Thought-action fusion across anxiety disorder diagnoses: specificity and treatment effects

Assessment of Comorbid Obsessive-Compulsive Disorder and Posttraumatic Stress Disorder

Obsessive-compulsive disorder (OCD) and posttraumatic stress disorder (PTSD) are commonly comorbid and share prominent features (e.g., intrusions, safety behaviors, and avoidance). Excellent self-report and clinician-administered assessments exist for OCD and PTSD individually, but few assess both disorders, and even fewer provide instruction on differential diagnosis or detection of comorbid OCD and PTSD. To address this gap in the literature, the current paper aims to (1) highlight diagnostic and functional similarities and differences between OCD and PTSD to inform differential diagnosis, (2) outline assessment recommendations for individuals with suspected comorbid OCD and PTSD, OCD with a significant trauma history or posttraumatic symptoms, or PTSD with significant obsessive-compulsive symptoms, and (3) explore future directions to evaluate and improve methods for assessing co-occurring OCD and PTSD.

Scrupulosity Obsessive-Compulsive Disorder in Children

It is important for psychiatric-mental health nurses and advanced practice nurses to be familiar with clinical presentations and recommended treatment for obsessive-compulsive disorder (OCD) in children and adolescents. The current article provides a brief overview of symptom presentation, diagnostic criteria, etiology, comorbidity, and prevalence in this population. Special attention is given to one of the lesser-known clinical presentations, scrupulosity. A scrupulosity theme entails intrusive thoughts that center around a religious, ethical, and/or moral framework. A vignette is provided to illustrate a scrupulosity presentation. Finally, empirically supported treatment is outlined, and nursing considerations are provided. [Journal of Psychosocial Nursing and Mental Health Services, 61(11), 10-16.].

Aversive Reactivity: A Transdiagnostic Functional Bridge Between Neuroticism and Avoidant Behavioral Coping

Aversive reactivity to negative affect has been described as a transdiagnostic mechanism that links distal temperamental vulnerabilities to clinically relevant behaviors. However, the abundance of constructs reflecting aversive reactivity has resulted in a proliferation of models that may ultimately be redundant. We performed a circumscribed review of studies measuring associations between six constructs - anxiety sensitivity, experiential avoidance, distress intolerance, intolerance of uncertainty, thought-action fusion, and negative urgency - and ten relevant coping behaviors. Results suggested that most constructs were measured in relation to a limited number of coping behaviors. Additionally, constructs were most often measured in isolation, rather than with similar constructs. Implications and suggestions for future research and treatment are discussed.

The Role of Magical Thinking, Sensitivity, and Thought Content in Thought-Action Fusion

Introduction: Cognitive models of obsessive-compulsive disorder (OCD) posit that maladaptive beliefs about intrusive thinking contribute to the disorder's development and maintenance. However, the findings concerning one notable belief, thought-action fusion (TAF), have been inconsistent. Current conceptualizations of TAF may conflate constructs such as magical thinking, sensitivity, and thought content that are already the subject of informative, interdisciplinary literatures. Methods: To tease apart these constructs, adult participants (N = 249) reported their trait levels of sensitivity and magical thinking, and were randomly assigned to engage with an intrusive thought in one of three content areas. We hypothesized that morality-related content would lead to heightened maladaptive outcomes, but only in combination with higher trait levels of sensitivity and magical thinking. Results: Results indicated that morality-related content, along with sensitivity to morality, played more of a prominent role in maladaptive outcomes, with magical thinking being implicated in general outcomes like worry. Discussion: These findings suggest that the link between TAF and maladaptive outcomes may depend on which TAF elements are present for an individual. Sensitivity, in tandem with other TAF elements (e.g., morality-related content, magical thinking) is predictive of divergent outcomes (e.g., worrying, urges to neutralize) and thus may be an important target of future interventions aimed at reducing TAF, worrying, and/or OC symptoms.

The Associations Between Attachment, Thought-Action Fusion, and Anxiety in Adolescents: Mediator Effect of Thought-Action Fusion

Background

This study examined the relationship between attachment quality, thought-action fusion (TAF), and the anxiety levels and mediator effect of TAF-likelihood-self in this relationship in adolescents.

