Treating Guilt-Inducing Self-Talk in Ocd with Dramatized Socratic Dialogue: A Step by Step Intervention.

Objective: Fear of moral guilt and conseque:nt increased attention to personal actions and intentions are the main ingredients of the self-criticism in patients suffering from obsessive-compulsive disorder (OCD). This pathogenic attitude takes shape in a typical guilt-inducing self-talk.The purpose of this work is to describe in detail a novel cognitive therapeutic procedure for OCD called "Dramatized Socratic Dialogue" (DSD). Method: DSD is a theory-oriented intervention that combine elements of Socratic dialogue, chairwork, and cognitive acceptance strategies derived from Mancini's model, which posits that obsessive-compulsive (OC) symptoms stem from a fear of deontological guilt. Results: DSD appears to have many strengths, being a theory-oriented treatment and focusing, as a therapeutic target, on the cognitive structures that determine pathogenic processes and OC symptoms. Furthermore, it is a short, flexible and tailor-made intervention. Conclusions: Detailed description of the intervention could foster future research perspectives and thus be used in evidence-based effectiveness studies to establish whether DSD reduces OC symptoms and to investigate its mechanism of action.

The Role of Childhood Experiences in the Development of Disgust Sensitivity: A Preliminary Study on Early Moral Memories.

Objective: Disgust is a basic emotion evolved to safeguard our omnivorous species from contagion. Although the factors eliciting disgust typically involve concerns related to physical contamination, physical disgust responses are also prompted by moral transgressions, (i.e. cannibalism, pedophilia, betrayal). The link between the general propensity to experience disgust (i.e. "Disgust Sensitivity") and morality, in particular in the deontological domain, is supported by an increasing amount of data on clinical and non-clinical sample. Evolutionistic explanations of this link posit that disgust evolved to indicate the presence of a threat to the integrity of the individual not only in the physical domain but also in the social and moral domain.In addition to the evolutionary point of view, this link could also be better investigated in terms of individual development. To the best of our knowledge, literature is scarce regarding which early experiences are associated to high DS. Therefore, this study aims to explore the content of early memories associated with disgust. Based on the strict link between disgust and morality, we hypothesized an association between DS and early memories of moral criticism. Method: 60 non-clinical participants filled in measures of DS. They were then presented with an auditory disgust induction, after which they recalled early memories through the technique of the "affect bridge". 10 independent raters assessed the emotional content of the memories on visual-analogical scales. Results: Results showed a positive association between disgust sensitivity and the propensity to experience deontological guilt. There was also a significant positive association between disgust sensitivity and moral memories, in particular relating to early experiences of being the object of contempt, moral criticism, anger, and of being held responsible. Conclusions: These data directly support the centrality of early morally-loaded interpersonal experiences in the development of DS, confirming the link between disgust and morality also at the level of individual historical development.

Guilt Feelings in Obsessive Compulsive Disorder: An Investigation between Diagnostic Groups.

Guilt plays a role in various forms of psychopathology. However, different types of guilt might be involved in different mental disorders. Obsessive-compulsive (OC) patients are prone to a type of guilt in which the violation of an internalized moral norm is necessary and sufficient, whereas data suggest that depression might be linked to more interpersonal types of guilt. However, the extent to which a specific guilt phenomenology is involved in each condition is yet to be determined. Here we assessed the association between different types of guilt and different diagnostic groups. Two clinical samples (33 OCD and 35 non-OCD) filled in the Moral Orientation Guilt Scale (MOGS) along with other OCD and depression measures. Regression was employed to test group differences in the MOGS subscales and to test the influence of MOGS subscales on OCD and depression levels. Results confirm that different types of guilt might be implicated in different psychopathological conditions. Specifically, moral norm violation guilt is more present in OC patients than in other disorders. Depression seems to be associated with different guilt feelings depending on the psychopathological condition, specifically in non-OC patients, with types of guilt involving a "victim", supporting the accounts viewing interpersonal guilt as involved in the emergence of depressive symptomatology and hyper-altruistic behavior as a vulnerability factor for depression.

Group Imagery Rescripting on Childhood Memories Delivered via Telehealth: A Preliminary Study.

Background: Imagery Rescripting (ImR) has proved to be effective in the treatment of different mental disorders as an integral part of broader clinical protocols or as a standalone technique. ImR has also been successfully incorporated as part of group Schema Therapy treatment; however, to the best of our knowledge, it has never been assessed as a standalone technique in a group setting. Aim: In this study, we focused on ImR delivered via telehealth in groups and we aimed to assess whether group ImR is effective in responding to basic emotional needs, in changing participants' affective state, and in reducing dysfunctional beliefs. We also wanted to assess whether memory realism is associated with a greater effectiveness of the technique. Methods: A total of 52 participants were presented with 3 ImR sessions on childhood memories related to the current dysfunctional belief that elicited more suffering. Results: The technique was effective in facilitating the retrieval of a memory in almost the entire sample (in the range of 92.3-100%). Overall, memory realism values (level of vividness, ability to immerse, and participants' distance from the images) were high in all three sessions. Almost all participants were reported having their needs met during ImR (89.7%). Importantly, need satisfaction was associated with the ability to immerse in the image. In addition, the intensity of the dysfunctional belief decreased significantly from pre-test to Session 3. The technique also changed the affective state, reducing arousal. Importantly, we also observed a general reduction in shame levels from the first to the third session. Conclusion: A telehealth delivered ImR group intervention on childhood memories provides cognitive and emotional improvement. Along with the ability to satisfy the patient's basic emotional needs, the technique seems to be effective in modifying maladaptive beliefs encapsulated in memory.

