A randomized controlled dismantling study of Visual Schema Displacement Therapy (VSDT) vs an abbreviated EMDR protocol vs a non-active control condition in individuals with disturbing memories.

Background: Visual Schema Displacement Therapy (VSDT) is a novel therapy for the treatment of fears and trauma-related mental health problems including PTSD. VSDT proved to be effective in reducing emotionality of aversive memories in healthy individuals in two previous randomized controlled trials and outperformed both a non-active control condition (CC) and an abbreviated version of EMDR therapy, a well-established first-line treatment for posttraumatic stress disorder. Objectives: In an effort to enhance the understanding concerning the efficacy of VSDT, and to determine its active components, a dismantling study was conducted in individuals with disturbing memories in which the effects of VSDT were tested against EMDR therapy, a non-active CC and three different VSDT-protocols, each excluding or altering a hypothesized active component. Method: Participants (N = 144) were asked to recall an emotional aversive event and were randomly assigned to one of these six interventions, each lasting 8 minutes. Emotional disturbance and vividness of participants' memories were rated before and after the intervention and at one and four-week follow-up. Results: Replicatory Bayesian analyses supported hypotheses in which VSDT was superior to the CC and the EMDR condition in reducing emotionality, both directly after the intervention and at one week follow-up. However, at four-week follow-up, VSDT proved equal to EMDR while both treatments were superior to the CC. Concerning vividness the data also showed support for hypotheses predicting VSDT being equal to EMDR and both being superior to the CC in vividness reduction. Further analyses specifying differences between the abbreviated VSDT protocols detected no differences between these conditions. Conclusion: It remains unclear how VSDT yields its positive effects. Because VSDT appears to be unique and effective in decreasing emotionality of aversive memories, replication of the results in clinical samples is needed.

Antecedentes: La terapia de desplazamiento del esquema visual (VSDT por sus siglas en inglés) es una terapia novedosa para tratar los miedos y los problemas de salud mental relacionados con el trauma, incluido el TEPT. La VSDT demostró ser eficaz para reducir la emocionalidad de los recuerdos aversivos en individuos sanos en dos ensayos previos controlados aleatorizados y superó tanto a una condición de control no activa (CC por sus siglas en inglés) como a una versión abreviada de terapia EMDR, una terapia de primera línea bien establecida para el trastorno de estrés postraumático.Objetivos: En un esfuerzo para mejorar la comprensión de la eficacia de VSDT y para determinar sus componentes activos, se realizó un estudio de desmantelamiento en individuos con recuerdos perturbadores en el que se probaron los efectos del VSDT en contraste con la terapia EMDR, una CC no activa y tres diferentes protocolos de VSDT, cada uno excluyendo o alterando un componente activo hipotético.Método: Se pidió a los participantes (N= 144) que recordaran un evento aversivo emocionalmente y fueron asignados aleatoriamente a una de las seis intervenciones, cada una con una duración de 8 minutos. La alteración emocional y la viveza de los recuerdos de los participantes fueron calificados antes y después de la intervención y en el seguimiento luego de una y cuatro semanas.Resultados: Los análisis bayesianos replicativos apoyaron la hipótesis en las que VSDT fue superior a las condiciones CC y EMDR en la reducción de la emocionalidad, tanto directamente después de la intervención y a la semana de seguimiento. Sin embargo, a las cuatro semanas de seguimiento, VSDT resultó ser igual a EMDR mientras que ambos tratamientos fueron superiores al CC. Con respecto a la viveza, los datos también mostraron apoyo hacia las hipótesis que predicen que VSDT es igual a EMDR y que ambos son superiores a CC en la reducción de la viveza. Los análisis adicionales que especifican las diferencias entre los protocolos VSDT abreviados no detectaron diferencias entre estas condiciones.Conclusiones: No está claro cómo VSDT produce sus efectos positivos. Debido a que VSDT parece ser único y efectivo en disminuir la emocionalidad de los recuerdos aversivos, se requiere la replicación de estos estos resultados en muestras clínicas.

