Obsessive beliefs predict cognitive behavior therapy outcome for obsessive compulsive disorder

Cognitive accounts of obsessive compulsive disorder (OCD) assert that core beliefs are crucial to the development, maintenance, and treatment of the disorder. There are a number of obsessive beliefs that are considered fundamental to OCD, including personal responsibility, threat estimation, perfectionism, need for certainty, importance of thoughts, and thought control. The present study investigated if pretreatment severity of obsessive beliefs, as well as the change in obsessive beliefs following treatment, predicted intensive, residential cognitive behavioral therapy (CBT) treatment outcome. A series of hierarchical regression analyses were carried out to investigate the relations between obsessive beliefs and treatment outcome. Results indicated that inflated pretreatment responsibility/threat estimation beliefs were significantly related to less overall obsessive compulsive (OC) symptom reduction at discharge, explaining 2% of the overall variance. Changes in obsessive beliefs broadly, and importance/control of thoughts specifically, were positively related to overall OC symptom reduction at discharge, respectively explaining 18% and 3.6% variance. Results are modestly consistent with a number of theoretical models, which argue that inflated responsibility, threat estimation, and thought control are important to the maintenance and treatment of OCD.     

Cognitive Mediation of Symptom Change in Exposure and Response Prevention for Obsessive-Compulsive Disorder

This study examined cognitive mediators of symptom change during exposure and response prevention (EX/RP) for obsessive–compulsive disorder (OCD). Based on cognitive models of OCD, obsessive beliefs were hypothesized as a mediator of symptom change. Participants were 70 patients with primary OCD receiving EX/RP either as part of a randomized controlled trial (n = 38) or in open treatment following nonresponse to risperidone or placebo in the same trial (n = 32). Blinded evaluations of OCD severity and self-report assessments of three domains of obsessive beliefs (i.e., responsibility/threat of harm, importance/control of thoughts, and perfectionism/intolerance of uncertainty) were administered during acute (Weeks 0, 4 and 8) and maintenance treatment (Weeks 12 and 24). Study hypotheses were examined using cross-lagged multilevel modeling. Contrary to predictions, the obsessive beliefs domains investigated did not mediate subsequent OCD symptom reduction. In addition, OCD symptoms did not significantly mediate subsequent change in obsessive beliefs. The present study did not find evidence of cognitive mediation during EX/RP for OCD, highlighting the need to investigate other plausible mediators of symptom improvement.     

The relationship between obsessive beliefs and symptom dimensions in obsessive-compulsive disorder

Research findings on the specific relationships between beliefs and OCD symptoms have been inconsistent, yet the existing studies vary in their approach to measuring the highly heterogeneous symptoms of this disorder. The Dimensional Obsessive-Compulsive Scale (DOCS) is a new measure that allows for the assessment of OCD symptom dimensions, rather than types of obsessions and compulsions per se. The present study examined the relationship between OCD symptom dimensions and dysfunctional (obsessive) beliefs believed to underlie these symptom dimensions using a large clinical sample of treatment-seeking adults with OCD. Results revealed that certain obsessive beliefs predicted certain OCD symptom dimensions in a manner consistent with cognitive-behavioral conceptual models. Specifically, contamination symptoms were predicted by responsibility/threat estimation beliefs, symmetry symptoms were predicted by perfectionism/certainty beliefs, unacceptable thoughts were predicted by importance/control of thoughts beliefs and symptoms related to being responsible for harm were predicted by responsibility/threat estimation beliefs. Implications for cognitive conceptualizations of OCD symptom dimensions are discussed.     

