on how to tailor aspects of exposure and response prevention to treat this specific form of OCD.
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Affiliation(s)
- Simone Leavell Bruce
- Department of Psychology, Spalding University, Louisville, KY, 40203, USA.
- Louisville OCD Clinic, Louisville, KY, USA.
| | - Terence H W Ching
- Department of Psychological Sciences, University of Connecticut, Storrs, CT, USA
| | - Monnica T Williams
- Department of Psychological Sciences, University of Connecticut, Storrs, CT, USA
- Louisville OCD Clinic, Louisville, KY, USA
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Andersson E, Hedman E, Wadström O, Boberg J, Andersson EY, Axelsson E, Bjureberg J, Hursti T, Ljótsson B. Internet-Based Extinction Therapy for Worry: A Randomized Controlled Trial. Behav Ther 2017; 48:391-402. [PMID: 28390501 DOI: 10.1016/j.beth.2016.07.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2016] [Revised: 07/11/2016] [Accepted: 07/17/2016] [Indexed: 11/26/2022]
Abstract
Worry is a common phenotype in both psychiatric patients and the normal population. Worry can be seen as a covert behavior with primary function to avoid aversive emotional experiences. Our research group has developed a treatment protocol based on an operant model of worry, where we use exposure-based strategies to extinguish the catastrophic worry thoughts. The aim of this study was to test this treatment delivered via the Internet in a large-scale randomized controlled trial. We randomized 140 high-worriers (defined as > 56 on the Penn State Worry Questionnaire [PSWQ]) to either Internet-based extinction therapy (IbET) or to a waiting-list condition (WL). Results showed that IbET was superior to WL with an overall large between-group effect size of d = 1.39 (95% confidence interval [1.04,1.73]) on the PSWQ. In the IbET group, 58% were classified as responders. The corresponding figure for WL participants was 7%. IbET was also superior to the WL on secondary outcome measures of anxiety, depression, meta-cognitions, cognitive avoidance, and quality of life. Overall treatment results were maintained for the IbET group at 4- and 12-month follow-up. The results from this trial are encouraging as they indicate that worry can be targeted with an accessible and novel intervention for worry. Replication trials with active control group are needed.
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Individuals with high obsessive-compulsive tendencies or undermined confidence rely more on external proxies to access their internal states. J Behav Ther Exp Psychiatry 2017; 54:263-269. [PMID: 27710870 DOI: 10.1016/j.jbtep.2016.09.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2015] [Revised: 05/27/2016] [Accepted: 09/20/2016] [Indexed: 11/20/2022]
Abstract
BACKGROUND AND OBJECTIVES The Seeking Proxies for Internal States (SPIS) hypothesis predicts that obsessive-compulsive disorder (OCD) is associated with a deficit in subjective convictions, which may lead to a reliance on external substitutes for the perceptions of an individual's internal states. Two well-designed studies were performed for the present work that adopted a false bio-feedback procedure in a muscle tension task to examine the SPIS hypothesis. METHODS The false bio-feedback paradigm was used to investigate our hypothesis. NeXus-10 Mark II hardware and V2011 BioTrace + software (Mind Media B.V., Herten, Netherlands) were utilized to measure the muscle tension of the flexor carpiulnaris muscle, which characterized the target's internal state. In addition, false EMG changes were recorded and displayed on a computer monitor and were considered external proxies. RESULTS Study 1 demonstrated that the participants with high obsessive-compulsive (OC) tendencies were more affected by the false bio-feedback and exhibited lower confidence in their judgments regarding their muscle tension compared with the participants with low OC tendencies. These findings indicate that subjects with high OC tendencies were more influenced by self-perception effects. In contrast, the subjects in the undermined confidence group in Study 2 were more easily influenced by the false bio-feedback compared with the control group, which suggests that the subjects in the undermined confidence group were more affected by self-perception effects. LIMITATIONS We did not combine the undermined confidence with OC tendencies or OCD symptoms in our paradigm to investigate their joint effects on self-perception. CONCLUSIONS Our findings provide further evidence that supports the SPIS hypothesis, which indicates that OC tendencies and the confidence in an individual's recognition of internal states appear to have similar effects on the assessment of internal states and reliance on proxies.