Methods

The participants consisted of 637 adolescents aged 12-17 (61.3% female, n = 391; 38.7% male, n = 246) obtained from 2 secondary schools in Istanbul. TAF was screened with Thought-Action Fusion-Child Version (TAFIC), and anxiety was assessed with the Trait Anxiety subscale of the State-Trait Anxiety Inventory for Children (STAIC). The short form of The Inventory of Parent and Peer Attachment-short version (s-IPPA) was used to determine the attachment quality of adolescents.

Results

Higher levels of TAF and lower levels of maternal attachment (MA) and paternal attachment (PA) quality were associated with higher levels of trait anxiety. In addition to this, TAF-likelihood-self had partial mediator role between attachment levels and anxiety symptoms.

Conclusion

The results of the present study suggested that low attachment quality can be a risk factor in terms of higher anxiety levels, and TAF problems may have an increasing effect on this association. It can be suggested that, in the clinical or academic field, interventions focusing on the differentiation between the thought and action may be beneficial in anxious adolescents with attachment problems.

Korean Version of the Thought-Action Fusion Scale: The Evidence for Its Psychometric Properties

OBJECTIVE

The Thought-Action Fusion Scale (TAFS) is a self-reported instrument used to measure a cognitive bias, namely, thoughtaction fusion (TAF), in which intrusive thoughts have moral and actual consequences. The aim of this study is to investigate the reliability and validity of the Korean version of the 19-item TAFS (K-TAFS) in Korean samples.

METHODS

In this study, 628 university students and 93 patients with obsessive-compulsive disorder (OCD) completed the K-TAFS and several other psychological scales. Descriptive analyses, correlations, group comparisons, and exploratory and confirmatory factor analyses were performed.

RESULTS

The results of the exploratory and confirmatory factor analyses indicated a two-factor structure with TAF-Morality and TAFLikelihood that best fits the data in the university sample. The reliability analyses showed that TAFS and its factors had excellent internal consistencies. Regarding the concurrent validity, positive correlations were observed between TAF-Likelihood and cognitive fusion, while the TAFS scores did not show any consistent correlations with other symptoms such as depression and anxiety. Compared to the university students, the OCD patients showed higher TAFS scores and their obsessive-compulsive symptoms were significantly associated with both TAF-Morality and TAF-Likelihood.

CONCLUSION

Overall, the findings of this study support the reliability and validity of the K-TAFS.

The effects of cognitive behavioral therapy on the whole brain structural connectome in unmedicated patients with obsessive-compulsive disorder

Cognitive behavioral therapy (CBT) is considered a first-line treatment for patients with obsessive-compulsive disorder (OCD), and it possesses advantages over pharmacological treatments in stronger tolerance to distress, lower rates of drop out and relapse, and no physical "side-effects". Previous studies have reported CBT-related alterations in focal brain regions and connections. However, the effects of CBT on whole-brain structural networks have not yet been elucidated. Here, we collected diffusion MRI data from 34 unmedicated OCD patients before and after 12 weeks of CBT. Fifty healthy controls (HCs) were also scanned twice at matched intervals. We constructed individual brain white matter connectome and performed a graph-theoretical network analysis to investigate the effects of CBT on whole-brain structural topology. We observed significant group-by-time interactions on the global network clustering coefficient and the nodal clustering of the left lingual gyrus, the left middle temporal gyrus, the left precuneus, and the left fusiform gyrus of 26 CBT responders in OCD patients. Further analysis revealed that these CBT responders showed prominently higher global and nodal clustering compared to HCs at baseline and reduced to normal levels after CBT. Such significant changes in the nodal clustering of the left lingual gyrus were also found in 8 CBT non-responders. The pre-to-post decreases in nodal clustering of the left lingual gyrus and the left fusiform gyrus positively correlated with the improvements in obsessive-compulsive symptoms in the CBT-responding patients. These findings indicated that the network segregation of the whole-brain white matter network in OCD patients was abnormally higher and might recover to normal after CBT, which provides mechanistic insights into the CBT response in OCD and potential imaging biomarkers for clinical practice.

