Non-clinical Control Participants Research Articles

Reduced tactile sensitivity is associated with mild cognitive impairment

Sensory impairment has been related to age-associated cognitive decline. While these associations were investigated primarily in the auditory and visual domain, other senses such as touch have rarely been studied. Thus, it remains open whether these results are specific for particular sensory domains, or rather point to a fundamental role of sensory deficits in cognitive decline. Data from 31 participants with mild cognitive impairment (MCI), 46 participants with frailty, and 23 non-clinical control participants (NCCs) were included. We assessed sensory function using visual acuity and contrast sensitivity, hearing threshold, and mechanical detection threshold. Cognitive function in participants with MCI was assessed using associative memory performance. Group differences on sensory thresholds were tested using analyses of covariance with age, sex, and years of education as covariates. Associations between measures within participants with MCI were evaluated using Spearman correlations. We found a significant difference in mechanical detection threshold between the groups (p<0.001, η2=0.18). Participants with MCI showed significantly reduced tactile sensitivity compared to participants with frailty and NCCs. In participants with MCI, lower associative memory performance was significantly related to reduced tactile sensitivity (rs=0.39, p=0.031) and auditory acuity (rs=0.41, p=0.022). Our results indicate that reduced tactile sensitivity is related to cognitive decline. Prospective studies should investigate the age-related alterations of multimodal sensory processes and their contribution to dementia-related processes. Deutsche Forschungsgemeinschaft (FL 156/41-1) and a grant of the Hector-Stiftung II, Weinheim, Germany.

The temporal dynamics of dissociation: protocol for an ecological momentary assessment and laboratory study in a transdiagnostic sample

BackgroundDissociation is a ubiquitous clinical phenomenon. Dissociative disorders (DD) are primarily characterized by dissociation, and dissociative states are also a criterion for borderline personality disorder (BPD) and the dissociative subtype of post-traumatic stress disorder (PTSD). Dissociative reactions (e.g., depersonalization/derealization or gaps in awareness/memory) across diagnostic categories are believed to be affect contingent and theorized to serve affect regulation functions. What is not clear, however, is how self-reported affect and physiological reactivity unfold within dissociative episodes. To address this issue, the present project aims to investigate the hypothesis (1) whether self-reported distress (as indicated by arousal, e.g., feeling tense/agitated, and/or valence, e.g., feeling discontent/unwell) and physiological reactivity increase before dissociative episodes and (2) whether self-reported distress and physiological reactivity decrease during and after dissociative episodes in a transdiagnostic sample of patients with DD, BPD, and/or PTSD.MethodsWe will use a smartphone application to assess affect and dissociation 12 times per day over the course of one week in everyday life. During this time, heart and respiratory rates will be remotely monitored. Afterwards, participants will report affect and dissociative states eight times in the laboratory before, during, and after the Trier Social Stress Test. During the laboratory task, we will continuously record heart rate, electrodermal activity, and respiratory rate, as well as measure blood pressure and take salivary samples to determine cortisol levels. Our hypotheses will be tested using multilevel structural equation models. Power analyses determined a sample size of 85.DiscussionThe project will test key predictions of a transdiagnostic model of dissociation based on the idea that dissociative reactions are affect contingent and serve affect regulation functions. This project will not include non-clinical control participants. In addition, the assessment of dissociation is limited to pathological phenomena.

Reduced coupling between offline neural replay events and default mode network activation in schizophrenia.

