The Paradoxical Effect of Repeated Body Checking on Subjective Uncertainty.

OBJECTIVE: Body checking is considered a behavioral expression of the core psychopathology of eating disorders (EDs), namely, overvaluation of body weight and shape. Compulsive checking is motivated by a desire to increase a sense of certainty regarding feared outcomes. Paradoxically, studies showed that repeated checking acts to reduce certainty, forming a vicious cycle. No previous study examined whether the same principle applies for body checking. This study filled this gap by examining the causal effect of repeated body checking on memory certainty regarding checked body parts. METHOD: In a laboratory-based study, 77 female participants without an ED checked the size and shape of six body parts. Their objective memory regarding which body part was last checked, and subjective certainty about this memory were assessed. Then, one group of participants continued to engage in repeated body checking, and another group repeatedly checked a neutral object. Finally, all participants completed the six body parts checking procedure again, and their objective memory and memory certainty were re-assessed. RESULTS: In both checking groups, objective memory regarding the last body part checked was unaffected by the type of checking performed. Importantly, certainty about memory dropped considerably only among those in the repeated body-checking group. DISCUSSION: The findings provide the first empirical evidence of a paradoxical effect demonstrating that repeated body checking reduces certainty about checked body parts. The study implies that repeated body checking reduces the quality of information obtained through checking and, as such, could potentially motivate further checking.

Evidence for Automatic, Stimulus Driven, Arithmetic Processing of Single-digit Multiplication Problems.

Certain stimuli can automatically trigger different behaviors in a stimulus-driven manner. To investigate whether mathematical equations automatically trigger the tendency to engage in arithmetic processing, we asked whether the presentation of multiplication equations in an irrelevant dimension can trigger the automatic task of arithmetic processing and if so, which processes are involved. To that end, we employed a color-naming task in which participants had to name the color of different stimuli, such as: mathematical equations (e.g., 4 × 6 = 24), neutral-symbols (e.g., ####), neutral-words (e.g., building), and same-number strings (e.g., 11111), which appeared as one of four different colors. We found that mathematical equations and regular words in the irrelevant dimension triggered more task conflict (i.e., color naming's reaction time was longer) as compared to same-number strings. In addition, we found evidence for the automatic activation of different numerical processes; such that large-size equations (7 × 9 = 63) triggered more conflict as compared with small-size (2 × 3 = 6) equations and same-parity incorrect equations (3 × 2 = 8) triggered more conflict as compared to different-parity incorrect equations (4 × 2 = 9). We found no evidence indicating a distinction between the correct and incorrect equations. We discussed the relevance of the findings to the automaticity of arithmetic abilities and other domains in numerical cognition.

Fostering positive attitudes toward food in individuals with restrained eating: the impact of flexible food-related inhibition.

Individuals exhibiting restrained eating behaviors demonstrate increased inhibitory control when exposed to food-related stimuli, indicating the presence of an automatic food-inhibition association. Existing literature proposes that this association contributes to the devaluation of food within this population. Efforts to disrupt this association by promoting the complete elimination of the inhibition of food responses have resulted in increased food consumption but have also led to heightened food-related anxiety in individuals with restrained eating behaviors. In the current investigation, we investigated whether a novel flexible food response/inhibition computerized task could yield favorable changes in attitudes toward food in individuals with restrained eating. We randomly assigned 78 females who engage in restrained eating to one of three training groups. In the flexible response/inhibition group, participants were instructed to equally inhibit or respond to food stimuli. In the response group, participants consistently responded to food stimuli, while in the inhibition group, participants consistently inhibited their response to food cues. Implicit attitudes toward food were assessed both before and after the manipulation. To examine the stability of the effect of the training, participants also engaged in a seemingly unrelated bogus taste test. Our results revealed that only the flexible response/inhibition group demonstrated a significant improvement in positive attitudes toward high-calorie foods after eating, while there were no observable changes in negative attitudes among the other two groups. These findings suggest that promoting a balance between the responding and inhibiting responses to food stimuli can increase positive attitudes toward food amongst individuals with restrained eating.

Negative emotional cues improve free recall of positive and neutral words in unmedicated patients with major depressive disorder.

