Directed forgetting in obsessive-compulsive disorder: replication and extension

Previous research indicates that patients with obsessive-compulsive disorder (OCD) show impaired ability to forget negative material (Behav Res Ther 34 (1996) 633). The present study was intended to replicate and extend these findings by separating emotional valence from personal relevance, using idiographic stimulus selection to control for heterogeneity of OCD concerns, and the addition of an anxious control group. We used a directed forgetting paradigm, in which participants were instructed to either remember or forget a series of words. No differences in impairment were found among the groups during a free recall test, in which they were asked to recall both "remember" and "forget" words. However, during a recognition test, OCD patients showed greater impaired forgetting for OCD-relevant words than did nonanxious and anxious controls. Valence of words did not emerge as a contributing factor to impaired forgetting.     

Cognitive processing of emotional information in panic disorder.

Panic-disordered (PD) patients, obsessive-compulsive (OCD) patients, and normal control subjects were exposed to either a high (i.e. exercise) or low arousal manipulation prior to performing a computerized version of the modified Stroop color-naming paradigm. Subjects named the colors of neutral nonlexical stimuli, positive words, and threat words associated with fear, bodily sensations, and catastrophes. After the Stroop task, subjects rated the personal emotional significance of the words. Inconsistent with the emotionality hypothesis of Stroop interference, PD patients rated positive words as more emotional than catastrophe words, but took longer to color-name the latter than the former. Yet consistent with the emotionality hypothesis, PD patients took as long to color-name positive words as to color-name fear and bodily sensation words. Contrary to expectation, OCD patients resembled PD patients in terms of interference, and arousal did not enhance interference for threat words in PD patients.     

Anxiety sensitivity, conscious awareness and selective attentional biases in children

The current study investigated whether physical anxiety sensitivity (AS) is associated with selective attentional biases to affective stimuli in children. The dot-probe paradigm was used to examine the deployment of attention towards words pertaining to anxiety symptomatology, socially threatening words, and positive words, in samples of 8-10-year-old children. Word pairs were presented under both masked and unmasked conditions. Irrespective of masking, children high in physical AS displayed an attentional vigilance for emotional words relative to neutral words, whereas those low in physical AS displayed a relative avoidance of such material. The results of this study are interesting as they not only suggest the presence of automatic AS-related biases in childhood, but that this is a general emotionality bias rather than one related to specific anxiety-related stimuli.     

Does anxiety lead to selective processing of threat-related information?

Four experiments investigating the detailed nature of the attentional bias in anxiety are reported. Previous research using the Stroop task has shown that, when compared with non-patient controls, anxious patients are relatively slower at colour naming threat-related words than non-threat words. Experiments One and Two investigated whether this apparent attentional bias is a function of anxiety per se and/or is related to patient/non-patient status. Experiment One compared colour-naming times for threat and non-threat words in low, medium and high trait anxiety normal subjects. High anxiety was not associated with slower colour-naming times for threat words. Experiment Two compared generalized anxiety disorder patients with equally anxious non-patients and found that the patients were significantly slower at colour-naming threat words. Read aloud and dwell tasks were also included in these experiments in order to identify the mechanism of Stroop interference. Experiments Three and Four investigated whether anxious patients' attentional bias is specific to threat-related material or also extends to certain positive, emotional material. In Experiment Three words used in previous Stroop studies were rated for emotionality. Threat words were more emotional, as well as more threatening, than control words, indicating that previous studies have confounded threat and emotionality. Experiment Four compared colour-naming times for threat words, equally emotional positive words, and neutral words. Consistent with the emotionality hypothesis, generalized anxiety disorder patients were slower than non-anxious controls at colour naming both threat words and positive words. The theoretical, methodological and clinical implications of these results are discussed.     

