Repeated checking really does cause memory distrust

Memory phenomena associated with obsessive-compulsive disorder (OCD) have received increased attention in the recent literature. Some debate remains about whether OCD is characterized by deficits in memory per se, or by poor memory confidence. Following from a recent study that demonstrated memory distrust results from repeated checking of a virtual computerized stove, we asked 50 undergraduate students to repeatedly turn on, turn off and check either a real kitchen stove (relevant checking) or a real kitchen faucet (irrelevant checking) in a standardized, ritualized manner. All participants completed a final check of the stove following these 19 checking trials. Results indicated that following repeated relevant checking, participants reported significantly reduced memory confidence, vividness and detail. Repeated irrelevant checking did not produce these decreases. Results are discussed in terms of cognitive-behavioural formulations of OCD and in terms of the effects of repetition on memory and metamemory.     

Exploring the boundaries of memory distrust from repeated checking: increasing external validity and examining thresholds

Checking behavior is among the most common forms of compulsions in OCD. Recent research suggests that repeated checking decreases memory confidence, and supports theoretical models of how repeated checking is maintained. The current paper presents findings from two studies exploring the boundaries of memory distrust from repeated checking. Results of study 1 show that repeated checking of a real stove decreases memory confidence, vividness, and detail (i.e., metamemory), and leads to a greater reliance on knowing as a source of memory, without meaningfully altering memory accuracy. Results of study 2 suggest that these changes in metamemory are observed after performing a relatively low number of checks on one occasion. The findings are considered within the context of theoretical models of checking and future directions are delineated.     

Phenomenological validity of an OCD-memory model and the remember/know distinction

In earlier experiments using interactive computer animation with healthy subjects, it was found that displaying compulsive-like repeated checking behavior affects memory. That is, checking does not alter actual memory accuracy, but it does affect 'meta-memory': as checking continues, recollections are experienced as less vivid and less detailed while confidence in memory is undermined. This procedure provides a model of OCD checking and suggests that checking is a counterproductive strategy to reduce memory distrust. The present experiment was carried out to specify the phenomenological quality of memory distrust after checking and to see if repeated checking produces a shift in the memory source that is used to decide about the outcome of checking: from 'remembering' to 'knowing' (Tulving, 1985). Using the same interactive computer-animation, the earlier findings on vividness, detail and confidence were replicated. In addition, it was found that checking made participants endorse quotations from OCD patients (Reed, 1985) expressing a specific ambivalence about memory: 'It is as though the memory is there, but is isn't definite enough', 'I remember doing it in a way, but it's all fuzzy....' And 'I can remember that I've done it. But the memory isn't clear somehow'. This finding adds to the validity of the experimental model. Furthermore, after checking subjects' beliefs about the outcome of checking became based on (general) knowing instead of (specific) remembering. It is suggested that OCD checkers feel a general and relatively strong need to be certain about the veracity of recollections and that they have high standards for memory performance. This may explain earlier findings that OCD checkers have a general tendency to distrust their episodic memory. A need for certainty and a critical attitude towards memory performance may not be problematic or abnormal. It is suggested that clinical problems arise when the patient tries to fight memory distrust by repeated checking. The latter does not reduce distrust but rather increases distrust and the patient may get trapped in a spiral of mutually reinforcing checking behavior and memory distrust.     

Repeated checking causes distrust in memory but not in attention and perception

Repeated checking to reduce memory distrust seems to be counterproductive: it increases memory distrust. Obsessive-compulsive (OC) patients tend to be uncertain about other cognitive domains as well, like attention and perception. In an experiment with 70 healthy participants, we tested whether perseverative checking induces distrust not only in memory, but also in attention and perception. Participants were administered a computer task in which they had to activate, deactivate, and check threat-irrelevant stimuli, and rate their confidence in memory, attention, and perception in a pre-test and post-test. In between these tests, the relevant checking group performed 20 checks of the same stimuli used in the pre- and post-test. The irrelevant checking group performed 20 checks of different stimuli. Although memory accuracy improved in both groups, repeated checking reduced confidence in memory, vividness, and detail in the relevant checking group, but not in the irrelevant checking group. A trend was found towards a decline in attentional confidence in the relevant checking group only. Perception was not affected by repetitive checking. A replication study revealed similar results of relevant checking on meta-memory, however, the trend for attentional distrust was not confirmed. The results suggest that perseveration may be domain specific, i.e., only the cognitive processes that are subject to perseveration are affected.     