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Belayachi S, Linden MVD. The Cognitive Heterogeneity of Obsessive-Compulsive Checking. JOURNAL OF COGNITIVE EDUCATION AND PSYCHOLOGY 2017. [DOI: 10.1891/1945-8959.16.1.9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The present article reviews the phenomenology of obsessive-compulsive checking, examining how action processing can be differentially affected across distinct checking subtypes. Checking is a normal phenomenon which ensures that an intended goal has been actually completed. Checking symptoms have consistently been connected to impairments in processing information related to self-performances. Theoretical and empirical work has explained compulsive checking as a result of various cognitive deficits related to action processing (e.g., low confidence in cognitive abilities, impaired memory for actions, abnormal reality monitoring, overactive action monitoring, defective goal processing). Such apparent inconsistencies are, however, in agreement with clinical and empirical observations highlighting substantial variability in the subjective experience preceding/accompanying checking. Many factors can in fact prevent the cognitive system from determining whether or not an intended goal has actually been achieved. We argue that several action processing mechanisms are likely affected in checking; the related subjective experience may vary accordingly.
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Alcolado GM, Radomsky AS. A novel cognitive intervention for compulsive checking: Targeting maladaptive beliefs about memory. J Behav Ther Exp Psychiatry 2016; 53:75-83. [PMID: 25777270 DOI: 10.1016/j.jbtep.2015.02.009] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2014] [Revised: 11/18/2014] [Accepted: 02/20/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND AND OBJECTIVES Compulsive checking is one of the most common symptoms of obsessive-compulsive disorder (OCD). Recently it has been proposed that those who check compulsively may believe their memory is poor, rather than having an actual memory impairment. The current study sought to develop and assess a brief cognitive intervention focused on improving maladaptive beliefs about memory, as they pertain to both checking symptoms and memory performance. METHODS Participants (N = 24) with a diagnosis of OCD and clinical levels of checking symptomatology were randomly assigned either to receive two weekly 1-hour therapy sessions or to self-monitor during a similar waitlist period. Time spent checking, checking symptoms, maladaptive beliefs about memory, and visuospatial memory were assessed both pre- and post-treatment/waitlist. RESULTS Results showed that compared to the waitlist condition, individuals in the treatment condition displayed significant decreases in their maladaptive beliefs about memory and checking symptoms from pre- to post-intervention. They also exhibited increased recall performance on a measure of visuospatial memory. Changes in beliefs about memory were predictors of reduced post-intervention checking, but were not predictive of increased post-intervention memory scores. LIMITATIONS The lack of long term follow-up data and use of a waitlist control leave questions about the stability and specificity of the intervention. CONCLUSIONS Findings provide preliminary evidence that strategies targeting beliefs about memory may be worthy of inclusion in cognitive-behavioural approaches to treating compulsive checking.
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Affiliation(s)
- Gillian M Alcolado
- Concordia University, Department of Psychology, 7141 Sherbrooke St. West, Montreal, Quebec, H4B 1R6, Canada
| | - Adam S Radomsky
- Concordia University, Department of Psychology, 7141 Sherbrooke St. West, Montreal, Quebec, H4B 1R6, Canada.
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18
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Toffolo MBJ, van den Hout MA, Radomsky AS, Engelhard IM. Check, check, double check: Investigating memory deterioration within multiple sessions of repeated checking. J Behav Ther Exp Psychiatry 2016; 53:59-67. [PMID: 26409927 DOI: 10.1016/j.jbtep.2015.09.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2015] [Revised: 08/10/2015] [Accepted: 09/06/2015] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND OBJECTIVES Extensive research has shown that repeated checking causes memory distrust. Therefore, it has been suggested that people may subsequently get into a vicious cycle of decreased memory confidence and increased checking behavior, which may play a role in the maintenance and development of OCD. This study investigated in two experiments how repeated checking influences memory distrust over multiple checking episodes. METHODS In experiment 1, 70 healthy undergraduates performed two sessions of a virtual checking task with a 30 min break in between. In experiment 2, 41 healthy undergraduates performed two sessions of the checking task on a real kitchen stove and sink. RESULTS Results of experiment 1 showed that memory confidence for checking the stove decreased after repeated checking in session 1, and remained low in session 2, but memory vividness and detail decreased in both sessions and recovered in between. In experiment 2, all three meta-memory ratings for checking the stove decreased after repeated checking in both sessions, but recovered in between. LIMITATIONS Future research may include patients with OCD. To further investigate the development of memory distrust over time, more checking episodes may be included and the time between sessions may be increased. Although replication is needed, the findings of experiment 2 seem more informative. CONCLUSIONS Repeated checking may decrease memory vividness and detail (and, in turn, presumably also decrease memory confidence) each time this counterproductive strategy is used, which may have implications for using this paradigm as a behavioral experiment in cognitive-behavioral therapy.
