Obsessive-compulsive Checking Research Articles

Developing image sets for inducing obsessive-compulsive checking symptoms

Visual stimuli are often used for obsessive-compulsive (OC) symptom provocation in research studies. We tested the induction of anxiety and OC checking symptoms across different types of checking provocation stimuli in three populations: individuals with obsessive compulsive disorder (OCD), individuals with checking symptoms but without a diagnosis of OCD, and control individuals with neither checking symptoms nor a clinical diagnosis. One set of provocative images depicted objects that are commonly associated with checking anxiety. Another set (‘enhanced provocative images’) depicted similar objects but also included contextual cues suggesting a specific harmful scenario that could occur. As expected, the enhanced provocative images were more effective at inducing anxiety and OC symptoms than the standard provocative images. Future studies requiring checking symptom provocation should therefore consider incorporating similarly suggestive images. Individuals with clinical OCD reported the greatest provocation in response to these images, followed by those with nonclinical checking, followed by control individuals. Thus, these stimuli are able to provoke OC checking symptoms and anxiety differentially across groups, with the intensity of provocation reflecting diagnostic status. All groups demonstrated a similar qualitative pattern of provocation across images. Finally, in all groups, reported anxiety closely tracked intrusive thoughts and checking urges.

The Cognitive Heterogeneity of Obsessive-Compulsive Checking

The present article reviews the phenomenology of obsessive-compulsive checking, examining how action processing can be differentially affected across distinct checking subtypes. Checking is a normal phenomenon which ensures that an intended goal has been actually completed. Checking symptoms have consistently been connected to impairments in processing information related to self-performances. Theoretical and empirical work has explained compulsive checking as a result of various cognitive deficits related to action processing (e.g., low confidence in cognitive abilities, impaired memory for actions, abnormal reality monitoring, overactive action monitoring, defective goal processing). Such apparent inconsistencies are, however, in agreement with clinical and empirical observations highlighting substantial variability in the subjective experience preceding/accompanying checking. Many factors can in fact prevent the cognitive system from determining whether or not an intended goal has actually been achieved. We argue that several action processing mechanisms are likely affected in checking; the related subjective experience may vary accordingly.

Exploring the Parsing of Dynamic Action in Checking Proneness

Impaired action processing may be a key feature of the obsessive-compulsive checking phenomenon, although the mechanism underlying the impairment remains to be explored. We examined the ability to parse a continuous flow of movements and perceptual changes into meaningful segments of action — a key component of action processing — in checking proneness. Participants (N= 65) completed a measure of obsessive-compulsive symptoms and, while viewing four videotaped movies, were requested to detect the transitions between significant action steps. The main result indicated that Checking — but not the other obsessive-compulsive dimensions — was negatively related, with the size of meaningful units identified. These findings suggest that checking proneness may be specifically connected with difficulties in processing actions on the basis of abstract features such as goal-related information. This could explain why people with checking symptoms find it more difficult to determine whether an intended goal has actually been achieved.

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.

An experimental analysis of obsessive-compulsive checking as avoidance behaviour.

Many explanatory models of obsessive-compulsive disorders (OCD) support the idea that compulsive behaviours are an attempt to avoid an aversive situation. There are few experimental studies carried out on the onset of repetitive behaviours. This study tries to create a repetitive checking behaviour as an analogue explaining similar OCD behaviours. An inter-group design with 3 levels of aversion (minimal, progressive and maximum) in a visuo-spatial reasoning task was used. 48 university students without OCD problems (mean= 23 years old) were the participants, randomly distributed in 16 per group. Checking frequency (semi-hidden chronometer) for each task was measured and the questionnaires TONI-2, STAI, MOCI and YBOCS-SR were applied. Participants with a minimal or maximum level difficulty showed a significantly higher level of checking behaviour than those in the progressive difficulty. The differences occurred between the minimal and the progressive group, and between the minimal and maximum difficulty. There were no differences in any other variable. In this analogue, the continuous checking of a chronometer was reinforced by the elimination of boring tasks. The momentary escape from an aversive situation explains the checking behaviour. This study could be an experimental analogue of checking behaviour, showing its avoidance function.

The impact of climate change on obsessive compulsive checking concerns

To investigate whether climate change has impacted on the nature of the obsessions or compulsions experienced by patients with obsessive compulsive disorder (OCD). The sample comprised 50 patients with OCD checking subtype who had presented at the Anxiety Disorders Clinic at The University of Sydney seeking treatment during the period March 2008 to November 2009. Details of the type of obsessions and compulsions directly related to climate change phenomena were identified. Fourteen of the 50 participants (28%) were identified as having OCD concerns directly related to climate change. The most frequent concerns involved electricity, water and gas wastage. Less frequent concerns included pets dying of thirst and one participant was concerned about house damage due to floors cracking, pipes leaking; roof problems and white ant activity. Compulsions included checking and rechecking pet water bowls, light switches, taps, stoves, skirting boards, pipes, roofs and wooden structures. While these behaviours are not particularly unusual for people with this condition, it was the rationale they provided for carrying them out that was surprising. Instead of checking and rechecking so as to prevent fire or flood, the rituals were specifically performed so as to reduce their global footprint, or respond to climate change-induced negative events. Our findings demonstrate that the types of obsessions and compulsions experienced by 28% of our sample were directly aligned with the current issue of climate change and the perceived dangers associated with this phenomenon. To our knowledge this represents the first documentation of the significant impact of climate change on the nature of the concerns experienced by people with OCD checking subtype. We suggest that mental health professionals need to be aware of, and assess for the presence of such concerns.