Linguistic dual tasking reduces emotionality, vividness and credibility of voice memories in voice-hearing individuals: Results from a controlled trial.

Dual taxation of the working memory during recall is an effective strategy to reduce the emotionality and vividness of visual intrusive memories and potentially changes dysfunctional beliefs associated with the memories. This study tested the hypothesis that dual tasking decreases emotionality, vividness and credibility of auditory intrusive images (i.e., memories of auditory hallucinations) with a two-level (time: pre and post; condition: dual tasking and recall only) within-subjects design. Thirty-seven voice-hearing participants selected two negative voice-hearing experiences. They recalled one of these experiences while performing a lingual dual task (i.e., language game on smartphone app) and recalled one memory without a dual task (in counterbalanced order). During the pre-test and post-test, emotionality and vividness of the voice-hearing memories were rated, as well as the credibility of the voice statements. There was a significantly greater decrease in emotionality, vividness and credibility during dual tasking than during recall only. This study provides proof of principle that the salience and credibility of the content of auditory hallucinations can be reduced by dual tasking; the clinical implications are also discussed.

Making eye movements during imaginal exposure leads to short-lived memory effects compared to imaginal exposure alone.

BACKGROUND AND OBJECTIVES: A plethora of eye movement desensitization and reprocessing (EMDR) analogue studies has shown that, in the short term, making eye movements (EM) during brief imaginal exposure ("recall + EM") blurs memories more than just imaginal exposure ("recall only"). Yet, results of the few studies that included a follow-up test are inconsistent. We improved this paradigm's ecological validity by including an extended intervention phase and multiple assessments per phase. We hypothesized that recall + EM results in larger immediate and 24 h reductions in memory vividness, negative valence, and distress than recall alone. We explored the persistence of the effects, as well as the predictive value of memory characteristics and individual differences. METHODS: Students (N = 100) selected a negative autobiographical memory and were randomized to recall + EM or recall alone; both interventions lasted 32 intervals of 24s. During the interventions they rated the memory after every four intervals. RESULTS: After 4 × 24s intervention, recall + EM resulted in memory deflation, while recall only caused memory inflation. After the full intervention (i.e., 32 × 24s), both conditions resulted in immediate and 24 h reductions on all outcome measures. Crucially, memory effects in the recall + EM condition partially relapsed 24 h later, while the effects in the recall only condition persisted. Change patterns were hardly explained by predictive variables. LIMITATIONS: We used a non-clinical sample; replication in clinical samples is warranted. CONCLUSION: Making EM during imaginal exposure leads to short-lived effects compared to imaginal exposure alone. However, EM may offer a response aid for those who avoid imaginal exposure.

Reducing the Emotionality of Auditory Hallucination Memories in Patients Suffering From Auditory Hallucinations.

Eye movement desensitization and reprocessing (EMDR) therapy targets emotionally disturbing visual memories of traumatic life events, and may be deployed as an efficacious treatment for posttraumatic stress disorder. A key element of EMDR therapy is recalling an emotionally disturbing visual memory while simultaneously performing a dual task. Previous studies have shown that auditory emotional memories may also become less emotional as a consequence of dual tasking. This is potentially beneficial for psychotic patients suffering from disturbing emotional auditory memories of auditory hallucinations. The present study examined whether and to what extent emotionality of auditory hallucination memories could be reduced by dual tasking. The study also assessed whether a modality matching dual task (recall + auditory taxation) could be more effective than a cross modal dual task (recall + visual taxation). Thirty-six patients suffering from auditory hallucinations were asked to recall an emotionally disturbing auditory memory related to an auditory hallucination, to rate emotionality of the memory, and to recall it under three conditions: two active conditions, i.e., visual taxation (making eye-movements) or auditory taxation (counting aloud), and one control condition (staring at a non-moving dot) counterbalanced in order. Patients re-rated emotionality of the memory after each condition. Results show the memory emotionality of auditory hallucinations was reduced and the active conditions showed stronger effects than the control condition. No modality-specific effect was found: the active conditions had an equal effect.