Repeated checking causes memory distrust

This paper attempts to explain why in obsessive-compulsive disorder (OCD) checkers distrust in memory persists despite extensive checking. It is argued that: (1) repeated checking increases familiarity with the issues checked; (2) increased familiarity promotes conceptual processing which inhibits perceptual processing; (3) inhibited perceptual processing makes recollections less vivid and detailed and finally; (4) reduction in vividness and detail promotes distrust in memory. An interactive computer animation was developed in which participants had to perform checking rituals on a virtual gas stove. Two separate experiments were carried out with n=39 (Experiment I) and n=40 (Experiment II) healthy participants. In both studies, the control group and the experimental group were given the same pre-test and post-test on the virtual gas stove. In between, the experimental group engaged in 'relevant checking', i.e. checking the gas stove, while the control group engaged in 'irrelevant checking', i.e. checking virtual light bulbs. In both experiments there were powerful effects of repeated 'relevant checking': while actual memory accuracy remained unaffected, the vividness and detail of the recollections were greatly reduced. Most pertinently, in both experiments relevant checking undermined confidence in memory. No such effects were observed in the control group. One might argue that the pre-test/post-test design may have made the control group anticipate a memory assessment at the post-test and that this artifact made them relatively alert producing memory confidence at post test that was artificially high. A third experiment was carried out (n=2 x 20) in which no pre-test was given while, other than that, Experiment III was identical to the first two experiments. Results confirmed earlier findings: compared to the irrelevant checking control group, recollections in the relevant checking group were non-vivid, non-detailed while confidence in memory was low. The theory and data suggest an answer to the question 'why memory distrust persists despite repetitive checking'. In people who check extensively, memory distrust may persist as a result of repetitive checking. OCD checking may be motivated by the wish to reduce uncertainty, but checking appears to be a counter-productive safety strategy. Rather than reducing doubt, checking fosters doubt and ironically increases meta-memory problems.     

Deteriorating memory confidence, responsibility perceptions and repeated checking: comparisons in OCD and control samples

Repeated checking has been repeatedly associated with memory distrust. We sought to extend previous research using a computer-based checking task by incorporating a group of 15 individuals with OCD, and examining the effect of increased perceived responsibility. Participants were asked to repeatedly check a virtual stovetop, with half the participants also placed under a condition of high-perceived responsibility. Our observations replicated previous research showing that the act of repeatedly checking leads to reductions in memory vividness, detail and confidence, without accompanying reductions in memory accuracy. Furthermore, while a sense of increased personal responsibility had little effect on a student control sample, it led to a significant further deterioration in memory confidence in individuals with OCD. These results suggest that in people with OCD, normal reductions in memory confidence over repeated trials are exacerbated and intensified by inflated responsibility perceptions.     

Reality monitoring and metacognitive beliefs related to cognitive confidence in obsessive-compulsive disorder

The present study investigated general reality monitoring ability, and selective reality monitoring ability for anxiety relevant actions in a group of individuals with obsessive-compulsive disorder (OCD) and a group of non-anxious controls. In addition, reality monitoring confidence was assessed, as well as specific meta-cognitive beliefs related to cognitive confidence (by means of the Meta-Cognitions Questionnaire (MCQ)). No differences were found between both groups in actual reality monitoring ability. Unlike previous studies, the reality monitoring task included actions that were related to the individual concerns of the OCD patients and were ideographically selected. Nevertheless, no differential reality monitoring effect was observed for the anxiety relevant stimuli. Data from the MCQ, however, revealed that OCD patients had less overall confidence in their memory for actions and their reality monitoring ability. Analysis of the confidence ratings of the reality monitoring task showed that this reduced confidence was restricted to the neutral actions. No differences were observed for patients that reported low or high frequencies of checking behaviour. The whole of these data do not support memory deficit models of OCD, but are in line with recent emphasis on the importance of memory confidence and other meta-cognitive beliefs in OCD.     