Schizophrenia is characterized by an abnormal resting state and default mode network brain activity. However, despite intense study, the mechanisms linking default mode network dynamics to neural computation remain elusive. During rest, sequential hippocampal reactivations, known as 'replay', are played out within default mode network activation windows, highlighting a potential role of replay-default mode network coupling in memory consolidation and model-based mental simulation. Here, we test a hypothesis of reduced replay-default mode network coupling in schizophrenia, using magnetoencephalography and a non-spatial sequence learning task designed to elicit off-task (i.e. resting state) neural replay. Participants with a diagnosis of schizophrenia (n = 28, mean age 28.2 years, range 20-40, 6 females, 13 not taking antipsychotic medication) and non-clinical control participants (n = 29, mean age 28.1 years, range 18-45, 6 females, matched at group level for age, intelligence quotient, gender, years in education and working memory) underwent a magnetoencephalography scan both during task completion and during a post-task resting state session. We used neural decoding to infer the time course of default mode network activation (time-delay embedding hidden Markov model) and spontaneous neural replay (temporally delayed linear modelling) in resting state magnetoencephalography data. Using multiple regression, we then quantified the extent to which default mode network activation was uniquely predicted by replay events that recapitulated the learned task sequences (i.e. 'task-relevant' replay-default mode network coupling). In control participants, replay-default mode network coupling was augmented following sequence learning, an augmentation that was specific for replay of task-relevant (i.e. learned) state transitions. This task-relevant replay-default mode network coupling effect was significantly reduced in schizophrenia (t(52) = 3.93, P = 0.018). Task-relevant replay-default mode network coupling predicted memory maintenance of learned sequences (ρ(52) = 0.31, P = 0.02). Importantly, reduced task-relevant replay-default mode network coupling in schizophrenia was not explained by differential replay or altered default mode network dynamics between groups nor by reference to antipsychotic exposure. Finally, task-relevant replay-default mode network coupling during rest correlated with stimulus-evoked default mode network modulation as measured in a separate task session. In the context of a proposed functional role of replay-default mode network coupling, our findings shed light on the functional significance of default mode network abnormalities in schizophrenia and provide for a consilience between task-based and resting state default mode network findings in this disorder.

Early life stress in adults with hoarding disorder: A mixed methods study

BackgroundTraumatic life events are common among individuals with hoarding disorder (HD), though rates of posttraumatic stress disorder are no higher than in other groups. HD symptoms typically begin to appear in mid-childhood, and early life stress (ELS) is a known associated feature of negative mental health outcomes. The specifics of this relationship are still unclear. MethodsWe obtained Early Life Stress Questionnaire (ELSQ) responses from 35 participants with HD, 22 participants with obsessive-compulsive disorder (OCD), and 23 non-clinical control participants. We combined these quantitative data with qualitative interviews exploring what role ELS experiences play in HD. ResultsPer the ELSQ, individuals with HD reported significantly more ELS events than the non-clinical control participants. In qualitative interviews, HD participants described the ELS events that were most impactful in shaping their relationship to material possessions; these events tended to be long in duration and elicited feelings of scarcity of emotional support. Participants described relying on possessions in place of relationships and viewed possessions as potential sources of connection to peers. ConclusionsOur qualitative and quantitative results build on the cognitive behavioral model of HD, emphasizing early experiences of prolonged stress or scarcity of emotional support as a key contributing vulnerability factor. Specific differences are consistent with earlier research that people with HD experience absence of early warmth. They further suggest that screening for ELS experiences is important when working with individuals with HD, and that HD treatments may benefit from increased focus on social and emotional connection building.

Are people with obsessive-compulsive disorder under-confident in their memory and perception? A review and meta-analysis.

People with obsessive-compulsive disorder (OCD) tend to distrust their memory, perception, and other cognitive functions, and many OCD symptoms can be traced to diminished confidence in one's cognitive processes. For example, poor confidence in recall accuracy can cause doubt about one's memory and motivate repeated checking. At the same time, people with OCD also display performance deficits in a variety of cognitive tasks, so their reduced confidence must be evaluated in relation to their actual performance. To that end, we conducted an exhaustive review and meta-analysis of studies in which OCD participants and non-clinical control participants performed cognitive tasks and reported their confidence in their performance. Our search resulted in 19 studies that met criteria for inclusion in the quantitative analysis, with all studies addressing either memory or perception. We found that both performance and reported confidence were lower in OCD than in control participants. Importantly, however, confidence was more impaired than performance in participants with OCD. These findings suggest that people with OCD are less confident in their memory and perception than they should be, indicating a genuine under-confidence in this population. We discuss potential mechanisms that might account for this finding and suggest avenues for further research into under-confidence and related meta-cognitive characteristics of OCD.

Adverse childhood experiences in patients with severe health anxiety: No evidence for an increased frequency compared to patients with obsessive-compulsive disorder.

Theoretical models of health anxiety emphasize adverse childhood experiences in the development of the disorder, but few studies examine such events in patients with severe health anxiety and the results are difficult to compare across studies. The present study examined adult retrospective reports of illness-related and traumatic childhood experiences in 31 patients with severe health anxiety, 32 non-clinical control participants, and a clinical control group of 33 patients with obsessive-compulsive disorder. No evidence of an increased frequency of adverse childhood experiences in patients with severe health anxiety was found. However, patients with severe health anxiety who had experienced the death of a friend or family member or a major upheaval during childhood, perceived these events as having been more traumatic than the control participants. These findings suggest that biases in how adverse childhood experiences are interpreted or remembered might play a role in severe health anxiety. The findings are discussed in relation to the cognitive behavioral model of health anxiety, and some of the processes in interpretation and memory that could explain how adverse childhood experiences might play a role in the development and maintenance of severe health anxiety are outlined.

