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.

Too little, too much, or just right? Does the amount of distraction make a difference during contamination-related exposure?

BACKGROUND AND OBJECTIVES: The extant literature has shown mixed results regarding the impact of distraction use on exposure outcome; however, a wide variety of distraction tasks have been utilized across studies. In order to better understand these discrepant findings, we aimed to evaluate the impact of differing levels of distraction on exposure outcome. Additionally, treatment acceptability and changes in self-efficacy were assessed to evaluate how these may differ as a function of distraction use. METHODS: In Experiment 1 (N = 176 participants tested), distraction tasks were experimentally validated through assessing changes in reaction time when completing concurrent tasks. Based on Experiment 1, distraction tasks were selected for use in Experiment 2, in which contamination-fearful participants were randomly assigned to one of four conditions: no, low, moderate, or high distraction during an exposure session. Participants (N = 124) completed a behavioural approach test and self-efficacy measure pre- and post-exposure and at one-week follow-up. Treatment acceptability was assessed immediately following the exposure session. RESULTS: There were no significant differences between conditions for changes in behavioural approach pre-to post-exposure or at one-week follow-up. However, increases in self-efficacy pre-to post-exposure were greatest for moderate distraction, and treatment acceptability was highest with moderate and high distraction. LIMITATIONS: Participants were not assessed for clinical severity, were not treatment-seeking, and only one specific type of fear was investigated. CONCLUSIONS: Distraction (at any level) did not appear to negatively impact exposure outcome (all conditions improved pre-to post-exposure and at follow-up), but utilizing moderate to high amounts of distraction increased treatment acceptability.

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.

Further Support for the Acceptability-Enhancing Roles of Safety Behavior and a Cognitive Rationale in Cognitive Behavioral Therapy for Anxiety Disorders.

It has been proposed that the judicious use of safety behavior may enhance the acceptability of cognitive behavioral therapy (CBT). Indeed, Milosevic and Radomsky (2013a) found that descriptions of CBT incorporating safety behavior were more acceptable than those that discouraged safety behavior. This study aimed to replicate and extend this work. Participants were 688 undergraduates who rated the acceptability of descriptions of CBT varying in safety behavior (judicious or discouraged) and rationale (cognitive or extinction). Consistent with Milosevic and Radomsky, CBT with safety behavior was significantly more acceptable than traditional CBT. Cognitively based CBT was preferred over extinction-based CBT. The effects of prior treatment and general distress were also examined. Overall, previous treatment and greater anxiety were associated with significantly lower acceptability ratings. Results support the acceptability-enhancing role of safety behavior in CBT and are discussed in terms of cognitive-behavioral theory and treatment of anxiety and related disorders.

Well that changes everything! The genesis of memory bias for threat with implications for delayed onset in anxiety disorders.

BACKGROUND AND OBJECTIVES: A number of aetiological pathways have been proposed in the development of anxiety disorders, including those associated with stressful triggering situations. Life events can provide new meaning to past situations, potentially leading to the delayed onset of a disorder. Whether or not a disorder will emerge is theoretically related to one's appraisal and memory of prior events, and memory biases are proposed to exist for threat-related information in association with anxiety. Given that new events may change the meaning of past experiences, threatening information may change one's memory for once-neutral events. METHODS: The current study aimed to examine the effect of threatening information on memory for previously encoded (neutral) stimuli. Undergraduate participants (n = 81) interacted with 30 neutral objects (displayed in two boxes) and completed a recall memory test for these objects. They were then randomly assigned to receive either new threatening or new neutral information about half (one box) of the already-learned objects; a second recall test was then administered. RESULTS: Individuals given threatening information showed a greater proportion of memory for items that were manipulated to total items recalled than did individuals given new non-threatening information. LIMITATIONS: A nonclinical sample reported relatively low ratings of disgust and anxiety. Additionally, the time between the two memory tests was brief, likely differing from the actual occurrence of delayed onset disorders. CONCLUSIONS: Results showed the genesis of a memory bias for threat in the presumed absence of an attentional bias, and are discussed in terms of the delayed onset of anxiety disorders.