Panic-Related fears in persons reporting a family history of panic disorder

Abstract We administered the Body Sensations Questionnaire, Health Hardiness Index, Panic Attack Questionnaire, and the Symptom Checklist 90-R to college students (n=71) who either reported or did not report a family history of panic disorder. Participants who reported a family history of panic disorder reported significantly less perceived control over their health status, a greater fear of bodily arousal, and greater frequency of unexpected panic attacks compared to participants without such a history, although no significant group differences were detected for Symptom Checklist-90-R scales that measure negative emotional experiences. After controlling for personal history of panic, differences between the positive family history group remained only for the control over health measure. We discuss the results as preliminary evidence that certain cognitive responses are overrepresented in self-classified first-degree relatives of persons with panic disorder.     

Group versus individual cognitive-behavioural treatment for obsessive-compulsive disorder: a controlled trial

The efficacy of group cognitive behaviour therapy (CBT) for obsessive-compulsive disorder (OCD) has received relatively little research attention compared with the large number of studies that have investigated individual CBT. The current study is the first controlled study to compare an identical CBT protocol, containing both cognitive and behavioural elements, delivered either individually or in a group. Participants were randomly assigned to either 10 weeks of individual CBT, 10 weeks of group CBT or a 10 week wait-list. Participants with significant rates of secondary comorbidity were included in the study to enhance the generalisability of results. Intention-to-treat and completer analyses were carried out and indicated no differences between the group and individual treatments on outcome measures. Large effect sizes were found for both conditions. Analysis of clinically significant change indicated that the individual treatment was associated with a more rapid response but that both treatments had equivalent rates of recovered participants by brief follow-up. The importance of further investigations of the efficacy of group CBT for OCD is discussed.     

Emotional avoidance: an experimental test of individual differences and response suppression using biological challenge

The present study examined the affective consequences of response inhibition during a state of anxiety-related physical stress. Forty-eight non-clinical participants were selected on the basis of pre-experimental differences in emotional avoidance (high versus low) and subjected to four inhalations of 20% carbon dioxide-enriched air. Half of the participants were instructed to inhibit the challenge-induced aversive emotional state, whereas the other half was instructed to simply observe their emotional response. Participants high in emotional avoidance compared to those low in emotional avoidance responded with greater levels of anxiety and affective distress but not physiological arousal. Individuals high in emotional avoidance also reported greater levels of anxiety relative to the low emotional avoidance group when suppressing compared to observing bodily sensations. These findings are discussed in terms of the significance of emotional avoidance processes during physical stress, with implications for better understanding the nature of panic disorder.     

Office-based vs home-based behavioral treatment for obsessive-compulsive disorder: a preliminary study

The current study investigated whether exposure with response prevention (ERP) for obsessive compulsive disorder (OCD) is more effective when administered in a participant's home or other natural environments where symptoms tend to occur, than in a therapist's office. Twenty-eight outpatients with a principal diagnosis of OCD were randomly assigned to receive ERP in their therapist's office vs. wherever their symptoms usually occur (e.g., at home, at work, in public places, in the car, etc.). Participants received 14, 90-min sessions of ERP with an individual therapist. Participants were assessed at pretreatment, post-treatment, and at 3- and 6-month follow-up. Assessments included both self-report as well as clinician-rated indicators of OCD symptom severity, depression, and functional impairment. Results suggested that participants improved significantly, regardless of where treatment occurred. There were no differences in efficacy between the home-based and office-based treatment for OCD. Implications of these findings are discussed.     

Selective attention in obsessive-compulsive disorder

Recent information-processing studies have suggested that a selective attention deficit may be involved in the symptomatology of obsessive-compulsive disorder (OCD). In this study, individuals diagnosed with OCD were distinguished from those with panic disorder and from control participants by their relatively poorer performance on a series of psychometric tasks of selective attention. These results are interpreted as supporting the hypothesis of a diminished ability of people with OCD to selectively ignore competing external (sensory) and internal (cognitive) stimuli, especially intrusive thoughts.     

