Effects of abstract versus concrete rumination about anger on affect.

BACKGROUND: The processing-mode theory of rumination proposes that an abstract mode of rumination results in more maladaptive consequences than a concrete ruminative mode. It is supported by evidence mostly from the area of depression and little is known of the relative consequences of abstract versus concrete rumination for anger. AIMS: We investigated the differential effects of abstract versus concrete rumination about anger on individuals' current affect. We hypothesized that abstract rumination would increase current anger and negative affect, and decrease positive affect, to a greater extent than concrete rumination. METHOD: In a within-subject design, 120 participants were instructed to focus on a past social event that resulted in intense anger and then to ruminate about the event in both an abstract and a concrete mode, in a randomly assigned order. Current anger, negative and positive affect were assessed before and after each rumination phase. RESULTS: Anger and negative affect increased and positive affect decreased from pre- to post-rumination. Contrary to expectations, these patterns were observed irrespective of the ruminative mode induced. CONCLUSIONS: This initial study does not support the hypothesis that abstract and concrete rumination about anger have different consequences for current affect. Replications and more extensive designs are needed.

Validity of the counter-app method in the assessment of intrusions.

BACKGROUND AND OBJECTIVES: The counter-app method is often used to assess the frequency of intrusions. The method requires the participants to press a button on a smartphone whenever an intrusion occurs during a predefined time period. We evaluated the convergent, discriminant, and predictive validity of the counter-app method in two studies. METHODS: In the first study, we assessed the frequency of intrusions with a counter-app method, thought-sampling method, and a retrospective measure in N = 77 students. Additionally, we assessed retrospectively-estimated duration, percentage of time, intensity, and intrusiveness of intrusions. The second study (N = 65) was identical to the first except the thinking-aloud method replaced the thought-sampling method, and additionally we assessed behavioral neutralizing. RESULTS: The counter-app frequency was positively correlated with the convergent (thought-sampling and thinking-aloud frequencies, and retrospectively-estimated frequencies of intrusions) and predictive (behavioral neutralizing) validity criteria. The correlations between counter-app frequency and discriminant validity criteria (retrospectively-estimated duration, percentage of time, intensity, and intrusiveness of intrusions) were not smaller than the correlations between counter-app frequency and convergent validity criteria. LIMITATIONS: We evaluated the predictive validity of the counter-app method using a criterion typical of obsessive-compulsive disorder research. Thus, the result for predictive validity might not transfer to other areas. CONCLUSIONS: Our findings support convergent and predictive, but not discriminant, validity of the counter-app method. The counter-app method can validly assess the frequency of intrusions but is not appropriate if the study requires the differentiation of frequency from other constructs such as duration.

Experience of learning from everyday work in daily safety huddles-a multi-method study.

BACKGROUND: To reduce patient harm, healthcare has focused on improvement based on learning from errors and adverse events (Safety-I). Daily huddles with staff are used to support incident reporting and learning in healthcare. It is proposed that learning for improvement should also be based on situations where work goes well (Safety-II); daily safety huddles should also reflect this approach. A Safety-II-inspired model for safety huddles was developed and implemented at the Neonatal Care Unit at a regional hospital in Sweden. This study followed the implementation with the research questions: Do patient safety huddles with a focus on Safety-II affect the results of measurements of the patient safety culture? What are the experiences of these huddles amongst staff? What experiences of everyday work arise in the patient safety huddles? METHODS: A multi-method approach was used. The quantitative part consisted of a questionnaire (151 items), submitted on four different occasions, and analysed using Mann Whitney U-test and Kruskal Wallis ANOVA-test. The qualitative data were analysed using thematic content analyses of interviews with staff (n = 14), as well as answers to open questions in the questionnaires. RESULTS: There were 151 individual responses to the questionnaires. The response rates were 44% to 59%. For most comparisons, there were no differences. There were minor changes in patient safety culture measurements. A lower rating was found in December 2020, compared to October 2019 (p < 0.05), regarding whether the employees pointed out when something was about to go wrong. The interviews revealed that, even though most respondents were generally positive towards the huddles (supporting factors), there were problems (hindering factors) in introducing Safety-II concepts in daily safety huddles. There was a challenge to understanding and describing things that go well. CONCLUSIONS: For patient safety huddles aimed at exploring everyday work to be experienced as a base for learning, including both negative and positive events (Safety-II); there is a need for an open and permissive climate, that all professions participate and stable conditions in management. Support from managers and knowledge of the underpinning Safety-II theories of those who lead the huddles, may also be of importance.