Attachment mediates the link between childhood maltreatment and loneliness in persistent depressive disorder

BackgroundA central concept of attachment theory is that early experiences with close attachment figures shape the way we interact with and relate to other social partners throughout life. As such, early experiences of childhood maltreatment (CM) have been suggested as a key precursor of adult insecure attachment representations. As CM has been linked to feelings of loneliness in adulthood, this study examines whether insecure attachment could explain the relationship between CM and loneliness. Also, the moderating role of a diagnosis of persistent depressive disorder (PDD) is investigated, a disorder characterized by high levels of CM and loneliness. Method60 patients with PDD (DSM-5) and 60 gender- and age-matched non-clinical control participants (NC) completed self-report questionnaires measuring attachment, loneliness, and CM. Mediation analyses (PDD as a moderator) were performed. ResultsPDD patients reported higher levels of CM, attachment anxiety, attachment avoidance, and loneliness than NC. CM was positively associated with loneliness in both groups. Mediation analyses demonstrated that the relationship between CM and loneliness was mediated by avoidant, but not anxious attachment, regardless of a diagnosis of PDD. LimitationsCaution when interpreting these results is crucial as the study lacked a clinical control group, relied on self-report measures, and the cross-sectional design limits the ability to draw causal inferences. ConclusionsAll constructs studied were present to a greater degree in PDD. Above, findings provide initial evidence that avoidant attachment may explain the relationship between CM and loneliness. Potentially, adult avoidant attachment may lead to and maintain feelings of loneliness, regardless of PDD.

“My life disappeared in illness”: bipolar disorder and themes in narrative identity

ABSTRACT Bipolar Disorder (BD) has substantial consequences for the course of life and the formation of self and identity. In the present study, we extended the existing literature by examining narrative identity. Fifteen female outpatients with remitted BD and fifteen non-clinical control participants described past and future chapters in their life stories. The chapters were coded for agency, communion, redemption and contamination. Patients diagnosed with BD described their past chapters with lower agency, lower communion and more contamination compared to the control group. Contrary to our expectations, the future chapters described by the BD patients did not differ significantly from the control group. A focus on narrative identity may contribute to understanding the disorder and inspire interventions targeting personal recovery.

Attenuated Access to Emotions in Obsessive-Compulsive Disorder

The Seeking Proxies for Internal States (SPIS) model of obsessive-compulsive disorder (OCD) posits that OCD is associated with attenuated access to internal states. Here we explored the implications of this model in the realm of emotions. Participants with OCD, anxiety disorders, and nonclinical control participants completed the Mayer-Salovey-Caruso Emotional Intelligence Test (MSCEIT), assessing two domains of emotional intelligence: Experiential emotional intelligence (EI), reflecting the ability to perceive and feel emotions accurately, and Strategic EI, reflecting the ability to understand and manage emotions correctly. As only Experiential EI requires accurate perception of one’s emotions for adequate performance, we predicted an interaction between group and EI area. Specifically, we predicted that compared to both anxiety disorders and healthy control participants, OCD participants would show a larger deficit in Experiential area of the MSCEIT relative to the Strategic area. Results were fully in line with this prediction. Moreover, supporting the specificity of the hypothesized deficit to OCD, participants with anxiety disorders did not differ from nonclinical control participants in their performance, and findings were not attributable to anxiety or depression levels. These results replicate and extend previous findings obtained with analogue samples and suggest that OCD is associated with attenuated access to emotional states, which may be partially compensated for by reliance on semantic knowledge of emotion.

Situational context influences the degree of hostile attributions made by individuals with schizophrenia or autism spectrum disorder.