Individuals with major depressive disorder (MDD) exhibit attentional biases toward negative, mood-congruent stimuli while filtering out positive and neutral stimuli, resulting in memory biases to negative content. While attentional and memory biases in MDD have been extensively studied, the underlying mechanisms of these biases remain unclear. The current study investigates a novel model proposing that exposure to negative emotional cues triggers a transient "attentional window" in individuals with MDD, leading to heightened and deeper cognitive processing of any subsequent information, irrespective of its content. Forty-two unmedicated patients with MDD and no comorbid disorder and 41 healthy controls, completed six blocks of the emotional memory task, in which they were asked to watch a short video (negative, neutral, or positive valence) followed by a memory test on a list of neutral or positive valance words. Results indicated that participants with MDD, but not healthy controls, had better recall performance after a negative video compared to after neutral or positive videos, and that this effect occurred for both neutral and positive word-lists. These findings provide evidence that participants with MDD engage in deeper information processing following exposure to negative emotional stimuli. Potential clinical implications are discussed.

Control your emotions: evidence for a shared mechanism of cognitive and emotional control.

The current investigation examined the bidirectional effects of cognitive control and emotional control and the overlap between these two systems in regulating emotions. Based on recent neural and cognitive findings, we hypothesised that two control systems largely overlap as control recruited for one system (either emotional or cognitive) can be used by the other system. In two experiments, participants completed novel versions of either the Stroop task (Experiment 1) or the Flanker task (Experiment 2) in which the emotional and cognitive control systems were actively manipulated into either a high or low emotional-load condition (achieved by varying the proportions of negative-valence emotional cues) and a high and a low cognitive control condition (achieved through varying the proportion of conflict-laden trials). In both experiments, participants' performance was impaired when both emotional and cognitive control were low, but significantly and similarly improved when one of the two control mechanisms were activated - the emotional or the cognitive. In Experiment 2, performance was further improved when both systems were activated. Our results give further support for a more integrative notion of control in which the two systems (emotional and cognitive control) not only influence each other, but rather extensively overlap.

Focused on the negative: emotions and visuospatial attention in generalized anxiety disorder.

Global-local visuospatial attention is a core mechanism which highly affects the way we process our visuospatial environment. The current study aimed to examine the effect of negative emotions on global-local visuospatial processing in participants with generalized anxiety disorder (GAD) and in healthy controls (HCs). Participants performed two versions of the global-local-arrow task: they were asked to determine the direction (left or right) of the global arrow or of the local arrows that composed it, with or without emotional prime-cues. In the non-emotional task and in the neutral-valence condition of the emotional task, the GAD group did not differ from that of HCs - both groups exhibited a classic global processing bias (reactions to the global dimension were faster and less affected by the local dimension). In the negative-valence condition, global processing bias was only slightly reduced in HCs and almost completely eliminated in the GAD group. The results of the current study suggest that, in non-emotional conditions, global processing bias does not differ significantly between individuals with GAD and HCs. However, task-irrelevant negative cues were found to have a greater impact in reducing global bias for individuals with GAD compared to HCs. Potential implications are discussed.

Reliable affordances: A generative modeling approach for test-retest reliability of the affordances task.

The affordances task serves as an important tool for the assessment of cognition and visuomotor functioning, and yet its test-retest reliability has not been established. In the affordances task, participants attend to a goal-directed task (e.g., classifying manipulable objects such as cups and pots) while suppressing their stimulus-driven, irrelevant reactions afforded by these objects (e.g., grasping their handles). This results in cognitive conflicts manifesting at the task level and the response level. In the current study, we assessed the reliability of the affordances task for the first time. While doing so, we referred to the "reliability paradox," according to which behavioral tasks that produce highly replicable group-level effects often yield low test-retest reliability due to the inadequacy of traditional correlation methods in capturing individual differences between participants. Alongside the simple test-retest correlations, we employed a Bayesian generative model that was recently demonstrated to result in a more precise estimation of test-retest reliability. Two hundred and ninety-five participants completed an online version of the affordances task twice, with a one-week gap. Performance on the online version replicated results obtained under in-lab administrations of the task. While the simple correlation method resulted in weak test-retest measures of the different effects, the generative model yielded a good reliability assessment. The current results support the utility of the affordances task as a reliable behavioral tool for the assessment of group-level and individual differences in cognitive and visuomotor functioning. The results further support the employment of generative modeling in the study of individual differences.

The aversiveness of intrusiveness: Evidence from involuntary musical imagery.