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Affiliation(s)
- Marieke B J Toffolo
- Department of Clinical and Health Psychology, Utrecht University, Utrecht, The Netherlands.
| | - Marcel A van den Hout
- Department of Clinical and Health Psychology, Utrecht University, Utrecht, The Netherlands
| | - Adam S Radomsky
- Department of Psychology, Concordia University, Montréal, QC, Canada
| | - Iris M Engelhard
- Department of Clinical and Health Psychology, Utrecht University, Utrecht, The Netherlands
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Bucarelli B, Purdon C. Stove checking behaviour in people with OCD vs. anxious controls. J Behav Ther Exp Psychiatry 2016; 53:17-24. [PMID: 27664817 DOI: 10.1016/j.jbtep.2016.03.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2015] [Revised: 11/06/2015] [Accepted: 03/10/2016] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND OBJECTIVES A growing body of research suggests that the repetition of an action degrades memory for that action, as well as confidence that is has been done correctly. This has important implications for understanding the compulsive repetition of actions characteristic of obsessive compulsive disorder (OCD). At this time, though, much of the research has been conducted on analogue or nonclinical OCD samples in comparison to healthy controls and often using virtual, as opposed to actual, threat stimuli. Furthermore, although it has been argued that people with OCD are overly attentive to threat stimuli, the research on actual attention to threat is scant. METHODS People with a principal diagnosis of OCD (n = 30) and people with a clinically significant diagnosis of an anxiety disorder, but no OCD (n = 18) completed measures of memory confidence and responsibility and then underwent a stove-checking task in a functioning kitchen while wearing a portable eye tracking device. Pre- and post-task ratings of harm and responsibility were taken, along with post-task ratings of memory and certainty. RESULTS People with OCD did not exhibit poorer memory confidence than the anxious control (AC) group, but did report greater trait and state responsibility for harm. The OCD group checked longer than did the AC group and check duration predicted post-task ratings of harm, but to the same extent in both groups. People with OCD attended to threat items less than did the AC group. Greater visual attention to the stove during the checking period was associated with greater post-task ratings of responsibility and harm and with less certainty in and memory for the check - but only for the AC group. LIMITATIONS The sample size was modest, women were over-represented and problems with the eye tracking device reduced the amount of reliable data available for analysis. CONCLUSIONS Compulsions are complex actions that are mediated by many trait, state and contextual factors. People with OCD may be able to circumvent self-perpetuating checking processes under certain circumstances. Future research should explore the factors that determine whether or not self-perpetuating mechanisms are activated.
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Affiliation(s)
- Bianca Bucarelli
- Department of Psychology, University of Waterloo, Waterloo, ON N2G 3L1, Canada.
| | - Christine Purdon
- Department of Psychology, University of Waterloo, Waterloo, ON N2G 3L1, Canada.