Cognitive-Behavioral Treatment of Obsessive-Compulsive Disorder: The Results of a Naturalistic Outcomes Study.

Cognitive−behavioral therapy is a well-established treatment for obsessive−compulsive disorder (OCD). There are a variety of cognitive and behavioral strategies, and it is necessary to analyze the outcomes of the treatments. The aim of the present study is to verify the effectiveness of a treatment that combines evidence-based procedures and specific cognitive interventions highlighting the issue of acceptance. Forty patients with OCD were recruited and underwent a specific treatment procedure. All patients had a psychodiagnostic assessment for OCD using the Y−BOCS (Yale−Brown obsessive−compulsive scale) performed twice: before treatment (t0) and after nine months (t1). Data analysis showed a decrease in the scores between t0 and t1 according to the Y−BOCS in terms of the interference, severity, and impairment of obsessive−compulsive symptoms. A repeated-measures ANOVA showed a significant reduction in symptoms after treatment, with values of F (1, 39) = 137.56, p < 0.001, and η2 = 0.78. The ANOVA results were corroborated by a Wilcoxon signed-rank test. A reliable change index analysis indicated that 33 participants reported improvements in symptoms, of which 23 were clinically significant. The results showed clinical relevance for OCD treatment and highlighted how this cognitive procedure favored positive outcomes.

Imagery Rescripting on Guilt-Inducing Memories in OCD: A Single Case Series Study.

BACKGROUND AND OBJECTIVES: Criticism is thought to play an important role in obsessive-compulsive disorder (OCD), and obsessive behaviors have been considered as childhood strategies to avoid criticism. Often, patients with OCD report memories characterized by guilt-inducing reproaches. Starting from these assumptions, the aim of this study is to test whether intervening in memories of guilt-inducing reproaches can reduce current OCD symptoms. The emotional valence of painful memories may be modified through imagery rescripting (ImRs), an experiential technique that has shown promising results. METHODS: After monitoring a baseline of symptoms, 18 OCD patients underwent three sessions of ImRs, followed by monitoring for up to 3 months. Indexes of OCD, depression, anxiety, disgust, and fear of guilt were collected. RESULTS: Patients reported a significant decrease in OCD symptoms. The mean value on the Yale-Brown Obsessive Compulsive Scale (Y-BOCS) changed from 25.94 to 14.11. At the 3-month follow-up, 14 of the 18 participants (77.7%) achieved an improvement of ≥35% on the Y-BOCS. Thirteen patients reported a reliable improvement, with ten reporting a clinically significant change (reliable change index = 9.94). Four reached the asymptomatic criterion. Clinically significant changes were not detected for depression and anxiety. CONCLUSIONS: Our findings suggest that after ImRs intervention focusing on patients' early experiences of guilt-inducing reproaches there were clinically significant changes in OCD symptomatology. The data support the role of ImRs in reducing OCD symptoms and the previous cognitive models of OCD, highlighting the role of guilt-related early life experiences in vulnerability to OCD.

Early maladaptive schemas in overweight and obesity: A schema mode model.

Obesity is a growing burden in our societies and, although different kinds of treatments are effective in the short time, weight gain often reoccurs in the longer period. One possible explanation might rely on the little comprehension of obese maladaptive schemas, as developed from early life experiences, which might interfere with treatment enduring efficacy. The aim of this study was to investigate early maladaptive schemas, their associated current schema-modes and dysfunctional coping strategies in overweight and obese individuals (N = 48). Results showed that overweight and obese subjects reported more severe insufficient self-control, abandonment, dependence and subjugation schemas, and actual schema-modes (i.e., impulsive and vulnerable child, detached protector), compared against normal-weight controls (N = 37). As well, the former displayed higher dysfunctional eating habits (i.e., bingeing and bulimic symptoms) and more emotional-avoidant coping strategies. Above all schemas, insufficient self-control predicted higher BMI, binge frequency and bulimic symptoms' severity. Furthermore, avoidant coping mediated between specific maladaptive schemas and frequency of bingeing and bulimic symptoms. Our findings illustrate that overweight and obese display more dysfunctional early maladaptive schemas and schema-modes, compared against normal-weight individuals, exhibiting more emotion-avoidant strategies such as over-eating and bingeing, which might stand for a detached self-soother coping mode. The insufficient self-control schema develops from a lack in self-discipline and an inability to tolerate frustration and might be embodied by the impulsive child mode. A deeper comprehension of schemas and modes, as addressed within the Schema Therapy model, might help to understand dysfunctional personality features that might interfere with the long-lasting efficacy of treatment interventions in obesity.