OBJECTIVE: Intrusive thoughts are characterized by a sense of intrusiveness of foreign entry into cognition. While not always consisting of negative content, intrusive thoughts are almost solely investigated in that context. Involuntary Musical Imagery (INMI) offers a promising alternative, as it is a type of involuntary cognition that can be used to evaluate intrusiveness without negative content. METHODS: In Study 1, 200 participants completed self-report questionnaires to assess several aspects of intrusiveness: meta-awareness, control, repetitiveness, frequency, and subjective experience of INMI. In Study 2, 203 participants completed self-report questionnaires to explore the clinical characteristics (depression, stress, anxiety, and rumination) which might mediate the connection between INMI frequency and INMI negative experience. RESULTS: Study 1 revealed, through exploratory factor analysis, that intrusiveness shares variance with the negative experience of INMI but not with INMI frequency. In Study 2, ruminative thinking was found to mediate the relationship between frequent INMI and the negative experience of INMI. CONCLUSION: These results suggest that INMI might be used to investigate intrusiveness in the lab without the potential confound of negative emotions. In addition, the results suggest that neither the content nor the frequency of intrusive thoughts can solely explain why these thoughts are aversive to some but not others. Ruminative style might be the missing link to explain how and why these intrusive thoughts become aversive and obsessive. In other words, we suggest that the cause for intrusiveness lies not in the thought or repetitiveness, but in the thinker.

Proactive control affects task conflict beyond contingency learning.

Various models of the Stroop task suggest that proactive task control adaptation accounts for the modulation of task conflict in different conditions of the Stroop task, for example, when task conflict is very frequent or very infrequent. Other researchers have argued that a contingency learning of colour-word associations is the main contributor to the modulations of the Stroop effect. In this work, we constructed a design that controls for confounds that are suspected to rule out the role of control adaptation in the Stroop task. We focused on one type of conflict-task conflict and tested whether colour-naming of neutral-words (where task conflict is present) differed from colour-naming of neutral-symbols (where task conflict is not present) in four different conditions: mostly words-congruent, mostly words-incongruent, mostly words-neutral, or mostly non-words-shape. Importantly, the conditions used for the task conflict marker were identical in all four conditions. We found that the marker of task conflict (reaction time [RT] for neutral-words > RT for neutral-symbols) was significant in the mostly non-words-shape condition, where proactive task control is relaxed, but not in the mostly words conditions, where proactive task control is activated, with no difference between these three words conditions. These findings suggest that control adaptation is the main contributor to the modulations of the Stroop effect. The relevance of the results to the current literature is discussed and the results are explained in light of the proactive control-task conflict (PC-TC) model.

Post-traumatic stress in war veterans and secondary traumatic stress among parents of war veterans five years after the 2014 Israel-Gaza military conflict.

Secondary traumatic stress (STS) has been studied in therapists, spouses, and mainly in children of traumatised individuals. To date, the relationship between children's posttraumatic stress disorder (PTSD) symptoms and their parents' mental health outcomes have been understudied, and specifically, long term STS symptoms of parents of war veterans were not investigated. The current study examined PTSD symptoms among veterans of the 2014 Israel-Gaza war and STS among their parents, five years after the war. The control group consisted of veterans from combat military units who were on active duty at the time of the war but did not actively participate in the war (stand-by units) - providing a natural experiment condition. We found that PTSD symptoms were almost twice as high in the directly active war veterans (DAV, N = 32) group compared to the indirectly active war veterans (IAV, N = 26) group. Results showed that mothers had higher STS symptoms in general, and DAV PTSD symptoms correlated with their fathers STS symptoms. The current study provides novel evidence for: (a) subclinical PTSD symptoms in war veterans 5 years after the war, and (b) transmission of trauma from war veterans to their parents. The overall negative effect of sending a child to war on the parents are also discussed.

The current study examined post-traumatic stress symptoms among undiagnosed war veterans of the 2014­2014 Israel-Gaza Military Conflict compared to matched control who were on active military duty at the same time but did not actively participate in the war. We found higher post-traumatic stress symptoms in the veterans who actively participated in the war, roughly five years after the war.Parents of veterans who actively participated in the war exhibited higher secondary traumatic stress compared to parents of veterans who did not actively participate in the war. This is especially interesting given that parents of all veterans were not aware of their whereabouts during the war. Overall, mothers exhibited higher secondary traumatic stress compared to fathers. However, fathers were more 'in-sync' with their sons' traumatic experience as evident by a significant correlation between the war veterans' post-traumatic stress and the fathers' secondary traumatic stress symptoms.