Dual-tasking during recall of negative memories or during visual perception of images: Effects on vividness and emotionality.

BACKGROUND AND OBJECTIVES: Several treatments are effective in reducing symptoms of post-traumatic stress disorder. We tested the effectiveness of an experimental intervention that consists of elements from two of these: virtual reality (VR) exposure therapy and eye movement desensitization and reprocessing. The latter is characterized by a dual-task approach: the patient holds a traumatic memory in mind while simultaneously making voluntary eye movements, resulting in reduced vividness and emotionality of the traumatic memory. If the experimental intervention is effective, it could provide a useful approach for highly avoidant individuals. METHODS: Participants recalled negative memories induced by a VR paradigm. The experimental group viewed VR screenshots that represented these negative memories while carrying out a dual-task. One control group recalled negative memories while carrying out the same dual-task (a standard dual-task condition) and another merely viewed the VR screenshots. Pre-to-post changes in self-rated memory vividness/emotionality were measured. RESULTS: The results indicate that viewing a screenshot only was outperformed by both dual-task interventions in terms of reductions in vividness/emotionality. Furthermore, the dual-task interventions had a comparable impact on vividness, but the screenshot variant led to greater decreases in emotionality. LIMITATIONS: Changes in memory vividness/emotionality were only assessed shortly after the interventions and no measures of avoidance behavior were included in the study. CONCLUSIONS: Looking at an image in VR that represents a memory while carrying out a dual-task may be at least as effective as recalling the memory during the dual-task. Interestingly, visually supporting a negative memory does not seem to prevent memory degrading by dual-tasking.

The Effect of modality specific interference on working memory in recalling aversive auditory and visual memories.

Both auditory and visual emotional memories can be made less emotional by loading working memory (WM) during memory recall. Taxing WM during recall can be modality specific (giving an auditory [visuospatial] load during recall of an auditory [visual] memory) or cross modal (an auditory load during visual recall or vice versa). We tested whether modality specific loading taxes WM to a larger extent than cross modal loading. Ninety-six participants undertook a visual and auditory baseline Random Interval Repetition task (i.e. responding as fast as possible to a visual or auditory stimulus by pressing a button). Then, participants recalled a distressing visual and auditory memory, while performing the same visual and auditory Random Interval Repetition task. Increased reaction times (compared to baseline) were indicative of WM loading. Using Bayesian statistics, we compared five models in terms of general and modality specific taxation. There was support for the model describing the effect on WM of dual tasking in general, irrespective of modality specificity, and for the model describing the effect of modality specific loading. Both models combined gained the most support. The results suggest a general effect of dual tasking on taxing WM and a superimposed effect of taxing in matched modality.

Effects of "Visual Schema Displacement Therapy" (VSDT), an abbreviated EMDR protocol and a control condition on emotionality and vividness of aversive memories: Two critical analogue studies.

BACKGROUND AND OBJECTIVES: Visual Schema Displacement Therapy (VSDT) is a novel therapy which has been described as a treatment for stress and dysfunction caused by a traumatic event. Although its developers claim this therapy is quicker and more beneficial than other forms of trauma therapy, its effectiveness has not been tested. METHODS: We compared the efficacy of VSDT to an abbreviated EMDR protocol and a non-active control condition (CC) in two studies. In Study 1 participants (N = 30) were asked to recall three negative emotional memories under three conditions: VSDT, EMDR, and a CC, each lasting 8 min. Emotional disturbance and vividness of the memories were rated before and after the (within group) conditions. The experiment was replicated using a between group study. In Study 2 participants (N = 75) were assigned to one of the three conditions, and a follow-up after 6-8 days was added. RESULTS: In both studies VSDT and EMDR were superior to the CC in reducing emotional disturbance, and VSDT was superior to EMDR. VSDT and EMDR outperformed the CC in terms of reducing vividness. LIMITATION: Results need to be replicated in clinical samples. CONCLUSIONS: It is unclear how VSDT yields positive effects, but irrespective of its causal mechanisms, VSDT warrants clinical exploration.

