Search

Background: While some obsessive-compulsive disorder (OCD) phenotypes are well-established and better understood, it is unclear whether the presence of health-related obsessive-compulsive symptoms (OCS) is associated with specific clinical characteristics. We aimed to investigate whether OCS involving concerns with illness, diseases, body parts or aspects of appearance (i.e. health-related OCS) are associated with differences in demographics, experience of stressful life events, clinical severity, clinical course, endorsement of established OCD dimensions, and psychiatric comorbidities., Methods: Individuals (N = 1001) with a clinical diagnosis of OCD (M = 34.85, SD = 12.99) completed a questionnaire battery assessing clinical course (age at symptom onset, age at diagnosis, duration of illness), total and dimensional symptom severity, and psychiatric comorbidities. We ran initial univariate, and follow-up multivariate analyses where appropriate, to compare individuals reporting health-related OCS with those not reporting health-related OCS in terms of demographics, symptom severity and clinical course, OCD symptom dimensions, and psychiatric comorbidities., Results: The presence of health-related OCS was associated with higher severity of contamination, hoarding and harm symptoms. Additionally, those with health-related OCS displayed significantly lower symptom insight, increased incidence of hypochondriasis, panic disorder and anxiety, and lower depression symptoms. Overall OCD symptom severity and clinical course did not differ between participants with and without health-related OCS., Implications: These novel findings provide clinicians with an enhanced understanding of health-related OCS in order to guide assessment and allow for more targeted treatment planning. Future investigations may examine the effectiveness of specialised treatment methods which target underlying clinical features of health-related OCS., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier B.V. All rights reserved.)

Background: Depression ranks as one of the top five contributors to ill health in youth, the most formative period in life. Extensive research has highlighted the significant role of impulsivity in understanding depression. However, there has been limited exploration into how each dimension of impulsivity uniquely affect depressive symptoms, especially across crucial developmental stages like adolescence and young adulthood., Methods: This study investigates the unique relationships between impulsivity (assessed by the short UPPS-P scale) and depression (assessed by the Patient Health Questionnaire-9) via network analysis. We analysed data from a total of 2296 participants, comprising 858 adolescents aged 14-17 years and 1438 young adults aged 18-25 years, to estimate both a combined network and age-group specific networks. Key features of the networks, including their structure, global connectivity, and bridge nodes, were compared., Results: The results indicated that age differentially impacts individual depression symptoms, both directly and indirectly, via impulsivity dimensions. The comparison test revealed consistent network structures between the two age groups, with several robust pathways, such as lack of perseverance to concentration difficulties, sensation seeking to suicidal ideation, and negative urgency to feelings of worthlessness. Negative urgency and lack of perseverance were identified as bridge nodes across the two networks., Limitations: The study employed a cross-sectional design, which limits the ability to estimate causal or temporal relationships., Conclusions: The current findings highlight the significance of tailoring intervention strategies to individual symptom profiles and assessing negative urgency and lack of perseverance as potential early targets for depression among youth., Competing Interests: Declaration of competing interest Dr. Albertella receives honoraria for her role as associate editor at two Elsevier journals. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Subthreshold obsessive-compulsive symptoms (OCS) are associated with increased distress, help seeking behaviours, and functional problems, and may predict progression into further mental health problems. This study investigated the effectiveness of a four-module internet-based acceptance and commitment therapy (iACT) for adults with OCS compared to internet-based progressive relaxation training (iPRT). Eighty-nine adults with OCS participated in a single-blinded randomised controlled trial of iACT or iPRT. Self-report assessments of OCS, psychological flexibility, and quality of life, among others, were measured at baseline, post-treatment, and at three-month follow-up. Both iACT and iPRT showed large pre-post improvements in OCS (b = 6.32, p < 0.001, d = 0.8) and medium improvements in psychological flexibility (b = -0.38, p = 0.011, d = 0.47) and quality of life (b = -5.26, p = 0.008, d = 0.58), with no significant differences in effects between groups. All improvements were maintained at follow-up. There were no differences in attrition or adherence between groups. iACT was rated more favourably by participants at post-treatment, and there were some differences in qualitative feedback across groups. These findings suggest both iPRT and iACT may be helpful in improving mental health in adults with OCS, but that iACT may be more acceptable., Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Shelley Viskovich and Kenneth Pakenham receive royalties from UniQuest for commercial (not research) licensing arrangements entered into by third parties who want to deliver YOLO. If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Modern internet pornography allows users to harness sexual novelty in numerous ways, which can be used to overcome desensitisation through increasing volume of use (quantitative tolerance), progressing to more stimulating genres (qualitative escalation), skipping between stimuli (tab-jumping), delaying orgasm ('edging'), and engaging in pornographic binges. However, existing research has not yet evaluated how these potentially reciprocal consumption patterns relate to problematic pornography use (PPU). To this end, we recruited two independent samples of male pornography users (N 1  = 1,356, M age  = 36.86, SD = 11.26; N 2  = 944, M age  = 38.69, SD = 12.26) and examined the relationships between these behavioural dimensions and self-reported difficulties in controlling one's pornography use. Data were analysed through the network analysis approach (using Gaussian graphical models). As hypothesised, i) quantitative tolerance was centrally placed within the overall network, and ii) acted as a statistical bridge node between other patterns of pornography use (e.g., pornographic binges), and all measured facets of PPU. Our results are consistent with other emerging literature suggesting that tolerance, pornographic binges, tab-jumping, and edging behaviours as relevant features ofPPU, and that upscaling overall usage may connect broader patterns of use with problematic engagement. Clinical and theoretical implications, as well as future research directions, are discussed., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024. Published by Elsevier Ltd.)