Exam-related unwanted intrusive thoughts and related neutralizing behaviors: Analogues to obsessions and compulsions.

Exam-related unwanted intrusive thoughts (UITs) and related neutralizing behaviors are common experiences among students. The present study investigated in what ways these UITs and behaviors are analogues to clinical obsessions and compulsions. Twenty-nine students completed three ecological momentary assessment surveys per day over 7 consecutive days, assessing the severity of exam-related UITs and related neutralizing behaviors, obsessive-compulsive (OC) symptoms, anxiety, distress, urge to neutralize, depressed mood, and stress in the week immediately before an exam period. Multilevel analysis demonstrated that the severity of exam-related UITs and related neutralizing behaviors was positively associated with OC symptoms, anxiety, distress, urge to neutralize, and stress but was not related to depressed mood. During the study period, the exam-related UITs occurred on average 7 times, and the related neutralizing behaviors on average 6 times. Overall, they were experienced with mild severity, low distress, and low urge to neutralize. Findings indicate that some aspects of exam-related UITs and related neutralizing behaviors (e.g., association with distress and urge to neutralize) might be analogous to OC symptoms but not all (e.g., no relation to depressed mood). We discuss how research on obsessive-compulsive disorder could benefit from considering exam-related UITs and related behaviors.

On the automatic detection of enacted compulsive hand washing using commercially available wearable devices.

BACKGROUND: Compulsive hand washing is one of the most frequent compulsions and includes highly ritualized, repetitive hand motions. Developing an algorithm that can automatically detect compulsive washing with off-the-shelf wearable devices is a first step toward developing more sophisticated sensor-based assessments and micro-interventions that might ultimately supplement cognitive behavioral therapy for obsessive-compulsive disorder (OCD). OBJECTIVE: The main objective was to establish whether enacted compulsive hand washing can be distinguished from routine hand washing. This distinction will inform future research on the development of an algorithm that can automatically detect compulsive hand washing. METHOD: Twenty-one participants were trained individually to wash their hands according to 1 of 5 scripted hand-washing procedures that were based on descriptions of pathological compulsive washes and additionally to wash their hands as they usually would, while wearing a smartwatch. Washes were video recorded to obtain validation data. To generate a baseline model, we opted to extract well-known features only (mean and variance of each sensor axis). We tested four classification models: linear support vector machine (SVM), SVM with radial basis functions, random forest (RF), and naive Bayes (NB). Leave-one-subject-out cross-validation was applied to gather F1, specificity, and sensitivity scores. RESULTS: The best-performing parameters were a classification window duration of 10 s, with a mean-variance feature set calculated from quaternions, rate of turn, and magnetic flux measurements. The detection performance varied with the particular enacted compulsive hand wash (F1 range: 0.65-0.87). Overall, enacted compulsive and routine hand washing could be distinguished with an F1 score of 79% (user independent), a sensitivity of 84%, and a specificity of 30%. CONCLUSIONS: Our analysis of the sensor data demonstrates that enacted compulsive hand washing could be distinguished from routine hand washing with acceptable sensitivity. However, specificity was low. This study is a starting point for a series of follow-ups, including the application in individuals diagnosed with OCD.

Rumination about obsessive symptoms and mood maintains obsessive-compulsive symptoms and depressed mood: An experimental study.

