Development and validation of the multidimensional version of the fear of self questionnaire: Corrupted, culpable and malformed feared possible selves in obsessive-compulsive and body-dysmorphic symptoms.

In recent years, cognitive-behavioural models of OCD have increasingly recognized the potential role of feared possible selves in the development and maintenance of OCD, while simultaneously re-examining factors that have historically been linked to self-perceptions in OCD. The current article describes the development and validation of a multidimensional version of the Fear of Self Questionnaire (FSQ-EV) in a non-clinical (N = 626) and clinical OCD sample (N = 79). Principal component analyses in the non-clinical sample revealed three conceptually and factorially distinct components revolving around a feared corrupted possible self, a feared culpable possible self and a feared malformed possible self. The questionnaire showed a strong internal inconsistency, and good divergent and convergent validity, including strong relationships to obsessional symptoms. In particular, the corrupted feared self predicted OCD symptoms independently from depression and other related self-constructs and obsessive beliefs, while also strongly interacting with importance and control of thoughts in the prediction of almost all specific symptoms of OCD. Results are consistent with the notion that self-constructs can be conceptually and empirically distinguished from obsessive beliefs and appraisals with significant potential to improve our understanding of OCD and related disorders.

Reduced fear-of-self is associated with improvement in concerns related to repugnant obsessions in obsessive-compulsive disorder.

OBJECTIVE: The potential causal and maintaining role of vulnerable self-themes and beliefs about the self in obsessive-compulsive disorder (OCD) have received increasing attention from cognitive-behavioural theorists. This interest was translated into the development of a self-report measurement of the feared self (the fear of who one might be or become), a construct theoretically and empirically pertinent to unwanted thoughts and impulses in OCD (i.e., repugnant obsessions). METHOD: The current study aimed to provide converging evidence on the relevance of the feared self in OCD, by examining whether improvements in symptoms associated with repugnant obsessions (measured on the Vancouver Obsessional Compulsive Inventory [VOCI] obsessions subscale) would be predicted by reduced feared self-perceptions (measured on the Fear-of-Self Questionnaire [FSQ]) in a sample of 93 patients receiving psychotherapy for OCD. RESULTS: Using a series of hierarchical linear regression models, we found that treatment-related reductions on the FSQ significantly and uniquely predicted reductions on the VOCI obsessions subscale and the contamination subscale. CONCLUSIONS: The current study thus replicated previous research suggesting the relevance of the feared possible self in psychological disorders such as OCD, where negative self-perception is a dominant theme. PRACTITIONER POINTS: Current results suggest that changes in feared self-perceptions may be the mechanism through which OCD symptoms improve via therapy. Interventions specifically aimed at changing feared self-perceptions may prove effective in improving cognitive-behavioural treatments for OCD. One limitation of the current study is the lack of behavioural measures of OCD to supplement self-report measures of OCD. Another limitation is that the small number of patients receiving some of the treatments precludes investigations into which treatments may be more effective in altering feared self-perceptions.

Obsessive-compulsive disorder and the risk of subsequent mental disorders: A community study of adolescents and young adults.

BACKGROUND: Comorbidity of obsessive-compulsive disorder (OCD) with other mental disorders has been demonstrated repeatedly. Few longitudinal studies, however, have evaluated the temporal association of prior OCD and subsequent mental disorders across the age period of highest risk for first onset of mental disorders. We examined associations between prior OCD and a broad range of subsequent mental disorders and simulated proportions of new onsets of mental disorders that could potentially be attributed to prior OCD, assuming a causal relationship. METHODS: Data from 3,021 14- to 24-year-old community subjects were prospectively collected for up to 10 years. DSM-IV OCD and other DSM-IV mental disorders were assessed with the Munich-Composite International Diagnostic Interview. We used adjusted time-dependent proportional hazard models to estimate the temporal associations of prior OCD with subsequent mental disorders. RESULTS: Prior OCD was associated with an increased risk of bipolar disorders (BIP; [hazard ratio, HR = 6.9, 95% confidence interval, CI, (2.8,17.3)], bulimia nervosa [HR = 6.8 (1.3,36.6)], dysthymia [HR = 4.4 (2.1,9.0)], generalized anxiety disorder (GAD; [HR = 3.4 (1.1,10.9)], and social phobia [HR = 2.9 (1.1,7.7)]). Of these outcome disorders, between 65 and 85% could be attributed to OCD in the exposed group, whereas between 1.5 and 7.7% could be attributed to OCD in the total sample. CONCLUSIONS: This study provides strong evidence that prior OCD is associated with an increased risk of subsequent onset of BIP, bulimia nervosa, dysthymia, GAD, and social phobia among adolescents and young adults. Future studies should evaluate if early treatment of OCD can prevent the onset of these subsequent mental disorders.