After a risky choice, decision makers must frequently wait out a delay period before the outcome of their choice becomes known. In contemporary sports-betting apps, decision makers can "cash out" of their bet during this delay period by accepting a discounted immediate payout. An important open question is how availability of a postchoice cash-out option alters choice. We investigated this question using a novel gambling task that incorporated a cash-out option during the delay between bet and outcome. Across two experiments ( N = 240 adults, recruited via Prolific), cash-out availability increased participants' bet amounts by up to 35%. Participants who were more likely to cash out when odds deteriorated were less likely to cash out when odds improved. Furthermore, the effect of cash-out availability on bet amounts was positively correlated with individual differences in cash-out propensity for bets with deteriorating odds only. These results suggest that cash-out availability may promote larger bets by allowing bettors to avoid losing their entire stake.

Background and Aims: Cognitive control and reward-related abnormalities are centrally implicated in addiction. However, findings from longitudinal studies addressing neurocognitive predictors of addictive behaviors are mixed. Further, little work has been conducted predicting non-substance-related addictive behaviors. Our study aimed to assess predictors of substance and non-substance addictive behaviors in a community sample, systematically evaluating each neurocognitive function's independent influence on addictive behavior., Methods: Australians (N = 294; 51.7% female; M[SD] age = 24.8[4.7] years) completed online neurocognitive tasks and surveys at baseline and 3-month follow-up. Self-report scales assessed problematic alcohol use, addictive eating (AE), problematic pornography use (PPU), and problematic internet use (PUI) at 3- and 6-month follow-ups. Linear regressions with bootstrapping assessed neurocognitive predictors for each addictive behavior across a 6-month period., Results: Neurocognition at baseline did not predict AE or PUI severity at 6-month follow-up. Less delay discounting at baseline predicted higher PPU at 6-month follow-up (β = -0.16, p = 0.005). Poorer performance monitoring at baseline predicted higher AE at 3-month follow-up (β = -0.16, p = 0.004), and more reward-related attentional capture at 3-months predicted higher AE at 6-month follow-up (β = 0.14, p = 0.033). Less reward-related attentional capture (β = -0.14, p = 0.003) and less risk-taking under ambiguity (β = -0.11, p = 0.029) at baseline predicted higher PUI at 3-month follow-up. All findings were of small effect size. None of the neurocognitive variables predicted problematic alcohol use., Discussion and Conclusions: We were unable to identify a core set of specific neurocognitive functions that reliably predict multiple addictive behavior types. However, our findings indicate both cognitive control and reward-related functions predict non-substance addictive behaviors in different ways. Findings suggest that there may be partially distinct neurocognitive mechanisms contributing to addiction depending on the specific addictive behavior.

