Uncertain and Fused: Cognitive Fusion, Thought-Action Fusion, and the Intolerance of Uncertainty as Predictors of Obsessive-Compulsive Symptom Dimensions

Neural correlates of thought-action fusion and their associations with rumination in patients with major depressive disorder

Thought-action fusion (TAF) is the metacognitive belief that the power of thoughts can have real-life consequences, often inducing unpleasant inner experiences and recruiting coping strategies such as rumination. Therefore, this study aimed to investigate the neural correlates of TAF and their associations with rumination in depression. A total of 37 patients with major depressive disorder (MDD) and 37 healthy controls (HCs) underwent functional magnetic resonance imaging with a TAF induction task and psychological assessments. In the TAF induction task, participants were asked to read the name of a close person (CP) or neutral person (NP) in association with negative (Neg) TAF and neutral (Neu) control statements. In this study, our TAF induction task activated brain regions, including the salient and default-mode networks, in the MDD and HC groups. However, along with higher likelihood TAF and rumination, behavioral data showed less negative feelings and longer reaction times under the NegCP condition in the MDD group compared with the HC group. Furthermore, in the MDD group, significantly higher activation in the bilateral caudate nuclei, left inferior frontal gyrus/anterior insula, putamen, and inferior parietal lobule under the NegCP condition was positively correlated with TAF and reflection. These findings suggest that during the TAF task, patients with MDD may activate different brain areas associated with the maintenance of high stimulus saliency and habit formation, which are important neural correlates linking TAF and rumination in depression.

Neural mechanisms of acceptance-commitment therapy for obsessive-compulsive disorder: a resting-state and task-based fMRI study

BACKGROUND

There is growing evidence for the use of acceptance-commitment therapy (ACT) for the treatment of obsessive-compulsive disorder (OCD). However, few fully implemented ACT have been conducted on the neural mechanisms underlying its effect on OCD. Thus, this study aimed to elucidate the neural correlates of ACT in patients with OCD using task-based and resting-state functional magnetic resonance imaging (fMRI).

METHODS

Patients with OCD were randomly assigned to the ACT (n = 21) or the wait-list control group (n = 21). An 8-week group-format ACT program was provided to the ACT group. All participants underwent an fMRI scan and psychological measurements before and after 8 weeks.

RESULTS

Patients with OCD showed significantly increased activation in the bilateral insula and superior temporal gyri (STG), induced by the thought-action fusion task after ACT intervention. Further psycho-physiological interaction analyses with these regions as seeds revealed that the left insular-left inferior frontal gyrus (IFG) connectivity was strengthened in the ACT group after treatment. Increased resting-state functional connectivity was also found in the posterior cingulate cortex (PCC), precuneus, and lingual gyrus after ACT intervention Most of these regions showed significant correlations with ACT process measures while only the right insula was correlated with the obsessive-compulsive symptom measure.

CONCLUSIONS

These findings suggest that the therapeutic effect of ACT on OCD may involve the salience and interoception processes (i.e. insula), multisensory integration (i.e. STG), language (i.e. IFG), and self-referential processes (i.e. PCC and precuneus). These areas or their interactions could be important for understanding how ACT works psychologically.

Can immorality be contracted? Appraisals of moral disgust and contamination fear

While extant research underlines the role of disgust in obsessive-compulsive disorder (OCD) with contamination fear, less research attention has been devoted to moral disgust. This study endeavored to examine the types of appraisals that are elicited by moral disgust in comparison to core disgust, and to examine their associations with both contact and mental contamination symptoms. In a within-participants design, 148 undergraduate students were exposed to core disgust, moral disgust, and anxiety control elicitors via vignettes, and provided appraisal ratings of sympathetic magic, thought-action fusion and mental contamination, as well as compulsive urges. Measures of both contact and mental contamination symptoms were administered. Mixed modeling analyses indicated that core disgust and moral disgust elicitors both provoked greater appraisals of sympathetic magic and compulsive urges than anxiety control elicitors. Further, moral disgust elicitors elicited greater thought-action fusion and mental contamination appraisals than all other elicitors. Overall, these effects were greater in those with higher contamination fear. This study demonstrates how a range of contagion beliefs are evoked by the presence of 'moral contaminants', and that such beliefs are positively associated with contamination concerns. These results shed light on moral disgust as an important target in the treatment of contamination fear.