Psychometric properties of the social phobia inventory: further evaluation

This study investigated the psychometric properties of the Social Phobia Inventory [SPIN; Connor, K. M., Davidson, J. R. T., Churchill, L. E., Sherwood, A., Foa, E., Wesler, R.H., 2000. Psychometric properties of the Social Phobia Inventory (SPIN). British Journal of Psychiatry, 176, 379-386], a measure of severity in social phobia (social anxiety disorder). Participants included 132 participants with social phobia, 57 participants with panic disorder and agoraphobia (PDA), and 62 participants with obsessive-compulsive disorder (OCD). Confirming findings from an initial validation study, the SPIN was found to have excellent internal consistency and good test-retest reliability. It also distinguished well between those with social phobia and those with either PDA or OCD. Good convergent and discriminant validity were established by examining correlations with other conceptually related and unrelated scales. Finally, the SPIN was sensitive to changes in social phobia severity following cognitive behavioral group treatment. In conclusion, the SPIN is both reliable and valid for the measurement of social phobia severity and outcome following psychological treatment.     

Stability of the Positive Mood Effect on Creativity When Task Switching,Practice Effect,and Test Item Differences are Taken into Consideration

Although experimentally induced positive mood can generally last for 20 min and the induced mood is conducive to creative performance, it is still unclear whether the facilitation effect is stable during these 20 min. Two studies were conducted to examine this issue while controlling for the impacts of task switching, practice effect, and test item differences. In Study 1, participants (N = 42) were randomly assigned to positive, negative, and neutral mood conditions. After watching a short video clip, participants answered four items of the Alternate Uses Test (AUT) in 20 min, with 5 min allotted for each item. Creative performance during each 5‐min period was scored in terms of fluency and flexibility. Separate repeated‐measures analyses of variances on these creativity scores showed that positive mood consistently enhanced performance over 20 min. Study 2 further eliminated the effects of test item differences and test order. Participants (N = 131) underwent the same mood induction procedure and answered the same four items of the AUT, except that these items were presented in four different sequences in accordance with the Latin square design. Consistent with the findings in Study 1, Study 2 showed that the facilitation effect of positive mood lasted for 20 min when the interference of task switching, practice effect, and test item differences were minimized. This finding not only sheds light on the debate regarding the stability of experimentally induced positive mood effect, but also contributes to the body of empirical evidence that future studies may use to examine the positive mood effect over a relatively long period of time.     

Autobiographical memories prompted by automatic thoughts in panic disorder and social phobia

This study examined the retrieval of autobiographical memories when prompted by automatic thoughts that were representative of maladaptive schema content specific to 2 anxiety disorders. Participants with panic disorder (n = 20), those with social phobia (n = 22) and non-anxious participants (n = 20) indicated the first specific memory that came to mind when cued with panic-related, social phobia-related and control automatic thoughts. Panic participants retrieved memories cued with panic disorder-related automatic thoughts more quickly than social phobic and non-anxious participants, and social phobic participants retrieved memories cued with social phobia-related automatic thoughts more quickly than non-anxious participants. Relative to non-anxious participants, participants in both patient groups retrieved more anxious/worried memories when cued with automatic thoughts related to their diagnosis and more fearful memories when cued with either type of diagnosis-related automatic thought. Results indicate that panic and social phobic participants were characterized by general threat-relevant autobiographical memory biases.     

Comparative neuropsychology of adult obsessive-compulsive disorder and attention deficit/hyperactivity disorder: Implications for a novel executive overload model of OCD

Research implicates frontostriatal pathophysiology in both attention deficit/hyperactivity disorder (ADHD) and obsessive-compulsive disorder (OCD). Nevertheless, ADHD is characterized with frontostriatal hypoactivity and OCD with hyperactivity. Furthermore, both disorders seem to lie on opposite ends of a clinical impulsive-compulsive continuum. While never having directly been compared, and despite these differences, OCD and ADHD appear to share similar neuropsychological impairments especially in executive functions. This study aimed at comparing adults with OCD and adults with ADHD on neuropsychological measures and behavioural impulsivity and OC measures. Thirty OCD, 30 ADHD, and 30 matched healthy control (HC) participants were administered a comprehensive neuropsychological battery and completed several questionnaires. The groups were compared on all neuropsychological and clinical measures and correlations between neuropsychological and clinical symptoms were computed. The ADHD and OCD groups performed more poorly than HC on all neuropsychological domains and most domain subtests. The ADHD group reported significantly higher impulsivity than the OCD group. OCD patients did not differ from HC on behavioural impulsivity. A unique dissociation was found between impulsivity and response inhibition where both clinical groups showed similar response inhibition deficit, but differed significantly on impulsivity. Moreover, a negative association between OC symptoms and response inhibition and a bias in self-perception of impulsivity was found only in the OCD group. We propose an executive overload model of OCD that views neuropsychological impairments in OCD as an epiphenomenon, according to which continuous attempts to control automatic processes are associated with obsessive thoughts overflow that causes an overload on the executive system.     

