Acceptance and commitment therapy as an add-on treatment for the management of patients with obsessive-compulsive disorder

Background

Obsessive compulsive disorder (OCD) is a chronic and long-lasting illness affecting approximately 2% of the population. Up to 40%-60% of patients with OCD do not have satisfactory outcomes, thereby leading to disability in performing daily routine activities. Acceptance and commitment therapy (ACT) provides a substitute for old-fashioned psychotherapies, as it involves the client directly experiencing the problematic emotion, that is, anxiety and obsessions in the case of OCD.

Aim

To observe the effect of ACT on patients with OCD and compare its effect on obsessive compulsive symptoms, thought control, thought and action fusion, acceptance and action, and depression.

Materials and Methods

A total of 62 patients diagnosed with OCD as per Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) in the age range between 18 and 60 years, having duration of illness less than two years, both male and female, literate and illiterate, hailing from rural and urban background, were included in the study. For pre- and post-assessment Yale-Brown Obsessive and Compulsive Scale (Y-BOCS), Hamilton Depression Rating Scale (HDRS), acceptance and commitment questionnaire, thought control questionnaire, and thought and action fusion questionnaire were used in this study, and ACT was used for management of OCD.

Results

There is a significant difference between the groups treated with ACT and those treated as usual, on every domain of thought control questionnaire (TCQ) -- distraction (t = 9.07), social control (t = 11.13), worry (t = 11.93), punishment (t = 16.78), and re-appraisal (t = 16.47). Significance is also seen in the thought and action fusion in the moral domain (t = 16.22), the likelihood domain (t = 16.49), and others (t = 9.23). On Y-BOCS, HDRS, and acceptance and action questionnaire (AAQ) both groups show a significant difference between each other.

Conclusion

The findings of the present study indicate that ACT is a productive method for patients with OCD as it encourages the patient to accept and integrate their lived experiences, challenges effective responses, and recognizes and eliminates the controlling dimensions.

Effects of psychosocial stress on prosociality: the moderating role of current life stress and thought control

To date, only a few studies have examined whether and when stressed individuals are still prosocially motivated and willing to help others, which is in contrast to the relevance and importance that helping others has for our society. The present study investigates the impact of affective and biopsychological acute stress responses on prosociality (prosocial motivation, helping behavior) under controlled laboratory conditions. In addition, it was examined whether this relationship is affected by individuals' current life stress and the cognitive ability to keep stress-related thoughts at bay. To induce acute stress responses (heart rate, negative affect, salivary alpha-amylase, cortisol), 55 individuals (28 women, M = 24 years old, SD = 4.53) were exposed to the Trier Social Stress Test (TSST). Current life stress (cortisol) was assessed over two days of participants' everyday lives. Thought control ability was assessed with the think/no-think paradigm and was additionally manipulated after the acute stress intervention (TSST) via instructions. The results showed that acute stress was positively associated with prosociality. Specifically, negative affect was positively related to prosocial motivation and salivary alpha-amylase was positively associated with helping behavior. Current life stress moderated the relationship between salivary cortisol and helping behavior: the association was positive at low levels of current life stress. The instruction to control one's thoughts but not participants' general ability to do so reduced stress responses (negative affect). In sum, the findings suggest that prosociality increases following acute stress and that this effect depends on the level of current life stress. Additionally, adopting the strategy of controlling stress-related thoughts was found to be promising for attenuating individuals' stress responses.

Lay Theories of the Wandering Mind: Control-Related Beliefs Predict Mind Wandering Rates in- and outside the Lab

People often fail to keep their mind from wandering. Here, we examine how the tendency to mind wander is affected by people's beliefs, or lay theories. Building on research on lay theories and self-regulation, we test whether differences in people's beliefs about the extent to which mind wandering is controllable affect thought control strategies and mind-wandering rates in daily life and the laboratory. We develop a new scale to assess control-related beliefs about mind wandering. Scores on the scale predict mind wandering (Study 1) and intrusive thoughts (Study 2) in everyday life, thought control strategies and dysfunctional responses to unwanted thoughts (Study 2), and mind wandering during reading in the laboratory (Studies 3-6). Moreover, experimentally induced lay theories affect mind-wandering rates during reading (Studies 4 and 5). Finally, the effectiveness of strategies people can use to reduce their mind wandering depends on their lay theories (Studies 2 and 6).

Stop Thinking: An Experience Sampling Study on Suppressing Distractive Thoughts at Work

In modern work environments, it can be difficult for workers to avoid becoming distracted from their current task. This study investigates person-situation interactions to predict thought control activities (kind of self-control), which aim to stop distracting thoughts that enter the mind. Specifically, it was examined (1) how challenging work demands (time pressure, task complexity) activate workers' thought control to stop distractive thoughts (n level 2 = 143) and relate to the effort to do so (n level 2 = 91) in daily working life and (2) how these relationships differ according workers' general cognitive ability to suppress unwanted thoughts. To understand these person-situation interactions, an experience sampling study was combined with a laboratory task assessing the ability to suppress unwanted thoughts (think/no-think task). Multilevel modeling revealed that workers' engage more often and more intensively in thought control activities at a moderate level of time pressure but only when they had a higher general ability to suppress unwanted thoughts. For workers with a lower ability to suppress unwanted thoughts, increasing time pressure was negatively related to thought control activities, even at very low levels of time pressure. Thus, whether time pressure activates or hinders thought control depends on individuals' ability to suppress distractive thoughts.

