Waxing and waning: The roles of chronotype and time of day in predicting symptom fluctuations in obsessive-compulsive disorder using a daily-monitoring design

Diurnal variation in anxiety and activity is influenced by chronotype and probable anxiety-related disorder status

Anxiety symptoms vary moment-to-moment within a day. One factor that may influence these variations is chronotype. Evening chronotypes prefer to engage in activities (e.g., sleep, physical and social activity) later in the day, and evening chronotype is implicated in psychopathology, including anxiety-related disorders. However, it is unknown whether chronotype influences diurnal variation in anxiety symptoms and whether these effects are amplified in individuals with a probable anxiety-related disorder. We examined the diurnal variation in anxiety symptoms and daily activities in morning and evening chronotypes with and without probable generalized anxiety disorder (GAD) or obsessive-compulsive disorder (OCD) in a community sample of adults (N = 410). Evening chronotypes reported higher anxiety symptoms, particularly in the evening hours, and lower engagement in daily activities, predominantly in the morning hours. Evening chronotypes with probable GAD or OCD reported worse anxiety symptoms in the evening. Our findings indicate that anxiety symptoms and engagement in daily activities fluctuate considerably across the day, and these patterns differ depending on chronotype. Evening chronotypes have more anxiety symptoms in the evening, despite preferring this time of day. Personalized treatment approaches that consider chronotype and target certain times of day may be efficient in alleviating peaks in anxiety symptoms.

Psychometric properties of a daily obsessive-compulsive symptom scale for ecological momentary assessment

Despite growing interest in ecological momentary assessment (EMA) in psychopathology and clinical observation of day-to-day fluctuations in obsessive-compulsive disorder (OCD) symptoms, there is not a standardized EMA measure of such symptoms that can guide systematic research. In the absence of such a measure, prior EMA research in OCD has utilized heterogeneous approaches to sampling momentary and daily OCD symptoms, which limits the ability to compare results between studies. The present study sought to examine the psychometric properties of a daily OCD symptom (d-OCS) measure that assesses common OCD symptom themes (e.g., contamination, checking, intrusive thoughts) in a sample of adults with OCD (n = 20), psychiatric controls (n = 27), and healthy controls (n = 27). Participants completed the d-OCS 3 times per day for 1 week. The d-OCS distinguished those with OCD from psychiatric controls and healthy controls. The d-OCS demonstrated good internal consistency, adequate test-retest reliability, and good convergent validity. These findings offer initial psychometric support for the use of the d-OCS in EMA research examining day-to-day fluctuations in symptoms of OCD. Additional investigation is needed to examine the discriminant validity of the d-OCS and generalize these findings to more diverse samples.

The Effect of Symptom-Provocation on Inhibitory Control in Obsessive-Compulsive Disorder Patients Is Contingent upon Chronotype and Time of Day

Studies have shown that alertness can affect inhibitory control, the mechanism responsible for stopping behaviors, thoughts, or emotions. Inhibitory control is particularly important for helping individuals with Obsessive-Compulsive Disorder (OCD) resisting their symptoms. Chronotype is the mechanism governing an individual's fluctuation of alertness throughout the day. Previous studies have shown that individuals with a 'morning' chronotype have worse OCD symptoms in the evening and vice versa. We administered a novel 'symptom-provocation stop signal task' (SP-SST), in which individually tailored OCD triggers were presented and inhibitory control was measured. Twenty-five treatment-seeking OCD patients completed the SP-SST three times per day for seven consecutive days. Stop signal reaction time (SSRT), which measures inhibitory control, was calculated separately for symptom-provocation trials and for neutral trials. Results yielded that: (a) stopping was significantly harder in the symptom-provocation compared to neutral trials, and (b) the chronotype by time-of-day interaction predicts inhibition for both symptom-provocation and neutral trials, indicating better inhibition in the optimal time of day. Furthermore, we concluded that individually tailored OCD triggers have a detrimental effect on inhibitory control. Most importantly, higher alertness levels, which can be predicted by the interaction of chronotype and time of day, affect inhibitory control, both in general and for OCD triggers specifically.

