When it's at: An examination of when cognitive change occurs during cognitive therapy for compulsive checking in obsessive-compulsive disorder.

BACKGROUND AND OBJECTIVES: The cognitive theory of compulsive checking in OCD proposes that checking behaviour is maintained by maladaptive beliefs, including those related to inflated responsibility and those related to reduced memory confidence. This study examined whether and when specific interventions (as part of a new cognitive therapy for compulsive checking) addressing these cognitive targets changed feelings of responsibility and memory confidence. METHODS: Participants were nine adults with a primary or secondary diagnosis of OCD who reported significant checking symptoms (at least one hour per day) on the Yale-Brown Obsessive-Compulsive Scale. A single-case multiple baseline design was used, after which participants received 12 sessions of cognitive therapy. From the start of the baseline period through to the 1 month post-treatment follow-up assessment session, participants completed daily monitoring of feelings of responsibility, memory confidence, and their time spent engaging in compulsive checking. RESULTS: Results revealed that feelings of responsibility significantly reduced and memory confidence significantly increased from baseline to immediately post-treatment, with very high effect sizes. Multilevel modelling revealed significant linear changes in feelings of responsibility (i.e., reductions over time) and memory confidence (i.e., increases over time) occurred following the sessions when these were addressed. Finally, we found that improvements in these over the course of the treatment significantly predicted reduced time spent checking. LIMITATIONS: The small sample size limits our ability to generalize our results. CONCLUSIONS: Results are discussed in terms of a focus on the timing of change in cognitive therapy.

Cognitive therapy for compulsive checking in obsessive-compulsive disorder: A pilot trial.

We evaluated a novel, empirically-based cognitive therapy for compulsive checking - a common form of obsessive-compulsive disorder. Twelve adults completed 12 sessions of the therapy. Significant reductions in checking-related symptoms were found pre- to post-treatment, and pre-treatment to 6-month follow-up (moderate to large effect sizes). Participants reported high treatment acceptability after the third session, which was maintained at post-treatment. This pilot trial provides preliminary support for treating compulsive checking using this novel cognitive approach.

Relationships between anger, symptoms, and cognitive factors in OCD checkers.

The purpose of this study was to examine whether individuals diagnosed with obsessive-compulsive disorder (OCD) with primary checking compulsions report higher levels of trait anger and anger expression compared with a student control group, and whether trait anger and anger expression are correlated with specific beliefs and interpretations that are common among individuals who compulsively check. A group of individuals with OCD reporting significant checking compulsions (n=33) and a group of undergraduate students (n=143) completed a questionnaire package that included measures of trait anger and anger expression, as well as measures of obsessive-compulsive symptoms and beliefs. The compulsive checking group reported greater trait anger, though not greater anger expression, than the student control group. Furthermore, beliefs concerning perfectionism and intolerance of uncertainty were positively correlated with anger expression and trait anger among compulsive checkers but not among the student control group. The implications of these findings are discussed in terms of cognitive-behavioural treatments for and models of compulsive checking in OCD.

An informational pathway to the development of a contamination-related memory bias.

BACKGROUND AND OBJECTIVES: Following from previous research in which post-encoding suggestions of threat led to the development of a memory bias (in the presumed absence of an attentional bias; Senn & Radomsky, 2012), we sought to examine whether the development of a similar threat-relevant memory bias could be fostered via a purely informational pathway. METHODS: A vignette about a classroom interaction was read aloud to (n = 96) undergraduate participants who then completed a post-encoding recall test. Participants were told that the experimenter forgot to read the last sentence of the vignette, and were then randomly assigned either to the Threat condition, in which the additional statement indicated that a character in the vignette had a highly contagious flu, or to the No-Threat condition, in which the additional statement indicated that a character in the vignette had been accepted to graduate school. A second recall test was then administered. RESULTS: Participants in the Threat condition (but not those in the No-Threat condition) demonstrated aproportionate memory bias in favor of threatening information. This bias was not evident at the initial recall test. LIMITATIONS: Time spent engaging in active recall was not assessed. Also, although the study was designed to minimize demand characteristics, it is possible that these played a role. CONCLUSIONS: An explicit memory bias for threat can be created through informational means alone, even when no threat was present at encoding. Results are discussed in terms of pathways to fear and of cognitive approaches to understanding and treating anxiety disorders.

Beliefs about control and the persistence of cleaning behaviour: an experimental analysis.

BACKGROUND AND OBJECTIVES: Low perceived control (PC) and overestimations of controllability have each been related to obsessive compulsive (OC) symptoms and behaviour. OC beliefs and symptoms are also associated with a discrepancy between low perceived control (PC) and a high desire for control (DC). The present study sought to examine the influence of components of PC, low control-related self-efficacy (CSE) and high predicted controllability (PRC), on the persistence of cleaning behaviour and DC ratings. METHODS: A cleaning task was used to observe cleaning time (in seconds) in undergraduate participants (n = 174) under two conditions of each of PRC (high versus low), and CSE (high versus low). DC ratings were taken prior to the cleaning task. RESULTS: It was demonstrated that PRC and CSE manipulations had differential effects on cleaning times and DC ratings, where significantly longer cleaning times were observed in the high (versus low) PRC condition, and in association with higher DC ratings reported in the low (versus high) CSE condition. However, regression analyses demonstrated that DC, PRC and CSE each accounted for significant variance in observed cleaning times. LIMITATIONS: Teasing apart predictability from controllability is a methodological challenge in the manipulation of perceived control. CONCLUSIONS: Findings highlight the importance of considering components of PC along with DC in OC-phenomenology; these will be discussed in the context of current cognitive theories of and treatments for OCD.