Previous work has demonstrated that the tendency to make hostile attributions is not a stable trait but varies across different social situations. Therefore, we sought to investigate whether hostile attributions within clinical samples are better understood as a persistent characteristic or one that varies across contexts. The current analyses investigated patterns of attributions among people diagnosed with schizophrenia (SCZ, n=271) or autism spectrum disorder (ASD, n=100) and non-clinical control participants (NCC, n=233) in an existing data set. Results showed that specific relational features in vignettes portraying different social encounters influence the way people make attributions and that variability across contexts is present in both non-clinical and clinical populations. Like non-clinical participants, participants diagnosed with ASD ascribed the greatest hostility to a scene involving an authority figure. In contrast, SCZ participants reported the greatest hostility in response to a scene involving a friend. These findings suggest that salient environmental factors should be considered when assessing social cognitive skills and biases. Hostile attributions should be perceived as situational constructs rather than stable and persistent characteristics. Hostile attributions were most prevalent among persons diagnosed with schizophrenia; however, on average, all participants showed greater hostility for situations involving an authority figure, an acquaintance, or a friend relative to those involving a co-worker or stranger. Psychotherapists and clinicians working with people diagnosed with schizophrenia or autism spectrum disorder could work on identifying situation triggers, which may prompt hostile attributions. Psycho-educational and psychotherapeutic interventions can be altered based on individual triggers of hostile attributions, and attempts can be made to lessen these attributions. Paranoia appears to be linked to hostile attributions regardless of the specific clinical diagnosis and should be considered in the therapeutic process.

Cognitive control over emotional information in current and remitted depression

Cognitive theories of depression propose that difficulty exerting cognitive control over emotional information may be involved in the development, maintenance, and/or recurrence of depression. This study evaluated depression-related biases in three cognitive control functions, namely inhibition, working memory updating, and set shifting. Currently depressed (n = 53), remitted depressed (n = 55), and non-clinical control (n = 51) participants completed computer-based paradigms designed to measure inhibition, working memory updating, and set shifting, respectively, involving emotional stimuli. As hypothesized, currently depressed participants exhibited biases in cognitive control over emotional information but did not exhibit broad impairments on a non-emotional measure of cognitive control. Specifically, currently depressed participants showed a reduced ability to inhibit the processing of negative distracting stimuli and to update working memory with emotional information, relative to control participants. Currently depressed participants also had greater difficulty shifting away from an emotion-relevant task set than from an emotion-irrelevant task set, whereas control participants did not show this bias. Remitted depressed participants did not demonstrate similar biases to currently depressed participants.

Narrative Identity in Psychopathology: A Negative Past and a Bright but Foreshortened Future

We examined narrative identity as a possible transdiagnostic marker of psychopathology by interviewing individuals with schizophrenia, individuals with depression and a nonclinical control group about past and future chapters in their life stories. Participants were 20 patients with schizophrenia, 20 patients with depression, and 20 nonclinical control participants matched on age, gender, and education. Participants described up to 10 chapters in their past and future life stories and self-rated chapters on emotional tone and self-event connections. In addition, cognitive function and current levels of symptoms was assessed. Both patient groups self-rated their past chapters as more negative and less positive compared to the control group, but did not differ from each other. There were no group differences in positivity of future chapters, but both patient groups identified fewer future chapters with shorter temporal projections. The results are consistent with the notion that negative past aspects of narrative identity are a transdiagnostic marker of psychopathology, while also suggesting that individuals with mental illness construct a positive future, which may support hope.

The Emotional Schemas and Obsessive-Compulsive Symptom Dimensions in People with Obsessive-Compulsive Disorder

Growing research shows an association between emotional schemas and psychopathology. Therefore, the study of emotional schemas in psychiatric disorders is an important issue regarding psychopathology. Also, emotional processes are important factors in relation to obsessive-compulsive disorder (OCD), but experimentally no study has examined the relations of emotional schemas to obsessive-compulsive (OC) symptom dimensions in people with OCD. The aims of this study were to compare emotional schemas between people with OCD and non-clinical control participants and to investigate the relationships between emotional schemas and OC symptom dimensions in OCD. Eighty individuals with OCD completed the Leahy Emotional Schema Scale (LESS) and measures of clinical characteristics. Results showed that people with OCD had higher scores on the maladaptive emotional schemas of guilt and uncontrollability than non-clinical control group. Non-clinical control participants had higher scores on the adaptive emotional schema of higher values than people with OCD. Guilt significantly predicted the OC symptom dimensions of responsibility for harm and symmetry after controlling for clinical characteristics. Uncontrollability was a significant predictor of the OC dimensions of unacceptable thoughts. These findings indicate that specific dimensions of maladaptive emotional schemas such as guilt and uncontrollability may be associated with some specific OC symptom dimensions in people with OCD. This study provided more evidence for Leahy’s emotional schema model in people with OCD.

