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.

Image-based analysis and long-term clinical outcomes of deep brain stimulation for Tourette syndrome: a multisite study.

BACKGROUND: Deep brain stimulation (DBS) can be an effective therapy for tics and comorbidities in select cases of severe, treatment-refractory Tourette syndrome (TS). Clinical responses remain variable across patients, which may be attributed to differences in the location of the neuroanatomical regions being stimulated. We evaluated active contact locations and regions of stimulation across a large cohort of patients with TS in an effort to guide future targeting. METHODS: We collected retrospective clinical data and imaging from 13 international sites on 123 patients. We assessed the effects of DBS over time in 110 patients who were implanted in the centromedial (CM) thalamus (n=51), globus pallidus internus (GPi) (n=47), nucleus accumbens/anterior limb of the internal capsule (n=4) or a combination of targets (n=8). Contact locations (n=70 patients) and volumes of tissue activated (n=63 patients) were coregistered to create probabilistic stimulation atlases. RESULTS: Tics and obsessive-compulsive behaviour (OCB) significantly improved over time (p<0.01), and there were no significant differences across brain targets (p>0.05). The median time was 13 months to reach a 40% improvement in tics, and there were no significant differences across targets (p=0.84), presence of OCB (p=0.09) or age at implantation (p=0.08). Active contacts were generally clustered near the target nuclei, with some variability that may reflect differences in targeting protocols, lead models and contact configurations. There were regions within and surrounding GPi and CM thalamus that improved tics for some patients but were ineffective for others. Regions within, superior or medial to GPi were associated with a greater improvement in OCB than regions inferior to GPi. CONCLUSION: The results collectively indicate that DBS may improve tics and OCB, the effects may develop over several months, and stimulation locations relative to structural anatomy alone may not predict response. This study was the first to visualise and evaluate the regions of stimulation across a large cohort of patients with TS to generate new hypotheses about potential targets for improving tics and comorbidities.

Langerian mindfulness, quality of life and psychological symptoms in a sample of Italian students.

BACKGROUND: Noticing new things, accepting the continuously changing nature of circumstances, and flexibly shifting perspectives in concert with changing contexts constitute the essential features of Langerian mindfulness. This contrasts with a "mindless" approach in which one remains fixed in a singular mindset and is closed off to new possibilities. Despite potentially important clinical applications for this construct, few studies have explored them. The instrument developed to measure Langerian mindfulness is the Langer Mindfulness Scale (LMS), although this tool has been limited primarily to English-speaking populations. The study aimed to test LMS validity in the Italian language and to analyze the relationships between Langerian mindfulness and well-being. METHODS: We translated the LMS into Italian, analyzed its factor structure, and investigated the correlation between mindfulness and quality of life and psychological well-being in a sample of 248 Italian students (88.7% females, mean age 20.05). A confirmatory factor analysis confirmed the tri-dimensional structure of the English LMS in the Italian version. RESULTS: The primary analysis found a significant negative correlation between mindfulness and psychological symptoms including obsessive-compulsive tendencies, depression, anxiety, and paranoid ideation. There was also a positive correlation between mindfulness and reports of quality of life. CONCLUSIONS: The Italian LMS appears reliable and it shows relevant correlations with well-being.

If it is absurd, then why do you do it? The richer the obsessional experience, the more compelling the compulsion.

Mounting evidence suggests that obsessive intrusions are often accompanied and amplified by perceptual experiences of different modalities (e.g., feeling dirt on one's skin while experiencing intrusive thoughts about contamination). Pilot studies conducted online with individuals endorsing mild obsessive-compulsive symptoms have linked the co-occurrence of perceptual experiences and obsessions to the severity of subsequent compulsive behaviour as well as low insight. However, it is presently unclear whether sensory experiences accompany all types of obsessional thoughts or are restricted to certain preoccupations (e.g., contamination and aggression). The present study examined a clinical inpatient and outpatient sample with a formally diagnosed obsessive-compulsive disorder (N = 34). Perceptual properties of intrusive thoughts were assessed with the Sensory Properties of Obsessions Questionnaire. The prevalence of perception-laden obsessive thoughts was comparable with prior studies (73.5%), but the intensity was significantly greater. No association was observed between perceptual experiences and expert-rated insight. However, the severity of perception-laden obsessions predicted the frequency of and impairment associated with compulsive behaviour. This was particularly strong for obsessions about contamination. The present study confirms the high prevalence and clinical relevance of perceptual experiences that accompany obsessions and further challenges the traditional trichotomy splitting mental phenomena into thoughts, intrusions, and hallucinations.

Musical obsessions: a comprehensive review of neglected clinical phenomena.