Does US expectancy mediate the additive effects of CS-US pairings on contingency instructions? Results from subjective, psychophysiological and neural measures.

Verbal instructions are a powerful pathway to learn new fear relations, and an important question has been what fear experience can still add to the effect of such instructions. Therefore, in previous studies, we investigated the effects of pairings between conditioned stimuli (CS) and unconditioned stimuli (US) after CS-US contingency instructions. Although these studies found that CS-US pairings do indeed add to the effects of contingency instructions on subjective, psychophysiological and neural measures of conditioned fear, they also produce increases in US expectancy ratings. In the current report we address whether these enhanced US expectancy ratings can account for the additive effects of CS-US pairings as suggested by expectancy models of fear conditioning. To address this question we made use of pathway models to investigate mediation in within-subjects designs. Our results demonstrate that US expectancy ratings do not mediate the effects of CS-US pairings on fear ratings, the startle reflex or amygdala activation pattern similarity. Additional exploratory analyses, however, revealed that subjective fear ratings do explain the effects of CS-US pairings on the other measures. We discuss how these results relate to expectancy models of fear conditioning and what they implicate for the validity of US expectancy and fear ratings.

Presence and Predictive Value of Obsessive-Compulsive Symptoms in Anxiety and Depressive Disorders.

OBJECTIVE: Obsessive-compulsive symptoms (OCS) co-occur frequently with anxiety and depressive disorders, but the nature of their relationship and their impact on severity of anxiety and depressive disorders is poorly understood. In a large sample of patients with anxiety and depressive disorders, we assessed the frequency of OCS, defined as a Young Adult Self-Report Scale-obsessive-compulsive symptoms score >7. The associations between OCS and severity of anxiety and/or depressive disorders were examined, and it was investigated whether OCS predict onset, relapse, and persistence of anxiety and depressive disorders. METHODS: Data were obtained from the third (at 2-year follow-up) and fourth wave (at 4-year follow-up) of data collection in the Netherlands Study of Anxiety and Depression cohort, including 469 healthy controls, 909 participants with a remitted disorder, and 747 participants with a current anxiety and/or depressive disorder. RESULTS: OCS were present in 23.6% of the total sample, most notably in those with current combined anxiety and depressive disorders. In patients with a current disorder, OCS were associated with severity of this disorder. Moreover, OCS predicted (1) first onset of anxiety and/or depressive disorders in healthy controls (odds ratio [OR], 5.79; 95% confidence interval [CI], 1.15 to 29.14), (2) relapse in those with remitted anxiety and/or depressive disorders (OR, 2.31; 95% CI, 1.55 to 3.46), and (3) persistence in patients with the combination of current anxiety and depressive disorders (OR, 4.42; 95% CI, 2.54 to 7.70) within the 2-year follow-up period Conclusions: OCS are closely related to both the presence and severity of anxiety and depressive disorders and affect their course trajectories. Hence, OCS might be regarded as a course specifier signaling unfavorable outcomes. This specifier may be useful in clinical care to adapt and intensify treatment in individual patients.

Auditory and Visual Memories in PTSD Patients Targeted with Eye Movements and Counting: The Effect of Modality-Specific Loading of Working Memory.