Cognitive deficits of executive functions and decision‐making in obsessive‐compulsive disorder

The nature of cognitive deficits in obsessive‐compulsive disorder (OCD) is characterized by contradictory findings in terms of specific neuropsychological deficits. Selective impairments have been suggested to involve visuospatial memory, set shifting, decision‐making and response inhibition. The aim of this study was to investigate cognitive deficits in decision‐making and executive functioning in OCD. It was hypothesized that the OCD patients would be less accurate in their responses compared to the healthy controls in rational decision‐making on a version of the Cambridge gambling task (CGT) and on the color‐word interference test and on a version of the Tower of Hanoi test (tower test) of executive functioning. Thirteen participants with OCD were compared to a group of healthy controls (n = 13) matched for age, gender, education and verbal IQ. Results revealed significant differences between the OCD group and the healthy control group on quality of decision‐making on the CGT and for achievement score on the tower test. On these two tasks the OCD group performed worse than the healthy control group. The symptom‐dimension analysis revealed performance differences where safety checking patients were impaired on the tower test compared to contamination patients. Results are discussed in the framework of cognition and emotion processing and findings implicate that OCD models should address, specifically, the interaction between cognition and emotion. Here the emotional disruption hypothesis is forwarded to account for the dysfunctional behaviors in OCD. Further implications regarding methodological and inhibitory factors affecting cognitive information processing are highlighted.     

Obsessive‐compulsive disorder across developmental trajectory: Cognitive processing of threat in children,adolescents and adults

Background . While the cognitive theory of obsessive‐compulsive disorder (OCD) is one of the most widely accepted accounts of the maintenance of the disorder in adults, no study to date has systematically evaluated the theory across children, adolescence and adults with OCD. Method . This paper investigated developmental differences in the cognitive processing of threat in a sample of children, adolescents and adults with OCD. Using an idiographic assessment approach, as well as self‐report questionnaires, this study evaluated cognitive appraisals of responsibility, probability, severity, thought‐action fusion (TAF), thought‐suppression, self‐doubt and cognitive control. It was hypothesised that there would be age related differences in reported responsibility for harm, probability of harm, severity of harm, thought suppression, TAF, self‐doubt and cognitive control. Results . Results of this study demonstrated that children with OCD reported experiencing fewer intrusive thoughts, which were less distressing and less uncontrollable than those experienced by adolescents and adults with OCD. Furthermore, responsibility attitudes, probability biases and thought suppression strategies were higher in adolescents and adults with OCD. Cognitive processes of TAF, perceived severity of harm, self‐doubt and cognitive control were found to be comparable across age groups. Conclusions . These results suggest that the current cognitive theory of OCD needs to address developmental differences in the cognitive processing of threat. Furthermore, for a developmentally sensitive theory of OCD, further investigation is warranted into other possible age related maintenance factors. Implications of this investigation and directions for future research are discussed.     

What clocks tell us about the neural correlates of spatial imagery

We review a series of experimental studies aimed at answering some critical questions about the neural basis of spatial imagery. Our group used functional magnetic resonance imaging (fMRI) to explore the neural correlates of an online behaviourally controlled spatial imagery task without need for visual presentation—the mental clock task. Subjects are asked to imagine pairs of times that are presented acoustically and to judge at which of the two times the clock hands form the greater angle. The cortical activation elicited by this task was contrasted with that obtained during other visual, perceptual, verbal, and spatial imagery tasks in several block design studies. Moreover, our group performed an event‐related fMRI study on the clock task to investigate the representation of component cognitive processes in spatial imagery. The bulk of our findings demonstrates that cortical areas in the posterior parietal cortex (PPC), along the intraparietal sulcus, are robustly involved in spatial mental imagery and in other tasks requiring spatial transformations. PPC is bilaterally involved in different kinds of spatial judgement. Yet the degree to which right and left PPC are activated in different tasks is a function of task requirements. From event‐related fMRI data we obtained evidence that left and right PPC are activated asynchronously during the clock task and this could reflect their different functional role in subserving cognitive components of visuospatial imagery.     