Obsessive-compulsive symptoms and dissociative experiences: Suggested underlying mechanisms and implications for science and practice

A strong and specific link between obsessive-compulsive disorder or symptoms (OCD/S) and a tendency for dissociative experiences (e.g., depersonalization-derealization, absorption and imaginative involvement) cannot be explained by trauma and is poorly understood. The present theoretical formulation proposes five different models conceptualizing the relationship. According to Model 1, dissociative experiences result from OCD/S through inward-focused attention and repetition. According to Model 2, dissociative absorption causally brings about both OCD/S and associated cognitive risk factors, such as thought-action fusion, partly through impoverished sense of agency. The remaining models highlight common underlying causal mechanisms: temporo-parietal abnormalities impairing embodiment and sensory integration (Model 3); sleep alterations causing sleepiness and dreamlike thought or mixed sleep-wake states (Model 4); and a hyperactive, intrusive imagery system with a tendency for pictorial thinking (Model 5). The latter model relates to Maladaptive Daydreaming, a suggested dissociative syndrome with strong ties to the obsessive-compulsive spectrum. These five models point to potential directions for future research, as these theoretical accounts may aid the two fields in interacting with each other, to the benefit of both. Finally, several dissociation-informed paths for further developing clinical intervention in OCD are identified.

An Integrative Model for Understanding Obsessive-Compulsive Disorder: Merging Cognitive Behavioral Theory with Insights from Clinical Neuroscience

Several models have been proposed for the emergence and maintenance of obsessive-compulsive disorder (OCD). Although these models have provided important insights and inspired treatment development, no single model has yet sufficiently accounted for the complexed phenotype of the disorder. In the current paper, we propose a novel model that integrates elements from cognitive behavioral models of OCD with neurocognitive approaches to the disorder. This Reciprocal Interaction Model (RIM) for OCD is based on two assumptions: (a) similar observed symptoms can stem from different etiological processes; and (b) neuropsychological deficits (such as reduced response inhibition and overreliance on the habit formation system) and cognitive behavioral processes (such as temporary reduction in anxiety after engaging in compulsive behaviors) mutually affect each other such that abnormalities in one system influence the second system and vice-versa-creating a vicious cycle of pathological processes. Indeed, the bidirectional inhibitory connection between anxiety/obsessions and executive control is at the heart of the model. We begin by briefly reviewing the current models for OCD. We then move on to describe the RIM, the supporting evidence for the model, the model's predictions, and potential clinical implications.

Delayed circadian rhythms and insomnia symptoms in obsessive-compulsive disorder

BACKGROUND

Accumulating evidence implicates sleep and circadian rhythm disturbance in obsessive-compulsive disorder (OCD). However, a multimethod characterization of sleep and circadian rhythms in OCD, their association with symptom severity, and the functional relationship between these variables is lacking.

METHODS

The present study measured multiple indicators of sleep and circadian rhythms in a sample of adults with OCD, adults without OCD, and healthy controls (n = 74). Participants completed measures of morningness-eveningness, delayed sleep-wake phase disorder (DSWPD), insomnia symptoms, and OCD symptoms, as well as one week of sleep monitoring via a sleep diary and actigraphy.

RESULTS

Delayed circadian rhythms (higher eveningness, later mid-sleep timing, and higher rates of DSWPD) and higher insomnia symptoms were observed in those with OCD compared to healthy controls, as well as associations between delayed circadian rhythms and insomnia symptoms and OCD symptom severity across the full sample. Further, insomnia symptoms mediated the relationship between delayed circadian rhythms and OCD symptoms. In contrast, there were no links between total sleep time or sleep quality and OCD.

LIMITATIONS

Data collection during COVID-19 pandemic, correlational data, no physiological measure of circadian rhythms.

CONCLUSIONS

These findings highlight a robust association between delayed circadian rhythms and OCD and suggest insomnia symptoms may be one mechanism in this relationship. Sleep and circadian rhythm disturbance may be novel targets for OCD treatment.

Sleep and anxiety: From mechanisms to interventions

Anxiety is the most common mental health problem worldwide. Epidemiological studies show that sleep disturbances, particularly insomnia, affect ∼50% of individuals with anxiety, and that insufficient sleep can instigate or further exacerbate it. This review outlines brain mechanisms underlying sleep and anxiety, by addressing recent human functional/structural imaging studies on brain networks underlying the anxiogenic impact of sleep loss, and the beneficial effect of sleep on these brain networks. We discuss recent developments from human molecular imaging studies that highlight the role of specific brain neurotransmitter mechanisms, such as the adenosinergic receptor system, on anxiety, arousal, and sleep. This review further discusses frontline sleep interventions aimed at enhancing sleep in individuals experiencing anxiety, such as nonbenzodiazepines/antidepressants, lifestyle and sleep interventions and cognitive behavioral therapy for insomnia. Notwithstanding therapeutic success, up to ∼30% of individuals with anxiety can be nonresponsive to frontline treatments. Thus, we address novel non-invasive brain stimulation techniques that can enhance electroencephalographic slow waves, and might help alleviate sleep and anxiety symptoms. Collectively, these findings contribute to an emerging biological framework that elucidates the interrelationship between sleep and anxiety, and highlight the prospect of slow wave sleep as a potential therapeutic target for reducing anxiety.