Intrusive musical imagery (IMI) consists of involuntarily recalled, short, looping fragments of melodies. Musical obsessions are distressing, impairing forms of IMI that merit investigation in their own right and, more generally, research into these phenomena may broaden our understanding of obsessive-compulsive disorder (OCD), which is phenomenologically and etiologically heterogeneous. We present the first comprehensive review of musical obsessions, based on the largest set of case descriptions ever assembled (N=96). Characteristics of musical obsessions are described and compared with normal IMI, musical hallucinations, and visual obsessional imagery. Assessment, differential diagnosis, comorbidity, etiologic hypotheses, and treatments are described. Musical obsessions may be under-diagnosed because they are not adequately assessed by current measures of OCD. Musical obsessions have been misdiagnosed as psychotic phenomena, which has led to ineffective treatment. Accurate diagnosis is important for appropriate treatment. Musical obsessions may respond to treatments that are not recommended for prototypic OCD symptoms.

Treatment of anxiety from musical obsessions with a cognitive behaviour therapy tool.

Musical obsessions and hallucinations are disturbing experiences of repeating internal music. Antipsychotic medication can sometimes reduce these symptoms but can also trigger or augment them. We report the case of a female patient with schizophrenia with drug-resistant obsessive musical hallucinations. The patient volunteered to participate in a 9-month pilot study to follow the development of the condition using an involuntary music and mood inventory. The patient perceived benefits from the intervention, including reduced anxiety, increased feeling of being in control and understanding the condition better. Findings from this case study suggest that cognitive therapy can be a useful complementary method of care for persons with musical obsessions. The presented tool requires further investigations among those with this rare condition.

Disgust, mental contamination, and posttraumatic stress: unique relations following sexual versus non-sexual assault.

Disgust and mental contamination (or feelings of dirtiness and urges to wash in the absence of a physical contaminant) are increasingly being linked to traumatic event exposure and posttraumatic stress (PTS) symptomatology. Evidence suggests disgust and mental contamination are particularly relevant to sexual assault experiences; however, there has been relatively little direct examination of these relations. The primary aim of the current study was to assess disgust and mental contamination-based reactivity to an individualized interpersonal assault-related script-driven imagery procedure. Participants included 22 women with a history of traumatic sexual assault and 19 women with a history of traumatic non-sexual assault. Sexual assault and PTS symptom severity predicted greater increases in disgust, feelings of dirtiness, and urges to wash in response to the traumatic event script. Finally, assault type affected the association between PTS symptom severity and increases in feelings of dirtiness and urges to wash in response to the traumatic event script such that these associations were only significant among sexually assaulted individuals. These findings highlight the need for future research focused on elucidating the nature of the relation between disgust and mental contamination and PTS reactions following various traumatic events.

Obsessive-compulsive behavior as a symptom of dementia in progressive supranuclear palsy.

AIMS: To describe obsessive-compulsive symptoms (OCS) as under-recognized behavioral and psychological symptoms of dementia of progressive supranuclear palsy (PSP) and to discuss possible mechanisms based on MRI and SPECT findings. METHODS: We studied 74 PSP patients. OCS are defined as persistent and unreasonable, but non-delusional/hallucinatory, ideas and behaviors. Demography, cognition, the widths of middle cerebellar peduncles (MCP) and the inter-caudate distances (ICD), both corrected by the intracranial size (MCP and ICD ratios), and changes on voxel-based SPECT were compared between the subgroups with and without OCS. Finally, the predicative power of various factors to OCS was investigated. RESULTS: We observed OCS in 18 patients (24%). They were obsessed with daily trifles and physical symptoms among other things. OCS was not associated with demography or cognitive levels. OCS-positive patients had significantly smaller MCP and ICD ratios and showed marked uptake decreases in the orbitofrontal cortex, caudate and thalamus. Relative uptake increases in the cerebellum, specifically the tonsils, were milder in OCS-positive than -negative patients. A smaller right MCP, a smaller ICD ratio and lower uptake increases in the right cerebellar were the significant predictors of OCS. CONCLUSIONS: OCS are frequent but under-recognized behavioral and psychological symptoms of dementia in PSP. Dysfunction of the fronto-caudate-thalamus-cerebellum circuit may be involved.

Are obsessive-compulsive tendencies related to reliance on external proxies for internal states? Evidence from biofeedback-aided relaxation studies.

This article presents two studies that examine the hypothesis that obsessive-compulsive (OC) tendencies are associated with a general deficiency in subjective conviction, which leads to seeking and reliance on external proxies to compensate for that deficiency. We examined this hypothesis using a biofeedback-aided relaxation procedure. In Study 1 low OC participants performed better on a relaxation task than high OC participants. More importantly, viewing the biofeedback monitor (an external proxy for the internal state of relaxation) had a different effect on the two groups: Whereas high OC participants performed better, low OC participants did not. In addition, when given the opportunity, high OC participants requested the biofeedback monitor more than did the low OC participants. In Study 2 high OC participants were more affected by false biofeedback when judging their level of relaxation compared to low OC participants. Real relaxation level differences between the two false biofeedback phases among the two groups were not found. These results provide preliminary support for the hypothesis that obsessive-compulsive disorder is associated with deficient subjective conviction in internal states and increased reliance on external proxies. Implications for the understanding of OCD-related rules and rituals as well as for cognitive therapy for OCD are discussed.

Acceptance and Commitment Therapy (ACT) with a learning disabled young person experiencing anxious and obsessive thoughts.