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.

Evidence of Impaired Event-Based Prospective Memory in Clinical Obsessive–Compulsive Checking

AbstractBased on findings from subclinical OCD checking samples (Cuttler & Graf, 2007; 2008), Cuttler and Graf (2009) suggested that checking may develop to compensate for prospective memory failures. The present study provides the first evidence of prospective memory problems in a clinical sample of OCD checkers (n = 26) compared to a group of healthy controls (n = 26). Consistent with earlier work with subclinical samples, the OCD checkers performed more poorly on an event-based, but not a time-based, prospective memory task. However, the OCD checkers did not report more subjective prospective memory failures than controls and their confidence in prospective memory accuracy was higher than that of controls. An explanation of the inconsistent findings with regard to metamemory in clinical and subclinical OCD checking is provided. Further research assessing both subjective memory performance and the strategies understood to support memory is needed to clarify the contribution of prospective memory to OCD checking.

Feeling of doing in obsessive–compulsive checking

Research on self-agency emphasizes the importance of a comparing mechanism, which scans for a match between anticipated and actual outcomes, in the subjective experience of doing. This study explored the “feeling of doing” in individuals with checking symptoms by examining the mechanism involved in the experienced agency for outcomes that matched expectations. This mechanism was explored using a task in which the subliminal priming of potential action-effects (emulating outcome anticipation) generally enhances people’s feeling of causing these effects when they occur, due to the unconscious perception of a match between primed and observed outcomes. The main result revealed a negative relationship between checking and self-agency for observed outcomes that were primed prior to actions. This suggests that checking individuals fail to grasp the correspondence between actual outcomes of their actions and expected ones. We discuss the possible role of undermined self-agency in checking phenomena and its relationship with cognitive dysfunction.

No evidence of attentional bias in obsessive compulsive checking on the dot probe paradigm

Attentional biases have been proposed as maintaining and causal factors in anxiety, and it has been suggested that training attentional bias can impact on emotional responding. Given the severity of obsessive compulsive disorder (OCD) and the considerable number of clients who do not respond to traditional therapies, understanding the factors that maintain anxiety in OCD is critical for the development of effective treatments. This study investigated attentional biases in a homogenous group of OCD patients whose primary concern was checking (OCD-Check; n=18) compared to a Control group individually matched for age, gender and level of education (Control; n=18) using a dot probe task. No evidence of attentional bias, or of differences in orienting to or disengaging from checking-relevant stimuli, was found in the OCD group compared to the matched Control group. From this data, it would appear that attentional bias may not be a feature of obsessive compulsive checking. The limitations of the present study and future research directions are discussed.

Obsessive–compulsive symptoms: The contribution of obsessional beliefs and experiential avoidance

Experiential (emotional) avoidance (EA), a core concept in acceptance and commitment therapy, involves an unwillingness to endure upsetting emotions, thoughts, memories, and other private experiences; and is hypothesized to play a role in obsessive–compulsive disorder (OCD). The present study examined how well EA, relative to traditional cognitive–behavioral theoretical constructs such as dysfunctional core beliefs about intrusive thoughts, predicts obsessive–compulsive (OC) symptoms. A sample of 353 non-clinical participants completed measures of EA, core “obsessive” beliefs, and OC symptoms. Individuals reporting greater levels of OC symptoms endorsed more obsessive beliefs and EA relative those with lower levels of OC symptoms, even when accounting for general levels of psychological distress. Among those with more OC symptoms, EA did not show relationships with obsessive beliefs. Moreover, EA did not add significantly to the prediction of OC symptom dimensions over and above the contribution of general distress and obsessive beliefs. Obsessive beliefs, meanwhile, contributed significantly to the prediction of OC checking and obsessing symptoms after accounting for EA. It appears the construct of EA is too general to explain OC symptoms over and above cognitive–behavioral constructs such as core obsessive beliefs, which are more specific.