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.

Global-Local Processing in ADHD Is Not Limited to the Visuospatial Domain: Novel Evidence From the Auditory Domain.

OBJECTIVE: Global-local visuospatial processing has been widely investigated in both healthy and clinical populations. Recent studies indicated that individuals with ADHD lack a global processing bias. However, the extant literature regarding global-local processing style focuses solely on the visual modality. METHODS: ADHD (N = 21) and typically developed (TD) controls (N = 24) underwent an auditory global-local task, in which they had to decide whether the melody is ascending or descending in global or local conditions. RESULTS: TD controls exhibited a classic global processing bias in the auditory task. The ADHD group exhibited no global processing bias, indicating similar processing for global and local dimensions, implying that individuals with ADHD are distracted by incongruent information in global and local conditions similarly, in both visual and auditory tasks. CONCLUSION: A lack of global processing bias in ADHD is not limited to the visuospatial modality and likely reflects a broader and more general processing style.

What is word? The boundary conditions of task conflict in the Stroop task.

The Stroop task is characterized by two types of conflicts-information conflict (between the incongruent word and ink color) and task conflict (between the relevant color-naming task and the competing, irrelevant, stimulus-driven, word reading task). It is not yet clear what stimuli trigger the task of reading, and thus task conflict, and to what extent. In the current study, we applied a novel low-control (high neutral proportion) between-subject design to test the effect of different neutral conditions (symbols, same-letter strings, illegal-letter strings, pseudo-words, and real-words) on task conflict, in both manual and vocal response-types. Results indicated that in the manual task, a reverse facilitation effect, a signature of task conflict, appeared in all non-word conditions in a similar magnitude, but did not appear in the real-words condition. In the vocal task, reverse facilitation was found only in the symbols condition, regular facilitation was exhibited in all other neutral conditions, and larger facilitation appeared in the real-words condition. Our results indicate that the reading process and the activation of task conflict, depend on response-types (manual vs. vocal). In both response-types we found support for a word superiority effect, such that words trigger task conflict to a greater extent, however, we only observed an orthographic effect in the vocal response-type where stimuli consisting of letters triggered the reading task. We concluded that in the manual response-type, conflict arises only in the lexical route, whilst in the vocal response-type, conflict arises in the lexical and orthographic routes.

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.

The effect of imagery rescripting on prospective mental imagery of a feared social situation.

BACKGROUND AND OBJECTIVES: Negative mental imagery appears to play a role in anxiety disorders and can involve aversive memories or anticipated future threats. Modulating aversive memories through imagery rescripting generally reduces negative memory appraisals and associated anxiety. This pre-registered two-day analog study investigated whether imagery rescripting of aversive memories also reduces negative imagery of future threats. METHODS: On Day 1, socially anxious individuals (N = 52) were randomly assigned to imagery rescripting of an aversive memory or progressive relaxation (control condition). Before each intervention, they were asked to imagine a feared social situation that may happen in their future and evaluate this situation. They also rated the aversive memory before and after the intervention phase. The feared future situation was again evaluated at follow-up on Day 2. RESULTS: Unexpectedly, no group differences were found on the main outcome measures. That is, negative memory appraisals reduced after both interventions. Likewise, in both groups, negative details decreased, and positive details increased in prospective mental imagery, and anxiety and avoidance towards the imagined event decreased. On the exploratory measures, the imagery rescripting group showed increased positive appraisals of memory and future threat, and decreased negative future-threat appraisals, compared to the progressive relaxation group. LIMITATIONS: No passive control group was included, so potential time or placebo effects cannot be precluded. CONCLUSIONS: The interventions had similar effects on the main outcomes and influenced mental imagery of future threats. Some differences were found on the exploratory measures that warrant further investigation with a passive control condition.

Maintenance of Wellness in Patients With Obsessive-Compulsive Disorder Who Discontinue Medication After Exposure/Response Prevention Augmentation: A Randomized Clinical Trial.