Rumination is common in individuals diagnosed with obsessive-compulsive disorder (OCD). We sought to clarify the causal role of rumination in the immediate and intermediate maintenance of obsessive-compulsive symptoms and depressed mood. In total, 145 individuals diagnosed with OCD were asked to read aloud their most distressing obsessive thought (OT). OT activation was followed by a thought-monitoring phase in which frequency of the OT was assessed. Participants were randomly allocated to one of three experimental conditions: rumination about obsessive-compulsive symptoms, rumination about mood, or distraction. Ratings of distress, urge to neutralize, and depressed mood and frequency ratings of the OTs were taken before and after the experimental manipulation. Obsessive-compulsive symptom severity and affect were assessed 2, 4, and 24 hr after the laboratory experiment using ecological momentary assessment. Compared to distraction, both types of rumination resulted in an immediate reduced decline of distress, urge to neutralize, depressed mood, and frequency of OTs, with medium to large effect sizes. Rumination about obsessive-compulsive symptoms did not have a stronger immediate effect than rumination about mood. Rumination about obsessive-compulsive symptoms increased obsessive-compulsive symptom severity and reduced positive affect compared to rumination about mood 24 hr later. Regarding negative affect, there was no difference in effect between the two types of rumination in the intermediate term. To conclude, rumination in OCD has an immediate and intermediate maintaining effect on obsessive-compulsive symptoms and mood and may require additional psychological interventions that supplement cognitive behavioral therapy. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Does laughing have a stress-buffering effect in daily life? An intensive longitudinal study.

Positive affect is associated with alleviating mental and physiological stress responses. As laughter is a common physiological operationalization of positive affect, we investigated whether the effects of experiencing a stressful event on stress symptoms is lessened by frequency and intensity of daily laughter. Using an intensive longitudinal design, we ambulatory assessed the self-reported experience of stressful events, stress symptoms and the frequency as well as the intensity of laughter in university students' daily lives. Our hierarchical ecological momentary assessment data were analyzed with multilevel models. The results support the stress-buffering model of positive affect: We found that the frequency of laughter attenuated the association between stressful events and subsequent stress symptoms. The level of intensity of laughter, however, was found to have no significant effect. Future studies should use additional psychophysiological indicators of stress and straighten out the differential contributions of frequency and intensity of daily laughter.

Is repetitive negative thinking a transdiagnostic process? A comparison of key processes of RNT in depression, generalized anxiety disorder, obsessive-compulsive disorder, and community controls.

BACKGROUND AND OBJECTIVES: The transdiagnostic view of repetitive negative thinking (RNT) claims that different forms of RNT are characterized by identical processes that are applied to disorder-specific content. The purpose of the study was to test whether the processes of RNT differ across major depression disorder (MDD), generalized anxiety disorder (GAD), and obsessive-compulsive disorder (OCD). METHODS: Forty-two individuals diagnosed with MDD, 35 individuals with GAD, 41 individuals with OCD, and 35 community controls were asked to think of a typical RNT episode and to rate its processes (core processes; use of mental capacity, unproductivity, abstractness, verbal quality, duration). Ratings were compared across groups using planned contrasts and analysis of variance. RESULTS: All individuals with a clinical diagnosis rated the key processes of RNT and avoidance function of RNT as higher than healthy controls. There were no differences between individuals diagnosed with MDD, GAD or OCD on key processes and avoidance function of RNT. LIMITATIONS: Results are based on retrospective self-reports, which might restrict validity of the measurements. CONCLUSIONS: Data support the transdiagnostic hypothesis of RNT. Transdiagnostic prevention and intervention techniques seem highly recommendable given these findings.

Mindfulness-based cognitive therapy (MBCT) in patients with obsessive-compulsive disorder (OCD) and residual symptoms after cognitive behavioral therapy (CBT): a randomized controlled trial.