A high density ERP comparison of mental rotation and mental size transformation

To compare mental rotation and mental size transformation, 128-channel EEG was recorded while subjects performed both tasks using random two-dimensional shapes as stimuli. Behavioural results showed significant linear effects of both size transformation and mental rotation on reaction times. Rotation ERPs showed experimental effects at two latencies: a bilateral component distributed over posterior parietal electrodes at a latency of approximately 232-300ms and a second component at approximately 424-492ms distributed over right anterior parietal electrodes. The latency and spatial distribution of this second effect is consistent with previous research indicating a functional connection between this component and mental rotation. ERPs for the size-transformation task showed an effect at 180-228ms distributed bilaterally over occipital-temporal electrodes. These results are consistent with previous hemodynamic imaging studies that show involvement of parietal cortex in mental rotation and also the involvement of BA 19 in size-transformation tasks. However, the superior temporal resolution of the present data indicates that BA 19 activation may occur at a latency that is more likely related to apparent motion than to the size-transformation operation per se.     

Managing unwanted intrusive thoughts in obsessive-compulsive disorder: Relative effectiveness of suppression, focused distraction, and acceptance

Suppression is one of various mental control techniques that people may use to manage unwanted thoughts. Evidence suggests that it is at best unsustainable and at worst counterproductive. This leads to the question: If suppression is a futile way to respond to unwanted, intrusive thoughts, what is a more effective alternative? In the current study, we evaluated the relative effectiveness of suppression and two alternative mental control techniques—focused distraction and acceptance—on the frequency of intrusions and distress associated with them. Results support the claim that suppression is a counterproductive technique for dealing with unwanted, intrusive thoughts in OCD. However, the harmfulness of suppression was reflected primarily in the magnitude of distress and not in intrusion frequency. Focused distraction and acceptance were the more effective techniques for managing clinically significant intrusive thoughts. We discuss implications for the cognitive treatment for OCD.     

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.     

The posterior parietal paradox: Why do functional magnetic resonance imaging and lesion studies on episodic memory produce conflicting results?

Recent functional magnetic resonance imaging (fMRI) studies addressing healthy subjects point towards posterior parietal cortex (PPC) involvement in episodic memory tasks. This is noteworthy, since neuropsychological studies usually do not connect parietal lesions to episodic memory impairments. Therefore an inventory of the possible factors behind this apparent paradox is warranted. This review compared fMRI studies which demonstrated PPC activity in episodic memory tasks, with findings with studies of patients with PPC lesions. A systematic evaluation of possible explanations for the posterior parietal paradox indicates that PPC activation in fMRI studies does not appear to be attributable to confounding cognitive/psychomotor processes, such as button pressing or stimulus processing. What may be of more importance is the extent to which an episodic memory task loads on three closely related cognitive processes: effort and attention, self‐related activity, and scene and image construction. We discuss to what extent these cognitive processes can account for the paradox between lesion and fMRI results. They are strongly intertwined with the episodic memory and may critically determine in how far the PPC plays a role in a given memory task. Future patient studies might profit from specifically taking these cognitive factors into consideration in the task design.     

Pointing and the interference effect in obsessive‐compulsive disorder (OCD)

The interference effect in obsessive‐compulsive disorder (OCD) was investigated in order to analyze cognitive aspects of motor stereotypy in OCD‐related compulsions. So far, the domain of cognitive control in compulsive behavior has been under‐investigated. Twelve participants (OCD patients and healthy controls) completed a newly created computer‐based pointing task as well as standard clinical and psychological background measures. Findings showed that the patients displayed a larger visual interference effect compared to the controls and pointing paths were longer in time as well as distance when a distractor stimulus was present. It is concluded that, for compensation, patients would need to generate excessive amounts of attentional resources not available to overcome motor rigidity on the one side and visual distraction on the other side.     

Why are some obsessions more upsetting than others?

