A narrative review of factors affecting memory confidence in the context of compulsive checking: A search for evidence-based potential therapeutic targets to improve memory confidence.

BACKGROUND AND OBJECTIVES: According to current models of compulsive checking, memory confidence greatly contributes to the development and maintenance of checking behaviours. However, how to intervene in memory confidence in an evidence-based manner has not yet been fully understood. Thus, the purpose of the current paper was to identify the factors influencing memory confidence through the review of experimental evidence. METHODS: PubMed, Google Scholar, OpenGrey and ProQuest databases were searched by combining two sets of keywords related to memory confidence and checking. Our search yielded 24 experiments. Due to the considerable heterogeneity of the studies regarding questionnaires, tasks and paradigms used, data were synthesized using a narrative review approach. RESULTS: Six factors emerged from a thorough review of the literature, including negative memory belief, higher memory standard, inflated sense of responsibility, familiarization with the checked stimuli, number of checks and anxious valence of the checked stimuli. CONCLUSION: The findings have important implications for the treatment of compulsive checking. We suggested general guidelines to translate these factors into a novel intervention to increase memory confidence in compulsive checkers.

Performance of compulsive behavior in rats is not a unitary phenomenon - validation of separate functional components in compulsive checking behavior.

A previous analysis of the quinpirole sensitisation rat model of obsessive-compulsive disorder revealed that the behavioral phenotype of compulsive checking consists of three constitutive components - vigor of checking performance, focus on the task of checking, and satiety following a bout of checking. As confirmation of this analysis, the aim of the present study was to reconstitute, without quinpirole treatment, each of the putative components, with the expectation that these would self-assemble into compulsive checking. To reconstitute vigor and satiety, the employed treatment was a bilateral lesion of the nucleus accumbens core (NAc), as this treatment was shown previously to exaggerate these components. To reconstitute focus, the employed treatment was a low dose of the serotonin-1A receptor agonist 8-hydroxy-2-(di-n-propylamino) tetralin hydrochloride (DPAT) (0.0625 mg/kg), as high doses of this drug induce compulsive behavior and exacerbate focus. Results showed that injection of DPAT to NAc lesion rats did yield compulsive checking. Neither the drug alone nor the NAc lesion by itself produced compulsive checking. The demonstrated synthesis of compulsive checking by the combined treatment of low-dose DPAT and NAc lesion strengthened the previous fractionation of the model obsessive-compulsive disorder phenotype into three constitutive components, and suggested a role for serotonin-1A receptors outside the NAc in enhanced focus on the task of checking.

Does responsibility for potential harm attenuate the effects of repeated checking on metamemory and automatization?

BACKGROUND AND OBJECTIVES: Repeated checking results in large reductions in metamemory variables (confidence, details, and vividness). It has been suggested that the underlying mechanism is gradual automatization. At the same time, individuals with obsessive-compulsive disorder (OCD) are reluctant to automatize routine processes. The aim was to investigate whether high responsibility for potential harm, typical of OCD, would attenuate the effects of repeated checking on metamemory variables and automatization. METHODS: One hundred seventy-five participants were initially provided with a cover story that put the subsequent virtual checking task in a context of potential harm for not checking properly. Participants were randomly allocated to four experimental groups (varying high and low responsibility, relevant and irrelevant checking) and performed a virtual checking task repeatedly, using either identical stimuli (relevant checking) or different stimuli (irrelevant checking) between the first and final checking trial. Metamemory variables were rated on visual analogue scales, and response latencies were assessed to establish automatization. RESULTS: Larger reductions in metamemory variables following relevant checking compared to irrelevant checking replicated previous findings. High responsibility did not affect these results. Large reductions in response latencies across the checking trials (automatization) were also independent of the perceived responsibility. LIMITATIONS: We did not include individuals with OCD. CONCLUSIONS: Since responsibility did not influence the effects of repeated checking on metamemory variables, findings are consistent with the idea that automatization remains a plausible explanation of the effects of repeated checking on metamemory variables in individuals with OCD.

