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.     

Thought suppression in obsessive-compulsive disorder

Social cognition research has indicated that attempts to suppress thoughts can lead to a paradoxical increase in the frequency of that thought. This phenomenon has been a central component of cognitive-behavioural models of obsessive-compulsive disorder (OCD); however, research has yet to demonstrate deficient thought suppression ability in OCD patients. We examined whether individuals with OCD (OCs) exhibit a deficit in the ability to suppress thoughts. In Experiment 1, attempted thought suppression led to a paradoxical increase in self-reported thoughts for OCs, but not for nonanxious controls (NACs) or anxious controls (ACs). In order to rule out self-report biases, in Experiment 2 we utilized a lexical decision paradigm that measured priming strength of a target word under thought suppression conditions. Results paralleled those of Experiment 1: OCs showed decreased lexical decision latency of the 'suppressed' thought (thought to reflect either increased priming strength or disrupted processing of nonsuppressed thoughts), thus exhibiting a paradoxical effect of thought suppression. This effect was not seen in NACs or ACs. These findings suggest that deficits in cognitive inhibitory processes may underlie the intrusive, repetitive nature of clinical obsessions.     

Thought dismissability in obsessive-compulsive disorder versus panic disorder

This study sought to better understand the persistence of obsessive-compulsive disorder (OCD) by studying the dismissability of obsessional thoughts in individuals with OCD relative to the dismissability of panic-relevant thoughts in individuals with panic disorder with or without agoraphobia (PD/A). Individuals with a principal diagnosis of OCD (n = 25) or PD/A (n = 25) completed a thought replacement task in which they replaced a primary obsession (target thought for the OCD group) or a primary panic-relevant thought (target thought for the PD/A group), with a neutral thought, signaling when the target thought occurred and when the neutral thought was in mind. The OCD group had more target thoughts and appraised the recurrence of the target thought more negatively. Whereas mood state did not change in the PD/A group, it declined in the OCD group, and this change was predicted by negative appraisal of target thought recurrences, but not amount of time thinking the target thought. These findings suggest that in vivo appraisal of the recurrence of obsessions may be a unique, key mechanism in the persistence of OCD and that the identification and exploration of appraisal of thought recurrences may be an especially important target in its treatment.     

Memory and metamemory in obsessive-compulsive disorder

Studies on the link between checking and memory problems have produced equivocal results regarding a general memory deficit in patients with obsessive-compulsive disorder and subclinical checkers. However, there is clear and consistent evidence that patients with obsessive-compulsive disorder (OCD) show lack of confidence in their memory performance. The purpose of the present study was to investigate memory and metamemory performance (feeling-of-knowing judgments) for neutral and threat-related material in three groups: OCD patients (OCs), subclinical checkers (SCs), and normal controls (NCs). Participants studied a list of neutral and threat word pairs. After an initial cued-recall test, they provided feeling-of-knowing (FOK) judgments for unrecalled word pairs, followed by a recognition test. The results showed that OCs but not SCs were impaired in both recall and recognition compared to NCs. OCs were also less confident about their future memory performance than the other two groups, as reflected in their lower FOK ratings. Moreover, FOK judgments of the OCs were not reliable predictors of their recognition performance. Finally, neither OCs nor SCs showed any evidence of memory bias for threat-relevant information. The results support the idea of a general memory and a metamemory deficit in OCs.     

Dysfunctional belief-based obsessive-compulsive disorder subgroups

An attempt was made to identify obsessive-compulsive disorder (OCD) subgroups based on differences in OCD related beliefs. OCD patients (N=367) were assessed with the Obsessional-Beliefs Questionnaire prior to treatment. Individuals' scores on measures of inflated personal responsibility and the tendency to overestimate threat, perfectionism and intolerance of uncertainty, and over-importance and over-control of thoughts were subjected to cluster analysis. Support for both a simple and complex subgroup model was found (2-subgroup and 5-subgroup taxonomies). A low-beliefs subgroup was identified in both taxonomies. The low-beliefs subgroups reported scores on belief measures equivalent to scores reported for non-OCD comparison groups in earlier studies. Additional analyses were conducted to determine relations between belief-based and symptom subgroups. Significant relationships were found (e.g., Symmetry symptom subgroup membership was associated with membership in the Perfectionism/Certainty beliefs subgroup), although the shared variance was modest. Implications for understanding OCD heterogeneity and for cognitive theory are discussed.     

Cognitive therapy for obsessive-compulsive disorder

A multiple baseline across subjects design was used to test the efficacy of cognitive therapy for obsessive–compulsive disorder (OCD). Six people with OCD received 10–18 sessions of weekly, outpatient cognitive therapy. Assessment included both structured interviews and diary data. For three to four of the six patients, stable baseline periods were followed by reductions of symptoms during intervention. Two clients met stringent criteria for Jacobson and Truax's (J. Consulting Clin. Psychol. 59 (1991) 12) recovered status at posttest according to the Yale–Brown Obsessive–Compulsive Scale (Arch. Gen. Psychiatry 46 (1989) 1006). For the group, large pretest–posttest effect sizes were found.     