Introduction: Eye movement desensitization and reprocessing (EMDR) therapy is an evidence-based treatment for post-traumatic stress disorder (PTSD). A key element of this therapy is simultaneously recalling an emotionally disturbing memory and performing a dual task that loads working memory. Memories targeted with this therapy are mainly visual, though there is some evidence that auditory memories can also be targeted. Objective: The present study tested whether auditory memories can be targeted with EMDR in PTSD patients. A second objective was to test whether taxing the patient (performing a dual task while recalling a memory) in a modality specific way (auditory demanding for auditory memories and visually demanding for visual memories) was more effective in reducing the emotionality experienced than taxing in cross-modality. Methods: Thirty-six patients diagnosed with PTSD were asked to recall two disturbing memories, one mainly visual, the other one mainly auditory. They rated the emotionality of the memories before being exposed to any condition. Both memories were then recalled under three alternating conditions [visual taxation, auditory taxation, and a control condition (CC), which comprised staring a non-moving dot] - counterbalanced in order - and patients rerated emotionality after each condition. Results: All three conditions were equally effective in reducing the emotionality of the auditory memory. Auditory loading was more effective in reducing the emotionality in the visual intrusion than the CC, but did not differ from the visual load. Conclusion: Auditory and visual aversive memories were less emotional after working memory taxation (WMT). This has some clinical implications for EMDR therapy, where mainly visual intrusions are targeted. In this study, there was no benefit of modality specificity. Further fundamental research should be conducted to specify the best protocol for WMT.

Modification of episodic memories by novel learning: a failed replication study.

Background: After reactivation, memories can become unstable and sensitive to modification before they are restored into long-term memory. Using behavioural manipulations, reactivated memories may be disrupted via the mechanism of interference (i.e. novel learning). In a laboratory study, Wichert et al. (2013a) showed that new learning after reactivation changed episodic memory, while new learning alone or reactivation alone did not. Objective: Given the potential clinical application of such a procedure in trauma-focused psychological treatments, such as CBT or EMDR, the aim of this study was to replicate Wichert et al. Method: On Day 1, participants (N = 96) viewed and recalled a series of emotional and non-emotional pictures. Then, participants were randomized to one of four groups. One week later, on Day 8, Group 1 reactivated the previously learned pictures and learned new pictures. To control for specific effects of reactivation or new learning, Group 2 only reactivated the previously learned pictures, and Group 3 only learned new pictures. Group 4 received no reactivation and no new learning. On Day 9, all groups indicated for each picture out of a series whether they had seen it on Day 1. Results: The data were analysed using Bayesian hypothesis testing, which allows for quantifying the evidence in favour of the alternative and the null hypothesis. In general, results showed that Group 1 recognized fewer pictures from Day 1 compared to Groups 2 and 4 on Day 9. However, the expected difference between new learning following reactivation (i.e. Group 1) and new learning alone (i.e. Group 3) was not substantially supported by the data for any of our dependent measures. Conclusions: We replicated some of the findings by Wichert et al., but did not find substantial support for the critical difference between new learning following reactivation and new learning alone.

Exploring expectation effects in EMDR: does prior treatment knowledge affect the degrading effects of eye movements on memories?

Background: Eye movement desensitization and reprocessing (EMDR) is an effective psychological treatment for posttraumatic stress disorder. Recalling a memory while simultaneously making eye movements (EM) decreases a memory's vividness and/or emotionality. It has been argued that non-specific factors, such as treatment expectancy and experimental demand, may contribute to the EMDR's effectiveness. Objective: The present study was designed to test whether expectations about the working mechanism of EMDR would alter the memory attenuating effects of EM. Two experiments were conducted. In Experiment 1, we examined the effects of pre-existing (non-manipulated) knowledge of EMDR in participants with and without prior knowledge. In Experiment 2, we experimentally manipulated prior knowledge by providing participants without prior knowledge with correct or incorrect information about EMDR's working mechanism. Method: Participants in both experiments recalled two aversive, autobiographical memories during brief sets of EM (Recall+EM) or keeping eyes stationary (Recall Only). Before and after the intervention, participants scored their memories on vividness and emotionality. A Bayesian approach was used to compare two competing hypotheses on the effects of (existing/given) prior knowledge: (1) Prior (correct) knowledge increases the effects of Recall+EM vs. Recall Only, vs. (2) prior knowledge does not affect the effects of Recall+EM. Results: Recall+EM caused greater reductions in memory vividness and emotionality than Recall Only in all groups, including the incorrect information group. In Experiment 1, both hypotheses were supported by the data: prior knowledge boosted the effects of EM, but only modestly. In Experiment 2, the second hypothesis was clearly supported over the first: providing knowledge of the underlying mechanism of EMDR did not alter the effects of EM. Conclusions: Recall+EM appears to be quite robust against the effects of prior expectations. As Recall+EM is the core component of EMDR, expectancy effects probably contribute little to the effectiveness of EMDR treatment.