Socio-demographic and psychopathological risk factors in obsessive-compulsive disorder: Epidemiologic study of school population

We assessed the presence of emotional disorders (obsessive-compulsive, anxiety and depressive) in 1,514 Spanish non-referred children (8–12 years old) to investigate the predictive ability of psychopathological and socio-demographic characteristics, and identify which of these were possible correlates for clinical obsessive-compulsive disorder (OCD) and subclinical OCD. At one year later, 562 subjects (risk group and without risk group) were re-assessed and we established the OCD diagnoses or the subclinical OCD diagnoses. We found that 20 participants presented clinical OCD and 46 participants presented subclinical OCD. Somatic and separation anxiety symptomatology were good predictors for clinical OCD, and obsessive concern was a predictor for subclinical OCD. Clinical OCD was associated with order/checking/pollution symptoms and with a lower socioeconomic status (SES). Subclinical OCD was associated with hyperactive and impulsive manifestations, obsessive concern, and superstition/mental compulsion. An early detection and the follow-up of anxiety or obsessive symptoms in children may be important for preventing the course of OCD.     

Cool and Hot Aspects of Executive Function in Childhood Obsessive-Compulsive Disorder

Aspects of executive functioning (EF) have been put forward as endophenotypes in obsessive- compulsive disorder (OCD) and meta-analyses support EF underperformance in adult samples. Childhood-onset OCD has been suggested to constitute a separate neurodevelopmental subtype of the disorder but studies on neuropsychological functioning in childhood OCD are limited. The aim of the present study was to investigate performance-based EF in pediatric OCD using observed and latent variable analyses. A case-control design was applied including 50 unmedicated children and adolescents with OCD aged 7–17 years of which 70% were female, 50 pairwise age and gender matched non-psychiatric controls (NP) and 38 children and adolescents with mixed anxiety disorders (MA). Participants underwent structured diagnostic interviews and assessment with a battery encompassing cool EF tasks of working memory, set shifting, inhibition, and planning, and hot EF tasks of decision making and dot probe paradigm affective interference. First, groups were compared on observed variables with multilevel mixed-effects linear regression and analysis of variance. Then the latent structure of cool EF was tested with confirmatory factor analysis (CFA) and groups were compared on the CFA scores. No significant differences between groups appeared on individual cool EF tasks. On the hot EF tasks the OCD group displayed significant interference effects on the dot probe paradigm OCD-specific stimuli relative to NP, but not compared to MA and no group differences emerged for decision making. In the CFA a one-factor solution showed best fit, but the groups did not differ significantly on the resulting latent variable. The present study does not support cool or hot EF impairments in childhood OCD.     

Threat processing in obsessive-compulsive disorder: evidence from a modified negative priming task

Individuals with obsessive-compulsive disorder (OCD) often experience intrusive thoughts. These intrusions may be due to biases in information processing mechanisms, including attention, memory, and learning. To examine this hypothesis, we presented a modified negative priming (NP) paradigm with idiographically selected words to 19 individuals with OCD (OCs) and 19 matched non-anxious control participants (NACs). The words included OCD-relevant threat, OCD-relevant positive, and neutral words. This paradigm typically elicits positive priming because participants may learn the contingency between the prime and probe that facilitates responding [Frings and Wentura (2006). Strategy effects counteract distractor inhibition: NP with constantly absent probe distractors. Journal of Experimental Psychology: Human Perception and Performance, 32, 854-864]. As predicted, NACs showed facilitation (i.e., positive priming) rather than NP for all word types, whereas OCs exhibited facilitation for only neutral words. For positive words, OCs exhibited no priming and for threat words they exhibited NP. These results suggest that for idiographic, OCD-relevant threat information, individuals with OCD show difficulty learning the contingency between the information in the prime and probe displays relative to the NACs.     