Introduction: Drinking motives and neurocognition play significant roles in predicting alcohol use. There is limited research examining how relief-driven drinking motives interact with neurocognition in alcohol use, which would help to elucidate the neurocognitive-motivational profiles most susceptible to harmful drinking. This study investigated the interactions between neurocognition (response inhibition and cognitive flexibility) and relief-driven drinking, in predicting problem drinking., Methods: Participants completed the Alcohol Use Disorders Identification Test - Consumption items (AUDIT-C) to measure drinking behaviour, and online cognitive tasks, including the Value-Modulated Attentional Capture and Reversal Task (VMAC-R) and the Stop Signal Task (SST). The sample ( N  = 368) were individuals who drink alcohol, which included a subsample ( N  = 52) with problematic drinking, as defined by self-identifying as having a primary drinking problem. Drinking motives were assessed using a binary coping question in the overall sample, and the Habit, Reward, and Fear Scale (HRFS) in the subsample. Moderation analyses were conducted to investigate whether cognitive flexibility and response inhibition moderated relationships between relief-driven motives and drinking., Results: Cognitive flexibility moderated the relationship between relief-driven motives and drinking (overall sample: β = 13.69, p  = 0.017; subsample: β = 1.45, p  = 0.013). Greater relief-driven motives were associated with heavier drinking for individuals with low cognitive flexibility. There was no significant interaction between response inhibition and relief-driven motives., Conclusions: Relief-driven drinking motives interact with cognitive inflexibility to drive heavier drinking. Greater understanding of these neurocognitive-motivational mechanisms may help to develop more targeted and effective interventions for reducing harmful drinking., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. Lara Piccoli is supported by an Australian Government Research Training Program PhD Scholarship. Rico Lee has received funding from the NHMRC Investigator Grant funded by the Medical Research Future Fund [APP1193946]. Murat Yücel has received funding from government funding bodies such as the NHMRC, Australian Research Council (ARC), Australian Defence Science and Technology (DST), the Department of Industry, Innovation, and Science (DIIS), the National Institutes of Health (NIH, USA); philanthropic donations from the David Winston Turner Endowment Fund, Wilson Foundation; sponsored investigator-initiated trials including Incannex Healthcare Ltd. Murat also sits on the Advisory Boards of: Centre of The Urban Mental Health, University of Amsterdam; and Enosis Therapeutics. The above funding sources have had no role in the present study design, collection, analysis or interpretation of the data, writing the manuscript, or the decision to submit this paper for publication., (© 2024 The Authors. Published by Elsevier Ltd.)

Background: Both impulsivity and compulsivity have been identified as risk factors for problematic use of the internet (PUI). Yet little is known about the relationship between impulsivity, compulsivity and individual PUI symptoms, limiting a more precise understanding of mechanisms underlying PUI., Aims: The current study is the first to use network analysis to (a) examine the unique association among impulsivity, compulsivity and PUI symptoms, and (b) identify the most influential drivers in relation to the PUI symptom community., Method: We estimated a Gaussian graphical model consisting of five facets of impulsivity, compulsivity and individual PUI symptoms among 370 Australian adults (51.1% female, mean age = 29.8, s.d. = 11.1). Network structure and bridge expected influence were examined to elucidate differential associations among impulsivity, compulsivity and PUI symptoms, as well as identify influential nodes bridging impulsivity, compulsivity and PUI symptoms., Results: Results revealed that four facets of impulsivity (i.e. negative urgency, positive urgency, lack of premeditation and lack of perseverance) and compulsivity were related to different PUI symptoms. Further, compulsivity and negative urgency were the most influential nodes in relation to the PUI symptom community due to their highest bridge expected influence., Conclusions: The current findings delineate distinct relationships across impulsivity, compulsivity and PUI, which offer insights into potential mechanistic pathways and targets for future interventions in this space. To realise this potential, future studies are needed to replicate the identified network structure in different populations and determine the directionality of the relationships among impulsivity, compulsivity and PUI symptoms.