Heightened but Inefficient Thought-Action Fusion in Obsessive-Compulsive Disorder: New Insight From a Multiple Trial Version of the Classic Thought-Action Fusion Experiment

OBJECTIVE

Thought-action fusion (TAF), which is a tendency to make the relationship between one's thoughts and external consequences, is a dysfunctional belief linked to obsessive-compulsive disorder (OCD). While the TAF is commonly evaluated using the Thought-Action Fusion Scale (TAFS), it cannot fully reflect the actual experience of experimentally evoked TAF. In the present study, we applied a multiple-trial version of the classic TAF experiment and evaluate two variables, reaction time (RT) and emotional intensity (EI).

METHODS

Ninety-three patients with OCD and 45 healthy controls (HCs) were recruited. The participants were asked to read the name of a close or neutral person embedded in different positive (PS) or negative (NS) TAF statements. During the experiments, RT and EI were gathered.

RESULTS

The OCD patients presented with longer RT and lower EI in the NS condition than HCs. In each group, the HCs showed a significant relationship between RT in the NS condition and TAFS scores, whereas the patients did not, although they had higher TAFS scores than the HCs. In contrast, the patients showed a trend toward a correlation between RT in the NS condition and guilt.

CONCLUSION

These findings may indicate our multiple-trial version of the classical TAF showed reliable results of the two new variables, especially RT, in the task and allow to newly identify paradoxical patterns in which the TAFS scores are high but actual performance is impaired, that is, the inefficient activation of TAF in OCD.

The Neural Correlates of Positive Versus Negative Thought-action Fusion in Healthy Young Adults

Objective

Thought-action fusion (TAF), one of the most-studied dysfunctional beliefs in obsessive-compulsive disorder, represents an individual’s belief that his/her thoughts directly influence events. TAF belief types are divided into personal thoughts relating to positive (positive TAF) and negative outcomes (negative TAF). However, the neural mechanisms underlying both aspects of the TAF response remain elusive.

Methods

This functional magnetic resonance imaging study aimed to investigate the neural circuits related to positive and negative TAF and their relationships with psychological measures. Thirty-one healthy male volunteers participated in a modified TAF task wherein they were asked to read the name of a close person embedded in positive statements (PS) or negative statements (NS).

Results

Conjunction analysis revealed activation of the fusiform and lingual gyri, midcingulate and superior medial frontal gyri, inferior orbitofrontal gyrus, and temporoparietal junction. The NS > PS comparison showed additional activation in the precuneus and medial prefrontal cortex, superior frontal gyrus, insula, globus pallidus, thalamus, and midbrain. Precuneus activity was associated with the TAF score among these areas. Moreover, activity in the inferior orbitofrontal gyrus, insula, superior, middle and medial frontal gyri, globus pallidus, inferior parietal lobule, and precuneus was associated with dimensional obsessive-compulsive scores. In contrast, the PS > NS comparison revealed no significant activation.

Conclusion

These results suggest that negative TAF, relative to positive TAF, recruits additional regions for self-referential processing, salience, and habitual responding, which may contribute to the activation of the belief that a negative thought increases the probability of that negative outcome.

The associations of obsessive-compulsive symptom dimensions and general severity with suicidal ideation in patients with obsessive-compulsive disorder: The role of specific stress responses to COVID-19

Suicidal ideation is prevalent in patients with obsessive-compulsive disorder (OCD); but, during COVID-19, it may be increased. The present study aimed to examine the effects of obsessive-compulsive (OC) symptom dimensions and OCD severity on suicidal ideation by considering the role of stress responses in reaction to COVID-19 in a clinical sample of patients with OCD. In a cross-sectional study, 304 patients with OCD completed measures of OC symptom dimensions, OCD severity, general mental health (depression and anxiety), and COVID-19-related stress. Results showed that after controlling for depression, anxiety, comorbidity, and lifetime suicide attempts, the OC symptom dimensions of responsibility for harm and unacceptable obsessional thoughts as well as general severity had indirect effects on suicidal ideation through the specific stress responses to COVID-19, including traumatic stress and compulsive checking. The study shows that OCD patients with specific OC symptom dimensions and severe OCD are more likely to have suicidal ideation during the pandemic. Further, the specific stress responses to COVID-19 may be an underlying mechanism. Clinicians should carefully assess suicidal ideation in patients with OCD who experience responsibility for harm and unacceptable thoughts, particularly during the pandemic.