Words may not be enough! No increased emotional Stroop effect in obsessive-compulsive disorder

Conflicting evidence has been obtained whether or not patients diagnosed with obsessive-compulsive disorder (OCD) share an attentional bias towards disorder-related stimuli. Some of these inconsistencies can be accounted for by suboptimal stimuli selection. In consideration of the heterogeneity of OCD, we investigated Stroop interference effects for two classes of OCD items (i.e., washing and checking) in 23 OCD patients and 23 healthy controls. In order to cover prevalent OCD concerns, item compilation was based on experts' appraisals. Patients neither displayed greater immediate as well as delayed Stroop interference nor any bias for OCD and subtype-congruent stimuli. On the contrary, for washing-related items, OCD patients, and here especially washers, displayed facilitation relative to healthy controls. Although the present study at first sight refutes the notion of an attentional bias in OCD in contrast to other anxiety disorders, several potential moderators need to be considered before this account is ultimately dismissed. In particular, an attentional bias may only be elicited using visual material that is more attention-grabbing than verbal stimuli. Finally, blockwise instead of random item administration and greater consideration of individual relevance may be crucial prerequisites for the effect to emerge.     

高强迫倾向个体注意脱困的电生理证据

对威胁信息的注意偏向可能是导致和维持强迫症症状的重要因素之一。本研究采用情绪Stroop范式,同时结合ERP技术,对强迫倾向个体注意偏向的时间进程进行研究,以期探究强迫倾向个体注意偏向的神经机制特点。结果发现,高强迫倾向个体对强迫症相关消极词比一般消极词和中性词表现出了更大的P2和LPPs振幅。实验结果表明,高强迫倾向个体对强迫症相关消极词表现出注意偏向,其成分为注意脱困,既表现在早期自动加工阶段的P2成分上也表现在晚期策略加工阶段的LPPs成分上。     

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.     

Preattentive bias for emotional information in panic disorder with agoraphobia.

A combined emotional Stroop and implicit memory (tachistoscopic identification) task with 3 types of words (panic-related, interpersonal threat, and neutral words) and 2 exposure conditions (subliminal, supraliminal) was administered to 35 patients with panic disorder and 35 age- and sex-matched controls. The patients showed Stroop interference for panic-related words both sub- and supraliminally and a similar but not equally robust effect on interpersonal threat words. On the tachistoscopic identification task, the patients identified more panic-related words than the controls did but showed no implicit memory bias effect. The patients' subliminal Stroop interference for panic-related words was found to correlate with trait anxiety and depression, although not with anxiety sensitivity.     

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.     

Do obsessional beliefs discriminate OCD without tic patients from OCD with tic and Tourette's syndrome patients?

There is considerable overlap in symptomatology between Tourette's syndrome (TS) and obsessive-compulsive disorder (OCD). Increased rates of tics are found in OCD and up to 60% obsessive-compulsive symptoms in TS. However, in OCD obsessive-compulsive symptoms are more often anxiety-related and, as a consequence, aimed at anxiety-reduction, whereas in TS these symptoms are more stimulus-bound. Therefore, it is of clinical interest to study whether these phenomenological differences are reflected in differences between dysfunctional cognitions accompanying OC symptoms in OCD with or without tics and TS. Current cognitive theory of OCD ascertains that specific dysfunctional beliefs are important in the etiology and maintenance of OCD. To assess these beliefs, the obsessive-compulsive beliefs questionnaire-87 (OBQ-87) has been developed. In the present study, OBQ-87 scores of OCD patients without tics, OCD with tics, and TS (without OCD) patients were compared to those of normal controls. Results: OCD without tic patients exhibited higher OBQ-87 scores than TS patients. No differences were found between OCD with or without tic patients on any of the OBQ-87 subscales. These results suggest that: (1) dysfunctional beliefs have no discriminative power with respect to OCD with or without tic patients; (2) the direct relationship between types of OC symptoms and specific dysfunctional beliefs is questionable. Therefore, one can doubt the specificity of cognitive theory of OCD to explain specific OC behavior.     