Little is known about why certain obsessional thoughts are more upsetting than others for people with obsessive compulsive disorder (OCD). Obsessional thought content often seems arbitrary to sufferers. The current study examined three possible reasons why particular thoughts would be especially upsetting for individuals, based on suggestions put forth by cognitive theories of obsessional thoughts. Twenty-eight individuals with a principal diagnosis of OCD completed questionnaires and interviews at two different periods of time on (1) their most upsetting current obsession and (2) their least upsetting current obsession. Results suggested that more upsetting obsessions were evaluated as more meaningful or significant than less upsetting obsessions, and more upsetting obsessions contradicted valued aspects of the self to a greater degree. All examples of current obsessions, both most and least upsetting, arose in the context of life concerns or issues. Results support cognitive theories in that the strength and nature of appraisal appears to be linked with the distress associated with a thought, and more upsetting thoughts are those that have implications for a person's sense of self.     

Are "obsessive" beliefs specific to OCD?: a comparison across anxiety disorders

Cognitive models of obsessive-compulsive disorder (OCD) assign a central role to maladaptive beliefs about threat, uncertainty, importance and control of thoughts, responsibility, and perfection. Previous research has demonstrated that such beliefs relate to specific OCD symptoms in a theoretically meaningful way. The aim of the present study was to determine whether these beliefs are endorsed more strongly by OCD patients than by those with other anxiety disorders. Eighty-nine adult OCD patients, 72 anxious control (AC) patients, and 33 nonclinical control (NCC) participants completed a measure of obsessive beliefs as well as measures of depression and trait anxiety. Compared to NCCs and ACs, OCD patients more strongly endorsed beliefs related to threat estimation, tolerance of uncertainty, importance and control of thoughts, and perfectionism, but not inflated responsibility. Using revised, condensed subscales, OCD patients differed from ACs on beliefs about perfectionism and certainty and about importance and control of thoughts, but not on beliefs about threat estimation and inflated responsibility. When controlling for depression and trait anxiety, the OCD and AC group did not differ on most belief domains, except for a belief that it is possible and necessary to control one's thoughts. Results are discussed in light of evolving cognitive-behavioral theories that highlight appraisals of thought control and the use and effectiveness of varying thought control strategies.     

自我控制资源与认知资源相互影响的机制:整合模型

尽管有学者认为自我控制资源和认知资源应该是两种独立的资源,但近期的研究却表明两种资源是互相影响的.以往研究从执行控制的角度解释两种资源为什么相互影响,但却没有指出两种资源如何影响执行控制,以及缺乏考虑神经机制和自我控制资源调节变量在其中的作用.为更系统地解释两种资源相互影响的机制,作者提出了一个整合模型,该模型指出:(1)两种资源相互影响的主要原因是两者都受到执行控制和前额叶皮层的影响;(2)个体进行自我控制或认知加工会消耗能量,产生心理疲劳,降低执行任务的动机,表现为前额叶皮层激活水平下降;(3)前额叶皮层激活不足进一步限制了执行控制在随后的自我控制和认知加工任务中的作用,因而影响后续自我控制或认知加工任务的表现;(4)自我控制资源调节变量通过提高个体对疲劳的耐受性、补充能量和提高动机等方法,使前额叶皮层和执行控制在完成前一阶段任务后仍然能够正常发挥作用,从而维持个体在后续自我控制或认知加工任务上的表现.未来的研究可考察自我控制资源与其他认知加工的关系;用动态的认知神经研究方法,建立前额叶皮层激活水平在前后两阶段任务之间的中介作用模型,以及研究自我控制资源调节变量的神经机制.     

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

Abstract

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

Thought control strategies in obsessive-compulsive disorder: a replication and extension

Previous research suggests that individuals with OCD use maladaptive strategies to control their unpleasant thoughts (Behav Res Ther (1977) 35, 775). These include worry and self-punishment strategies. In the present study we replicated and extended the previous findings by comparing thought control strategies used by patients with OCD to strategies used by anxious and non-anxious control participants. We also examined changes in thought control strategies for OCD patients who underwent cognitive-behavioral therapy. Compared to controls, OCD patients reported more frequent use of worry and punishment strategies, and less frequent use of distraction. Following successful treatment, OCD patients evidenced increased use of distraction and decreased use of punishment. Findings are discussed in terms of the cognitive model of OCD.     