Fifteen Years Controlling Unwanted Thoughts: A Systematic Review of the Thought Control Ability Questionnaire (TCAQ)

Thought control ability is a vulnerability factor implicated in the etiology and maintenance of emotional disorders. This manuscript aims to systematically review the use and psychometric performance of the Thought Control Ability Questionnaire (TCAQ), designed to assess people's ability to control unwanted thoughts. Three electronic databases were searched for papers administering the TCAQ published in indexed peer-reviewed journals. Data (participants characteristics, country, study design, etc.) were extracted from the results for qualitative synthesis. The TCAQ's content validity, dimensionality, internal consistency, test-retest reliability, convergent/divergent validity, floor/ceiling effects, and interpretability were summarized. Two reviewers independently screened articles and assessed quality taking COSMIN criteria into account. Finally, the review included 17 papers. The TCAQ has been administered to healthy individuals, students, and adult patients, in six languages from nine countries. We found that the TCAQ, and its shorter versions, demonstrate robust reliability and adequate content validity. Of interest is the TCAQ's capacity to predict performance in diverse experimental tasks focused on thought control. The TCAQ unidimensionality has been supported in exploratory and confirmatory factor analyses. Regarding construct validity, the TCAQ is significantly related to a wide range of psychopathological measures of anxiety, worry, depression, obsessive-compulsive symptoms, etc. However, as only a few of the included studies had a longitudinal design, we are unable to draw firm conclusions about the measure's temporal stability. Moreover, psychometric aspects such as factorial invariance across different samples have not been analyzed. Despite these limitations, based on available psychometric evidence we can recommend using the TCAQ for measuring perceived control of unwanted thoughts.

Can Distressing Sexual Thoughts Be Regulated? Experiential Willingness Versus Distraction

This study examines the effects of different techniques on the management of unwanted sexual thoughts. Participants (N = 150; 67 who found sexual thoughts distressing, 83 participants who did not) were randomly placed into one of three experimental conditions: experiential willingness, distraction, or no strategies for dealing with unwanted sexual thoughts. Participants answered questions assessing attitudes about their sexual thoughts and recorded sexual thought frequency for a 3-minute period pre- and post-intervention. Thought frequencies decreased for all groups post intervention for both the distressed and nondistressed samples. Acceptability of thoughts increased for the experiential willingness group, remained similar for the distraction group, and decreased for the control group. The findings indicate that distraction was more easily implemented, more commonly used, and equally effective to experiential willingness at reducing sexual thoughts in the short term. However, the short experiential willingness intervention increased acceptability of sexual thoughts, which could have an impact on longer-term results.

Freedom of Thought and Mental Integrity: The Moral Requirements for Any Neural Prosthesis

There are many kinds of neural prostheses available or being researched today. In most cases they are intended to cure or improve the condition of patients affected by some cerebral deficiency. In other cases, their goal is to provide new means to maintain or improve an individual's normal performance. In all these circumstances, one of the possible risks is that of violating the privacy of brain contents (which partly coincide with mental contents) or of depriving individuals of full control over their thoughts (mental states), as the latter are at least partly detectable by new prosthetic technologies. Given the (ethical) premise that the absolute privacy and integrity of the most relevant part of one's brain data is (one of) the most valuable and inviolable human right(s), I argue that a (technical) principle should guide the design and regulation of new neural prostheses. The premise is justified by the fact that whatever the coercion, the threat or the violence undergone, the person can generally preserve a "private repository" of thought in which to defend her convictions and identity, her dignity, and autonomy. Without it, the person may end up in a state of complete subjection to other individuals. The following functional principle is that neural prostheses should be technically designed and built so as to prevent such outcomes. They should: (a) incorporate systems that can find and signal the unauthorized detection, alteration, and diffusion of brain data and brain functioning; (b) be able to stop any unauthorized detection, alteration, and diffusion of brain data. This should not only regard individual devices, but act as a general (technical) operating principle shared by all interconnected systems that deal with decoding brain activity and brain functioning.

Thought Control Ability Is Different from Rumination in Explaining the Association between Neuroticism and Depression: A Three-Study Replication

Neuroticism is the most common vulnerability factor of depression. However, the mechanism underlying this vulnerability is still unclear. Previous studies suggested that rumination intensifies the negative effect of neuroticism on depression. However, whether cognitive control could explain the association between neuroticism and depression remains unclear to date. Therefore, this study evaluated the indirect effects of rumination and thought control on the relationship between neuroticism and depression. Seven self-report measures were employed among healthy and main depression disorder (MDD) participants. Three studies were used to examine the hypotheses. Results of the three studies showed significant correlations among neuroticism, rumination, thought control, and depression. Rumination mediated the link between neuroticism and depression among healthy young adults, and this finding replicated previous studies. This study provided new evidence that thought control mediates the association between neuroticism and depression in both healthy and MDD populations. In conclusion, rumination increases neuroticism risk for depression, but high-level thought control decreases the effect of neuroticism on depression. This study may serve as a reference to develop effective and focused interventions for MDD patients.