Up to one-third of individuals with obsessive-compulsive disorder (OCD) do not benefit from evidence-based psychotherapy. We examined the efficacy of mindfulness-based cognitive therapy (MBCT) as a complementary treatment option. In a prospective, bicentric, assessor-blinded, randomized, and actively controlled clinical trial, 125 patients with OCD and residual symptoms after cognitive behavioral therapy (CBT) were randomized to either an MBCT group (n = 61) or to a psychoeducational group (OCD-EP; n = 64) as an active control condition. At post-treatment, there was no significant benefit of MBCT over OCD-EP with the Yale-Brown-Obsessive-Compulsive Scale (Y-BOCS) as the primary outcome measure, but with the Obsessive-Compulsive Inventory [OCI-R; F(1, 101) = 5.679, p = .036, effect size η2partial = 0.053]. Moreover, the response rate and the improvement on secondary outcomes such as obsessive beliefs and quality of life was significantly larger in the MBCT group. Non-completion rates were below 10%. At the 6-month follow-up, OC symptoms were further improved in both groups; group differences were no longer significant. Our findings suggest that MBCT, compared to a psychoeducational program, leads to accelerated improvement of self-reported OC symptoms and secondary outcomes, but not of clinician-rated OC symptoms. In the midterm, both interventions yield similar and stable, but small improvements, suggesting that additional treatment options may be necessary.

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.

The Termination of Checking and the Role of Just Right Feelings: A Study of Obsessional Checkers Compared with Anxious and Non-clinical Controls.

BACKGROUND: Repeated checking in OCD can be understood from a cognitive perspective as the motivated need to achieve certainty about the outcome of a potentially risky action, leading to the application of Elevated Evidence Requirements (EER) and overuse of subjective criteria. METHOD: Twenty-four obsessional checkers, 22 anxious controls, and 26 non-clinical controls were interviewed about and rated recent episodes where they felt (a) they needed to check and (b) checked mainly out of habit (i.e. not obsessionally). RESULTS: Both subjective and objective criteria were rated as significantly more important in obsessional checkers than in controls; obsessional checkers also used more criteria overall for the termination of the check, and rated more criteria as "extremely important" than the control groups. The termination of the check was rated as more effortful for obsessional checkers than for the comparison groups. Analysis of the interview data was consistent with the ratings. Feelings of "rightness" were associated with the termination of a check for obsessional checkers but not for controls. CONCLUSION: Results were consistent with the proposal that the use of "just right feelings" to terminate checking are related to EER.

Relevance of orbitofrontal neurochemistry for the outcome of cognitive-behavioural therapy in patients with obsessive-compulsive disorder.

Since the advent of non-invasive methods such as proton magnetic resonance spectroscopy ((1)H-MRS), obsessive-compulsive disorder (OCD) has been increasingly associated with an altered composition of neurometabolites and neurotransmitters in several brain areas. Particularly, Inositol has not only been implicated in OCD pathophysiology, but also shown effective in pilot studies in therapy-refractory OCD patients. However, the relevance of regional brain neurochemistry for therapy outcome has not yet been investigated. Whereas numerous neuroimaging findings support a dysfunction of the orbitofrontal cortex (OFC) in OCD, MR-spectroscopic investigations of this region are missing. (1)H-MRS and psychometric measurements were obtained from twenty unmedicated patients with OCD, subsequently enrolled in a 3-month structured inpatient cognitive-behavioural therapy programme, and from eleven matched control subjects. Multiple regression of symptom score changes (Y-BOCS) on (myo-)inositol concentrations in three areas (right orbitofrontal cortex (OFC), right striatum and anterior cingulate cortex) was performed. The concentration of (myo-)inositol in the OFC only predicted the outcome of subsequent CBT regarding Y-BOCS score reduction (Spearman's r(s) = .81, P < 0.003, corrected). The (myo-)inositol concentration did not differ between OCD patients and healthy controls and did not change during therapy. We provide preliminary evidence for a neurochemical marker that may prove informative about a patient's future benefit from behaviour therapy. Inositol, a metabolite involved in cellular signal transduction and a spectroscopic marker of glial activity, predicted the response to CBT selectively in the OFC, adding to the evidence for OFC involvement in OCD and highlighting neurobiological underpinnings of psychotherapy.