Memory and memory confidence in obsessive-compulsive disorder

Pathological doubt, often found in individuals with obsessive-compulsive disorder (OCD), has been theoretically linked to memory deficits, but empirical evidence for such deficits has been mixed. In contrast, many studies suggest that individuals with OCD have low confidence in their memories. The present study aimed to build upon previous research by measuring memory accuracy and confidence in OCD using ecologically valid, idiographically-selected stimuli. Individuals with OCD (OCs), anxious controls (ACs), and nonanxious controls (NACs) were exposed to a set of objects that the OCs had identified as safe, unsafe, or neutral. Participants were then asked to recall as many objects as possible and to rate their confidence in each memory. This process was repeated 6 times, using the same stimuli for each trial. Contrary to hypothesis, no group differences emerged in memory accuracy. However, OCs' memory confidence for unsafe objects showed a progressive decline over repeated trials. This pattern was not observed among NACs or ACs. Furthermore, OCs with primary checking reported lower confidence in long-term memory than did OCs without primary checking. These results suggest that when OCs are repeatedly exposed to threat-related stimuli (such as repeated checking), their level of confidence in remembering these stimuli paradoxically decreases.     

Obsessive compulsive disorder,checking, and non-verbal memory: a neuropsychological investigation

There is considerable evidence in the literature for the presence of non-verbal and praxic memory deficits in OCD. Such deficits may represent the cognitive substrate of doubt-related phenomenon such as checking. Neuropsychological tests of non-verbal memory functioning and memory for actions were administered to patients with OCD (whose predominant symptom was checking) and a group of matched healthy controls. Significant differences were found between the experimental and control groups, suggesting some memory impairment in the OCD group; however, no significant relationship was found linking neuropsychological test indices with checking. Significant relationships were found linking recognition memory problems and immediate memory for actions with general symptom severity.     

Attenuating memory distrust in a repeated checking task

Repeated checking has been demonstrated to lead to reductions in memory confidence in several previous studies using student and clinical samples. This process of reduced confidence in memory and detail for memory, are thought to arise from the inhibition of perceptual processing that develops during repeated checking. Our research investigated whether reduced memory confidence from repeated checking could be attenuated through the use of novel stimuli during the repeated checking task. Three groups were generated through random assignment of 65 undergraduate students. As seen in previous research, individuals who repeatedly checked a stimulus (a virtual stovetop) showed reduced memory confidence, vividness, and detail, when compared with individuals who repeatedly checked a different stimulus. A third group in which the colour of the repeatedly-checked stovetop changed every five trials showed no significant decline in memory confidence between the pre-test and post-test. Results suggest that increased memory distrust can be ameliorated through the use of stimuli with characteristics that are novel and distinctive. Findings are discussed in the context of the existing model of repeated checking and memory confidence, and implications for treatment methods are presented.     