Memory bias in obsessive-compulsive disorder (OCD).

There is a memory bias associated with depression, and good reason to expect a memory bias associated with anxiety. However, the results of studies reported to date have been ambiguous. Accordingly, an experiment was conducted to assess memory for contamination in people with different types of anxiety. Memory for contaminated stimuli among participants who met DSM-IV criteria for obsessive-compulsive disorder (OCD) and indicated a fear of contamination (n = 10) was compared to memory in a group of anxious controls (n = 10), and in undergraduate students (n = 20). Participants were shown 50 objects, 25 of which were contaminated by the experimenter and 25 which were touched but not contaminated. They then completed a neuropsychological memory assessment, after which the participants were asked to recall all of the objects touched by the experimenter. They were then asked to approach each object and to rate their anxiety about touching it. Finally, participants were asked about their perceptions of the cleanliness of each object. The OCD group had better memory for contaminated objects than for clean ones. Neither control group showed such a bias. Neuropsychological test scores indicated that this bias is not the result of differences in general memory ability. The results are discussed in terms of the memory-deficit theory of OCD and of behavioural and cognitive approaches to understanding the role of information processing in fear and anxiety.     

Competitive Memory Training (COMET) for OCD: A Self-treatment Approach to Obsessions

Competitive Memory Training (COMET) is a cognitive intervention that aims to change the maladaptive cognitive-emotional networks underlying obsessive-compulsive disorder (OCD). COMET has not been previously tried as a self-help intervention. The present study tested the preliminary feasibility, acceptability, and effectiveness of COMET for OCD implemented as a self-help intervention. Sixty-five participants with OCD recruited through online OCD self-help fora completed an online baseline assessment including measures of OCD symptoms, self-esteem, and depression. Participants were randomly assigned to either COMET or a wait-list control group. All participants were approached 4 weeks later to complete an online post-assessment. There was no evidence for a greater decline of OCD symptoms or depression under COMET. When analyses were limited to only those participants who reported reading the entire manual at least once, self-esteem was higher at post-assessment in the COMET group. Although 78.1% of patients in the COMET group rated it as appropriate for self-administration, only 56.5% performed COMET exercises regularly and 26.4% read the entire manual at least once. The feasibility and effectiveness of COMET as a self-help internet intervention for OCD was not supported in this study. Further work is needed to better understand if modifications to our implementation of COMET may yield improved outcomes.     

Obsessive-compulsive tendencies may be associated with attenuated access to internal states: Evidence from a biofeedback-aided muscle tensing task

The present study was motivated by the hypothesis that inputs from internal states in obsessive-compulsive (OC) individuals are attenuated, which could be one source of the pervasive doubting and checking in OCD. Participants who were high or low in OC tendencies were asked to produce specific levels of muscle tension with and without biofeedback, and their accuracy in producing the required muscle tension levels was assessed. As predicted, high OC participants performed more poorly than low OC participants on this task when biofeedback was not available. When biofeedback was provided, the difference between the groups was eliminated, and withdrawing the monitor again reversed this effect. Finally, when given the opportunity, high OC participants were more likely than low OC participants to request biofeedback. These results suggest that doubt in OCD may be grounded in a real and general deficiency in accessing internal states.     

强迫倾向个体的信息加工灵活性

摘 要 以高低强迫倾向个体为研究对象,考察其在不同概率情景设置的Flanker任务中的信息加工灵活性,研究结果表明：高强迫倾向个体的信息加工方式相对较缓慢、单一,以集中加工方式为主;高强迫倾向个体对情境的变化较少做出反应,在信息加工的灵活性上存在缺陷,而低倾向个体的信息加工方式相对较灵活;高强迫倾向个体不易受线索提示的影响,对信息加工方式的策略性调控能力不足。     

Is panic a unique emotional experience?