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20
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Taylor J, Purdon C. Responsibility and hand washing behaviour. J Behav Ther Exp Psychiatry 2016; 51:43-50. [PMID: 26773341 DOI: 10.1016/j.jbtep.2015.12.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2015] [Revised: 12/19/2015] [Accepted: 12/21/2015] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND OBJECTIVES Recent research suggests that compulsions persist due to a self-perpetuating mechanism of poor memory confidence and repetition. However, most of this work has examined checking compulsions and findings may not generalize well to washing compulsions. This study examined the role of responsibility in the persistence of washing behaviour. METHODS Hand washing was examined in undergraduates (n = 80) high and low in contamination fears (CF) under conditions of high or low responsibility (RL). Wash duration and number of visits to objects/locations key to the wash (e.g., soap) were examined. RESULTS Overvalued responsibility predicted washing duration across groups. Neither wash duration nor number of visits was associated with memory for the wash. Wash duration predicted post-wash certainty that the wash had prevented harm, but only in the high CF group, and that effect varied according to RL: longer wash duration predicted greater certainty under conditions of low RL but predicted less certainty under conditions of high RL. Greater repetition predicted poorer sensory confidence, but only in the high CF group under high RL conditions. LIMITATIONS The data were collected in an analogue sample of modest size. Replication in a clinical sample is required. CONCLUSIONS Self-perpetuating mechanisms identified in perseverative checking seem to also be present in perseverative washing, but only under conditions of high responsibility. Sensory confidence may be more important to perseverative washing than memory confidence. More research is required to understand self-perpetuating mechanisms at play when washing to under conditions of high responsibility.
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Affiliation(s)
- Jasmine Taylor
- Department of Psychology University of Waterloo Waterloo, ON, N2L 3G1, Canada.
| | - Christine Purdon
- Department of Psychology University of Waterloo Waterloo, ON, N2L 3G1, Canada.
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21
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Oren E, Friedmann N, Dar R. Things happen: Individuals with high obsessive-compulsive tendencies omit agency in their spoken language. Conscious Cogn 2016; 42:125-134. [PMID: 27003263 DOI: 10.1016/j.concog.2016.03.012] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2015] [Revised: 03/09/2016] [Accepted: 03/11/2016] [Indexed: 11/29/2022]
Abstract
The study examined the prediction that obsessive-compulsive tendencies are related to an attenuated sense of agency (SoA). As most explicit agency judgments are likely to reflect also motivation for and expectation of control, we examined agency in sentence production. Reduced agency can be expressed linguistically by omitting the agent or by using grammatical framings that detach the event from the entity that caused it. We examined the use of agentic language of participants with high vs. low scores on a measure of obsessive-compulsive (OC) symptoms, using structured linguistic tasks in which sentences are elicited in a conversation-like setting. As predicted, high OC individuals produced significantly more non-agentic sentences than low OC individuals, using various linguistic strategies. The results suggest that OC tendencies are related to attenuated SoA. We discuss the implications of these findings for explicating the SoA in OCD and the potential contribution of language analysis for understanding psychopathology.
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Affiliation(s)
- Ela Oren
- School of Psychological Sciences, Tel Aviv University, Tel Aviv, Israel.
| | - Naama Friedmann
- Language and Brain Lab, School of Education and Sagol School of Neuroscience, Tel Aviv University, Tel Aviv, Israel.
| | - Reuven Dar
- School of Psychological Sciences, Tel Aviv University, Tel Aviv, Israel.
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Moshier SJ, Molokotos EK, Stein AT, Otto MW. Assessing the Effects of Depressed Mood and Cognitive Control Training on Memory Confidence and Accuracy Following Repeated Checking. Int J Cogn Ther 2015. [DOI: 10.1521/ijct_2015_8_02] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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23
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Perseveration causes automatization of checking behavior in obsessive-compulsive disorder. Behav Res Ther 2015; 71:1-9. [PMID: 25989162 DOI: 10.1016/j.brat.2015.05.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2014] [Revised: 04/29/2015] [Accepted: 05/09/2015] [Indexed: 11/20/2022]
Abstract
Repeated checking leads to reductions in meta-memory (i.e., memory confidence, vividness and detail), and automatization of checking behavior (Dek, van den Hout, Giele, & Engelhard, 2014, 2015). Dek et al. (2014) suggested that this is caused by increased familiarity with the checked stimuli. They predicted that defamiliarization of checking by modifying the perceptual characteristics of stimuli would cause de-automatization and attenuate the negative meta-memory effects of re-checking. However, their results were inconclusive. The present study investigated whether repeated checking leads to automatization of checking behavior, and if defamiliarization indeed leads to de-automatization and attenuation of meta-memory effects in patients with OCD and healthy controls. Participants performed a checking task, in which they activated, deactivated and checked threat-irrelevant stimuli. During a pre- and post-test checking trial, check duration was recorded and a reaction time task was simultaneously administered as dual-task to assess automatization. After the pre- and post-test checking trial, meta-memory was rated. Results showed that relevant checking led to automatization of checking behavior on the RT measure, and negative meta-memory effects for patients and controls. Defamiliarization led to de-automatization measured with the RT task, but did not attenuate the negative meta-memory effects of repeated checking. Clinical implications are discussed.