How checking breeds doubt: Reduced performance in a simple workingmemory task

A paradox of memory research is that repeated checking results in a decrease in memory certainty, memory vividness and confidence [van den Hout, M. A., & Kindt, M. (2003a). Phenomenological validity of an OCD-memory model and the remember/know distinction. Behaviour Research and Therapy, 41, 369-378; van den Hout, M. A., & Kindt, M. (2003b). Repeated checking causes memory distrust. Behaviour Research and Therapy, 41, 301-316]. Although these findings have been mainly attributed to changes in episodic long-term memory, it has been suggested [Shimamura, A. P. (2000). Toward a cognitive neuroscience of metacognition. Consciousness and Cognition, 9, 313-323] that representations in working memory could already suffer from detrimental checking. In two experiments we set out to test this hypothesis by employing a delayed-match-to-sample working memory task. Letters had to be remembered in their correct locations, a task that was designed to engage the episodic short-term buffer of working memory [Baddeley, A. D. (2000). The episodic buffer: a new component in working memory? Trends in Cognitive Sciences, 4, 417-423]. Of most importance, we introduced an intermediate distractor question that was prone to induce frustrating and unnecessary checking on trials where no correct answer was possible. Reaction times and confidence ratings on the actual memory test of these trials confirmed the success of this manipulation. Most importantly, high checkers [cf. VOCI; Thordarson, D. S., Radomsky, A. S., Rachman, S., Shafran, R, Sawchuk, C. N., & Hakstian, A. R. (2004). The Vancouver obsessional compulsive inventory (VOCI). Behaviour Research and Therapy, 42(11), 1289-1314] were less accurate than low checkers when frustrating checking was induced, especially if the experimental context actually emphasized the irrelevance of the misleading question. The clinical relevance of this result was substantiated by means of an extreme groups comparison across the two studies. The findings are discussed in the context of detrimental checking and lack of distractor inhibition as a way of weakening fragile bindings within the episodic short-term buffer of Baddeley's (2000) model. Clinical implications, limitations and future research are considered.     

Phenomenal characteristics of memories of daily actions in checking‐prone individuals

The purpose of this study was to investigate memories of daily actions in checking‐prone participants. A sample of 419 non‐clinical participants completed a questionnaire evaluating Obsessive–Compulsive Disorder (OCD) and a questionnaire evaluating sensory details, emotions, vividness, confidence and memory perspective of seven everyday actions such as ‘brushing one's teeth’. The main results indicated that checking was related to low levels of visual, kinaesthetic and spatial details in memories for actions, more negative emotions and anxiety when performing actions and low confidence in memory quality. In addition, checking‐prone individuals more frequently reported their memories from the perspective of an external observer than non‐checking‐prone individuals. In general, these results seem to indicate that checking is associated with impersonal memories for everyday actions, as well as low confidence in these memories. The role of anxiety is also evoked, as it was significantly related to poor memory characteristics. Copyright © 2007 John Wiley & Sons, Ltd.     

Believe in yourself: Manipulating beliefs about memory causes checking

One of the most common compulsions in obsessive–compulsive disorder (OCD) is repeated checking. Although individuals often report that they check to become more certain, checking has been shown to have the opposite effect – increased checking causes increased uncertainty. However, checking may also be thought of as beginning because of memory uncertainty. Beliefs about responsibility, over-estimation of threat, intolerance of uncertainty, perfectionism, and importance of and control of thoughts are already known to affect different aspects of OCD symptomatology. Beliefs about memory, however, are not currently considered to influence compulsive behaviour. In the current study, beliefs about memory were manipulated to test whether or not they affected urges to check. Ninety-one undergraduate participants received (positive or negative) false feedback about their performance on aspects of a standardized memory test, and then completed two additional memory tasks. Their urges to check following these tasks were assessed. Consistent with our hypotheses, individuals in the low memory confidence condition had greater urges to check following the memory tasks than those in the high memory confidence condition, demonstrating that manipulations of beliefs about memory can influence checking. Results and implications are discussed in terms of cognitive-behavioural models of and treatments for OCD.     