Evaluating the effects of a brief motivational interviewing protocol on excessive acquisition.

BACKGROUND AND OBJECTIVES: Individuals with hoarding disorder, especially those with problems around acquiring, typically demonstrate a lack of motivation and awareness of their problematic behaviours. Since acquiring behaviours are important targets in interventions for hoarding, effective strategies for increasing motivation in this population are required to enhance the acceptability and efficacy of these interventions. METHODS: The aim of the current study was to evaluate the ability of a brief online motivational intervention to reduce acquiring in a community sample of high acquirers (N = 159). Participants were randomly assigned to either a motivational interviewing protocol (n = 73) or progressive muscle relaxation control condition (n = 86). Readiness to change and motivation to acquire was measured via self-report, and acquiring behaviour was measured using a modified version of the Preston Acquisition Decision Making Task (to increase ecological validity). RESULTS: In both conditions, participants' readiness and motivation to change increased over time. Contrary to hypotheses, the magnitude of this improvement did not significantly differ between conditions. Furthermore, conditions did not perform differently on the behavioural measure of acquiring. LIMITATIONS: Insufficient dose of the intervention may have precluded any differences being observed between conditions. CONCLUSIONS: Results underscore the need to better address the problem of lowered motivation in this population.

Reappraisal of disgust: Self-report and behavioural assessment of individuals with moderate to high contamination fears.

Previous research has linked certain psychological disorders, including obsessive-compulsive disorder (OCD), to the experience of disgust and how it is interpreted/appraised. Therefore, the present study examined whether targeting primary and secondary disgust appraisals (i.e., cognitive reappraisal) in individuals with moderate to high OCD-relevant contamination fears can effectively reduce disgust. Fifty-two participants were randomly assigned to one of three conditions; two of which involved reading a brief script modifying either a primary disgust appraisal (i.e., likelihood of a feared outcome) or a secondary disgust appraisal (i.e., the individual's ability to cope), and a third control condition with no reappraisal script. Following this experimental manipulation of disgust appraisal, participants completed two contamination-relevant behavioural approach tasks which involved 1) increasing proximity to, and eventually touching, a dead cockroach, and 2) drinking apple juice from an unused urine sample collection container. Results indicated that the interventions successfully modified their intended appraisal targets. Furthermore, on the second behavioural approach task, the secondary reappraisal condition demonstrated significantly less disgust-related avoidance relative to the control condition and reported significantly less disgust relative to the primary reappraisal condition. Our results incrementally add to the existing literature that emphasises the potential advantages of modifying disgust appraisals and specifically secondary disgust appraisals when treating disgust-based psychological disorders.

The impact of modifying obsessive-compulsive beliefs about perfectionism.

BACKGROUND AND OBJECTIVES: Cognitive-behavioural models of obsessive-compulsive disorder (OCD) suggest that maladaptive beliefs about perfectionism play a key role in the development and maintenance of OCD. Cognitive-bias modification for interpretation bias (CBM-I) is an experimental procedure that can test this proposed causal relation. METHODS: As such, the current study investigated whether multiple CBM-I sessions administered in different contexts can modify perfectionism biases. Undergraduate students high in OCD-related perfectionism beliefs were randomly allocated to either an experimental (n = 44) or control (n = 44) training condition and completed self-report and behavioural measures of perfectionism and OCD symptoms. RESULTS: As predicted, relative to the control condition, participants in the experimental condition exhibited a significant decrease in perfectionism beliefs, from baseline to after one CBM-I training session, which was maintained at one-week follow-up. Contrary to hypotheses, there were no significant differences between conditions on measures of OCD symptoms and perfectionistic behaviour. LIMITATIONS: Issues with the current study's behavioural measures may have precluded any differences between conditions. CONCLUSIONS: Results underscore the need to further refine cognitive-behavioural models of OCD to understand the precise causal relation between beliefs and symptoms.

Depressive symptoms and social context modulate oxytocin's effect on negative memory recall.

Oxytocin promotes social affiliation across various species, in part by altering social cognition to facilitate approach behaviour. However, the effects of intranasal oxytocin on human social cognition are mixed, perhaps because its effects are context dependent and subject to inter-individual differences. Few studies have included explicit manipulations of social context to test this supposition. We examined oxytocin's effects on autobiographical memory recall in two contexts, with and without social contact, and evaluated whether these effects were moderated by depressive symptoms. Two non-clinical samples (Study 1, n = 48; Study 2, n = 63) completed randomised, placebo-controlled, within-subject experiments. We assessed autobiographical memory recall across two sessions (intranasal oxytocin or placebo) and two contexts (memories elicited by an experimenter or by computer). Overall, intranasal oxytocin increased ratings of the vividness of recalled memories during the social context only. Individuals with elevated depressive symptoms also recalled memories that were more negative following oxytocin relative to placebo only in the non-social context across the two studies. Findings highlight the negative consequences of increasing oxytocin bioavailability in vulnerable persons in the absence of social contact. Contextual factors such as social isolation among depressed populations may complicate the clinical use of oxytocin.

