The Implicit Relational Assessment Procedure (IRAP) as a measure of obsessive beliefs in relation to disgust

Anti-Disgust Cognitive Behavioral Therapy for Contamination-Based Obsessive Compulsive Disorder: A Randomized Controlled Clinical Trial

Background: Disgust is a strong and persistent emotion that frequently occurs during exposure-based treatments for contamination-based obsessive compulsive disorder (C-OCD). This study aimed to examine the efficacy of augmenting cognitive behavioral therapy (CBT) with a novel type of anti-disgust cognitive intervention in reducing the severity of OCD, disgust propensity/sensitivity, and refusal rate of exposure and response prevention, while simultaneously increasing acceptance of disgust. Materials and Methods: Fifty-five individuals with C-OCD (mean age 28.1 years, SD = 3.52; 77% female) were randomly assigned to 15 weekly sessions of anti-disgust plus CBT (AD-CBT) or CBT alone. They were evaluated for outcomes four times (pretreatment, prior to exposure and response prevention (ERP) sessions, posttreatment, and three-month follow-up), and mixed-design ANOVAs were used to analyze the data. Results: The findings indicated that when compared to CBT alone, AD-CBT significantly reduced OCD severity, disgust propensity/sensitivity, and concurrently increased disgust acceptance (p < 0.001). Additionally, engaging in an anti-disgust cognitive intervention was associated with lower ERP refusal rate (4% vs. 16%). The superiority of AD-CBT over CBT persisted through the three-month follow-up period. Conclusions: The current study suggests that supplementing CBT for C-OCD with an anti-disgust cognitive intervention significantly increased acceptance of disgust and decreased the refusal rate of ERP, OCD severity, and disgust-related factors.

Implicit Cognition and Psychopathology: Looking Back and Looking Forward

Implicit cognitive processing is theorized to have a central role in many forms of psychopathology. In the current review, we focus on implicit associations, by which we mean evaluative representations in memory that are difficult to control and do not require conscious reflection to influence affect, cognition, or behavior. We consider definitional and measurement challenges before examining recent empirical evidence for these associations in anxiety, obsessive–compulsive, posttraumatic stress, depressive, and alcohol use disorders. This examination is framed by a brief review of the ways that prominent models of psychopathology represent biased implicit processing of disorder-relevant information. We consider to what extent models reflect more traditional automatic/implicit versus strategic/explicit dual-process perspectives or reflect more recent dynamical systems perspectives in which mental representations are iteratively reprocessed, evolving continuously. Finally, we consider the future research needed to better understand the interactive and temporal dynamics of implicit cognition in psychopathology.

Cognitive mechanisms of disgust in the development and maintenance of psychopathology: A qualitative review and synthesis

A growing body of research has implicated disgust in various psychopathologies, especially anxiety-related disorders. Although the observed role of disgust in many disorders is robust, the mechanisms that may explain this role are unclear. Cutting-edge research in cognitive science has the potential to elucidate such mechanisms and consequently improve our understanding of how disgust contributes to the etiology and maintenance of psychopathology. In this qualitative review, we systematically assess cognitive bias mechanisms that have been linked to disgust and its disorders. This review suggests that disgust-related biases may be observed in memory, interpretation, judgment of expectancies, and attention, as well as at implicit levels. Of these cognitive domains, the most robust bias appears to be observed at the level of attention. However, reliable moderators of attentional biases for disgust have not yet been identified, and this bias has not been systematically linked to other levels of analysis. Despite these limitations, the available research indicates that attentional avoidance rather than orienting or maintenance may be the most characteristic of disgust. Attentional avoidance of disgust may have important implications for etiological and treatment models of disorders characterized by excessive disgust reactions. The implications for advancing such models are discussed in the context of a combined cognitive bias hypothesis.

A meta-analysis of criterion effects for the Implicit Relational Assessment Procedure (IRAP) in the clinical domain

BACKGROUND AND OBJECTIVES

The Implicit Relational Assessment Procedure (IRAP) is a technique that is attracting a substantial body of research literature, particularly within the clinical domain.

METHOD

In response, the present paper outlines a meta-analysis of clinically-focused IRAP effects (N = 494) to provide the first estimate of how well such effects validate against their respective criterion variables in general.

RESULTS

The meta-analysis incorporated clinically-focused IRAP effects from 15 studies yielding a large effect size, r¯ = .45, with a desirably narrow 95% credibility interval (.23, .67). The funnel plot and subsequent sensitivity analyses indicated that this meta-effect was not subject to publication bias.

LIMITATIONS

The present meta-effect is an estimate based upon an IRAP literature that is still evolving rapidly in the clinical domain, and so as per its accompanying credibility interval, all conclusions that follow are necessarily provisional even if bounded. Apart from the fact that the current meta-effect might be subject to inadvertent under- and/or over-estimations of the current literature, the present meta-effect might strengthen with further refinements of the IRAP.

CONCLUSIONS

The current meta-effect provides the means to calculate what sample size would be required to achieve a statistical power of .80 when testing the criterion validity of clinically-focused IRAP effects using a given parametric statistic. For example, first-order Pearson correlations would hypothetically require an N of 29-37 for such purposes depending upon how conservatively over-estimation of the present meta-effect is controlled for. Overall, the IRAP compares favourably with alternative implicit measures in clinical psychology.