Confidence in memory and other cognitive processes in obsessive-compulsive disorder

Previous studies have implicated beliefs about one's memory (i.e., meta-memory), in maintaining the symptoms of obsessive–compulsive disorder (OCD), particularly with respect to checking rituals. However, most research has focused on task- or situation-specific perceptions about memory performance. Expanding on this research, we undertook two studies with analogue and clinical cohorts to examine the relationship between general ‘trait’ beliefs about memory and related processes and OCD symptoms. Trait meta-memory as measured in the current study was conceptualised as a multi-dimensional construct encompassing a range of beliefs about memory and related processes including confidence in one's general memory abilities, decision-making abilities, concentration and attention, as well as perfectionistic standards regarding one's memory. Meta-memory factors were associated with OCD symptoms, predicting OCD symptoms over-and-above mood and other OCD-relevant cognitions. Meta-memory factors were found to be particularly relevant to checking symptoms. Implications for theory and research are discussed.     

Perseverative and compulsive-like staring causes uncertainty about perception

Earlier studies have found that perseverative checking provokes memory distrust for checked stimuli, suggesting that compulsive checking is a counter-productive strategy to increase memory confidence. Obsessive Compulsive (OC) uncertainty also occurs for functions other than memory, like perception. Uncertainty about perception in OC patients gives rise to prolonged attending to the issues that patients feel uncertain about. In an experiment with 40 healthy volunteers, it was tested whether OC-like, perseverative (visual) attending induces OC-like experiences of dissociation and perceptual uncertainty. Participants had to look at an object (a gas stove or a light bulb) during a pre-test and a post-test. In between these tests, participants in the experimental condition were asked to stare at an object that was the same as the to-be-looked-at object during the pre/post-tests. Participants in the control condition stared at an object that was different from the object they looked at during pre/post-test. Both in the experimental and control conditions, dissociation was observed; the effects were equally strong. Critically, with regards to OC-like perceptual uncertainty, the effects were significantly stronger in the experimental condition. The findings indicate that OC-like perseveration induces distrust, not only about memory, but also about perception. To explain the results, we suggest that perseveration interferes with spreading of activation and that cognitive uncertainty (and possibly derealisation) is the experiential end-product of perseveration. It is suggested that all forms of OC perseveration share such interference and that all undermine confidence in cognitive operations.     

Memory and metamemory for semantic information in obsessive-compulsive disorder

Several studies have been conducted on OCD patients' memory and metamemory performance in episodic tasks. However, there is a clear lack of research addressing these issues for semantic memory (i.e., retrieval of information from long-term memory). Although findings regarding a memory deficit is somewhat equivocal, the empirical evidence clearly demonstrates that OCD patients with primarily checking compulsions show reduced confidence in their memory performance. The purpose of the present study was to investigate memory and metamemory performance of checkers in semantic memory domain. We compared checker OCD patients, non-checker OCD patients and normal controls on their ability to retrieve answers to general knowledge questions with a recall as well as a recognition test. We also investigated prospective (feeling-of-knowing (FOK)) and retrospective (confidence) metamemory judgments. Checker OCs were not poorer in retrieving semantic information from long-term memory. Neither were they less confident about their ability to remember currently unrecallable information in the future (FOK judgments) or about the accuracy of retrieved information (confidence judgments). Moreover, accuracy of metamemory judgments were comparable across groups. Overall, our results revealed that checker OCs do not show a memory or metamemory deficit when semantic memory was concerned, suggesting that any memory and metamemory deficit may be special to recently experienced materials.     

How checking as a cognitive style influences working memory performance

Compulsive checking is known to influence memory, yet there is little consideration of checking as a cognitive style within the typical population. We employed a working memory task where letters had to be remembered in their locations. The key experimental manipulation was to induce repeated checking after encoding by asking about a stimulus that had not been presented. We recorded the effect that such misleading probes had on a subsequent memory test. Participants drawn from the typical population but who scored highly on a checking‐scale had poorer memory and less confidence than low scoring individuals. While thoroughness is regarded as a quality, our results indicate that a cognitive style that favours repeated checking does not always lead to the best performance as it can undermine the authenticity of memory traces. This may affect various aspects of everyday life including the work environment and we discuss its implications and possible counter‐measures. Copyright © 2010 John Wiley & Sons, Ltd.     