Intranasal oxytocin increases state anhedonia following imagery training of positive social outcomes in individuals lower in extraversion, trust-altruism, and openness to experience.

Psychological disorders such as major depressive disorder are characterised by interpersonal difficulties and anhedonia. A cognitive mechanism proposed to contribute to the maintenance of these problems is a diminished ability to generate positive mental imagery, especially regarding social interactions. The current study examined whether the effects of social imagery training on social activity and anhedonia could be enhanced with the addition of intranasal oxytocin, and whether these effects might be augmented in persons with a high propensity to engage socially (i.e., high extraversion). University students (N = 111) were randomised to self-administer intranasal oxytocin or placebo, followed by a single session of positive social or non-social imagery training that required participants to imagine 64 positive scenarios occurring in either a social or non-social context, respectively. There were no main effects of imagery type and drug, and no interaction effect on anhedonia and social activity, measured respectively via self-report and a behavioural task. Individuals low in extraversion, trust-altruism, and openness to experience reported significantly more anhedonia after receiving oxytocin relative to placebo, but only following imagery training of positive social outcomes. Results highlight the negative consequences of increasing oxytocin bioavailability after priming social contact in more withdrawn individuals.

Poor inhibition of personally-relevant facial expressions of sadness and anger predicts an elevated cortisol response following awakening six months later.

Failure to inhibit interference from distracting emotional stimuli may obstruct an individual's ability to regulate their behavioural and emotional responses to environmental stressors. Few studies have examined the longitudinal association between cognitive inhibition and regulation of the hypothalamic-pituitary-adrenal axis (HPA) in the natural environment. Seventy-nine healthy adults underwent two assessments 6 months apart. Participants' ability to suppress interference from distracting emotional stimuli was assessed using a negative affective priming task that included both generic and personally-relevant (i.e., participants' intimate partners) facial expressions of emotion. Poorer inhibition of personally-relevant sad and angry faces, but not generic stimuli, significantly predicted an increased cortisol awakening response (CAR) six months later. Moreover, poor inhibition of personally-relevant sad faces mediated the relation between chronic stress and an elevated CAR. Difficulties inhibiting personally-relevant emotional information may represent a key mechanism in understanding how environmental stress influences HPA functioning.

Manipulating visual perspective for obsessional imagery and its impact on obsessive-compulsive symptoms in an analogue sample.

Visual perspective may have an important role in the phenomenology of intrusive images relevant to psychological disorders such as obsessive-compulsive disorder (OCD). The aim of the current study was to examine the subjective and behavioural effects of manipulating visual perspective, to either field or observer, on intrusive images related to doubting and contamination concerns. One hundred and twelve undergraduate participants with high levels OCD symptoms were asked to identify and imagine an intrusive image related to either doubting or contamination concerns. We then randomly assigned them to re-visualise their image from either a field (first-person) or observer (third-person) visual perspective. Participants shifted towards using an observer perspective demonstrated a greater decrease on ratings of subjective measures of image-related distress, prospective likelihood of the image occurring, and urges to suppress the image, relative to those shifted to a field perspective. In addition, those in the observer perspective evidenced a greater decrease on behavioural indices relevant to OCD, such as reduced frequency of the intrusive image and decreased efforts to neutralise the image. We discuss implications for imagery in OCD.

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.

Inverse reasoning processes in obsessive-compulsive disorder: Replication in a clinical sample.

The inference-based approach (IBA) is one cognitive model that aims to explain the aetiology and maintenance of obsessive-compulsive disorder (OCD). IBA theory suggests that certain reasoning processes lead an individual with OCD to confuse imagined possibilities with actual probabilities, a process termed inferential confusion. One such reasoning process is inverse reasoning, where hypothetical causes form the basis of conclusions about reality. Recently, we developed a task-based measure of inverse reasoning. In an online sample, we reported significant and positive associations between endorsement of inverse reasoning on this task and OCD symptomatology. We concluded that there was some support for the role of inverse reasoning in OCD but these results required extension using a between-groups design in a clinical sample. Therefore, the present study compared endorsement in inverse reasoning on this task between individuals diagnosed with OCD, anxiety and/or mood disorder (clinical controls), and healthy individuals (healthy controls). Relative to both control groups, the OCD group demonstrated significantly greater endorsement in inverse reasoning on scenarios where OCD relevant concerns were prompted. When non-OCD relevant concerns were involved, the OCD group only evidenced greater endorsement in inverse reasoning relative to the healthy control group. Implications for IBA theory are discussed.