Neurocognitive deficits have been implicated as transdiagnostic risk markers of substance use disorders. However, these have yet to be comprehensively evaluated in other, non-substance addictions. In a large, general community sample (N = 475) the present study evaluated the neurocognitive correlates of problem alcohol use and three non-substance-related addictive behaviors: addictive eating (AE), problematic pornography use (PPU), and problematic use of the internet (PUI), to identify potential shared and distinct neurocognitive correlates. A sample of Australian residents (54.4 % female M[SD] age = 32.4[11.9] years) completed a comprehensive online assessment of neurocognitive tasks tapping into eight distinct expert-endorsed domains purportedly associated with addiction. Multiple linear regressions with bootstrapping were used to examine associations among each addictive behavior of interest and neurocognition, trait impulsivity, and compulsivity, as well as key covariates. Neurocognition was differentially associated with each addictive behavior. None of the neurocognitive domains were significantly associated with problematic alcohol use or AE (p >.05), poorer performance monitoring was significantly associated with higher levels of PPU and PUI (β = -0.10, p =.049; β = -0.09, p =.028), and a preference for delayed gratification was associated with more severe PUI (β = -0.10, p =.025). Our findings have theoretical implications for how we understand non-substance addiction and suggest the need for a more nuanced approach to studying addictive behaviors that take into account the underlying neurocognitive mechanisms associated with each type of addiction., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Background: Neuropsychological assessments traditionally include tests of executive functioning (EF) because of its critical role in daily activities and link to mental disorders. Established traditional EF assessments, although robust, lack ecological validity and are limited to single cognitive processes. These methods, which are suitable for clinical populations, are less informative regarding EF in healthy individuals. With these limitations in mind, immersive virtual reality (VR)-based assessments of EF have garnered interest because of their potential to increase test sensitivity, ecological validity, and neuropsychological assessment accessibility., Objective: This systematic review aims to explore the literature on immersive VR assessments of EF focusing on (1) EF components being assessed, (2) how these assessments are validated, and (3) strategies for monitoring potential adverse (cybersickness) and beneficial (immersion) effects., Methods: EBSCOhost, Scopus, and Web of Science were searched in July 2022 using keywords that reflected the main themes of VR, neuropsychological tests, and EF. Articles had to be peer-reviewed manuscripts written in English and published after 2013 that detailed empirical, clinical, or proof-of-concept studies in which a virtual environment using a head-mounted display was used to assess EF in an adult population. A tabular synthesis method was used in which validation details from each study, including comparative assessments and scores, were systematically organized in a table. The results were summed and qualitatively analyzed to provide a comprehensive overview of the findings., Results: The search retrieved 555 unique articles, of which 19 (3.4%) met the inclusion criteria. The reviewed studies encompassed EF and associated higher-order cognitive functions such as inhibitory control, cognitive flexibility, working memory, planning, and attention. VR assessments commonly underwent validation against gold-standard traditional tasks. However, discrepancies were observed, with some studies lacking reported a priori planned correlations, omitting detailed descriptions of the EF constructs evaluated using the VR paradigms, and frequently reporting incomplete results. Notably, only 4 of the 19 (21%) studies evaluated cybersickness, and 5 of the 19 (26%) studies included user experience assessments., Conclusions: Although it acknowledges the potential of VR paradigms for assessing EF, the evidence has limitations. The methodological and psychometric properties of the included studies were inconsistently addressed, raising concerns about their validity and reliability. Infrequent monitoring of adverse effects such as cybersickness and considerable variability in sample sizes may limit interpretation and hinder psychometric evaluation. Several recommendations are proposed to improve the theory and practice of immersive VR assessments of EF. Future studies should explore the integration of biosensors with VR systems and the capabilities of VR in the context of spatial navigation assessments. Despite considerable promise, the systematic and validated implementation of VR assessments is essential for ensuring their practical utility in real-world applications., (©Rebecca Kirkham, Lars Kooijman, Lucy Albertella, Dan Myles, Murat Yücel, Kristian Rotaru. Originally published in JMIR Serious Games (https://games.jmir.org), 26.02.2024.)