Toward a Unified Treatment for Emotional Disorders: Update on the Science and Practice

Mental health professionals have long been concerned with describing and proscribing a structure around the myriad variations of psychological and emotional distress that are deemed to be disordered. This has frequently been characterized as a conflict between so-called "lumpers" and "splitters"-those who advocate broad categorizations based on overarching commonalities versus those who endeavor toward a highly refined structure emphasizing unique characteristics. Many would argue that with the era of the modern Diagnostic and Statistical Manual of Mental Disorders (DSM-III to DSM-5), a splitting ideology has been dominant despite re-emerging concerns that some groups of diagnoses, particularly disorders of anxiety and other emotions, may be more similar than different. As a result of such concerns, transdiagnostic or unified models of psychopathology have burgeoned. In this review, we describe the work of Barlow, Allen, and Choate (2004), whose invited paper "Toward a Unified Treatment for Emotional Disorders" reignited transdiagnostic perspectives of emotional disorders. We provide an update on the scientific models and evidence-based treatments that have followed in the wake of this 2004 publication, including key areas for future study in the advancement of transdiagnostic and unified treatment of emotional disorders.

The many faces of anxiety-neurobiological correlates of anxiety phenotypes

Anxiety is an all-inclusive concept incorporating somatic symptoms (palpitations, dizziness, dyspnea), emotional and cognitive elements (negative affect, fear, worry, rumination) and behavioral components (e.g., avoidance). The aim of this study was to examine the specific neural correlates associated with anxiety phenotypes (worry, rumination, somatic anxiety) and negative affect (neuroticism). Twenty-nine anxious participants and 30 healthy controls were included in the study. We analyzed seed-based intrinsic connectivity and used correlation maps in a multivariable regression model to describe the specific effect of each anxiety phenotype independently of the effects of age and the other measures of anxiety. Worry severity was uniquely correlated with increased intrinsic connectivity between right anterior insula (RAI) and the precuneus. Global and somatic anxiety were associated with the limbic and paralimbic structures (increased connectivity between the amygdala, PVN, and hippocampus), while neuroticism was correlated with increased connectivity between limbic and prefrontal structures. Rumination severity did not correlate significantly with any measures of functional connectivity once we controlled for other clinical measures of anxiety. Measures of worry, global anxiety, somatic anxiety, and neuroticism have distinct 'neural signatures'. These results advocate for a fine-grain approach when analyzing the neural substrates of clinical samples with various anxiety disorders.

Susceptibility to cognitive distortions: the role of eating pathology

BACKGROUND

Thought-Shape Fusion (TSF) and Thought-Action Fusion (TAF) are cognitive distortions that are associated with eating and obsessional pathology respectively. Both involve the underlying belief that mere thoughts and mental images can lead to negative outcomes. TSF involves the belief that food-related thoughts lead to weight gain, body dissatisfaction, and perceptions of moral wrong-doing. TAF is more general, and involves the belief that merely thinking about a negative event (e.g., a loved one getting into a car accident) can make this event more likely to happen, and leads to perceptions of moral wrong-doing. However, the shared susceptibility across related cognitive distortions-TAF and TSF-has not yet been studied.

METHOD

The effects of TSF and TAF inductions in women with an eating disorder (n = 21) and a group of healthy control women with no history of an eating disorder (n = 23) were measured. A repeated-measures design was employed, with all participants exposed to a TSF, TAF and neutral induction during three separate experimental sessions. Participants' cognitive and behavioral responses were assessed.

RESULTS

Individuals with eating disorders were more susceptible to TSF and TAF than were control participants, demonstrating more neutralization behavior after TSF and TAF inductions (i.e., actions to try to reduce the negative effects of the induction), and reporting higher levels of trait TAF and TSF than did controls.

CONCLUSIONS

Individuals with eating disorders are particularly susceptible to both TAF and TSF. Clinical implications of these findings will be discussed.

A role for the precuneus in thought-action fusion: evidence from participants with significant obsessive-compulsive symptoms

Likelihood thought-action fusion (TAF-L) refers to a cognitive bias in which individuals believe that the mere thought of a negative event increases its likelihood of occurring in reality. TAF-L is most commonly associated with obsessive-compulsive disorder (OCD) but is also present in depression, generalized anxiety disorder and psychosis. We induced TAF-L in individuals with high (High-OC, N = 23) and low (Low-OC, N = 24) levels of OC traits, and used low resolution electromagnetic tomography (LORETA) to localise the accompanying electrical brain activity patterns. The results showed greater TAF-L in the High-OC than in the Low-OC group (p < .005), which was accompanied by significantly greater upper beta frequency (19-30 Hz) activity in the precuneus (p < .05). Further, the precuneus activity was positively correlated with self-reported magnitude of TAF-L (p < .01), suggesting a specific role of this region in this cognitive bias. Results are discussed with reference to self-referential processing and the default-mode network.