The Treatment of Mental Contamination: A Case Series

The recommended treatment for obsessive-compulsive disorder (OCD) is cognitive behavior therapy (CBT) incorporating exposure and response prevention (ERP), which is effective for approximately 50% of patients. However, there has been little advance in treatment outcomes since the introduction of ERP in 1979. It has been suggested that some progress can be made in treating contamination obsessions and washing compulsions by addressing feelings of dirtiness and contamination that arise without physical contact with a tangible contaminant. To date, the treatment of these “mental contamination” fears in OCD has not been systematically explored. This paper reports on a case series of 12 participants with OCD who received 10 to 20 sessions of a CBT-based treatment for mental contamination. At the end of treatment, 7 participants no longer met the diagnostic criteria for OCD and mental contamination and these gains were maintained at 6-month follow-up. The clinical implications of these findings are discussed.     

Biased interpretation in perfectionism and its modification

Perfectionism is a transdiagnostic construct associated with a range of diagnoses, including depression, eating disorders and obsessive compulsive disorder. Treatments that directly target perfectionist cognitions have been shown to successfully reduce associated pathologies. However, the way in which they do this is not clear. We set out to assess the role of one candidate mechanism of action, namely the cognitive process of interpretation of ambiguity. In one experiment we looked for associations between biased interpretation and perfectionism. In a second, we manipulated interpretations, thereby providing a strong test of their aetiological significance. Results from the first experiment confirmed the presence of biased interpretation in perfectionism and demonstrated that these are highly specific to perfection relevant information, rather than reflecting general negativity. The second experiment succeeded in manipulating these perfection relevant interpretations and demonstrated that one consequence of doing so is a change in perfectionist behaviour. Together, these data experimentally demonstrate that biased interpretation of perfection relevant ambiguity contributes to the maintenance of perfectionism, but that it is also possible to reverse this. Clinical implications include the identification of one likely mechanism of therapeutic change within existing treatments, as well as identification of an appropriate evidence-based focus for future treatment development. Targeting underlying functional mechanisms, such as biased interpretation, has the potential to offer transdiagnostic benefits.     

Educational risk factors for psychological truancy in Lesotho: a qualitative exploration

A qualitative case study design was used to explore educational risk factors that may contribute to psychological truancy in a Lesotho secondary school. Purposively sampled teachers (n = 4, females = 50%) and pupils (n = 4, females = 75%), who have experience of psychological truancy, took part in a focus group and individual interviews. Inductive content analysis was used to analyse data emanating from the interviews. The findings indicate that pupil–teacher relationships, the use of English as medium of instruction and a lack of resources may be educational risk factors contributing to psychological truancy. Positive pupil–teacher relationships and active classroom engagement are prerequisites for successful and active learning.     

The role of schizotypy and creativity in a group problem-solving task

The well-studied link between psychotic traits and creativity is a subject of much debate. The present study investigated the extent to which schizotypic personality traits – as measured by O-LIFE (Oxford–Liverpool Inventory of Feelings and Experiences) – equip healthy individuals to engage as groups in everyday tasks. From a sample of 69 students, eight groups of four participants – comprised of high, medium, or low-schizotypy individuals – were assembled to work as a team to complete a creative problem-solving task. Predictably, high scorers on the O-LIFE formulated a greater number of strategies to solve the task, indicative of creative divergent thinking. However, for task success (as measured by time taken to complete the problem) an inverted U shaped pattern emerged, whereby high and low-schizotypy groups were consistently faster than medium schizotypy groups. Intriguing data emerged concerning leadership within the groups, and other tangential findings relating to anxiety, competition and motivation were explored. These findings challenge the traditional cliché that psychotic personality traits are linearly related to creative performance, and suggest that the nature of the problem determines which thinking styles are optimally equipped to solve it.     

The Impact of Conflict Issues on Fixed-Pie Perceptions, Problem Solving, and Integrative Outcomes in Negotiation

It is argued that a negotiator's fixed-pie perception, cooperative motivation, problem-solving behavior, and integrative outcomes are influenced by the content of the negotiation—the conflict issue. Negotiation involves conflicting interests, conflicting ideas about intellective problems, or conflicting ideas about evaluative problems. Study 1 showed that individuals in a negotiation about interests have a stronger fixed-pie perception and have a lower cooperative motivation than individuals in an evaluative negotiation, with intellective negotiations taking an intermediate position. Study 2 showed that individuals in a negotiation about interests made more trade-offs and reached higher joint outcomes than individuals in an intellective or evaluative negotiation. Study 3 replicated this finding in a field study. The studies bridge insights from negotiation research and decision-making research and show that the conflict issue has important effects on the negotiation process.     

Fishing for happiness: the effects of generating positive imagery on mood and behaviour

Experimental evidence using picture-word cues has shown that generating mental imagery has a causal impact on emotion, at least for images prompted by negative or benign stimuli. It remains unclear whether this finding extends to overtly positive stimuli and whether generating positive imagery can increase positive affect in people with dysphoria. Dysphoric participants were assigned to one of three conditions, and given instructions to generate mental images in response to picture-word cues which were either positive, negative or mixed (control) in valence. Results showed that the positive picture-word condition increased positive affect more than the control and negative conditions. Participants in the positive condition also demonstrated enhanced performance on a behavioural task compared to the two other conditions. Compared to participants in the negative condition, participants in the positive condition provided more positive responses on a homophone task administered after 24h to assess the durability of effects. These findings suggest that a positive picture-word task used to evoke mental imagery leads to improvements in positive mood, with transfer to later performance. Understanding the mechanisms underlying mood change in dysphoria may hold implications for both theory and treatment development.     

Cognitive-Behavior Therapy for Compulsive Checking in OCD

There is substantial evidence for the effectiveness of psychological treatments for OCD, and various approaches have been widely recommended. These approaches tend to be characterized by exposure and response prevention (ERP) and also tend to be applied equally to all forms of OCD. Patients/clients (and some therapists) often find ERP to be a difficult treatment, and both dropout and refusal rates are unacceptably high. Based on specific cognitive conceptualizations of different manifestations of OCD, new and refined cognitive treatment methods are now available. The present article describes a specific cognitively based approach to the treatment of compulsive checking.