Obsessive-compulsive Checkers Research Articles

The effect of enhanced responsibility on attentional bias in obsessive–compulsive checkers

The present study investigated whether enhanced responsibility could affect attentional bias in obsessive compulsive checkers. The participants were 69 undergraduate students: 35 students who have obsessive–compulsive checking tendencies and 34 students who have no obsessive–compulsive checking tendencies. All participants were randomly assigned to high or low responsibility conditions and were asked to perform a pill classification task. After performing the task, the vigilance and maintenance of attentional bias toward three emotional words (obsessive–compulsive (OC) threat, negative, positive) were measured by an eye tracker. The results indicate that OC checkers detected OC threat stimuli more quickly than did non-checkers. Furthermore, within the OC checker group, high responsibility conditions revealed a longer latency to initial fixation and a longer maintenance toward OC threat words than low responsibility conditions. However, this difference was not observed in the non-checker group. This result suggests that OC checkers are more anxious under high responsibility situations, leading to vigilance and maintenance patterns toward OC threat words. Therefore, it is necessary to use cognitive strategies to reduce perceived responsibility for OC checkers.

Dysfunctional beliefs in the process of change of cognitive treatment in obsessive compulsive checkers

Cognitive behaviour therapy (CBT) is considered to be effective in the reduction of obsessive compulsive symptoms. However, questions remain as to how CBT works. Cognitive-behavioural models postulate that negative appraisals of intrusive thoughts and dysfunctional beliefs that give rise to them underlie the development and maintenance of obsessive-compulsive disorder (OCD). The current study aimed to study this hypothesis by investigating the processes of change over the course of cognitive treatment for OCD. Furthermore, a new theoretical approach and method for studying processes of change was presented. The participants were seven patients suffering from OCD with predominantly checking symptoms. Process variables (beliefs, anxiety and compulsions) were measured using idiosyncratic diaries and were analysed on an intra- and inter-individual level using dynamic systems methods. Results showed significant decreases in credibility of dysfunctional beliefs in six out of the seven participants, which is in line with the cognitive-behavioural model. Associations between process variables were in general medium to high. However, the actual patterns of change showed important intra- and interpersonal differences. Results indicated that different paths can lead to clinical recovery, and it was concluded that process studies that focus on individual trajectories of change can contribute to our understanding of OCD and its treatment. Furthermore, dynamic systems methods provide insight into intra-individual processes and shed a new light on variability.

Danger Ideation Reduction Therapy for Obsessive–Compulsive Checking: Preliminary Findings

Danger Ideation Reduction Therapy (DIRT) is a cognitive treatment package developed in the mid-1990s to treat obsessive–compulsive (OC) washing. DIRT is solely directed at decreasing threat expectancies and does not involve direct or indirect exposure. The effectiveness of the DIRT package for OC washers has been examined, and to date a number of publications, including two randomised controlled trials, support its efficacy. Recently, the DIRT package was modified to treat people with the OC checking subtype. In the current study, three adult OC checkers received DIRT in 12 to 14 individual 1-hr sessions conducted by a clinical psychologist. At posttreatment, substantial and clinically significant reductions in scores on a range of standardized outcome measures of obsessive–compulsive disorder symptom severity were apparent for all three participants. Crucially, these improvements were maintained at 4-month follow-up. Although further research is clearly warranted, these preliminary findings suggest that DIRT for checkers may prove as effective as DIRT for OC washers.

Diencephalic Serotonin Transporter Availability Predicts Both Transporter Occupancy and Treatment Response to Sertraline in Obsessive-Compulsive Checkers

To our knowledge, no studies have investigated the predictive value of central serotonin transporter (SERT) availability for treatment response to serotonin reuptake inhibitors (SSRIs) in patients with obsessive-compulsive disorder (OCD). This study used brain imaging to examine the relationship between pretreatment SERT availability and transporter occupancy as well as treatment response by sertraline in patients displaying prominent behavioral checking compulsions (OC checkers). Single photon emission computed tomography (SPECT) was used to measure thalamic-hypothalamic SERT availability with [(123)I]-2beta-carbomethoxy-3beta-(4-iodophenyl)-tropane in 28 nondepressed OC checkers at baseline and after 14 weeks of treatment with sertraline (175 mg daily). SERT availability was correlated with OC severity and treatment response as assessed with the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS). Associations between individual transporter occupancies and clinical parameters were investigated. 1) Correlation analyses between thalamic-hypothalamic SERT availability and OC severity showed significant negative associations at baseline and after treatment with sertraline. 2) Pretreatment SERT availability correlated significantly with both transporter occupancy and treatment response; in addition, a positive association was found between transporter occupancy and treatment response directly. 3) Using multivariate statistical models, the data demonstrated that higher pretreatment SERT availability significantly predicted higher occupancy rates as well as better treatment response 14 weeks later. Higher pretreatment thalamic-hypothalamic SERT availability may predict both higher occupancy rates and better treatment response to sertraline. The data suggest a strong connection between transporter occupancy and treatment response.