Examination of a brief computerized Cognitive Anxiety Sensitivity intervention on obsessive-compulsive symptoms

OBJECTIVES

Despite the existence of several first-line treatments for obsessive-compulsive disorder (OCD), many patients fail to experience symptom reduction and/or do not complete treatment. As a result, the field has increasingly moved towards identifying and treating malleable underlying risk factors that may in turn improve treatment efficacy. One salient underlying risk factor, anxiety sensitivity (AS) cognitive concerns, has been found to be uniquely associated with obsessive-compulsive (OC) symptom dimensions. However, no studies have yet examined whether reductions in AS cognitive concerns will lead to subsequent reductions in OC symptoms.

METHODS

The current study attempted to fill this gap by recruiting individuals reporting elevations on both AS cognitive concerns and at least one OC symptom dimension. Participants were randomly assigned to receive either a one-session AS cognitive concerns intervention (n = 35) or a single health information control session (n = 37). AS cognitive concerns were assessed at post-intervention and one-month follow-up.

RESULTS

The active intervention produced significantly greater reductions in AS cognitive concerns post-intervention than the control intervention. However, this effect was no longer significant at one-month follow-up. Further, while there was not an effect of treatment condition on OC symptoms at one-month follow-up, changes in AS cognitive concerns from baseline to post-intervention mediated changes in OC symptoms at one-month follow-up.

CONCLUSIONS

Findings support previous research attesting to the malleable nature of AS. Extending this research, findings provide initial support for the efficacy of AS interventions among individuals with elevated OC symptoms.

PRACTITIONER POINTS

Clinicians should consider assessing anxiety sensitivity (AS) among patients with obsessive-compulsive disorder. If elevated, clinicians should consider targeting AS as an adjunct to treatment as usual.

Thought-Action Fusion as Predictors of Obsessive-Compulsive Symptom Dimensions

OBJECTIVE

There have been several studies investigating the relationships between dysfunctional beliefs and obsessive-compulsive (OC) symptoms in obsessive-compulsive disorder (OCD). However, studies about the relationships between dysfunctional beliefs, especially thought-action fusion (TAF), and OC symptom dimensions have been scarce. Therefore, this study examined to what extent and how TAF subcomponents account for unique variability in four OC symptom dimensions.

METHODS

Sixty-five patients with OCD and 45 healthy controls aged between 18 and 30 years completed measures for OC symptom dimensions, OC symptoms, and dysfunctional beliefs such as TAF, trait-guilt, and inflated responsibility.

RESULTS

Three facets of TAF were exclusively associated with two symptom domains, namely, responsibility for harm and unacceptable thoughts, and explained the additional but small amount of variance to predict these two domains. In particular, the likelihood-others TAF positively predicted the unacceptable thoughts domain, whereas the likelihood-self TAF negatively predicted the aforementioned domain. For OC symptoms measured by the OC Inventory, no TAF components predicted the corresponding obsessing and mental neutralizing symptoms.

CONCLUSION

This study provides supporting evidence that the three TAF subcomponents may be differently associated with certain OC symptom dimensions, and a dimensional approach may complement typical symptom-oriented OC measures.

Models of Cognition and Their Applications in Behavioral Economics: A Conceptual Framework for Nudging Derived From Behavior Analysis and Relational Frame Theory