Independent manipulation of emotion in an emotional stroop task using classical conditioning

The effects of emotional connotation on emotional Stroop interference in anxiety were examined. First, a classical conditioning paradigm was used in which neutral words and nonwords were paired with either negative or neutral pictures. These conditioned stimuli were then presented in an emotional Stroop paradigm. Finally, participants rated each word and nonword for emotional connotation. The high-anxious group demonstrated significant interference for the nonwords that had been negatively conditioned, and these effects did not dissipate over time. The affective rating data supported the view that nonwords, but not the words had been successfully conditioned in the high-anxious group. This experiment provides evidence for the importance of emotional connotation rather than confounded semantic factors in the emotional Stroop effect.     

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.     

Emotion and adherence to treatment in people with asthma: An application of the emotional Stroop paradigm

This study explored whether an emotional Stroop paradigm might represent an appropriate means of assessing individuals' emotional representations of asthma. In addition, the opportunity was taken to investigate whether emotional representations of asthma, as assessed by this method, were associated with adherence to inhaled preventative medication. An asthma Stroop task was devised which comprised three sets of stimuli: asthma symptom words, general negative words, and neutral words. Three groups of participants were compared on their performance on this task: individuals with asthma, individuals without asthma, and individuals without asthma who had been primed about the condition. It was found that individuals with asthma experienced significantly more interference when colour‐naming the asthma symptom words, but not when colour‐naming the general negative words. Furthermore, their performance on the asthma Stroop task was associated with self‐reported adherence levels. Specifically, individuals who reported the highest and lowest levels of adherence displayed more interference when colour‐naming the asthma symptom words than individuals with intermediate levels of adherence. It is concluded that the emotional Stroop paradigm might provide an objective and sensitive means of assessing individuals’ emotional representations of illness. Additionally, it is proposed that emotional responses to illness should be assessed and included in research designed to explain health behaviours and, furthermore, that such research should not assume that any relationship between emotional representations and health behaviours will be linear.     

Attention bias towards personally relevant stimuli: the individual emotional Stroop task

The emotional Stroop task is a widely used method for investigating attentional bias towards stimuli due to mood or affect. In general, standardized stimuli are used, which might not be appropriate when investigating individual contextual frameworks. It was investigated whether words chosen to be related to individuals' personal life events would produce more pronounced Stroop interference (as an indicator of attentional bias) than stimuli without any personal relevance. Twenty-six nonclinical subjects, 20 female and 6 male, participated in the study. Mean age was 36.1 yr. (SD = 18.1). All were recruited by means of local advertising. Stimulus material consisted of four word types: personal words related to negative life events with and without current personal relevance, and negative and neutral words without any personal relevance. Words were presented in three blocks. Analysis of variance showed main effects for word type and blocks, with slower reactions in the personally relevant conditions than in the negative, or neutral conditions, and in response to the first blocks as opposed to the last. These findings indicate that regardless of the word valence, personally relevant stimuli evoke more pronounced Stroop interference than do stimuli without personal relevance.     

“Why Am I so Anxious?” A Study of Attention Bias in Obsessive Compulsive Disorder

Previous research investigating attentional bias has produced intriguingly equivocal results. The present large-scale study explored attentional bias in subjects diagnosed with obsessive-compulsive disorder (OCD) and in a control group (n = 80) using the Emotional Stroop Test. Results clearly indicated poorer performances across the board amongst patients diagnosed with OCD compared to the control group, particularly in the case of anxiety-related stimuli. This paper discusses, in the light of current models of attentional bias towards threat in anxiety disorders, the processes whereby attentional bias towards anxiety stimuli might play a vital role in the causation and maintenance of OCD.     