Attention in sub-clinical obsessive-compulsive checkers

The aim of the study was to explore differential attention profiles, according to attention types, in sub-clinical obsessive-compulsive checkers compared to controls. To examine attention biases in obsessive-compulsive phenomena, we compared sub-clinical checkers to non-checkers on their recall and recognition performances, using neutral and threat-relevant stimuli in three attention paradigms: focused attention, divided attention, and passive attention. Forty-six volunteer university students participated in the study: 24 checkers (14 males, 10 females), and 22 non-checkers (15 males, 7 females). We found that the checkers’ recall and recognition performances were higher than those of the non-checkers for threat-relevant stimuli. Even though instructions and tasks were different in each attention paradigm, the checkers showed similar attention biases in all paradigms. Results indicate that there is an attention bias in obsessive-compulsive checkers that is independent from the type of attention.

Investigation of an attentional bias for fear-related material in obsessive-compulsive checkers

Prior studies on attentional biases in obsessive-compulsive disorder (OCD) have yielded conflicting results. Using a new methodology based on a spatial cueing paradigm, it was investigated whether OCD checkers display heightened vigilance for concern-related material or difficulties disengaging from such stimuli. Twenty-eight OCD patients, 21 of whom were checkers, were compared to 27 controls. In the spatial cueing paradigm task, patients and controls responded to a visual target at one out of two possible locations, which was preceded by a verbal cue word presented at the same or at the opposite location of the target. Cue words were either checking-relevant (e.g., doubt), neutral (e.g., box), or paranoia-related (e.g., spy). No evidence for an attentional bias in OCD checkers was found. This study is in accordance with previous studies, which were unable to detect attentional biases in OCD patients.

“Perhaps you only imagined doing it”: Reality-monitoring in obsessive-compulsive checkers using semi-idiographic stimuli

Memory failures reported by obsessive–compulsive (OC) checkers often seem to be errors of “reality-monitoring”, or misremembering whether one performed or imagined performing an action. To examine these memory processes in the context in which such errors are said to occur, an in-home reality-monitoring experiment involving bothersome and non-bothersome actions was conducted with 21 OC checkers and 24 non-clinical controls. OC checkers reported poorer confidence in memory, but both groups performed similarly on tests of immediate and delayed free and prompted recall. Among OC checkers (but not controls), accuracy in recall and confidence in memory were correlated. Theoretical implications are discussed.

Perception of memory ability and confidence in recollections in obsessive-compulsive checking

Inconsistencies in research on deficits in memory for actions in studies of obsessive-compulsive (OC) checking have refocused investigators on beliefs such as confidence in the accuracy of recall as a possible motivation for checking. Poor confidence in relation to recall may be specific (perceived poor recall for a particular event) or general (perceived poor memory ability for that class of events). The present study examines both perception of memory ability and confidence in recollections in OC checkers across a range of situations, obsessive and non-obsessive. These ratings were compared with those of non-checking obsessional patients, anxious controls and non-clinical controls. OC checkers reported poorer perception of memory ability than other groups in situations for which they are responsible, both OC relevant and OC non-relevant. OC checkers also reported lower confidence in recollections compared to the other groups; this was specific to obsessional situations for which they are responsible. These findings are considered in the context of the cognitive model of OCD.

Elucidating the mechanism of uncertainty and doubt in obsessive-compulsive checkers

The article presents three studies that explore the scope and mechanism of reduced confidence in obsessive-compulsive (OC) checkers. In the first study OC checkers, but not panic disorder patients, reported less confidence in their answers to a general knowledge test compared to non-anxious (NA) participants. The second study replicated these findings, but contrary to our prediction, the reduced confidence in OC checkers was not reflected in a disconfirmation bias in this population when both types of evidence were available. The third study found that when the same questions were repeated three times, the confidence of OC checkers progressively decreased, while that of the NA participants progressively increased.