IMPORTANCE: Serotonin reuptake inhibitors (SRIs) are the only medications approved for obsessive-compulsive disorder (OCD), yet most patients taking SRIs exhibit significant symptoms. Adding exposure/response prevention (EX/RP) therapy improves symptoms, but it is unknown whether patients maintain wellness after discontinuing SRIs. OBJECTIVE: To assess whether patients with OCD who are taking SRIs and have attained wellness after EX/RP augmentation can discontinue their SRI with noninferior outcomes compared with those who continue their SRI therapy. DESIGN, SETTING, AND PARTICIPANTS: A 24-week, double-blind, randomized clinical trial was performed from May 3, 2013, to June 25, 2018. The trial took place at US academic medical centers. Participants included 137 adults with a principal diagnosis of OCD (≥1 year) who were taking an SRI (≥12 weeks), had at least moderate symptoms (defined as Yale-Brown Obsessive-Compulsive Scale [Y-BOCS] score ≥18 points), and received as many as 25 sessions of EX/RP therapy. Those who attained wellness (Y-BOCS score ≤14 points; 103 patients [75.2%]) were study eligible. Data were analyzed from June 29, 2019, to October 2, 2021. INTERVENTION: Participants were randomly assigned either to receive taper to placebo (taper group) or to continue their SRI (continuation group) and monitored for 24 weeks. MAIN OUTCOME AND MEASURES: The Y-BOCS score (range, 0-40 points) was the primary outcome; the Hamilton Depression Rating Scale (HDRS; range, 0-52 points) and the Quality-of-Life Enjoyment and Satisfaction Questionnaire-Short Form (Q-LES-Q-SF; range, 0%-100%) scores were secondary outcomes. Outcomes were assessed at 8 time points by independent evaluators who were blinded to randomization. The taper regimen was hypothesized to be noninferior to continuation at 24 weeks using a 1-sided α value of .05. RESULTS: A total of 101 patients (mean [SD] age, 31.0 [11.2] years; 55 women [54.5%]) participated in the trial: 51 patients (50.5%) in the taper group and 50 patients (49.5%) in the continuation group. At 24 weeks, patients in the taper group had noninferior results compared with patients in the continuation group (mean [SD] Y-BOCS score: taper group, 11.47 [6.56] points; continuation group: 11.51 [5.97] points; difference, -0.04 points; 1-sided 95% CI, -∞ to 2.09 points [below the noninferiority margin of 3.0 points]; mean [SD] HDRS score: taper group, 5.69 [3.84] points; continuation group, 4.61 [3.46] points; difference, 1.08 points; 1-sided 95% CI, -∞ to 2.28 points [below the noninferiority margin of 2.5 points]; mean [SD] Q-LES-Q-SF score: taper group, 68.01% [15.28%]; continuation group, 70.01% [15.59%]; difference, 2.00%; 1-sided 95% CI, -∞ to 6.83 [below the noninferiority margin of 7.75]). However, the taper group had higher rates of clinical worsening (23 of 51 [45%] vs 12 of 50 [24%]; P = .04). CONCLUSIONS AND RELEVANCE: Results of this randomized clinical trial show that patients with OCD who achieve wellness after EX/RP therapy could, on average, discontinue their SRI with noninferior outcomes compared with those who continued their SRI. Those who tapered the SRI had higher clinical worsening rates. Future research should evaluate if SRI half-life alters these rates. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT01686087.

Neutral affordances: Task conflict in the affordances task.

Task conflict emerges when a stimulus triggers two or more competing tasks. To date, task conflict has been studied mainly using the color-word Stroop task. We hypothesized that task conflict also emerges in the affordances task between the goal-directed relevant task (e.g., classifying manipulable objects such as cups and pots), and the automatic, stimulus-driven, irrelevant task afforded by these objects (e.g., grasping their handles). Thus, we expected task conflict to manifest in both congruent and incongruent trials, separately from the well-known affordances response conflict that manifests in incongruent trials between responding with the right vs. the left hand. To this end, we aimed to identify a neutral condition for the affordances task. In Experiment 1, participants performed an affordances task that included images of manipulable objects and houses. While manipulable objects evoke automatic grasping tendencies, house images were hypothesized to serve as neutral, conflict-free stimuli. House images yielded shorter reaction time (RT) than incongruent trials, indicating that they may serve as neutral stimuli for the task. House images also yielded shorter RT than congruent trials, suggesting that task conflict manifests in congruent (as well as in incongruent) affordances trials. In Experiment 2 we manipulated cognitive control in the affordance task by creating low-control and high-control blocks. While both congruent and incongruent trials were impacted by this manipulation of cognitive control, neutral trials remained unaffected. These findings indicate that the affordances task involves conflicts at both the task level and the level of response, and can be used as a supplementary, non-linguistic measure of task conflict and the activation of task control.