Affective flexibility and generalized anxiety disorder: valence-specific shifting difficulties

ABSTRACTBackground: Growing evidence suggests that generalized anxiety disorder (GAD) is associated with poor affective flexibility, defined as the ability to switch between emotional aspects and non-emotional aspects of a situation. However, it is unclear whether affective inflexibility is valence-specific in GAD.Methods: Participants with GAD (n = 21) and non-clinical control participants (n = 28) were tested on an Affective Switching Task during which participants were asked to categorize pictures either by the valence or by the number of humans present in the pictures.Results: Individuals with GAD, but not healthy controls, exhibited greater difficulty shifting from emotional aspects of negative material compared to emotional aspects of positive material and shifting to the emotional aspects of positive material compared to emotional aspects of negative material.Conclusions: These findings suggest that GAD is associated with valence-specific affective flexibility biases. The relevance of the findings and directions for future research are discussed.

Responsibility beliefs and persecutory delusions

Recent research implicates cognitive processes traditionally linked to anxiety disorders in the maintenance of paranoia. Responsibility beliefs have traditionally been associated with OCD, and recent research suggests they may be transdiagnostic. The present study reports the first data on responsibility beliefs in individuals with persecutory delusions. 30 people with persecutory delusions completed measures of psychotic symptoms and responsibility beliefs. Participants were also asked to identify who they held responsible for their persecution. Quantitative data on responsibility beliefs were compared with 29 matched non-clinical control participants, and with published data from patients with OCD and anxiety disorders. People with persecutory delusions identified a number of different entities responsible for harm. The persecutory delusions group had higher responsibility beliefs than those with OCD, anxiety disorders and nonclinical controls. The results suggest that responsibility beliefs are a facet of the phenomenology of persecutory beliefs. Cognitive-behavioural therapy for psychosis might usefully draw from OCD interventions and focus on responsibility beliefs, perhaps especially in Bad Me paranoia.

Automatic processing of emotional stimuli in euthymic patients with bipolar disorder

BackgroundBiased information processing styles are a core feature of cognitive models of unipolar depression (UD). The manic-defence hypothesis (MDH) posits that UD and Bipolar Disorder (BD) are subject partially to the same underlying cognitive processes, which may act as putative vulnerability factors. Previous studies have used experimental paradigms as a way of measuring automatic (non-intentional) processing of emotional information in order to test the MDH with some studies providing some evidence for a negatively biased automatic processing of emotionally-relevant information in BD. However, most prior studies used supraliminal stimuli (i.e. presented above perceptual threshold). Based on the MDH we predicted that subliminally presented negative stimuli will affect performance of patients with BD differently than non-clinical participants, but similarly to what has been observed in prior studies with currently depressed patients. MethodsThe current study used an affective priming paradigm with both supraliminally and subliminally presented emotional images as primes to measure automatic processing. Seventeen euthymic individuals with a BD diagnosis were recruited along with seventeen non-clinical control participants (NCC) matched for age and gender. ResultsWe found interference (increased response times) due to masked, subliminally presented negative primes in patients with BD when negative prime images were followed by negative targets, but decreased response times (facilitation) in NCCs. LimitationsWe did not include a psychiatric control group and the sample size was small. ConclusionOur findings suggest that euthymic patients with BD do exhibit an affective bias suggesting an increased sensitivity to negative emotional information even when euthymic.

Predictors of self-reported negative mood following a depressive mood induction procedure across previously depressed, currently anxious, and control individuals.

