An experimental re-examination of the inferential confusion hypothesis of obsessive-compulsive doubt

The Centrality of Doubting and Checking in the Network Structure of Obsessive-Compulsive Symptom Dimensions in Youth

OBJECTIVE

Obsessive-compulsive disorder (OCD) is a heterogeneous condition with well-established symptom dimensions across the lifespan. The objective of the present study was to use network analysis to investigate the internal structure of these dimensions in unselected schoolchildren and in children with OCD.

METHOD

We estimated the network structure of OCD symptom dimensions in 6,991 schoolchildren and 704 children diagnosed with OCD from 18 sites across 6 countries. All participants completed the Obsessive-Compulsive Inventory-Child Version.

RESULTS

In both the school-based and clinic-based samples, the OCD dimensions formed an interconnected network with doubting/checking emerging as a highly central node, that is, having strong connections to other symptom dimensions in the network. The centrality of the doubting/checking dimension was consistent across countries, sexes, age groups, clinical status, and tic disorder comorbidity. Network differences were observed for age and sex in the school-based but not the clinic-based samples.

CONCLUSION

The centrality of doubting/checking in the network structure of childhood OCD adds to classic and recent conceptualizations of the disorder in which the important role of doubt in disorder severity and maintenance is highlighted. The present results suggest that doubting/checking is a potentially important target for further research into the etiology and treatment of childhood OCD.

Inverse reasoning processes in obsessive-compulsive disorder: Replication in a clinical sample

The inference-based approach (IBA) is one cognitive model that aims to explain the aetiology and maintenance of obsessive-compulsive disorder (OCD). IBA theory suggests that certain reasoning processes lead an individual with OCD to confuse imagined possibilities with actual probabilities, a process termed inferential confusion. One such reasoning process is inverse reasoning, where hypothetical causes form the basis of conclusions about reality. Recently, we developed a task-based measure of inverse reasoning. In an online sample, we reported significant and positive associations between endorsement of inverse reasoning on this task and OCD symptomatology. We concluded that there was some support for the role of inverse reasoning in OCD but these results required extension using a between-groups design in a clinical sample. Therefore, the present study compared endorsement in inverse reasoning on this task between individuals diagnosed with OCD, anxiety and/or mood disorder (clinical controls), and healthy individuals (healthy controls). Relative to both control groups, the OCD group demonstrated significantly greater endorsement in inverse reasoning on scenarios where OCD relevant concerns were prompted. When non-OCD relevant concerns were involved, the OCD group only evidenced greater endorsement in inverse reasoning relative to the healthy control group. Implications for IBA theory are discussed.

Inductive reasoning and doubt in obsessive compulsive disorder

BACKGROUND AND OBJECTIVES

Previous studies show that individuals with obsessive compulsive disorder (OCD) accord more importance than healthy controls (HC) to alternative conclusions, resulting in increased doubt regarding an initial conclusion. The goal of the present study was to replicate and extend this finding.

METHODS

Eighteen participants diagnosed with OCD and 16 HC completed the Reasoning with Inductive Arguments Task (RIAT), which operationalizes doubt as change in confidence towards a conclusion after alternative conclusions are presented. To examine conditions that facilitate doubt, the impact of alternative conclusions that both supported and contradicted the initial conclusion was compared, as well as the effect of neutral and OCD-relevant item content.

RESULTS

Both the OCD and HC groups decreased confidence after contradicting conclusions, but only the HC group increased confidence when presented with supporting conclusions. Furthermore, decrease in confidence in the OCD group correlated with OCD symptom severity.

LIMITS

The RIAT could be adapted to better take into account of OCD subtypes.

CONCLUSION

Doubt generation may contribute to obsessional doubting.

Causal role for inverse reasoning on obsessive-compulsive symptoms: Preliminary evidence from a cognitive bias modification for interpretation bias study

BACKGROUND AND OBJECTIVES

The inference-based approach (IBA) is a cognitive account of the genesis and maintenance of obsessive-compulsive disorder (OCD). According to the IBA, individuals with OCD are prone to using inverse reasoning, in which hypothetical causes form the basis of conclusions about reality. Several studies have provided preliminary support for an association between features of the IBA and OCD symptoms. However, there are currently no studies that have investigated the proposed causal relationship of inverse reasoning in OCD.

METHODS

In a non-clinical sample (N = 187), we used an interpretive cognitive bias procedure to train a bias towards using inverse reasoning (n = 64), healthy sensory-based reasoning (n = 65), or a control condition (n = 58). Participants were randomly allocated to these training conditions. This manipulation allowed us to assess whether, consistent with the IBA, inverse reasoning training increased compulsive-like behaviours and self-reported OCD symptoms.

RESULTS

Results indicated that compared to a control condition, participants trained in inverse reasoning reported more OCD symptoms and were more avoidant of potentially contaminated objects. Moreover, change in inverse reasoning bias was a small but significant mediator of the relationship between training condition and behavioural avoidance. Conversely, training in a healthy (non-inverse) reasoning style did not have any effect on symptoms or behaviour relative to the control condition.

LIMITATIONS

As this study was conducted in a non-clinical sample, we were unable to generalise our findings to a clinical population.

CONCLUSIONS

Findings generally support the IBA model by providing preliminary evidence of a causal role for inverse reasoning in OCD.

Inverse reasoning processes in obsessive-compulsive disorder

The inference-based approach (IBA) is one cognitive model that aims to explain the aetiology and maintenance of obsessive-compulsive disorder (OCD). The model proposes that certain reasoning processes lead an individual with OCD to confuse an imagined possibility with an actual probability, a state termed inferential confusion. One such reasoning process is inverse reasoning, in which hypothetical causes form the basis of conclusions about reality. Although previous research has found associations between a self-report measure of inferential confusion and OCD symptoms, evidence of a specific association between inverse reasoning and OCD symptoms is lacking. In the present study, we developed a task-based measure of inverse reasoning in order to investigate whether performance on this task is associated with OCD symptoms in an online sample. The results provide some evidence for the IBA assertion: greater endorsement of inverse reasoning was significantly associated with OCD symptoms, even when controlling for general distress and OCD-related beliefs. Future research is needed to replicate this result in a clinical sample and to investigate a potential causal role for inverse reasoning in OCD.

The inference-based approach to obsessive-compulsive disorder: A comprehensive review of its etiological model, treatment efficacy, and model of change

BACKGROUND

The inference-based approach (IBA) postulates that individuals with obsessive-compulsive disorder (OCD) confuse a possibility with reality (inferential confusion) according to specific inductive reasoning devices and act as if this possibility were true. A new treatment modality, the inference-based therapy (IBT), was developed. The aim of this study was to critically review empirical evidence regarding the etiological model, treatment efficacy, and model of change of IBA.

METHODS

A search of the literature was conducted using PsycINFO and Medline.

RESULTS

Thirty-four articles were included in the review. The review reveals that intrusive thoughts of non-clinical and OCD individuals may occur in different contexts. There is support for a specific inductive reasoning style in OCD. Inferential confusion is associated with OCD symptoms. There is good evidence that IBT is an efficacious treatment for OCD, including two randomized controlled trials showing that IBT was as efficacious as cognitive-behavior therapy. There is some but limited evidence that the process of change during treatment is coherent with IBA's assumptions.

LIMITATIONS

Key premises were investigated in only a few studies. Some of these studies were conducted in non-clinical samples or did not include an anxious control group.

CONCLUSIONS

IBA's etiological model, treatment modality, and model of change make a significant contribution to OCD.