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Andersson E, Ljótsson B, Hedman E, Hesser H, Enander J, Kaldo V, Andersson G, Lindefors N, Rück C. Testing the Mediating Effects of Obsessive Beliefs in Internet-Based Cognitive Behaviour Therapy for Obsessive-Compulsive Disorder: Results from a Randomized Controlled Trial. Clin Psychol Psychother 2014; 22:722-32. [PMID: 25418575 DOI: 10.1002/cpp.1931] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2014] [Revised: 10/21/2014] [Accepted: 10/22/2014] [Indexed: 11/05/2022]
Abstract
UNLABELLED Although cognitive interventions for obsessive-compulsive disorder (OCD) have been tested in randomized trials, there are few trials that have tested the specific mechanisms of cognitive interventions, i.e. how they achieve their effects. In this study, we aimed to investigate the mediating effects of a short cognitive intervention in the treatment of OCD and used data from a recently conducted randomized controlled trial where 101 participants were allocated to either Internet-based CBT (ICBT) or to a control condition. Obsessive beliefs were measured at pre-treatment, at the time they had received the cognitive intervention, and also at post-treatment. Weekly OCD symptoms were measured throughout the 10 weeks of treatment. We hypothesized that (1) the ICBT group would have greater reductions in obsessive beliefs (controlling for change in OCD symptoms) after completing the cognitive intervention, and that (2) this reduction would, in turn, predict greater OCD symptom reduction throughout the rest of the treatment period. Contrary to our expectations, the longitudinal mediation analysis indicated that (1) being randomized to ICBT actually increased the degree of obsessive beliefs after receiving the cognitive intervention at weeks 1-3, and (2) increase in obsessive beliefs predicted better outcome later in treatment. However, when repeating the analysis using cross-sectional data at post-treatment, the results were in line with the initial hypotheses. Results were replicated when the control condition received ICBT. We conclude that, although obsessive beliefs were significantly reduced at post-treatment for the ICBT group, early increase rather than decrease in obsessive beliefs predicted favourable outcome. KEY PRACTITIONER MESSAGE This study investigated the impact of cognitive interventions on obsessive beliefs for patients with obsessive-compulsive disorder. Results showed that a sudden increase in obsessive beliefs is not an indicator of worse treatment response. On the contrary, it is more likely that the patient is better off when having this sudden increase. Clinicians should not be alarmed if the patient has a sudden increase in obsessive beliefs, but we do recommend the clinician to investigate the reasons for this further.