Memory confidence and memory accuracy deterioration following repeated checking: A systematic review and meta-analysis.

BACKGROUND AND OBJECTIVES: Rachman (2002) proposed a reciprocal detrimental relationship between repeated checking and memory confidence. Many experimental studies have indicated that repeated checking causes memory confidence deterioration while having no or little impact on memory accuracy. Thus, our main objective was to carry out a comprehensive meta-analysis to synthesize the existing research. Investigating the potential heterogeneity across studies using several moderator variables was also of interest. METHODS: The comprehensive search of several databases yielded 29 studies comprising 67 substudies (N = 2180). Considering the substantial heterogeneity across these (sub)studies, data were analyzed using a random-effects meta-analytic approach. Subgroup analyses and meta-regressions were also carried out to explain some of the heterogeneity across studies. RESULTS: The pooled effect size (Hedges' g) was equal to 0.870 (95% CI = 0.712-1.027, p < 0.001) for memory confidence and 0.213 (95% CI = 0.118-0.307, p < 0.001) for memory accuracy. However, we found evidence of publication bias in the literature. For both outcome variables, the effect was larger in studies inducing high responsibility or using real stimuli. A greater number of repeated checks was only associated with memory confidence decline. LIMITATIONS: Results obtained from the analogue samples may have lower generalizability to people with OCD. CONCLUSIONS: Repeated checking considerably deteriorates memory confidence while having a minor effect on memory accuracy. It is not clear whether memory accuracy contributes to memory confidence deterioration, particularly because memory accuracy declines were moderate in studies inducing high responsibility or using real objects.

Responsibility, probability, and severity of harm: An experimental investigation of cognitive factors associated with checking-related OCD.

The cognitive model of compulsive checking (Rachman, 2002) proposes that perceptions of responsibility, seriousness of harm and probability of harm interact to promote checking behaviour. We examined these factors in an ecologically valid experimental paradigm. Two groups of participants (participants with OCD who compulsively check and undergraduate controls) were assigned to a high or low responsibility condition, and then checked objects representing: (a) high seriousness of harm (stove burners), (b) low seriousness of harm (light bulbs), (c) high probability of harm (functional burners and bulbs), and (d) low probability of harm (non-functional burners and bulbs). In general, a diagnosis of OCD, as well as conditions of increased severity/likelihood of harm, and to a lesser degree, increased responsibility, led to a greater period of time spent checking. Implications for the cognitive-behavioural model of and treatment for compulsive checking are discussed.

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.

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.

Contrafreeloading in Rats Is Adaptive and Flexible: Support for an Animal Model of Compulsive Checking.

Contrafreeloading involves working unnecessarily to obtain a reward that is otherwise freely available. It has been observed in numerous species and can be adaptive when it provides an organism with updated information about available resources. Humans frequently update their knowledge of the environment through checking behaviors. Compulsive checking occurs when such actions are performed with excessive frequency. In a putative animal model of compulsive checking, rats treated chronically with the dopamine agonist quinpirole display exaggerated contrafreeloading for water. Although this effect has been attributed to behavioral rigidity, some evidence suggests the behavior remains somewhat flexible and may be adaptive under certain conditions. We assessed the ability of quinpirole-treated rats with contrafreeloading experience to adapt to changing contingencies by requiring them to alternate between response levers. Rats treated with quinpirole or saline were first trained to obtain water by pressing either of two levers. Next, free water was made available for 8 days, and contrafreeloading was measured. Rates of contrafreeloading were significantly higher in the drug-treated rats than in controls. On the following 5 days, each reward caused the associated lever to become inactive until a reward was earned from the alternate lever. Quinpirole-treated rats learned this new response requirement more quickly than controls. Thus, exaggerated checking behavior induced by chronic quinpirole treatment can be advantageous when environmental contingencies change. These results provide support for this animal model of compulsive checking and hint at the presence of a specialized neural checking module involving the dopamine system.

A novel cognitive intervention for compulsive checking: Targeting maladaptive beliefs about memory.