This paper puts forward a rounder conceptual model for interpreting short- and long-term effects of choice behavior. As a further development of dual-process theory, Kahneman (2003) distinguished between intuition and reasoning, which served as the respective precursors of the cognitive processing systems 1 and 2. We maintain that they reflect the more rigorous distinction between brief and immediate and extended and elaborated relational responding, which may be reinterpreted through an analysis of their functional properties. Repertoires of relational responding are offered by the multi-dimensional multi-level model. Specifically, we provide a conceptual account of how nudging, or the manipulation of environmental contingencies, works on the creation and modification of relational framing. Educative nudges, or boosts, are a subset of nudges that may more easily maintain target choice behavior in the future. The central role of verbal behavior is essential toward formulating rules, which inform and guide choice behavior over time. Although nudges are traditionally regarded as System 1-steered aspects, they are herein regarded as cues for responding to relational frames, which may induce System 2-steered aspects. We suggest adopting the implicit relational assessment procedure (IRAP) to inform how coherent and immediate responding to novel relational responding may occur in the presence of choice behavior. Several examples are included to support the claim of encompassing relational responding and choice behavior. We address the instances of consumer behavior, stereotypy and prejudices, eating behavior, and overcoming cognitive biases. The conclusions depict a promising way forward for the study of choice: an improved model for interpreting and overcoming human errors, due to changes in the contingencies of behavior.

Not just thinking, but believing: Obsessive beliefs and domains of cognitive fusion in the prediction of OCD symptom dimensions

Cognitive fusion (CF) involves the tendency to "buy in" to thoughts and feelings and consists of three empirically established domains: somatic concerns, emotion regulation, and negative evaluation. CF is hypothesized to play a role in obsessive-compulsive disorder (OCD). The present study examined how well the CF domains, relative to traditional cognitive-behavioural constructs (i.e., obsessive beliefs such as inflated responsibility), predict OCD symptoms. Fifty-two treatment-seeking adults with OCD completed self-report measures of CF, obsessive beliefs, OCD symptoms, and general distress. Domains of CF were differentially associated with the responsibility for harm, symmetry, and unacceptable thoughts of OCD dimensions; yet after accounting for obsessive beliefs, only the negative evaluation domain of CF significantly predicted symmetry OCD symptoms. Obsessive beliefs significantly predicted all OCD dimensions except for contamination. These findings provide additional support for existing cognitive-behavioural models of OCD across symptom dimensions, with the exception of contamination symptoms, and suggest that the believability of thoughts and feelings about negative evaluation adds to the explanation of symmetry symptoms. Conceptual and treatment implications, study limitations, and future directions are discussed.

Using an Acceptance and Commitment Therapy Approach When Exposure and Cognitive Therapy Become Rituals in the Treatment of Obsessive-Compulsive Disorder

Exposure and response prevention (ERP) for obsessive-compulsive disorder (OCD) is often highly effective, yet some patients experience relapses following a seemingly successful course of treatment. In this article we describe the conceptual basis of ERP, and then present a client who relapsed after seemingly achieving substantial improvement following 11 sessions of ERP. Likely reasons for the relapse and strategies for enhancing ERP to achieve better long-term treatment outcomes are discussed from the perspective of acceptance and commitment therapy (ACT). These strategies mainly apply to the implementation of situational (in vivo) and imaginal exposure therapy, but also include suggestions for optimizing the use of cognitive therapy for OCD.

The neural correlates of thought-action fusion in healthy adults: A functional magnetic resonance imaging study

BACKGROUND

Thought-action fusion (TAF) represents an individual's belief that a thought is like action. Inflated TAF has been considered a central mechanism for developing obsessive thoughts. However, the neural mechanisms underlying TAF are yet unknown.

METHODS

We recruited 32 healthy men to participate in a functional magnetic resonance imaging (fMRI) study. Whereas inside the 3T MRI scanner, participants were asked to read negative statements describing the expectation of bad events associated with close persons (CPs condition) or neutral persons (NPs condition). They also completed the assessment of TAF and obsessive-compulsive (OC) symptoms.

RESULTS

Both CP and NP conditions commonly activated the lingual gyrus, caudate nucleus, precuneus, and several areas of the frontal cortex. Importantly, many of these regions were positively correlated with measures of OC symptoms, especially for the CP condition. The CP condition showed higher activation in the insula and temporal gyrus than the NP condition. In contrast, the NP condition evoked higher activation in regions associated with mentalizing, such as the medial prefrontal cortex and dorsal anterior cingulate cortex than the CP condition.

CONCLUSIONS

We introduced and validated a TAF-induction paradigm suitable for fMRI studies and characterized the neural circuits engaged during this paradigm. Further studies using this task may help us to better understand how dysfunctions in TAF neural processing may contribute to psychiatric conditions such as obsessive-compulsive disorder.