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Affiliation(s)
- Erik Andersson
- Department of Clinical Neuroscience, Division of Psychiatry, Karolinska Institutet, Stockholm, Sweden.,Department of Clinical Neuroscience, Division of Psychology, Karolinska Institutet, Stockholm, Sweden
| | - Brjánn Ljótsson
- Department of Clinical Neuroscience, Division of Psychology, Karolinska Institutet, Stockholm, Sweden
| | - Erik Hedman
- Department of Clinical Neuroscience, Division of Psychology, Karolinska Institutet, Stockholm, Sweden.,Osher Center for Integrative Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Hugo Hesser
- Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden
| | - Jesper Enander
- Department of Clinical Neuroscience, Division of Psychiatry, Karolinska Institutet, Stockholm, Sweden
| | - Viktor Kaldo
- Department of Clinical Neuroscience, Division of Psychiatry, Karolinska Institutet, Stockholm, Sweden
| | - Gerhard Andersson
- Department of Clinical Neuroscience, Division of Psychiatry, Karolinska Institutet, Stockholm, Sweden.,Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden
| | - Nils Lindefors
- Department of Clinical Neuroscience, Division of Psychiatry, Karolinska Institutet, Stockholm, Sweden
| | - Christian Rück
- Department of Clinical Neuroscience, Division of Psychiatry, Karolinska Institutet, Stockholm, Sweden
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Radomsky AS, Dugas MJ, Alcolado GM, Lavoie SL. When more is less: doubt, repetition, memory, metamemory, and compulsive checking in OCD. Behav Res Ther 2014; 59:30-9. [PMID: 24952303 DOI: 10.1016/j.brat.2014.05.008] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2014] [Revised: 05/05/2014] [Accepted: 05/21/2014] [Indexed: 01/07/2023]
Abstract
Memory and metamemory phenomena associated with obsessive-compulsive disorder (OCD) have received much attention in literature dedicated to a better understanding of the doubt and repetition associated with obsessions and compulsions. Following previous work on repeated checking among nonclinical participants, we asked participants to repeatedly turn on, turn off and check a real kitchen stove (n = 30 compulsive checkers diagnosed with OCD and n = 30 non-clinical undergraduates), or a real kitchen faucet (n = 30 non-clinical undergraduates) in a standardized, ritualized manner, in two connected experiments. Results indicated that following repeated relevant checking, both clinical and nonclinical participants reported significantly reduced memory confidence, vividness and detail; those who completed repeated irrelevant checking did not. The effects of repeated checking on memory accuracy were also explored. Results are discussed in terms of cognitive-behavioural formulations of OCD and in terms of the effects of repetition on memory and metamemory in association with checking behaviour.
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26
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Brain activation of the defensive and appetitive survival systems in obsessive compulsive disorder. Brain Imaging Behav 2014; 9:255-63. [DOI: 10.1007/s11682-014-9303-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Shafran R, Radomsky AS, Coughtrey A, Rachman S. Advances in the Cognitive Behavioural Treatment of Obsessive Compulsive Disorder. Cogn Behav Ther 2013; 42:265-74. [DOI: 10.1080/16506073.2013.773061] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Further Evidence That Repeated Checking Leads to Reduced Memory Confidence, Vividness and Detail: New Evidence That Repeated Object Exposure Also Results in Memory Distrust. BEHAVIOUR CHANGE 2013. [DOI: 10.1017/bec.2013.16] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Researchers have suggested that distrust in one's memory is both a cause and a consequence of repeated checking. We investigated whether reduced clarity and confidence occurs to an equal degree with repeated object use and repeated checking. In addition, whether decreased memory confidence persists after a delay in checking or use was examined. Participants (N = 113) either repeatedly checked or repeatedly used a virtual stove or a light bulb stimulus (the control stimulus). Significant declines in memory accuracy, confidence, vividness and detail were observed for the experimental compared to the control stimulus. No significant differences in these effects between the checking and exposure conditions were found. A significant increase in state anxiety across pre-, mid- and post-test was found for both conditions. These findings provide further support for the notion that repeated checking can be self-perpetuating due to its impact on memory processes. The findings also suggest that checking is not necessary for these effects to occur as repeated use without checking also results in significant declines in memory accuracy, confidence, vividness and detail. Theoretical and clinical implications are discussed.
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Harkin B, Miellet S, Kessler K. What checkers actually check: an eye tracking study of inhibitory control and working memory. PLoS One 2012; 7:e44689. [PMID: 23049755 PMCID: PMC3458048 DOI: 10.1371/journal.pone.0044689] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2012] [Accepted: 08/06/2012] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Not only is compulsive checking the most common symptom in Obsessive Compulsive Disorder (OCD) with an estimated prevalence of 50-80% in patients, but approximately ∼15% of the general population reveal subclinical checking tendencies that impact negatively on their performance in daily activities. Therefore, it is critical to understand how checking affects attention and memory in clinical as well as subclinical checkers. Eye fixations are commonly used as indicators for the distribution of attention but research in OCD has revealed mixed results at best. METHODOLOGY/PRINCIPAL FINDING Here we report atypical eye movement patterns in subclinical checkers during an ecologically valid working memory (WM) manipulation. Our key manipulation was to present an intermediate probe during the delay period of the memory task, explicitly asking for the location of a letter, which, however, had not been part of the encoding set (i.e., misleading participants). Using eye movement measures we now provide evidence that high checkers' inhibitory impairments for misleading information results in them checking the contents of WM in an atypical manner. Checkers fixate more often and for longer when misleading information is presented than non-checkers. Specifically, checkers spend more time checking stimulus locations as well as locations that had actually been empty during encoding. CONCLUSIONS/SIGNIFICANCE We conclude that these atypical eye movement patterns directly reflect internal checking of memory contents and we discuss the implications of our findings for the interpretation of behavioural and neuropsychological data. In addition our results highlight the importance of ecologically valid methodology for revealing the impact of detrimental attention and memory checking on eye movement patterns.