Feared identity and obsessive-compulsive disorder

We tested predictions from cognitive-behavioural theory that people with obsessive-compulsive disorder (OCD) regard their intrusions as revealing unacceptable aspects of their character. We compared an OCD sample with anxious controls (AC) and non-anxious controls (NAC) on a measure of the extent to which intrusions led to negative inferences about the self, assessed the discrepancy between their actual and feared self, and recorded the traits making up the feared self. The OCD sample did not differ from AC on self-discrepancies, but did differ from both control groups on the measure of negative inferences about the self. In addition, the feared self of the OCD sample was significantly more likely to consist of bad and immoral traits.     

Rates of abuse in body dysmorphic disorder and obsessive-compulsive disorder

Body dysmorphic disorder (BDD) continues to challenge professionals due to symptom severity, co-morbidity, suicidal ideation, and overvalued ideation. Despite the disorder's severity, little research exists. Clinical observation suggests a noteworthy history of abuse; therefore the present study investigated the reported rate of physical, sexual, and emotional abuse in BDD patients. OCD patients were chosen as a comparison group because BDD is considered to be an obsessive-compulsive spectrum disorder. A group survey design was used (N = 50 for each group). Results show significantly higher levels of emotional and sexual abuse in the BDD sample versus the OCD sample. No significant differences were found in physical abuse. Abuse may be a contributing factor in BDD, but not in OCD.     

The paradox of quetiapine in obsessive-compulsive disorder

Schizophrenia and obsessive-compulsive disorder (OCD) have historical, clinical, and epidemiological links. The clinical use of atypical neuroleptics (ie, dual serotonin-dopamine antagonists) to treat both conditions sheds a new light on them. We report the first two cases of obsessive-compulsive symptoms (OCS) induced by quetiapine in schizophrenia patients. A case of successful augmentation by quetiapine in refractory OCD is also presented. A review of the literature on OCS induced by atypical neuroleptics follows. This paradoxically induced OCD symptomology in schizophrenia patients administered atypical neuroleptics is discussed from new pathophysiological and clinical perspectives. The discussion emphasizes the prognostic implications of OCS in schizophrenia and available therapies for this comorbidity.     

Anxiety and selective attention in obsessive-compulsive disorder

Recently, there has been increasing evidence for information-processing deficits in individuals with obsessive-compulsive disorder (OCD). While impairments in selective attention have been identified to be central to the symptomatology of OCD, the role that situational anxiety plays in attentional processes has not been fully explored. Previous research findings were limited to tasks containing anxiety-relevant materials, only permitting for the evaluation of the impact of anxiety on simultaneous cognitive processing. Furthermore, it has not yet been determined whether the impact of anxiety is limited to selective attention or is indicative of a more general cognitive impairment. This study was designed to examine the role that situational anxiety plays in selective attention impairments. OCD participants and controls were presented with an anxiety producing statement and a neutral statement, followed by the Stroop Task. Results indicated that situational anxiety plays a significant role in the performance of tasks that require selective attention in OCD. A significant deterioration was detected in performance on selective attention tasks for the OCD participants after confronting anxiety-provoking scenarios, as compared to neutral scenarios. Anxiety did not impair performance on simple reading tasks. Possible explanations are discussed.     

An investigation of self-ambivalence in obsessive-compulsive disorder

Individuals vulnerable to obsessive-compulsive disorder (OCD) are hypothesized to have ambivalence about their self-worth, morality and lovability [Guidano, V., & Liotti, G. (1983). Cognitive processes and emotional disorders. New York: Guildford Press]. The purpose of this study was to examine whether self-ambivalence was associated with OCD phenomena and beliefs relevant to OCD. It also examined whether patients with OCD had higher levels of self-ambivalence compared to non-clinical controls and patients with other anxiety disorders. Participants were 73 OCD patients, 50 patients with another anxiety disorder, 225 non-clinical undergraduate students and 43 non-clinical community controls. They completed measures of self-ambivalence, OCD phenomena, OCD-relevant beliefs, depression, anxiety and self-esteem. Self-ambivalence was significantly associated with OCD phenomena and OCD-relevant beliefs, after controlling for self-esteem, depression and anxiety. Further, OCD participants were significantly more ambivalent than the non-clinical groups, but did not differ from anxious controls. It was argued that these results provide a basis for extending the cognitive-behavioural model of OCD to include ambivalent self-perceptions as a component of the cognitive mechanisms relevant to the disorder.     

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.     

Cognitive inhibition in trichotillomania and obsessive-compulsive disorder

Cognitive inhibition was investigated in 21 trichotillomania (TTM), 21 obsessive-compulsive disorder (OCD) and 26 healthy control (HC) participants using a block cued directed forgetting task. After encoding a word list, participants were instructed to intentionally FORGET these words and to REMEMBER another word list. Both lists included TTM-related and neutral (kitchen-related) words in equal proportions, with the TTM-related words generally of negative valence and the kitchen-related words generally of neutral valence for all participants. A superior free recall of REMEMBER versus FORGET words suggests intact cognitive inhibition. The performance of OCD participants indicated a specific deficit in inhibiting the retrieval of information with negative valence, which was not found in TTM. HC participants, in contrast to TTM and OCD participants, were rather inattentive to negative information. In conclusion, although attention was disproportionately directed towards negative information in both disorders, cognitive inhibition deficits appeared specific to OCD.     