This case study describes how the ACT model was adapted to treat anxious and obsessive thoughts in a young person with moderate/severe learning disabilities. Using mindfulness and ACT-based experiential activities, the client learned to notice her thoughts and distance herself from their literal content. The negative impact that the client's anxious thoughts had on her life was reduced and she was able to return to a part-time college course. The article describes how the client engaged with some ACT-based activities, such as mindfulness and defusion exercises. The outcome suggests that the experiential, activity-based nature of ACT may offer a more accessible intervention model for learning disabled people than traditional CBT models based on verbal reasoning skills. However, the intervention also required considerable individual adaptation and it is likely that this will be the case in work with people with learning disabilities.

[The psychopathology of "as if" experiences]. / Zur Psychopathologie des "Als-ob".

After a descriptive phenomenological sketch, we try to elucidate the structure of the "as if" experience. This experience is concerned with appearance, with what 'seems' to a person as opposed to actual reality. Normally there is always the possibility of error trying to recognize reality, which is accessible to anybody. In contrast, for the individual no error is possible regarding an appearance which is accessible to nobody but the person to whom it appears. In daily life we are often unaware of the confusions of reality and appearance. The obsessive patient cannot permit himself such customary confusions. The delusional patient cannot realize relevant confusions of reality and appearance, in spite of encounters with outside persons. As mentioned, reality and appearance get pathologically entangled in both obsessive and delusional patients. Some therapeutic proposals are offered from the standpoint of these "as if" patents.

Tratamiento de rituales compulsivos en un caso de esquizofrenia residual: eficacia de la hipnosis / Treatment of compulsive rituals in a case of residual schizophrenia: efficacy of hypnosis

Los autores describen el tratamiento de una conducta compulsiva en un caso de esquizofrenia residual. Tras realizar una descripción general del cuadro clínico y un análisis de las conductas evaluadas, se comentan las distintas etapas de intervención: línea base, control de estímulos, entrenamiento en y tratamiento mediante hipnosis, y seguimiento. Se utilizó un método de inducción mediante la fijación ocular, con sugestiones de relajación y de tranquilidad para la profundización hipnótica, y se dieron instrucciones en forma de sugestiones poshipnóticas para extinguir la conducta. Finalmente, se valoran las implicaciones de la hipnosis en el tratamiento de síntomas obsesivo-compulsivos en cuadros de esquizofrenia a propósito de la extinción de aquella conducta

The authors describe the treatment of compulsive behaviour in a case of residual schizophrenia. Following the description of the clinical profile and an analysis of the assessed behaviours, the stages of intervention are discussed, i.e., baseline, stimulus control, training and treatment via hypnosis, and follow up. A method of induction by ocular fixation was used, with suggestions of relaxation and tranquillity to deepen the hypnosis, and instructions were given in the form of post-hypnotic suggestions to extinguish the behaviour. Finally, implications of hypnosis in the treatment of obsessive-compulsive symptoms in schizophrenia are discussed

'Obsessions' in children with autism or Asperger syndrome. Content analysis in terms of core domains of cognition.

BACKGROUND: We report a survey of the content of obsessions in children with autism spectrum conditions. We use the term 'obsessions' narrowly, to indicate strong, repetitive interests. We predicted that obsessions would not cluster randomly, but rather would occur significantly more often in the domain of 'folk physics' (an interest in how things work), and significantly less often in the domain of 'folk psychology' (an interest in how people work). These predictions were tested relative to a control group of 33 children with Tourette syndrome. AIMS: To examine the content of autistic obsessions, and to test the theory that these reflect an evolved cognitive style of good folk physics alongside impaired folk psychology. METHOD: Ninety-two parents returned a questionnaire designed to determine the subject of their child's obsessional interests. The results were analysed in terms of core domains of cognition. RESULTS: Both predictions were confirmed. CONCLUSIONS: These results suggest that impaired folk psychology and superior folk physics are part of the cognitive phenotype of autism. A content-free theory of obsessions is inadequate.

Tarantism, dancing mania and demonopathy: the anthro-political aspects of 'mass psychogenic illness'.

This study questions the widely held assumption that the phenomenon known as mass psychogenic illness (MPI) exists per se in nature as a psychiatric disorder. Most MPI studies are problematical, being descriptive, retrospective investigations of specific incidents which conform to a set of pre-existing symptom criteria that are used to determine the presence of collective psychosomatic illness. Diagnoses are based upon subjective, ambiguous categories that reflect stereotypes of female normality which assume the presence of a transcultural disease or disorder entity, underemphasizing or ignoring the significance of episodes as culturally conditioned roles of social action. Examples of this bias include the mislabelling of dancing manias, tarantism and demonopathy in Europe since the Middle Ages as culture-specific variants of MPI. While 'victims' are typified as mentally disturbed females possessing abnormal personality characteristics who are exhibiting cathartic reactions to stress, it is argued that episodes may involve normal, rational people who possess unfamiliar conduct codes, world-views and political agendas that differ significantly from those of Western-trained investigators who often judge these illness behaviours independent of their local context and meanings.