Dissociable contributions of the left and right posterior medial orbitofrontal cortex in motivational control of goal-directed behavior

Several findings from both human neuroimaging and nonhuman primate studies suggest that the posterior medial orbitofrontal cortex (OFC) may be critical for the motivational control of goal-directed behavior. The present study was conducted to clarify the role of the left and right posterior medial OFC in that function by examining the effects of focal unilateral lesions to this region on the performance on an incentive working memory task. The study covered patients who had undergone surgery for an ACoA aneurysm and normal control subjects (C). The patients were subdivided into three groups: those with resection of the left (LGR+) or right (RGR+) posterior part of the gyrus rectus, and without such a resection (GR−). Participants performed a 2-back working memory task under three motivational conditions (penalty, reward, and no-incentive). The C group performed worse in the penalty condition and better in the reward condition as compared to the no-incentive condition. Similar results were obtained for the GR− group. Performance of the LGR+ group did not depend on incentive manipulations, whereas the RGR+ group performed better in both the penalty and reward conditions than in the no-incentive condition. The results show that the posterior medial OFC is involved in the motivational modulation of working memory performance. Our findings also suggest that the left posterior medial OFC plays a crucial role in this function, whereas the right posterior medial OFC is particularly involved in the processing of the punishing aspect of salient events and it probably mediates in guiding behavior on the basis of negative outcomes of action.     

Recruitment of lateral rostral prefrontal cortex in spontaneous and task-related thoughts

Behavioural and neuroimaging studies suggest that spontaneous and task-related thought processes share common cognitive mechanisms and neural bases. Lateral rostral prefrontal cortex (RPFC) is a brain region that has been implicated both in spontaneous thought and in high-level cognitive control processes, such as goal/subgoal integration and the manipulation of self-generated thoughts. We therefore propose that the recruitment of lateral RPFC may follow a U-shaped function of cognitive demand: relatively high in low-demand situations conducive to the emergence of spontaneous thought, and in high-demand situations depending on processes supported by this brain region. We used functional magnetic resonance imaging to investigate brain activity while healthy participants performed two tasks, each with three levels of cognitive demands, in a block design. The frequency of task-unrelated thoughts, measured by questionnaire, was highest in the low cognitive demand condition. Low and high cognitive demand conditions were each compared to the intermediate level. Lateral RPFC and superior parietal cortex were recruited in both comparisons, with additional activations specific to each contrast. These results suggest that RPFC is involved both when (a) task demands are low, and the mind wanders, and (b) the task requires goal/subgoal integration and manipulation of self-generated thoughts.     

Cognitive control of obsessional thoughts

A defining characteristic of obsessive-compulsive disorder (OCD) is unsuccessful suppression of unwanted thoughts. Recent evidence of individual differences in ability to control intrusive thoughts may inform our understanding of failures of cognitive control associated with OCD symptomatology. The current study investigated characteristics of cognitive style that are potentially associated with OCD symptoms and may influence response to unwanted thoughts, including perceived ability to control thoughts and tendency to ruminate. Undergraduate students (N = 166) completed self-report measures of OCD symptoms, perceived thought control, and ruminative thinking. They were then presented with a distressing target thought and completed a standard thought suppression paradigm. Correlational results indicated that, controlling for anxiety and depression, OCD symptoms were positively associated with rumination and inversely associated with perceived thought control ability. In addition, OCD symptoms were associated with higher levels of distress and greater spontaneous efforts to suppress the target thought during a baseline period, while perceived thought control ability predicted frequency of target thoughts during suppression. Finally, results of the experimental manipulation confirmed that participants instructed to suppress experienced more intrusions during the recovery period. Clinical implications and future directions are discussed.