BACKGROUND AND OBJECTIVES: Compulsive checking is one of the most common symptoms of obsessive-compulsive disorder (OCD). Recently it has been proposed that those who check compulsively may believe their memory is poor, rather than having an actual memory impairment. The current study sought to develop and assess a brief cognitive intervention focused on improving maladaptive beliefs about memory, as they pertain to both checking symptoms and memory performance. METHODS: Participants (N = 24) with a diagnosis of OCD and clinical levels of checking symptomatology were randomly assigned either to receive two weekly 1-hour therapy sessions or to self-monitor during a similar waitlist period. Time spent checking, checking symptoms, maladaptive beliefs about memory, and visuospatial memory were assessed both pre- and post-treatment/waitlist. RESULTS: Results showed that compared to the waitlist condition, individuals in the treatment condition displayed significant decreases in their maladaptive beliefs about memory and checking symptoms from pre- to post-intervention. They also exhibited increased recall performance on a measure of visuospatial memory. Changes in beliefs about memory were predictors of reduced post-intervention checking, but were not predictive of increased post-intervention memory scores. LIMITATIONS: The lack of long term follow-up data and use of a waitlist control leave questions about the stability and specificity of the intervention. CONCLUSIONS: Findings provide preliminary evidence that strategies targeting beliefs about memory may be worthy of inclusion in cognitive-behavioural approaches to treating compulsive checking.

When more is less: doubt, repetition, memory, metamemory, and compulsive checking in OCD.

Memory and metamemory phenomena associated with obsessive-compulsive disorder (OCD) have received much attention in literature dedicated to a better understanding of the doubt and repetition associated with obsessions and compulsions. Following previous work on repeated checking among nonclinical participants, we asked participants to repeatedly turn on, turn off and check a real kitchen stove (n = 30 compulsive checkers diagnosed with OCD and n = 30 non-clinical undergraduates), or a real kitchen faucet (n = 30 non-clinical undergraduates) in a standardized, ritualized manner, in two connected experiments. Results indicated that following repeated relevant checking, both clinical and nonclinical participants reported significantly reduced memory confidence, vividness and detail; those who completed repeated irrelevant checking did not. The effects of repeated checking on memory accuracy were also explored. Results are discussed in terms of cognitive-behavioural formulations of OCD and in terms of the effects of repetition on memory and metamemory in association with checking behaviour.

Impaired executive functioning in subclinical compulsive checking with ecologically valid stimuli in a working memory task.

We previously showed that working memory (WM) performance of subclinical checkers can be affected if they are presented with irrelevant but misleading information during the retention period (Harkin and Kessler, 2009, 2011). The present study differed from our previous research in the three crucial aspects. Firstly, we employed ecologically valid stimuli in form of electrical kitchen appliances on a kitchen countertop in order to address previous criticism of our research with letters in locations as these may not have tapped into the primary concerns of checkers. Secondly, we tested whether these ecological stimuli would allow us to employ a simpler (un-blocked) design while obtaining similarly robust results. Thirdly, in Experiment 2 we improved the measure of confidence as a metacognitive variable by using a quantitative scale (0-100), which indeed revealed more robust effects that were quantitatively related to accuracy of performance. The task in the present study was to memorize four appliances, including their states (on/off), and their locations on the kitchen countertop. Memory accuracy was tested for the states of appliances in Experiment 1, and for their locations in Experiment 2. Intermediate probes were identical in both experiments and were administered during retention on 66.7% of the trials with 50% resolvable and 50% irresolvable/misleading probes. Experiment 1 revealed the efficacy of the employed stimuli by revealing a general impairment of high- compared to low checkers, which confirmed the ecological validity of our stimuli. In Experiment 2 we observed the expected, more differentiated pattern: High checkers were not generally affected in their WM performance (i.e., no general capacity issue); instead they showed a particular impairment in the misleading distractor-probe condition. Also, high checkers' confidence ratings were indicative of a general impairment in metacognitive functioning. We discuss how specific executive dysfunction and general metacognitive impairment may affect memory traces in the short- and in the long-term.