No deficits in nonverbal memory, metamemory and internal as well as external source memory in obsessive-compulsive disorder (OCD)

A large body of literature suggests that some symptoms of obsessive-compulsive disorder (OCD) result from mnemonic dysfunctions. The present study tested various formulations of the memory deficit hypothesis considering important moderators, such as depression and response slowing. Thirty-two OCD patients and 32 healthy controls were presented verbal or nonverbal instructions for actions (e.g. simple gestures). These actions should either be performed or imagined. For recognition, previously presented as well as novel actions were displayed. Decisions had to be made whether an action was previously displayed (verbally vs. nonverbally) or not and whether an action was performed or imagined (internal source memory). Moreover, both judgments required confidence ratings. Groups did not differ in memory accuracy and metamemory for verbally presented material. Patients displayed some impairment for nonverbally presented material and imagined instructions, which, however, could be fully accounted for by response slowing and depressive symptoms. The study challenges the view that primary memory deficits underlie OCD or any of its subtypes. We claim that research should move forward from the mere study of objective impairment to the assessment of cognitive performance in conjunction with personality traits such as inflated responsibility.     

Incompleteness and harm avoidance in OCD symptom dimensions

Incompleteness (INC) and harm avoidance (HA) are motivational core dimensions of OCD. While HA-related concepts (e.g., inflated responsibility, overestimation of threat) are a main focus of current cognitive-behavioural OCD research, there is also a renewed interest in INC feelings and "not just right experiences" with an inability to achieve "closure" concerning actions/perceptions. This study systematically examines the association of OCD symptom dimensions with INC and HA in a large clinical OCD sample (n=202). Hierarchical linear multiple regression analyses controlling for anxiety, depression and symptom severity demonstrated a unique association of symmetry/ordering and checking (but not of contamination/washing and obsessional thoughts) with INC, and of obsessional thoughts and checking with HA. Thus, in contrast with symmetry/ordering (predominantly INC-related) and obsessional thoughts (predominantly HA-related), checking was motivationally heterogeneous, i.e., associated with INC and HA to a comparable and substantial degree. Contamination/washing failed to show a unique association with HA in two of three analyses, and with INC in all three analyses. Symptom severity uniquely contributed to INC in two of three analyses, but not to HA. Clinically, our results indicate that a conceptualization of OCD as an anxiety disorder is too narrow.     

Cognitive Beliefs Across the Symptom Dimensions of Pediatric Obsessive-Compulsive Disorder: Type of Symptom Matters

The cognitive model of obsessive-compulsive disorder (OCD) posits that dysfunctional cognitive beliefs are crucial to the onset and maintenance of OCD; however, the relationship between these cognitive beliefs and the heterogeneity of OCD symptoms in children and adolescents remains unknown. We examined how the major belief domains of the cognitive model (inflated responsibility/threat estimation, perfectionism/intolerance of uncertainty, importance/control of thoughts) and dysfunctional metacognitions were related to OCD symptoms across the following dimensions: doubting/checking, obsessing, hoarding, washing, ordering, and neutralization. Self-report ratings from 137 treatment-seeking youth with OCD were analyzed. When cognitive beliefs and symptom dimensions were analyzed in tandem, inflated responsibility/threat estimation and dysfunctional metacognitions were uniquely related to doubting/checking, obsessing, and hoarding and perfectionism/intolerance of uncertainty to ordering. Cognitive beliefs explained a large proportion of variation in doubting/checking (61%) and obsessing (46%), but much less so in ordering (15%), hoarding (14%), neutralization (8%), and washing (3%). Similar relations between cognitive beliefs and symptom dimensions were present in children and adolescents. Cognitive beliefs appear to be relevant for pediatric OCD related to harm, responsibility, and checking, but they do not map clearly onto contamination and symmetry-related symptoms. Implications for OCD etiology and treatment are discussed.