A mood-as-input account of perseverative checking: the relationship between stop rules, mood and confidence in having checked successfully

The present paper reports the results of two experiments designed to test predictions from the mood-as-input account of perseverative checking. Using an analogue checking task, both experiments showed that perseveration, as indicted by a range of measures relevant to compulsive checking, was affected by the configuration of the stop rule for the task and mood at the outset of checking. Perseveration was most significant in the condition that most closely resembled the characteristics of obsessive-compulsive checkers (negative mood combined with a stop rule that specifies that the task should be done as thoroughly as possible—namely, an ‘as many as can’ stop rule). The studies also indicated that confidence at having completed the checking task successfully was (1) significantly related to the use of ‘as many as can’ stop rules at the outset of checking, (2) mood ratings at the end of checking, and (3) checking perseveration generally. These findings provide support for a mood-as-input explanation of perseverative psychopathologies such as compulsive checking, and begin to cast some light on how anxiety-reduction and ‘confidence’ models of compulsive checking, might be explained within broader mechanisms of perseveration.

Realism of confidence in obsessive-compulsive checkers.

Realism of confidence in obsessive-compulsive checkers.

Realism of confidence in obsessive-compulsive checkers.

The study examined whether obsessive-compulsive (OC) checkers have reduced confidence in their knowledge. OC checkers were compared with panic disorder (PD) patients and nonpatient controls using a calibration-of-knowledge procedure. Participants completed a general knowledge questionnaire, rated their confidence in each answer, and estimated the total number of correct answers. These responses were converted to 2 measures of confidence relative to performance--over/underconfidence and over/underestimation. OC checkers had lower scores than nonpatients did on both measures, whereas the PD patients did not differ from either group. For the OC checkers, relative confidence was inversely related to the severity of obsessions. The authors speculate that confidence may depend on a confirmation bias in testing hypotheses and that the reduced confidence in OC checkers may reflect a disconfirmation bias in this population.

Negative priming for obsessive-compulsive checkers and noncheckers.

Negative priming for obsessive-compulsive checkers and noncheckers.

Memory for actual and imagined events in OC checkers

Information-processing theorists have suggested that obsessive-compulsive (OC) checking may be a function of either (1) an impaired memory of emotional events, (2) an attenuated ability to distinguish between real and imagined events or (3) a dissatisfaction with one's recall without actual memory impairment. These hypotheses were tested by having OC and control Ss engage in real and imagined actions. Some of the actions were designed to produce anxiety in the OC Ss while other events were designed to be emotionally neutral. No differences in reality-monitoring ability were found between OC and control Ss. Contrary to our prediction, OC Ss recall of their last actual behavior was superior to controls, but only for those actions that elicited anxiety. OC Ss, but not controls, reported that they desired higher levels of memory vividness than they were able to produce. The potential mechanism whereby dissatisfaction with memory vividness could contribute to repetitive checking is discussed.

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.

Imaginal and in vivo exposure: A comparison with obsessive-compulsive checkers

The efficacy of imaginal and in vivo exposure was compared in 19 obsessive-compulsives who manifested checking rituals. Response prevention was not instituted in either group. No difference between the two procedures was detected either at posttreatment or at follow-up; both were moderately effective in ameliorating obsessive-compulsive symptoms. There appears to be a tendency for patients treated with in vivo exposure to improve further at follow-up, whereas those treated with imaginal exposure maintained the level of gains achieved at posttreatment. In comparison with a treatment regimen which includes both exposure and response prevention, the exposure procedures in vestigated here yielded inferior outcomes. The finding of no difference between in vivo and imaginal exposure modalities is incongruent with studies on phobics. Possible explanations for this discrepancy are discussed.

Effects of imaginal exposure to feared disasters in obsessive-compulsive checkers

The combined effects of imaginal exposure to feared catastrophes and in vivo exposure to external stimuli were compared with the effects of in vivo exposure alone in 15 obsessive-compulsives with checking rituals. The first group received 90 min of uninterrupted exposure in imagination, which concentrated mainly on disastrous consequences, followed by 30 min of exposure in vivo to stimuli-situations which triggered rituals. The second group was given 2 hr of exposure in vivo only. Both groups were prevented from performing rituals. Treatment consisted of 10 daily sessions within a 2 week period. Assessments were conducted before and after treatment and at follow-up ranging from 3 months to 2.5 yr with a mean of 11 months. At post-treatment both groups improved considerably and did not differ. But at follow-up those who received imaginal and in vivo exposure maintained their gains, whereas the group who were treated by exposure in vivo alone evidenced partial relapse on four of the six dependent measures. The results tend to indicate that a closer match between a patient's internal fear model and the content of exposure enhances long term treatment efficacy.