Thought Control Strategies and Symptom Dimensions in Obsessive-Compulsive Disorder: Associations With Treatment Outcome

Treatment effectiveness of exposure and response prevention for obsessive-compulsive disorder (OCD) might be attenuated in part because of the complex, heterogeneous nature of OCD. Previous studies have indicated relationships between thought control strategies and OCD severity. This study replicates and extends these findings by using a dimensional measure of OCD and examining changes in thought control strategies across treatment. Participants included 49 patients with OCD attending residential and intensive outpatient treatment. Statistical analyses revealed significant reduction in worry and punishment thought control strategies from pre- to posttreatment as well as relationships between reduced use of specific thought control strategies and specific types of OCD symptomatology. Findings suggest that developing and employing modified forms of treatment more aligned with individuals' specific OCD symptomatology could be worthwhile to improve treatment of OCD.

Failing to forget: inhibitory-control deficits compromise memory suppression in posttraumatic stress disorder

Most people have experienced distressing events that they would rather forget. Although memories of such events become less intrusive with time for the majority of people, those with posttraumatic stress disorder (PTSD) are afflicted by vivid, recurrent memories of their trauma. Often triggered by reminders in the daily environment, these memories can cause severe distress and impairment. We propose that difficulties with intrusive memories in PTSD arise in part from a deficit in engaging inhibitory control to suppress episodic retrieval. We tested this hypothesis by adapting the think/no-think paradigm to investigate voluntary memory suppression of aversive scenes cued by naturalistic reminders. Retrieval suppression was compromised significantly in PTSD patients, compared with trauma-exposed control participants. Furthermore, patients with the largest deficits in suppression-induced forgetting were also those with the most severe PTSD symptoms. These results raise the possibility that prefrontal mechanisms supporting inhibitory control over memory are impaired in PTSD.

Joseph Hersey Pratt (1872-1956): An early proponent of cognitive-behavioural therapy in America

The treatment of mild psychoneuroses in America began shifting in the 1950s from Freudian psychoanalysis to various forms of psychotherapy that do not delve into patient's subconscious. Some of the new approaches were termed cognitive, behavioural or cognitive behavioural therapy and in America were practised notably by Joseph Wolpe, Albert Ellis and Aaron T Beck. Modern psychiatric literature makes little mention of two prior innovators in this area - the French neurologist Jules Dejerine and his Boston disciple Joseph H Pratt. In the early 1900s, Dejerine treated patients at La Salpêtrière in Paris using techniques adopted subsequently by Pratt during the 1930s and employed by the trio some decades later. This paper revisits the early history of psychotherapy in America and includes a brief summary of Pratt's medical career.

Emotion regulation, attention to emotion, and the ventral attentional network

Accounts of the effect of emotional information on behavioral response and current models of emotion regulation are based on two opposed but interacting processes: automatic bottom-up processes (triggered by emotionally arousing stimuli) and top-down control processes (mapped to prefrontal cortical areas). Data on the existence of a third attentional network operating without recourse to limited-capacity processes but influencing response raise the issue of how it is integrated in emotion regulation. We summarize here data from attention to emotion, voluntary emotion regulation, and on the origin of biases against negative content suggesting that the ventral network is modulated by exposure to emotional stimuli when the task does not constrain the handling of emotional content. In the parietal lobes, preferential activation of ventral areas associated with “bottom-up” attention by ventral network theorists is strongest in studies of cognitive reappraisal. In conditions when no explicit instruction is given to change one's response to emotional stimuli, control of emotionally arousing stimuli is observed without concomitant activation of the dorsal attentional network, replaced by a shift of activation toward ventral areas. In contrast, in studies where emotional stimuli are placed in the role of distracter, the observed deactivation of these ventral semantic association areas is consistent with the existence of proactive control on the role emotional representations are allowed to take in generating response. It is here argued that attentional orienting mechanisms located in the ventral network constitute an intermediate kind of process, with features only partially in common with effortful and automatic processes, which plays an important role in handling emotion by conveying the influence of semantic networks, with which the ventral network is co-localized. Current neuroimaging work in emotion regulation has neglected this system by focusing on a bottom-up/top-down dichotomy of attentional control.

Cognitive and affective control in insomnia

Insomnia is a prevalent disabling chronic disorder. The aim of this paper is fourfold: (a) to review evidence suggesting that dysfunctional forms of cognitive control, such as thought suppression, worry, rumination, and imagery control, are associated with sleep disturbance; (b) to review a new budding field of scientific investigation - the role of dysfunctional affect control in sleep disturbance, such as problems with down-regulating negative and positive affective states; (c) to review evidence that sleep disturbance can impair next-day affect control; and (d) to outline, on the basis of the reviewed evidence, how the repetitive-thought literature and the affective science literature can be combined to further understanding of, and intervention for, insomnia.