Differences and similarities between obsessive and ruminative thoughts in obsessive-compulsive and depressed patients: a comparative study.

Repetitive, intrusive cognitive phenomena are central both to obsessive-compulsive patients - typically as obsessive thoughts - and to depressed patients - typically as ruminative thoughts. The objective of the present study is to compare obsessive and ruminative thoughts in non-depressed obsessive-compulsive and depressed patients. Thirty-four patients diagnosed with obsessive-compulsive disorder and 34 patients diagnosed with major depression disorder were asked to identify both a personally relevant obsessive and a personally relevant ruminative thought and to subsequently evaluate these thoughts on a modified version of the Cognitive Intrusions Questionnaire (CIQ) developed by Freeston, Ladouceur, Thibodeau, and Gagnon (1991). The CIQ assesses general descriptors, emotional reactions, appraisal and coping strategies on a nine-point Likert scale. A mixed-model ANOVA demonstrated that obsessive and ruminative thoughts are distinct cognitive processes, clearly distinguishable in form, appraisal and temporal orientation across disorders. In obsessive-compulsive patients, ruminative thoughts were more common and more emotionally distressing than predicted. In depressed patients, obsessive thoughts occurred infrequently and were not associated with high negative emotions. Clarifying similarities and differences between ruminative and obsessive thoughts and understanding their interaction might ultimately help to expand on the role of cognitive vulnerability factors in obsessive-compulsive and major depression disorder.

The Perseverative Thinking Questionnaire (PTQ): validation of a content-independent measure of repetitive negative thinking.

Repetitive negative thinking (RNT) has been found to be involved in the maintenance of several types of emotional problems and has therefore been suggested to be a transdiagnostic process. However, existing measures of RNT typically focus on a particular disorder-specific content. In this article, the preliminary validation of a content-independent self-report questionnaire of RNT is presented. The 15-item Perseverative Thinking Questionnaire was evaluated in two studies (total N = 1832), comprising non-clinical as well as clinical participants. Results of confirmatory factor analyses across samples supported a second-order model with one higher-order factor representing RNT in general and three lower-order factors representing (1) the core characteristics of RNT (repetitiveness, intrusiveness, difficulties with disengagement), (2) perceived unproductiveness of RNT and (3) RNT capturing mental capacity. High internal consistencies and high re-test reliability were found for the total scale and all three subscales. The validity of the Perseverative Thinking Questionnaire was supported by substantial correlations with existing measures of RNT and associations with symptom levels and clinical diagnoses of depression and anxiety. Results suggest the usefulness of the new measure for research into RNT as a transdiagnostic process.

Relations between a ruminative thinking style and obsessive-compulsive symptoms in non-clinical samples.

There is tremendous interest in understanding the cognitive processes behind obsessive-compulsive disorder (OCD). Whereas previous research on cognitive OCD models has focused on the dysfunctional content of obsessional thinking, processes and styles of thinking have not yet been investigated. The present study investigated the relationship between a ruminative response style and obsessive-compulsive (OC) symptomatology in two non-clinical samples. In Sample 1, 261 students completed the Ruminative Response Scale, the Padua-Inventory, Revised, and the Beck Depression Inventory. Tendency to ruminate was positively correlated with the severity of OC symptoms and particularly with obsessive rumination, even after controlling for depression. Results were replicated in Sample 2 (211 students). Data indicate that a ruminative response style and obsessive rumination share common processual features. Understanding the interaction between rumination and obsessional thinking might help to further elucidate the role of cognitive vulnerability factors in OCD and to expand cognitive and metacognitive models of OCD.

Neither saints nor wolves in disguise: ambivalent interpersonal attitudes and behaviors in obsessive-compulsive disorder.