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Affiliation(s)
- Ben Harkin
- Institute of Neuroscience and Psychology, University of Glasgow, Glasgow, United Kingdom
| | | | - Klaus Kessler
- Institute of Neuroscience and Psychology, University of Glasgow, Glasgow, United Kingdom
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Lazarov A, Dar R, Liberman N, Oded Y. Obsessive–compulsive tendencies may be associated with attenuated access to internal states: Evidence from a biofeedback-aided muscle tensing task. Conscious Cogn 2012; 21:1401-9. [DOI: 10.1016/j.concog.2012.07.002] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2012] [Revised: 06/22/2012] [Accepted: 07/01/2012] [Indexed: 10/28/2022]
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Affiliation(s)
- Vlasios Brakoulias
- Discipline of Psychiatry, Sydney Medical School, The University of Sydney, Sydney, Australia.
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32
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Lazarov A, Dar R, Liberman N, Oded Y. Obsessive-compulsive tendencies and undermined confidence are related to reliance on proxies for internal states in a false feedback paradigm. J Behav Ther Exp Psychiatry 2012; 43:556-64. [PMID: 21835134 DOI: 10.1016/j.jbtep.2011.07.007] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2011] [Revised: 05/19/2011] [Accepted: 07/14/2011] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND OBJECTIVES We have previously hypothesized that obsessive-compulsive (OC) tendencies are associated with a general lack of subjective conviction regarding internal states, which leads to compensatory seeking of and reliance on more discernible substitutes (proxies) for these states (Lazarov, A., Dar, R., Oded, Y., & Liberman, N. (2010). Behaviour Research and Therapy, 48, 516-523). This article presents two studies designed to provide further support to this hypothesis by using false biofeedback as a proxy for internal states. METHODS In Study 1 we presented high and low OC participants with pre-programmed false feedback showing either increasing or decreasing levels of muscle tension. In Study 2 we presented similar false feedback on level of relaxation to non-selected participants, half of which received instructions that undermined their confidence in their ability to assess their own level of relaxation. RESULTS In Study 1, high OC participants were more affected by false biofeedback when judging their own level of muscle tension than were low OC participants. In Study 2, undermined confidence participants were more affected by false biofeedback when judging their own level of relaxation as compared to control participants. LIMITATIONS Our findings are based on a non-clinical, highly functioning, largely female student sample and their generalization to OCD requires replication with a sample of OCD patients. CONCLUSIONS These results provide converging evidence for our hypothesis by replicating and extending our previous findings. We discuss the implication of our hypothesis for the understanding and treatment of OCD and outline directions for future research.
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Affiliation(s)
- Amit Lazarov
- Department of Psychology, Tel Aviv University, Tel Aviv 69978, Israel
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Giele CL, van den Hout MA, Engelhard IM, Dek ECP, Hofmeijer FK. Obsessive-compulsive-like reasoning makes an unlikely catastrophe more credible. J Behav Ther Exp Psychiatry 2011; 42:293-7. [PMID: 21349245 DOI: 10.1016/j.jbtep.2010.12.012] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2010] [Revised: 12/20/2010] [Accepted: 12/23/2010] [Indexed: 11/26/2022]
Abstract
When obsessive-compulsive (OC) patients are confronted with disorder-relevant situations, they tend to reason in chains of small steps between the current situation and a highly improbable catastrophe. It was hypothesized that this type of "perseverative reasoning" would increase the subjective likelihood of the feared catastrophe. In an experiment with 63 healthy undergraduates, we tested whether OC-like perseverative reasoning induces feelings of uncertainty about a harmful outcome and makes this outcome more credible. Furthermore, we explored whether making multiple series of events increases these effects. Participants were administered a neutral situation with a catastrophic improbable outcome. In a pre- and post-test, they rated the credibility of this outcome and feelings of uncertainty about the outcome. In between, two experimental groups were instructed to generate respectively one or five series of intermediate steps between the situation and the harmful outcome, while a control group carried out a filler task. Consistent with the predictions, perseverative reasoning enhanced the credibility of a negative, improbable outcome. However, there were no differences between the two experimental conditions (one or five reasoning chains), and perseverative reasoning did not increase uncertainty about the outcome. The OC-like generation of small steps between an innocuous situation and a negative outcome increases the credibility of a feared outcome, potentially serving to maintain obsessive-compulsive disorder (OCD) problems.