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

Obsessive-compulsive disorder (OCD) symptoms fluctuate throughout the day, but scientists are not sure what underlies these fluctuations. One factor which may explain how OCD symptoms wax and wane throughout the day is alertness. Increased alertness is associated with greater inhibitory control, a factor which plays a significant role in patients' ability to overcome their OCD symptoms. The current study examined the relationship between chronotype (morningness/eveningness preference, a measure of alertness) and within-day OCD symptom severity fluctuations. We hypothesized that increased alertness leads to better inhibitory abilities and, therefore, reduced OCD symptoms. OCD Symptoms were measured through 7-days of monitoring in which participants were asked to retrospectively rate their symptoms at several timepoints throughout the day. Chronotype was measured using the Morningness/Eveningness Questionnaire (MEQ). Consistent with our hypotheses, results revealed an interaction between chronotype and time of day, such that those with an eveningness preference tended to have worse symptoms in the morning, and vice versa. In addition, we also report novel findings regarding the effect of bedtime, sleep duration, and sleep quality on symptom severity the next day. Taken together, these findings suggest that alertness may modulate OCD symptom severity throughout the day such that individuals experience more severe symptoms during times of low alertness. The clinical and theoretical implications of these findings are discussed.

Maximizing remission from cognitive-behavioral therapy in medicated adults with obsessive-compulsive disorder.

Practice guidelines for adults with obsessive-compulsive disorder (OCD) recommend augmenting serotonin reuptake inhibitors (SRIs) with exposure and ritual prevention (EX/RP). However, fewer than half of patients remit after a standard 17-session EX/RP course. We studied whether extending the course increased overall remission rates and which patient factors predicted remission. Participants were 137 adults with clinically significant OCD (Yale-Brown Obsessive Compulsive Scale [Y-BOCS] score ≥18) despite an adequate SRI trial (≥12 weeks). Continuing their SRI, patients received 17 sessions of twice-weekly EX/RP (standard course). Patients who did not remit (Y-BOCS ≤12) received up to 8 additional sessions (extended course). Of 137 entrants, 123 completed treatment: 49 (35.8%) remitted with the standard course and another 46 (33.6%) with the extended course. Poorer patient homework adherence, more Obsessive-Compulsive Personality Disorder (OCPD) traits, and the Brain-Derived Neurotrophic Factor (BDNF) Val66MET genotype were associated with lower odds of standard course remission. Only homework adherence differentiated non-remitters from extended course remitters. Extending the EX/RP course from 17 to 25 sessions enabled many (69.3%) OCD patients on SRIs to achieve remission. Although behavioral (patient homework adherence), psychological (OCPD traits), and biological (BDNF genotype) factors influenced odds of EX/RP remission, homework adherence was the most potent patient factor overall.

Control over task conflict in the stroop and affordances tasks: an individual differences study.

Task conflict is a type of conflict that emerges when a stimulus triggers two or more competing tasks. In the Stroop task, task conflict occurs between the relevant color-naming task and irrelevant word reading task and can be observed mainly on congruent trials, which only involve task conflict and are devoid of additional conflict types. We hypothesized that task conflict also manifests in the affordances task between the relevant task (e.g., classifying manipulatable objects), and the automatic task afforded by the object (e.g., grasping the object), and is mostly evident on congruent trials. Using an individual differences design we assessed the relationship between control mechanisms operating on Stroop congruent and affordances congruent trials under conditions of high and low cognitive control requirements. We hypothesized that task control is employed in both tasks. One-hundred and twenty-three participants performed an affordances task and two blocks of a Stroop task, each requiring a different level of task control (high vs. low). In a hierarchical regression model, we found a significant and specific correlation between affordances congruent and Stroop congruent conditions only in the high-control block, designed to greatly engage participants' task control, thus linking the task control mechanism in both tasks. These results indicate that task control underlies diverse modalities of response (visuomotor and linguistic), independently of other conflict types. We suggest that the affordances task may serve as a supplementary tool for the assessment of task control in the lab.