Inflated responsibility is ascribed a pivotal role in the pathogenesis of obsessive-compulsive disorder (OCD). The aim of the study was to assess interpersonal attitudes and behaviors contributing to enhanced responsibility in OCD. In particular, we tested the hypothesis that individuals diagnosed with OCD share stronger latent aggression toward others, resulting in a high degree of interpersonal ambivalence. A total of 176 participants with OCD, 42 participants with anxiety or depression as well as 42 healthy controls completed the Responsibility and Interpersonal Behaviors and Attitudes Questionnaire (RIBAQ). The factor analysis confirmed three factors: (1) inflated worry/responsibility, (2) latent aggression/calculating behavior and (3) suspiciousness/distrust. Whereas the psychiatric group displayed enhanced scores relative to healthy participants regarding responsibility and suspiciousness, OCD patients achieved significantly higher scores on the latent aggression dimension relative to both control groups. Results are consistent with the notion that participants with OCD show both inflated levels of (authentic) responsibility and latent aggression.

Quetiapine addition to serotonin reuptake inhibitors in patients with severe obsessive-compulsive disorder: a double-blind, randomized, placebo-controlled study.

OBJECTIVE: Although many patients with obsessive-compulsive disorder (OCD) benefit from treatment with serotonin reuptake inhibitors (SRIs), it is estimated that 40% to 60% of them do not respond. The objective of the present study was to evaluate the efficacy of quetiapine added to baseline treatment with SRIs for the treatment of OCD in severely ill adult subjects. METHOD: Forty patients (21 men, 19 women) with primary OCD according to Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition criteria participated in a 12-week, double-blind, placebo-controlled trial. They were randomly assigned to dosages of quetiapine titrated up to 400 mg/d (n = 20) or to placebo (n = 20) in addition to their SRI treatment. During the continuation phase (weeks 6-12), subjects received different dosages between 400 and 600 mg/d depending on clinical response. At entry, all patients were unresponsive to at least 1 course of at least 12 weeks of treatment with SRIs at defined doses. The total Yale-Brown Obsessive-Compulsive Scale score was the primary efficacy parameter. RESULTS: Intention-to-treat, last-observation-carried-forward analysis demonstrated a mean +/- SD decrease in Yale-Brown Obsessive-Compulsive Scale score of 5.2 +/- 5.4 in the quetiapine group and 3.9 +/- 4.9 in the placebo group. The analysis of treatment effects between the 2 groups showed no significant difference. There were no significant group differences in any of the other self-rating scales or clinician-administered rating scales. CONCLUSIONS: In this study, augmentation of SRI treatment with quetiapine in severe OCD had no additional effect.

'I wash until it feels right' the phenomenology of stopping criteria in obsessive-compulsive washing.

Recent elaborations of cognitive behavioral theory in OCD suggest that difficulties in deciding when to stop a compulsive action may be related to the use of counter-productive termination criteria by obsessional patients [Salkovskis, P. M. (1999). Understanding and treating obsessive-compulsive disorder. Behaviour Research and Therapy, 37, s29-s52]. Such criteria are characterized by their subjective nature, i.e. a primarily internal reference point (e.g. 'just right' feelings), and are conceptualized as the "top level" of a general strategy involving elevated evidence requirements. Thirty-eight obsessional washers, 41 obsessionals with other problems and 43 healthy controls were interviewed about and rated two situations varying in the degree of urgency to wash; they also washed their hands in a behavioral test. Washers reported using subjective criteria more frequently and rated them as more important for the termination of the washes than the other groups in questionnaire, interview and laboratory data. Both obsessional groups considered more criteria before stopping than the healthy controls, suggesting that using multiple criteria is a general strategy. The data are consistent with the predictions of the elaborated cognitive-behavioral model of OCD. They indicate that the use of subjective criteria and elevated evidence requirements is affected by the perceived significance of the situation in a similar way for obsessional and non-obsessional individuals.