Prediction Errors in Depression: A Quasi-Experimental Analysis.

The overprediction and underprediction of fear, pain, and other constructs have been linked with etiology and maintenance of anxiety disorders. We aimed to extend this research to depression by investigating the overprediction of effort and the underprediction of reward and enjoyment associated with a simple task. Participants with depression (n = 20) and a control group (n = 40) predicted how much effort and reward/enjoyment would be experienced during a short walk around the university. Post-walk, participants reported the actual effort required and the actual experienced reward and enjoyment. Compared to the control group, who demonstrated accurate predictions, depressed individuals significantly overpredicted the required effort associated with the walk even though there were no between-group differences in actual effort required. There was no evidence to suggest that the depressed group underestimated or were inaccurate in their predictions of walk-related reward and enjoyment relative to the control group. Implications for cognitive and behavioral approaches to depression are discussed.

Causal role for inverse reasoning on obsessive-compulsive symptoms: Preliminary evidence from a cognitive bias modification for interpretation bias study.

BACKGROUND AND OBJECTIVES: The inference-based approach (IBA) is a cognitive account of the genesis and maintenance of obsessive-compulsive disorder (OCD). According to the IBA, individuals with OCD are prone to using inverse reasoning, in which hypothetical causes form the basis of conclusions about reality. Several studies have provided preliminary support for an association between features of the IBA and OCD symptoms. However, there are currently no studies that have investigated the proposed causal relationship of inverse reasoning in OCD. METHODS: In a non-clinical sample (N = 187), we used an interpretive cognitive bias procedure to train a bias towards using inverse reasoning (n = 64), healthy sensory-based reasoning (n = 65), or a control condition (n = 58). Participants were randomly allocated to these training conditions. This manipulation allowed us to assess whether, consistent with the IBA, inverse reasoning training increased compulsive-like behaviours and self-reported OCD symptoms. RESULTS: Results indicated that compared to a control condition, participants trained in inverse reasoning reported more OCD symptoms and were more avoidant of potentially contaminated objects. Moreover, change in inverse reasoning bias was a small but significant mediator of the relationship between training condition and behavioural avoidance. Conversely, training in a healthy (non-inverse) reasoning style did not have any effect on symptoms or behaviour relative to the control condition. LIMITATIONS: As this study was conducted in a non-clinical sample, we were unable to generalise our findings to a clinical population. CONCLUSIONS: Findings generally support the IBA model by providing preliminary evidence of a causal role for inverse reasoning in OCD.

Inverse reasoning processes in obsessive-compulsive disorder.

The inference-based approach (IBA) is one cognitive model that aims to explain the aetiology and maintenance of obsessive-compulsive disorder (OCD). The model proposes that certain reasoning processes lead an individual with OCD to confuse an imagined possibility with an actual probability, a state termed inferential confusion. One such reasoning process is inverse reasoning, in which hypothetical causes form the basis of conclusions about reality. Although previous research has found associations between a self-report measure of inferential confusion and OCD symptoms, evidence of a specific association between inverse reasoning and OCD symptoms is lacking. In the present study, we developed a task-based measure of inverse reasoning in order to investigate whether performance on this task is associated with OCD symptoms in an online sample. The results provide some evidence for the IBA assertion: greater endorsement of inverse reasoning was significantly associated with OCD symptoms, even when controlling for general distress and OCD-related beliefs. Future research is needed to replicate this result in a clinical sample and to investigate a potential causal role for inverse reasoning in OCD.

Distrust of the senses and its association with obsessive-compulsive symptoms.

BACKGROUND AND OBJECTIVES: Leading cognitive theories of OCD suggests that despite prevalent and persistent doubt, individuals with OCD do not have perceptual deficits. An alternate cognitive theory, the Seeking Proxies for Internal States hypothesis (SPIS), proposes that sensory distrust in OCD stems from actual deficits in accessing internal states. Consistent with the SPIS, previous research has found that high-OC individuals were less accurate than low-OC individuals in producing target levels of muscle tension in a biofeedback task and that OC symptoms were positively associated with reliance on an external proxy. METHODS: The current study aimed to replicate and extend the SPIS hypothesis in two experiments using a modified version of the biofeedback-aided muscle tensing task using grip strength as the sensory input and a distance perception task. We contrasted the performance of undergraduate students self-reporting high- and low-OC symptoms. RESULTS: Overall, our findings failed to substantially support the SPIS hypothesis such that OC symptoms were not associated with deficient access to internal states of grip strength and distance perception or increased reliance on feedback. LIMITATIONS: As this study was conducted in a non-clinical sample, we were unable to generalise our findings to a clinical population. CONCLUSIONS: Findings are commensurate with the wider OCD literature suggesting the absence of cognitive and perceptual deficits in OCD individuals.