No Effects of D-Cycloserine Enhancement in Exposure With Response Prevention Therapy in Panic Disorder With Agoraphobia: A Double-Blind, Randomized Controlled Trial.

PURPOSE/BACKGROUND: D-cycloserine (DCS) is a partial N-methyl-D-aspartate receptor agonist that potentially augments response to exposure therapy in anxiety disorders by enhancing extinction learning. This randomized, double-blinded, placebo-controlled augmentation trial examined (1) the effectiveness of adding 125 mg of DCS to exposure therapy (before or directly after the first 6 treatment sessions) in patients with panic disorder with agoraphobia and (2) the effectiveness of DCS augmentation preceding exposure relative to DCS augmentation directly postexposure. METHODS/PROCEDURES: Fifty-seven patients were allocated to 1 of 3 medication conditions (placebo and pre-exposure and postexposure DCS) as an addition to 6 exposure sessions within a 12-session exposure and response prevention protocol. The primary outcome measure was the mean score on the "alone" subscale of the Mobility Inventory (MI). FINDINGS/RESULTS: No differences were found in treatment outcome between DCS and placebo, administered either pre-exposure or postexposure therapy, although at 3-month follow-up, the DCS postexposure group compared with DCS pre-exposure, exhibited greater symptom reduction on the MI-alone subscale. Ancillary analyses in specific subgroups (responders vs nonresponders, early vs late responders, severely vs mildly affected patients) did not reveal any between-group DCS versus placebo differences. Finally, the study did not find an effect of DCS relative to placebo to be specific for successful exposure sessions. IMPLICATIONS/CONCLUSIONS: This study does not find an effect of augmentation with DCS in patients with severe panic disorder and agoraphobia administered either pretreatment or directly posttreatment sessions. Moreover, no preferential effects are revealed in specific subgroups nor in successful exposure sessions. Yet, a small effect of DCS administration postexposure therapy cannot be ruled out, given the relatively small sample size of this study.

Intervention strength does not differentially affect memory reconsolidation of strong memories.

Recently, it has become clear that retrieval (i.e., reactivation) of consolidated memories may return these memories into a labile state before they are restored into long-term memory ('reconsolidation'). Using behavioral manipulations, reactivated memories can be disrupted via the mechanism of novel learning. In the present study, we investigated whether changing a strong memory during reconsolidation depends on the strength of novel learning. To test this, participants (N=144) in six groups acquired a relatively strong memory on Day 1 by viewing and recalling a series of pictures three times. On Day 8, these pictures were reactivated in three groups, and they were not reactivated in the other three groups. Then, participants viewed and recalled new pictures once (weak new learning) or three times (strong new learning), or they did not learn any new pictures. On Day 9, participants performed a recognition test in which their memory for Day 1 pictures was assessed. Two main results are noted. First, the groups that reactivated pictures from Day 1 and received weak or strong new learning did not differ in memory performance. Second, these two groups consistently performed similar to groups that controlled for new learning without reactivation. Because these results contradict what was expected based on the reconsolidation hypothesis, we discuss possible explanations and implications.

The Effects of ß-Adrenergic Blockade on the Degrading Effects of Eye Movements on Negative Autobiographical Memories.