Attenuation of attention bias in obsessive-compulsive disorder

Cognitive theories of obsessive-compulsive disorder (OCD) suggest that the disorder is characterized by an attention bias towards personally relevant threatening material. However, existing research on attention bias in OCD has yielded conflicting findings. One possibility that might account for the null findings is that attention bias may diminish over the course of the experiment. The present study tested this hypothesis using a visual dot-probe task with idiographic word selection. Results from our study confirmed that individuals with OC symptoms show an attention bias towards idiographically selected, threatening information in the first block of trials, and that the degree of this bias is correlated with the severity of OC symptoms. The temporal pattern of attention bias over the course of the experiment was consistent with our hypothesis. A comparison of early and late blocks of trials revealed an attenuation of attention bias in individuals with OC symptoms, potentially reflecting habituation to threatening information over the course of the experiment.     

Subtyping obsessive-compulsive disorder: neuropsychological correlates

We administered neuropsychological measures considered sensitive to prefrontal dysfunction (both orbitofrontal and dorsolateral prefrontal neocortex) to obsessive-compulsive disorder (OCD) patients and control subjects. OCD subjects exhibited performance deficits, in comparison to community controls, on three measures sensitive to orbitofrontal neocortex dysfunction. Contrary to expectation, OCD patients also exhibited performance deficits on measures sensitive to dorsolateral prefrontal neocortex dysfunction. However, distinct neurocognitive profiles emerged when we examined the impact of comorbid schizotypal personality features on neuropsychological test performance. Primary OCD patients displayed impaired performance on measures sensitive to orbitofrontal dysfunction; however, they did not differ from control subjects on tests of dorsolateral function. OCD subjects presenting with schizotypal personality features performed poorly not only on tests sensitive to orbitofrontal dysfunction, but also on tests sensitive to dorsolateral dysfunction. Findings suggest that OCD can be subdivided into clinical subtypes, and distinct prefrontal subsystems may be differentially involved in these subtypes.     

A neurocomputational approach to obsessive-compulsive disorder

A recent article shows that a change in a single parameter in a neural-network model of brain dynamics leads to repetitive behaviors that resist termination and towards which the network tends. These findings may have implications for obsessive-compulsive disorder and are consistent with evidence of glutamatergic hyperactivity in this disorder.     

Videoconferencing-based cognitive-behavioral therapy for obsessive-compulsive disorder

Obsessive-compulsive disorder (OCD) is a prevalent, chronic and disabling anxiety disorder. Despite the efficacy and strength of pharmacologic interventions for OCD, medications are not always well accepted or effective, making an efficacious psychosocial alternative especially attractive. Cognitive-behavioral therapy (CBT) has been established as an effective treatment for adult OCD, yet access to such treatment is limited, especially in rural areas. Technological advances allow for therapy to be provided in a real-time format over a videoconferencing network. This method allows therapists to provide state-of-the-art treatment to patients who would not otherwise have access to it. This paper presents three cases of OCD successfully treated via videoconferencing CBT. The presence of OCD was established via structured clinical interview and clinician-rated outcome measures were completed by evaluators blinded to the method of treatment. A multiple baseline across individuals design was used to support the internal validity of the CBT outcome data. Patient ratings of therapeutic alliance were high across all three cases. Information gathered from qualitative interviews post-treatment confirmed quantitative measures finding high levels of patient satisfaction. This pilot study suggests that videoconferencing-based CBT is a promising method to bring appropriate treatment to thousands who live far distances from well-trained therapists.     

Neurosurgical approaches to intractable obsessive-compulsive disorder

Although significant progress has been made over the last decade in the treatment of obsessive-compulsive disorder (OCD), approximately 20% of OCD patients remain refractory to nonsurgical therapies, including pharmacologic and cognitive-behavioral therapy. Because a number of neural circuits involving the basal ganglia, thalamus, limbic system, and frontal lobes have been implicated in the pathophysiology of OCD, the need for an effective intervention in these patients has brought the focus on surgical approaches, including cingulotomy and capsulotomy procedures. Unlike free-hand surgical approaches used in the past, current neurosurgical interventions have been greatly enhanced by advances in technology, which allow lesioning to an accuracy of 1 mm. Today's neurosurgical approaches have shown significant benefit in as many as 60% of refractory patients, while preserving personality and cognitive functioning and limiting morbidity. A study of gamma knife capsulotomy conducted at Brown University School of Medicine showed that 40% of patients undergoing two lesioning procedures were much or very much improved 2 years postsurgery. The inherent obstacles to conducting placebo-controlled studies in these severely ill patients mean that further study is required to identify optimal candidates for surgical intervention.