Two Reasoning Strategies in Patients With Psychological Illnesses.

Hyper-emotion theory states that psychological disorders are conditions in which individuals experience emotions that are appropriate to the situation but inappropriate in their intensity. When these individuals experience such an emotion, they are inevitably compelled to reason about its cause. They therefore develop characteristic strategies of reasoning depending on the particular hyper-emotion they experience. In anxiety disorders (e.g., panic attack, social phobia), the perception of a disorder-related threat leads to hyper-anxiety; here, individuals' reasoning is corroboratory, adducing evidence that confirms the risk (corroboratory strategy). In obsessive-compulsive disorders, the threat of having acted in an irresponsible way leads to both hyper-anxiety and guilt; here, individuals' reasoning is refutatory, adducing only evidence disconfirming the risk of being guilty (refutatory strategy). We report three empirical studies corroborating these hypotheses. They demonstrate that patients themselves recognize the two strategies and spontaneously use them in therapeutic sessions and in evaluating scenarios in an experiment.

Reducing the Meta-Emotional Problem Decreases Physiological Fear Response during Exposure in Phobics.

Anxiety disorders may not only be characterized by specific symptomatology (e.g., tachycardia) in response to the fearful stimulus (primary problem or first-level emotion) but also by the tendency to negatively evaluate oneself for having those symptoms (secondary problem or negative meta-emotion). An exploratory study was conducted driven by the hypothesis that reducing the secondary or meta-emotional problem would also diminish the fear response to the phobic stimulus. Thirty-three phobic participants were exposed to the phobic target before and after undergoing a psychotherapeutic intervention addressed to reduce the meta-emotional problem or a control condition. The electrocardiogram was continuously recorded to derive heart rate (HR) and heart rate variability (HRV) and affect ratings were obtained. Addressing the meta-emotional problem had the effect of reducing the physiological but not the subjective symptoms of anxiety after phobic exposure. Preliminary findings support the role of the meta-emotional problem in the maintenance of response to the fearful stimulus (primary problem).

Specific dysphoric symptoms are predicted by early maladaptive schemas.

Early maladaptive schemas (EMSs) are cognitive patterns resulting from unmet core emotional needs in childhood that have been linked to the development of psychopathology. As depression is a multifaceted phenomenon, we hypothesized that specific dysphoric symptoms would be predicted by different EMSs. Four hundred and fifty-six participants completed a measure of EMSs (Young Schema Questionnaire) and reported on the severity of the symptoms of criterion A for major depression in DSM-IV during the occurrence of a dysphoric episode in the previous 12 months. A series of stepwise multiple regression analyses were performed to investigate the predictive power of the EMSs for the severity of each specific depressive symptom. When controlling for gender and current levels of depression, specific symptoms were predicted by different EMSs: sadness by Negativity/Pessimism; anhedonia by Failure; self-harm by Emotional Deprivation and Vulnerability to Harm or Illness; worthlessness by Failure and Negativity/Pessimism; psychomotor retardation/restlessness by Vulnerability to Harm or Illness and Entitlement/Grandiosity; and poor concentration by Insufficient Self-Control/Self-Discipline. The more physical symptoms of fatigue, insomnia/hypersomnia, and appetite loss/appetite gain were not predicted by any of the EMSs. Although the cross-sectional design of the study does not allow for conclusions about the direction of effects, results suggest that depression is not a unitary phenomenon and provide a possible explanation for previous inconsistent findings.

The role of personal goals in depressive reaction to adverse life events: a cross-sectional study.

Consistent with cognitive views of depression, we aimed to investigate the mediating role of personal goals in the relationship between stressful events and distinct patterns of depressive symptoms in a nonclinical sample. Participants identified a dysphoric episode that occurred in the previous year by reporting the severity of 12 depressive symptoms and their plausible cause. A goal taxonomy was used to determine how much the event interfered with the achievement of a series of personal goals. After controlling for age and current level of depression, the patterns of symptoms differed based on the triggering events. The relationship between sadness and affective losses was partially mediated by the personal goal of lovableness, and success was a partial mediator in the association between an event of failure and symptoms of worthlessness and anhedonia. Although the cross-sectional design of the study does not allow for conclusions on the direction of effects, findings suggest the importance of motivational factors in the development of specific patterns of depressive symptoms to adverse events. Assuming a continuum from low mood to clinical depression, treatment models could benefit from a precise identification of the specific stressors that initiate depressive behaviour and the personal meaning assigned to those events.