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Affiliation(s)
- Catharina L Giele
- Clinical and Health Psychology, Utrecht University, PO Box 80140, 3508 TC Utrecht, The Netherlands.
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Boschen MJ, Wilson KL, Farrell LJ. Attenuating memory distrust in a repeated checking task. Behav Res Ther 2011; 49:466-71. [DOI: 10.1016/j.brat.2011.05.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2011] [Revised: 04/30/2011] [Accepted: 05/04/2011] [Indexed: 10/18/2022]
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Harkin B, Kessler K. The role of working memory in compulsive checking and OCD: A systematic classification of 58 experimental findings. Clin Psychol Rev 2011; 31:1004-21. [DOI: 10.1016/j.cpr.2011.06.004] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2011] [Revised: 06/06/2011] [Accepted: 06/08/2011] [Indexed: 10/18/2022]
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Harkin B, Rutherford H, Kessler K. Impaired executive functioning in subclinical compulsive checking with ecologically valid stimuli in a working memory task. Front Psychol 2011; 2:78. [PMID: 21687449 PMCID: PMC3110482 DOI: 10.3389/fpsyg.2011.00078] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2011] [Accepted: 04/13/2011] [Indexed: 11/28/2022] Open
Abstract
We previously showed that working memory (WM) performance of subclinical checkers can be affected if they are presented with irrelevant but misleading information during the retention period (Harkin and Kessler, 2009, 2011). The present study differed from our previous research in the three crucial aspects. Firstly, we employed ecologically valid stimuli in form of electrical kitchen appliances on a kitchen countertop in order to address previous criticism of our research with letters in locations as these may not have tapped into the primary concerns of checkers. Secondly, we tested whether these ecological stimuli would allow us to employ a simpler (un-blocked) design while obtaining similarly robust results. Thirdly, in Experiment 2 we improved the measure of confidence as a metacognitive variable by using a quantitative scale (0–100), which indeed revealed more robust effects that were quantitatively related to accuracy of performance. The task in the present study was to memorize four appliances, including their states (on/off), and their locations on the kitchen countertop. Memory accuracy was tested for the states of appliances in Experiment 1, and for their locations in Experiment 2. Intermediate probes were identical in both experiments and were administered during retention on 66.7% of the trials with 50% resolvable and 50% irresolvable/misleading probes. Experiment 1 revealed the efficacy of the employed stimuli by revealing a general impairment of high- compared to low checkers, which confirmed the ecological validity of our stimuli. In Experiment 2 we observed the expected, more differentiated pattern: High checkers were not generally affected in their WM performance (i.e., no general capacity issue); instead they showed a particular impairment in the misleading distractor-probe condition. Also, high checkers’ confidence ratings were indicative of a general impairment in metacognitive functioning. We discuss how specific executive dysfunction and general metacognitive impairment may affect memory traces in the short- and in the long-term.
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Affiliation(s)
- Ben Harkin
- Institute of Neuroscience and Psychology, University of Glasgow Glasgow, UK
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Believe in yourself: Manipulating beliefs about memory causes checking. Behav Res Ther 2011; 49:42-9. [DOI: 10.1016/j.brat.2010.10.001] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2010] [Revised: 09/30/2010] [Accepted: 10/02/2010] [Indexed: 11/19/2022]
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