The establishment of Panic Disorder (PD) as a distinct diagnostic category stems largely from the conceptualization of panic as a phenomenon qualitatively different from severe levels of anxiety. The current study utilized patients with Generalized Anxiety Disorder (GAD) and Obsessive Compulsive Disorder (OCD) as comparison groups to examine the validity of this conceptualization. Seventeen PD, 29 OCD, and 12 GAD patients completed self-report inventories from which a panic factor was derived. Controlling for level of overall anxiety, the total panic factor was rated significantly higher by the PD group. A cluster of symptoms emerged which differentiated the PD group from the other two groups. The panic items and total score were correlated with total levels of state and trait anxiety but correlations were generally low, accounting for a limited amount of the total variance. Results were interpreted as providing only equivocal support for viewing panic as a separate dimension apart from high levels of general anxiety. A discussion of conceptual issues is presented.     

Illusion of control and behavioral control attempts in obsessive-compulsive disorder

The present research used the illusion-of-control paradigm to examine the relationships among obsessive-compulsive disorder (OCD) symptoms, behavioral control attempts, and illusory sense of control. Participants were presented with a preprogrammed sequence of aversive and neutral visual stimuli and were encouraged to attempt to control the sequence with keyboard presses. Participants rated their perceived level of control 3 times during the task. In addition, the authors used the repetitiveness of keyboard presses as a measure of rigid, compulsive-like behavior. In Study 1, this procedure was administered to a sample of 55 students who also completed measures of OCD and depression. In Study 2, the task was administered to 22 participants with OCD and 22 matched participants without OCD. In line with predictions, OCD symptoms were correlated with higher illusory sense of control and with more repetitive behavioral control attempts. The authors discuss the central role of control in OCD and specifically the relationships between need for control and compulsive rituals, which may be conceptualized as means for achieving an illusory sense of control over stressful life events.     

Differences in reported symptom profile between panic disorder and other DSM-III-R anxiety disorders.

Previous research has indicated that reports of panic attacks are associated with a different set of symptoms to reports of generalized anxiety. The present two studies attempted to extend these findings to specific (situational) fears. In Study 1, 55 subjects with panic disorder were compared on their symptom profile during their panic attacks to 65 subjects with other anxiety disorders [simple phobia, social phobia and obsessive-compulsive disorder (OCD)] during response to their feared cue. The results indicated that, compared to subjects with other anxiety disorders, subjects with panic disorder were more likely to report parasthesias, dizziness, faintness, unreality, dyspnea, fear of dying and fear of going crazy/losing control. In Study 2, 90 subjects meeting diagnostic criteria for both panic disorder and another anxiety disorder (simple phobia, social phobia or OCD) were compared on the symptoms experienced during their unexpected panic attacks and their situationally-triggered fears respectively. Combining the symptoms found in Study 1 to differ between the groups into a linear combination, there was a significant interaction found between the type of fear reaction (panic attack vs cued fear response) and symptom group. Taken together, these findings suggest that reports of unexpected panic attacks associated with panic disorder are characterized by a different symptom profile to reports of specific fear reactions that are part of a phobic disorder or OCD.     

Multimodal assessment of disgust in contamination-related obsessive-compulsive disorder

The present study utilizes multiple methods to examine the relationship between disgust and contamination-related obsessive-compulsive disorder (OCD) symptoms in an analogue sample. Questionnaire findings revealed that participants with high OCD contamination concerns showed stronger disgust sensitivity than did participants with low OCD contamination symptoms after controlling for negative affect. High OCD participants (N=30) also reported significantly more disgust than did low OCD participants (N=30) when exposed to a disgust-inducing video, whereas no significant between-group differences were detected on other negative emotional dimensions. Results from a series of disgust-specific behavioral avoidance tasks (BATs) revealed that high OCD participants demonstrated both less compliance and less approach behavior. Subsequent analysis also revealed that disgust sensitivity generally mediated avoidance on the BATs among high OCD subjects. High OCD participants also rated the BATs as more fearful and disgusting than did low OCD participants, with disgust generally emerging as the dominant emotional response. The results are consistent with a disgust-based, disease-avoidance approach in understanding contamination-related OCD themes.