This study identified and examined a set of potential predictors of self-reported negative mood following a depressive mood induction procedure (MIP) in a sample of previously depressed, clinically anxious, and control participants. The examined predictor variables were selected on the basis of previous research and theories of depression, and included symptoms of depression and anxiety, negative and positive affect, negative and positive automatic thoughts, dysfunctional beliefs, rumination, self-concept, and occurrence and perceived unpleasantness of recent negative events. The sample consisted of 33 previously depressed, 22 currently anxious, and 26 non-clinical control participants, recruited from community sources. Participant group status was confirmed through structured diagnostic interviews. Participants completed the Velten negative self-statement MIP as well as self-report questionnaires of affective, cognitive, and psychosocial variables selected as potential predictors of mood change. Symptoms of anxiety were associated with increased self-reported negative mood shift following the MIP in previously depressed participants, but not clinically anxious or control participants. Increased occurrence of recent negative events was a marginally significant predictor of negative mood shift for the previously depressed participants only. None of the other examined variables was significant predictors of MIP response for any of the participant groups. These results identify factors that may increase susceptibility to negative mood states in previously depressed individuals, with implications for theory and prevention of relapse to depression. The findings also identify a number of affective, cognitive, and psychosocial variables that do not appear to influence mood change following a depressive MIP in previously depressed, currently anxious, and control individuals. Limitations of the study and directions for future research are discussed. Current anxiety symptomatology was a significant predictor and occurrence of recent negative events was a marginally significant predictor of greater negative mood shift following the depressive mood induction for previously depressed individuals. None of the examined variables predicted change in mood following the depressive mood induction for currently anxious or control individuals. These results suggest that anxiety symptoms and experience with negative events may increase risk for experiencing depressive mood states among individuals with a vulnerability to depression. The generalizability of the present results to individuals with comorbid depression and anxiety is limited. Future research employing appropriate statistical approaches for confirmatory research is needed to test and confirm the present results.

The Relationship between Anhedonia and Positive, Negative, and General Symptomatology in Patients with Schizophrenia

An inability to experience pleasure or a reduction in the ability to do so is a prominent feature of schizophrenia that is often included among the negative symptoms of the disorder. As a whole, dysfunction in the affective experience of pleasure in patients with schizophrenia is poorly understood and is mediated by a number of cognitive and emotional processes. Whilst there is evidence that patients with schizophrenia have an impaired ability to derive and experience pleasure from non-current tasks, there is some evidence that they report current pleasurable experiences similar to non-clinical control participants. Previous studies investigating anhedonia have a number of methodological shortcomings that fail to examine the impact of general symptomology on the ability to experience pleasure. This current study involved 55 adults meeting the criteria for a diagnosis of schizophrenia. We looked specifically at relationships between anhedonia and positive, negative and general symptomatology. The results support the notion that anhedonia may best be considered as a separate phenomenon from negative symptoms of schizophrenia and from related symptomatology. The implications of these findings are considered in relation to future treatment initiatives.

Fearful responding to interoceptive exposure in social anxiety disorder

There is accumulating evidence suggesting that anxiety sensitivity (AS) may play a role in social anxiety disorder (SAD; e.g., Ball, Otto, Pollack, Uccello, & Rosenbaum, 1995). Precedent research has demonstrated the role of AS in panic disorder and posttraumatic stress disorder, and subsequently, treatment techniques aimed at reducing AS (i.e., interoceptive exposure (IE)) have been studied in these populations (Schmidt & Trakowski, 2004; Wald & Taylor, 2008). The purpose of this study was to examine the types of responses elicited during IE exercises among individuals with SAD. This study describes the responses of individuals with SAD (n=37) and nonclinical control participants (n=28) to six IE exercises. Significant differences in responses to the IE exercises were found between participants with SAD and nonclinical controls. However, there were no significant differences in responses to the exercises among persons with SAD, depending on whether the exercises were completed in private versus group settings. Similarity to symptoms during naturally occurring anxiety significantly predicted fearful responding across all exercises in persons with SAD. Implications and directions for future research are discussed.

Behavior as information: “If I avoid, then there must be a danger”

Background and objectivesCognitive models of anxiety disorders view safety-seeking behaviors (i.e., avoidance, washing, etc.) as playing a crucial role in the maintenance of irrational fear. An explanation of how these behaviors may contribute to the maintenance of unrealistic beliefs is that patients use their safety behaviors as a source of information about the situation (behavior as information): the behavior is clear evidence of the danger. This study investigates whether, relative to non-clinical control participants, anxious participants actually infer danger on the basis of their safety behaviors, rather than on the basis of objective information. MethodsThree groups of individuals affected by anxiety disorders (31 obsessive-compulsive participants, 22 panic participants, and 17 participants with social phobia) and a group (31) of non-clinical controls rated the danger perceived in scripts in which information about objective safety vs. objective danger, and safety behavior vs. no-safety behavior were systematically varied. ResultsAs expected, anxious participants were influenced by both objective danger information and safety behavior information, while the non-clinical controls were mainly influenced by objective danger but not by safety behavior information. The effect was disturbance specific, but only for individuals with social phobia and obsessive-compulsive disorder. ConclusionsThe tendency to infer danger on the basis of the use of safety behavior may play a role in the development and maintenance of anxiety disorders.