Children’s emotional norms for 600 French words

The present study provides a French child database containing a large corpus of words (N=600) that were rated on emotional valence (positive, neutral, and negative) by French children differing in both age (5, 7, and 9 years old) and sex (girls and boys). Good response reliability was observed in each of the three age groups. The results showed some age differences in the children’s ratings. With increasing age, the percentage of words rated positive decreased, whereas the percentage of neutral words increased and the percentage of negative words remained stable. Our study did not reveal marked differences across sex groups. The database compiled here should become a useful tool for experimental studies in which verbal material is used with children. It would be worthwhile in future research to study how children process emotional words and also to control the emotional variable in the same way as other linguistic variables in the experimental design. The norms from this study may be downloaded from brm.psychonomic-journals.org/content/supplemental.     

Updating the contents of working memory in depression: interference from irrelevant negative material

This study was designed to assess the effects of irrelevant emotional material on the ability to update the contents of working memory in depression. For each trial, participants were required to memorize 2 lists of emotional words and subsequently to ignore 1 of the lists. The impact of irrelevant emotional material on the ability to update the contents of working memory was indexed by response latencies on a recognition task in which the participants decided whether or not a probe was a member of the relevant list. The authors compared response latencies to probes from the irrelevant list to response latencies to novel probes of the same valence (intrusion effect). The results indicate that, compared to control participants in both neutral and sad mood states, depressed participants showed greater intrusion effects when presented with negative words. In an important finding, intrusion effects for negative words were correlated with self-reported rumination. These findings indicate that depression is associated with difficulties removing irrelevant negative material from working memory. Results also indicate that the increased interference from irrelevant negative material is associated with rumination.     

Cognitive processing of personally relevant information

Abstract

Subjects performed an idiographic, computerised version of the modified Stroop colour-naming task after having undergone a film-induced mood manipulation designed to produce either anxiety, elation, or a neutral mood. The Stroop stimuli were words related either to the subject's positive current concerns (e.g. goals, interests), to the subject's negative current concerns (e.g. personal worries), or to neither. The results indicated that words strongly related to subject's positive as well as to negative current concerns produced significantly more Stroop interference than did words unrelated or weakly related to their current concerns. Although the films strongly influenced the subjects' moods in predicted directions initially, mood changes were largely not maintained throughout the experiment. Thus, it is not surprising that no significant interactions with word type were found. These results indicate that the “emotional Stroop effect” occurs in normal subjects as well as in anxious patients, and occurs with positive as well as with negative material of strong personal relevance.     

A follow-up study of cognitive bias in generalized anxiety disorder

Patients with generalized anxiety disorder (GAD) without concurrent depression (n = 11) and normal controls (n = 17) were tested twice, about 2 months apart, on a modified Stroop colour-naming task, which presented anxiety-related, depression-related and neutral words in masked and unmasked exposure conditions. GAD patients received cognitive behaviour therapy in the test-retest interval, and were also retested at follow-up, about 20 months after initial testing. GAD patients showed interference in colour-naming negative words across both masked and unmasked conditions before treatment, but not post-treatment, compared with controls. Reduced interference effects of masked threat words over time correlated with reduced ratings of anxious thoughts at post-treatment, and at follow-up, in GAD patients. Thus, the preconscious bias for threat information in GAD appears to vary over time in association with changes in anxious thoughts and worries.     

Influence of affective valence on working memory processes

Recent research has revealed widespread effects of emotion on cognitive function and memory. However, the influence of affective valence on working or short-term memory remains largely unexplored. In two experiments, the present study examined the predictions that negative words would capture attention, that attention would be difficult to disengage from such negative words, and that the cost of attention switching would increase the time required to update information in working memory. Participants switched between two concurrent working memory tasks: word recognition and a working memory digit updating task. Experiment 1 showed substantial switching cost for negative words, relative to neutral words. Experiment 2 replicated the first experiment, using a self-report measure of anxiety to examine if switching cost is a function of an anxiety-related attention bias. Results did not support this hypothesis. In addition, Experiment 2 revealed switch costs for positive words without the effect of the attention bias from anxiety. The present study demonstrates the effect of affective valence on a specific component of working memory. Moreover, findings suggest why affective valence effects on working memory have not been found in previous research.