BACKGROUND: Eye movement desensitization and reprocessing (EMDR) is an effective treatment for posttraumatic stress disorder. During EMDR, patients make horizontal eye movements (EMs) while simultaneously recalling a traumatic memory, which renders the memory less vivid and emotional when it is later recalled again. Recalling highly emotional autobiographical memories enhances noradrenergic neurotransmission. Noradrenaline (NA) strengthens memory (re)consolidation. However, memories become less vivid after recall+EMs. Therefore, NA might either play no significant role or serve to strengthen memories that are degraded by EMs. The present study was designed to test the latter hypothesis. We predicted that blocking NA would abolish the memory degrading effects of EMs. METHODS: Fifty-six healthy participants selected three negative autobiographical memories. One was then recalled while making EMs, one was recalled without EMs, and one was not recalled. Vividness and emotionality of the memories as well as heart rate and skin conductance level during memory retrieval were measured before, directly after, and 24 hours after the EM task. Before the task, participants received a placebo or the noradrenergic ß-receptor blocker propranolol (40 mg). RESULTS: There were no effects of EMs on memory emotionality or psychophysiological measures in the propranolol and placebo groups. However, in the placebo group, but not in the propranolol group, memory vividness significantly decreased from pretest to posttest and follow-up after recall+EMs relative to the control conditions. CONCLUSIONS: Blocking NA abolished the effects of EMs on the vividness of emotional memories, indicating that NA is crucial for EMDR effectiveness and possibly strengthens the reconsolidation of the degraded memory.

Approach behavior as information.

BACKGROUND AND OBJECTIVES: Anxious individuals infer danger from information about physiological responses, anxiety responses, and safety behaviors. This study investigated whether anxious individuals also infer safety from approach behavior. METHODS: 325 students rated the danger they perceived in general and spider-relevant scenarios in which information about objective safety versus objective danger, and approach behavior versus no approach behavior, was varied. A high and low spider fearful group was created with a median split on spider fear. RESULTS: Participants with a high fear of spiders, compared to participants with low spider fear, rated spider scenarios with approach behavior as safer than spider scenarios without approach behavior. This effect was similar for objectively dangerous and safe spider scenarios. No behavior as information effects were found for general scenarios. LIMITATIONS: The data were collected in a non-clinical student sample. CONCLUSIONS: Spider fearful individuals infer safety from approach behavior in spider-relevant scenarios. For spider fearful individuals, approach behavior may add to the beneficial effects of exposure therapy. Future research is needed to investigate whether patients with anxiety disorders also show a tendency to infer safety from approach behavior.

Disconfirming contamination-related threat beliefs by exposure plus safety behavior.

BACKGROUND AND OBJECTIVES: Safety behavior (SB) is detrimental to the beneficial effects of exposure, because it prevents patients from obtaining evidence that disconfirms their excessive threat beliefs. However, previous studies showed that cleaning SB during exposure to a contaminant does not prevent a reduction in feelings of contamination, fear of contamination, danger, and disgust (CFDD). We aimed to directly examine the effect of SB during exposure to a contaminant on threat beliefs associated with CFDD. METHOD: Healthy participants were randomly assigned to one of three groups: repeated exposure to a contaminant whilst abstaining from SB (exposure plus response prevention; E + RP); with the use of disinfectant wipes after each instance of exposure (exposure plus SB; E + SB); or no exposure or safety behavior (control condition). Participants identified their threat belief associated with the contaminant and rated CFDD and the degree to which they believed their threat belief at the pre- and post-test. RESULTS: The E + RP and E + SB condition resulted in a larger decrease of CFDD and threat belief ratings than the control condition, whereas these reductions did not differ between the E + RP and E + SB condition. LIMITATIONS: Results were obtained from a nonclinical sample, and with a single session of exposure. CONCLUSION: Cleaning SB did not impede the beneficial effects of exposure.

Comparisons of eye movements and matched changing visual input.

