Not all checking decreases memory confidence: Implications for obsessive-compulsive disorder.

BACKGROUND AND OBJECTIVES: Repetitive checking, a frequently reported compulsive behavior associated with obsessive-compulsive disorder (OCD), may, at least in part, result from a lack of memory confidence. Surprisingly, numerous studies have shown that when participants repeatedly perform an action and check that they performed it correctly, memory confidence decreases across repetitions, suggesting that repeated checking produces memory distrust. It is not clear, however, whether the checking component of each trial is critical for the decrease in confidence to occur. Five experiments tested whether the checking component is either necessary or sufficient to produce memory distrust. METHODS: Participants repeatedly turned on and off virtual stove burners, with some conditions checking that the burners were off on each trial. Memory for the specific burners turned on and off was tested on the first and last trials, along with memory confidence. RESULTS: Confidence decreased across trials even when the checking component was eliminated. However, increasing the number of times each person checked on each trial did not decrease confidence. LIMITATIONS: A sample of individuals formally diagnosed with OCD was not tested. Also, our results only speak to massed (within-trial) checking, not spaced checking occurring over longer time intervals. CONCLUSIONS: Whereas we consistently replicated the increase in memory distrust across repeated trials that is typically found with the stove-checking task, the checking component of each trial is neither necessary nor sufficient for the accrual of memory distrust. The build-up of proactive interference across repeated trials may cause the memory distrust.

Stop checking: Repeated checking and its effects on response inhibition and doubt.

BACKGROUND: Repeated checking is a common ritual in obsessive-compulsive disorder (OCD). van den Hout and Kindt (2003b) devised a task demonstrating paradoxical reductions in memory confidence following repeated checking. This effect was later found to be contingent upon response inhibition. The current study aims to (1) test an alternative interpretation, whereby repeated-checking effects are caused by viewing multiple exemplars, and (2) test whether repeated checking affects response inhibition. METHOD: 132 students participated in two experiments (66 in Experiment 1 and 66 in Experiment 2). Participants were randomly allocated to a repeated-checking task or a simple-action task that featured similar multiple exemplars without the need for checking. Both tasks were followed by a stop-signal task, measuring response inhibition. Experiment 1 featured a stop-signal task with neutral go-signals while Experiment 2 incorporated familiar and unfamiliar stimuli from the previous task as go-signals. RESULTS: In both experiments, the repeated-checking group exhibited reduced memory confidence compared to the simple-action group. Groups did not differ in their response inhibition for neutral stimuli (Experiment 1), while familiar go-signals had a detrimental effect on response inhibition (Experiment 2). LIMITATIONS: Our results examine the association between checking and response inhibition in healthy participants without attention deficit hyperactivity disorder and dyslexia. Replication with clinical samples awaits future studies. CONCLUSIONS: Repeated checking impairs memory confidence. Increased familiarity of stimuli shortens the time it takes to respond to them while it impairs inhibition response to them. These effects possibly provide initial evidence for the hypothesized role of response inhibition in the maintenance of OCD.

Imagery versus verbal interpretive cognitive bias modification for compulsive checking.

Pathological doubting and checking is a common symptom presentation in obsessive-compulsive disorder (OCD). Previous research has established that compulsive checkers do not display an actual memory deficit, but lack confidence in their memories and experience intolerance of uncertainty regarding the completion of tasks. We investigated whether interpretive cognitive bias modification (CBM-I) reduced memory distrust and intolerance of uncertainty in a nonclinical sample. We also examined the possible enhancement of CBM-I for OCD through imagery training. The results provide evidence that participants who received positive imagery CBM-I training may have interpreted novel ambiguous checking scenarios more adaptively and endorsed negative checking beliefs less relative to participants in the control imagery CBM-I condition. Findings on behavioural checking tasks did not indicate any specific response to CBM-I training. Future research may translate these suggestive findings into a useful adjunct to traditional strategies targeting maladaptive OCD beliefs.

Perseveration causes automatization of checking behavior in obsessive-compulsive disorder.

Repeated checking leads to reductions in meta-memory (i.e., memory confidence, vividness and detail), and automatization of checking behavior (Dek, van den Hout, Giele, & Engelhard, 2014, 2015). Dek et al. (2014) suggested that this is caused by increased familiarity with the checked stimuli. They predicted that defamiliarization of checking by modifying the perceptual characteristics of stimuli would cause de-automatization and attenuate the negative meta-memory effects of re-checking. However, their results were inconclusive. The present study investigated whether repeated checking leads to automatization of checking behavior, and if defamiliarization indeed leads to de-automatization and attenuation of meta-memory effects in patients with OCD and healthy controls. Participants performed a checking task, in which they activated, deactivated and checked threat-irrelevant stimuli. During a pre- and post-test checking trial, check duration was recorded and a reaction time task was simultaneously administered as dual-task to assess automatization. After the pre- and post-test checking trial, meta-memory was rated. Results showed that relevant checking led to automatization of checking behavior on the RT measure, and negative meta-memory effects for patients and controls. Defamiliarization led to de-automatization measured with the RT task, but did not attenuate the negative meta-memory effects of repeated checking. Clinical implications are discussed.