Desire for control, sense of control and obsessive-compulsive checking: An extension to clinical samples

Research in non-clinical samples has suggested that control beliefs, specifically desire for control and sense of control, may play a role in Obsessive-Compulsive Disorder. The present study extends a previous research design to clinical participants [Moulding, R., Kyrios, M., & Doron, G. (2007). Obsessive-compulsive behaviours in specific situations: The relative influence of appraisals of control, responsibility and threat. Behaviour Research and Therapy, 45, 1693–1702]. In this study, clinical participants with OCD-checking symptoms ( n = 16), anxiety disorders ( n = 17) and community controls ( n = 27) were presented with four hypothetical scenarios. Using a manipulation paradigm, the relationship between control appraisals and other OCD-relevant constructs (threat, responsibility) was examined. As in the non-clinical study, desire for control was moderately affected by responsibility and threat manipulations, while sense of control was not affected by these manipulations. Individuals with OCD recorded higher desire for control and lower sense of control relative to community controls, and a higher desire for control than the anxiety group, suggesting some specificity to OCD. A possible interactive model of control, threat and responsibility is 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.

A check on the memory deficit hypothesis of obsessive–compulsive checking

A number of recent studies have challenged the hypothesis that patients with obsessive-compulsive disorder (OCD) display global memory deficits. An alleviated form of the memory deficit hypothesis posits that OCD patients share deficits to vividly recall memory episodes. According to the latter view, checking rituals can be understood as counter-productive coping strategies to "enrich" memory episodes in order to make them more distinctive. A source memory task was administered to 27 OCD (17 checkers) and 51 healthy participants. Along with confidence judgments, a remember-know procedure was employed to assess whether OCD patients display problems with conscious/vivid recollection. Patients with or without checking compulsions did not exhibit differences to controls on source memory accuracy and meta-memory. Patients forgot more self-generated items, which, however, was related to comorbid depressive but not OCD symptoms. Findings challenge the ubiquity of memory deficits in OCD. To account for the inconclusive pattern of results in the literature, it is suggested that patients mistrust their memories and adopt checking rituals only when perceived responsibility is inflated.

Cognitive Change During Treatment of Compulsive Checking

AbstractCognitive variables hypothesised to be mediating obsessive—compulsive behaviour include an overestimation of the probability and consequences of danger, a sense of overinflated personal responsibility for harm to oneself or others, a belief in the overimportance of thoughts, a lack of confidence in memory, an intolerance of uncertainty and a need to control thoughts. In the present study, the relationship between these variables and improvement in OCD symptoms was examined. Fourteen obsessive—compulsives with checking concerns completed a 12-session treatment program of exposure and response prevention (ERP). Before and after treatment, subjects completed the Maudsley Obsessional-Compulsive Inventory (MOCI) and a self-rating of severity (SER), and each week they completed the Yale-Brown Obsessive Compulsive Scale (YBOCS) and answered seven questions that were used to rate their beliefs in the six cognitive domains outlined above. Changes in perception of danger, intolerance of uncertainty and need to control thoughts all correlated significantly with improvement in symptoms. Moreover, significant changes in these variables occurred immediately prior to or concurrent with major symptom improvement, supporting the possibility that they are mediators of the disorder. Changes in ratings of responsibility, overimportance of thoughts and confidence in memory were not related to improvements in compulsive checking on any scale and, in the case of responsibility, ratings actually increased (i.e., worsened) in the week prior to major improvement in symptoms. For most subjects, major reductions in responsibility ratings only took place after symptom reduction. The implications of these findings for the role of these variables in mediating obsessive—compulsive checking are discussed.

Obsessive–Compulsive Symptoms and the Expression of Anger

The present study investigates the association between Obsessive–Compulsive (OC) symptoms and the expression of anger in a sample of 131 undergraduates. Participants were divided into two groups based on their self-reported OC symptoms and compared on their tendency to suppress anger inwardly, express anger outwardly, and control their anger. In addition, the associations between anger and specific OC symptoms were investigated. Results indicated that individuals high in OC symptoms tended to experience more anger, be more likely to suppress it inwardly, and report more difficulty controlling their anger than individuals low in OC symptoms. However, these differences appear to be attributable to the presence of depressive symptoms in the participants with high levels of OC symptoms. In addition, OC checking was found to be weakly associated with anger independent of depressive symptoms. These results were discussed within the framework of the cognitive theory of obsessive compulsive disorder.

Compulsive checking diminished when over-checking instructions were disobeyed

Four patients with obsessive-compulsive checking behaviour residual to previous successful treatment of other compulsive symptoms, were instructed in a behavioural technique designed along the lines of the “safety signals” hypothesis. They showed remarkable improvement in spite of the fact that they did not follow the instructions. Some hypotheses regarding the basis of the changes obtained are put forward.

Self-directed in vivo treatment of an obsessive compulsive checking ritual

A multiple treatment program including operant reinforcement, disruption of the chain of ritualistic behaviors, systematic desensitization of related fears, and response prevention was successful in the elimination of ritualistic checking in a 63-yr-old man. The program was carried out by the client in vivo with minimal assistance from the therapist. The report correlates the week-by-week changes in checking time with the changes in treatment strategy. The advantage of a multiple treatment approach and the need for consideration of motivational aspects are discussed.