BACKGROUND AND OBJECTIVES: During EMDR trauma therapy, performing EM taxes WM, and simultaneously recalled memories become less vivid. It has been proposed that this WM occupation results from CVI which occurs during EM. This study sought to compare the effects of EM on memory to a task presenting identical visual stimulus to stationary eyes.. METHOD: In Study 1, participants recorded RT while performing two tasks: EM, and a task with visually identical images displayed on screen. In Study 2, these same tasks were performed while simultaneously recalling negative emotional memories. RESULTS: Study 1 found RT was slowest in the EM condition, while RT in the CVI condition was still slower than in the control condition. Study 2 found decreases in memory vividness and emotionality after EM, while after CVI there was a small decrease in negativity which was not greater than in the control.. LIMITATIONS: Neither study included EM with no visual input; conclusions cannot be made about the effect of motor movement on WM taxation or recall. As neither study was conducted with trauma patients, it is unknown if the observed effects would be comparable in the population for which EMDR is intended. CONCLUSIONS: Performing EM taxes more WM resources and has greater impact on both memory vividness and emotionality than matched CVI. This demonstrates that the effects observed in EMDR treatment are the result of more than occupying WM systems with visual stimuli alone..

Patients With Obsessive-Compulsive Disorder Check Excessively in Response to Mild Uncertainty.

Patients with obsessive-compulsive disorder (OCD) not only respond to obsessions with perseverative checking, but also engage in more general checking, irrespective of their obsessive concerns. This study investigated whether general checking is specific to OCD and exacerbated when only mild uncertainty is induced. Thirty-one patients with OCD, 26 anxiety- and 31 healthy controls performed a visual search task with eye-tracking and indicated in 50 search displays whether a target was "present" or "absent". Target-present trials were unambiguous, whereas target-absent trials induced mild uncertainty, because participants had to rely on not overlooking the target. Checking behavior was measured by assessing search time and the number of fixations, measured with an eye-tracker. Results showed that in both target-present and target-absent trials patients with OCD searched longer and made more fixations than healthy and anxiety controls. However, the difference in checking behavior between patients with OCD and the control groups was larger in target-absent trials (where mild uncertainty was induced). Anxiety and healthy controls did not differ in checking behavior. Thus, mild uncertainty appears to specifically promote checking in patients with OCD, which has implications for treatment.

Blurring emotional memories using eye movements: individual differences and speed of eye movements.

BACKGROUND: In eye movement desensitization and reprocessing (EMDR), patients make eye movements (EM) while recalling traumatic memories. Making EM taxes working memory (WM), which leaves less resources available for imagery of the memory. This reduces memory vividness and emotionality during future recalls. WM theory predicts that individuals with small working memory capacities (WMCs) benefit more from low levels of taxing (i.e., slow EM) whereas individuals with large WMC benefit more from high levels of taxing (i.e., fast EM). OBJECTIVE: We experimentally examined and tested four prespecified hypotheses regarding the role of WMC and EM speed in reducing emotionality and vividness ratings: 1) EM-regardless of WMC and EM speed-are more effective compared to no dual task, 2) increasing EM speed only affects the decrease in memory ratings irrespective of WMC, 3) low-WMC individuals-compared to high-WMC individuals-benefit more from making either type of EM, 4) the EM intervention is most effective when-as predicted by WM theory-EM are adjusted to WMC. METHOD: Undergraduates with low (n=31) or high (n=35) WMC recalled three emotional memories and rated vividness and emotionality before and after each condition (recall only, recall + slow EM, and recall + fast EM). RESULTS: Contrary to the theory, the data do not support the hypothesis that EM speed should be adjusted to WMC (hypothesis 4). However, the data show that a dual task in general is more effective in reducing memory ratings than no dual task (hypothesis 1), and that a more cognitively demanding dual task increases the intervention's effectiveness (hypothesis 2). CONCLUSIONS: Although adjusting EM speed to an individual's WMC seems a straightforward clinical implication, the data do not show any indication that such a titration is helpful.