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.     

Cognitive confidence in obsessive-compulsive disorder: distrusting perception, attention and memory

Previous studies have established that obsessive-compulsive disorder (OCD) is characterised by significant levels of distrust in memory (e.g. for actions). Ironically, this lowered confidence is at least in part due to repeated checking, which is assumed to lower perceptual processing and thereby reduces vividness and detail of the recollections. In a previous study, Hermans, D., Martens, K., De Cort, K., Pieters, G., and Eelen, P. [(2003). Reality monitoring and metacognitive beliefs related to cognitive confidence in OCD. Behaviour Research and Therapy, 41, 383-401] observed that OCD is not only characterised by reduced confidence in memory, but also by a similar distrust in attention (Hermans et al., 2003). The present study aimed at replicating and extending this finding. It was observed (a) that patients suffering from OCD showed less confidence in attention and memory than a clinical and a nonclinical control group; (b) that confidence in attention was uniquely related to checking behaviour, and (c) that repeated checking caused increased levels of distrust in attention. In addition, it was observed that cognitive distrust while performing OCD-related actions not only extends to attention, but also to perception. It is argued that research on metacognition in OCD should move beyond the study of memory.     

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.     

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.     

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.     

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.     

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.     

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.     

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.     

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.     

A longitudinal study of adolescents' recollections of family violence

This investigation focuses on adolescents' recollections of childhood exposure to aversive events and the extent to which such recollections are related to variables from the traditional memory literature. Participants (n=153) were questioned about mother‐directed abuse, child‐directed abuse and punishment, and nonabusive events documented 6 years earlier. The teens forgot many details of family aggression, particularly when their mothers were the victims. Thirty‐four per cent of those exposed to spousal violence failed to remember or report it, and 20% forgot or failed to report child abuse or punishment. Few participants exposed to escalated violence remembered and reported it, although almost all reported less severe aggression. Remembering was positively related to other measures of nontraumatic autobiographical memory, age, negative attitudes about the abuser, and recent exposure to family aggression. The results suggest that recollections of childhood abuse can be explained in part by variables that apply to a wide range of memory tasks. Copyright © 2005 John Wiley & Sons, Ltd.     

Deficits in set-shifting ability in nonclinical compulsive checkers

Recent studies suggest deficits in set-shifting ability in patients with obsessive-compulsive disorder (OCD) as measured by tasks such as the Wisconsin Card Sorting Test (WCST; Berg, 1948). The present study examined the extent to which these deficits were demonstrated by nonclinical subjects selected on the basis of their checking scores on the Maudsley Obsessional-Compulsive Inventory. A multivariate analysis revealed that frequent checkers performed significantly worse on the WCST than noncheckers, making more total errors and more perseverative errors and requiring more time to complete the test. A follow-up analysis on a subset of the original sample found similar performance deficits in checkers. While the poorer performance of checkers could be statistically accounted for by anxiety during the first administration of the WCST, anxiety could not explain the relationship between checking status and WCST performance at follow-up. Therefore, there does appear to be some relationship between checking status and WCST performance beyond what can be explained by affective variables.     

Memory in sub-clinical obsessive-compulsive checkers

In a series of experiments we extended the research on possible memory deficits in subclinical obsessive-compulsive Ss who reported excessive checking. Using a variety of memory tests we compared 20 subclinical checkers to 20 Ss without obsessive-compulsive symptomatology. Contrary to hypothesis, checkers remembered self-generated words better than read words just as much as did normals, but they were more likely than normals to report thinking they had studied words that, in fact, had not been on the study list. Further, they more often confused whether they read or generated the words at study. Checkers did not appear to perseverate on already-recalled words on repeated free recall tests any more than did normals. However, checkers remembered fewer actions overall and more often misremembered whether they had performed, observed, or written these actions. Such memory deficits may contribute to the development of excessive checking.     

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.     

The identity function of autobiographical memory: time is on our side

Autobiographical memory plays an important role in the construction of personal identity. We review evidence of the bi-directional link between memory and identity. Individuals' current self-views, beliefs, and goals influence their recollections and appraisals of former selves. In turn, people's current self-views are influenced by what they remember about their personal past, as well as how they recall earlier selves and episodes. People's reconstructed evaluations of memories, their perceived distance from past experiences, and the point of view of their recollections have implications for how the past affects the present. We focus on how people's constructions of themselves through time serve the function of creating a coherent--and largely favourable--view of their present selves and circumstances.     

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 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.     

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.     

Relationships between anger, symptoms, and cognitive factors in OCD checkers

The purpose of this study was to examine whether individuals diagnosed with obsessive-compulsive disorder (OCD) with primary checking compulsions report higher levels of trait anger and anger expression compared with a student control group, and whether trait anger and anger expression are correlated with specific beliefs and interpretations that are common among individuals who compulsively check. A group of individuals with OCD reporting significant checking compulsions (n=33) and a group of undergraduate students (n=143) completed a questionnaire package that included measures of trait anger and anger expression, as well as measures of obsessive-compulsive symptoms and beliefs. The compulsive checking group reported greater trait anger, though not greater anger expression, than the student control group. Furthermore, beliefs concerning perfectionism and intolerance of uncertainty were positively correlated with anger expression and trait anger among compulsive checkers but not among the student control group. The implications of these findings are discussed in terms of cognitive-behavioural treatments for and models of compulsive checking in OCD.