Background: Attentional biases towards reward stimuli have been implicated in substance use-related problems. The value-modulated attentional capture (VMAC) task assesses such reward-related biases. The VMAC task widely used in lab studies tends to be monotonous and susceptible to low effort. We therefore tested a gamified online version of the VMAC that aimed to increase participant engagement. Our goal was to examine how VMAC is associated with substance use-related problems and addictive behaviors, and whether this association is moderated by cognitive control., Methods: We recruited 285 participants from an online community, including heavy alcohol users. All participants completed a novel gamified version of the VMAC task, measures of substance use and addictive behaviors (addictive-like eating behavior, problematic smartphone use), the WebExec measure of problems with executive functions, and the Stroop Adaptive Deadline Task (SDL) as a measure of cognitive control., Results: The gamified VMAC task successfully identified value-modulated attentional capture effects towards high-reward stimuli. We found no significant associations between VMAC scores, problematic alcohol or cannabis use, addictive behaviors, or any moderation by a behavioral measure of cognitive control. Exploratory analyses revealed that self-reported cognitive problems were associated with more alcohol-, and cannabis-related problems, and addictive behaviors. Greater attentional capture (VMAC) was associated with more cannabis use-related problems among individuals with higher levels of self-reported cognitive problems., Conclusions: Our study is one of the first to demonstrate the utility of the gamified version of the VMAC task in capturing attentional reward biases. Self-reported problems with cognitive functions represent a key dimension associated with substance use-related problems and addictive behaviors., Competing Interests: The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Murat Yücel receives funding from: government funding bodies such as the NHMRC, Australian Research Council (ARC), Australian Defence Science and Technology (DST), the Department of Industry, Innovation and Science (DIIS), the National Institutes of Health (NIH, USA); philanthropic donations from the David Winston Turner Endowment Fund, Wilson Foundation; sponsored Investigator-Initiated trials including Incannex Healthcare Ltd; and payments in relation to court-, expert witness-, and/or expert review-reports. Murat Yücel also sits on the Advisory Boards of: Centre of The Urban Mental Health, University of Amsterdam; Monash Biomedical Imaging Centre; and Enosis Therapeutics. These funding sources had no role in the data analysis, presentation, or interpretation and write-up of the data. All other authors declare no conflicts of interest., (© 2024 The Author(s).)

Objective: Cross-sectional studies show that habitual use of alcohol is associated with severity of alcohol dependence reflected across a range of domains and lower number of detoxifications in multiple settings. In this study, we investigated whether alcohol use disorder (AUD) patients with greater habitual use of alcohol at baseline showed worse outcomes after one year of follow-up., Methods: A sample of inpatients with Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) alcohol use disorder (AUD) was assessed at baseline (n = 50) and after one year (n = 30). The Habit, Reward, and Fear Scale (HRFS) was employed to quantify affective (fear or reward) and non-affective (habitual) drives for alcohol use, the Alcohol Dependence Scale (ADS) was used to assess clinical outcomes, and the Depression, Anxiety and Stress Scale (DASS-21) was used to quantify and control for associated affective symptoms., Results: There was a significant reduction in the three HRFS scores at the follow-up. Regression analyses demonstrated that greater habit- and fear-related drives at baseline predicted greater decreases in the ADS scores at the endpoint. However, after controlling for age, sex and affective symptoms, only reward and fear were associated with reductions in ADS scores at the end of one year. Prescriptions of naltrexone and antidepressants/benzodiazepines did not predict decreases in reward and fear-related motivations., Conclusion: Although we were unable to confirm that habitual subscores at baseline predict worse long-term outcomes among inpatients with AUD, we found that a greater fear and reward motives for the use of alcohol predicted a greater magnitude of improvement in the AUD symptoms after one year. We hope that these findings will help develop new approaches toward AUD treatment and inform models of addiction research., Competing Interests: Declaration of competing interest None., (Copyright © 2023 Elsevier Ltd. All rights reserved.)

Background: Obsessive-compulsive symptom fluctuations may be contingent on the number of stressful pandemic-related events and the resilience characterizing different cultures. We investigated the influence of the pandemic on symptom changes in a sample of obsessive-compulsive disorder (OCD) patients from Brazil and Italy, two countries that were highly affected by the outbreak., Methods: Ninety-one OCD outpatients were evaluated at baseline and about one year later. Thirty of them were assessed in Brazil and 61 in Italy. Socio-demographic variables, symptoms' severity and the number of stressful pandemic-related events were collected. Comparisons between countries' samples were performed, and a linear regression examined whether the country of origin, demographic features and the number of stressful events were able to predict the symptoms' severity at the follow-up., Results: Brazilian patients experienced more stressful pandemic-related events than Italian patients (p = 0.018). However, along with higher age (p < 0.01) and increased severity of symptoms at baseline (p < 0.01), lower number of events predicted increased symptoms' severity after one year (p < 0.01). Country of origin was not a significant predictor of severity., Limitations: Small number of subjects; lack of information regarding duration of illness; and potential sample differences between countries., Conclusions: During the pandemic, the occurrence of more stressful pandemic-related events was associated with decreased severity of patients' OCD symptoms. Nevertheless, older patients and those with more severe symptoms seemed prone to exhibit increased OCD severity at follow-up., Competing Interests: Declaration of competing interest The authors have no conflict of interests to report., (Copyright © 2023 Elsevier B.V. All rights reserved.)

Compulsivity is a transdiagnostic construct crucial to understanding multiple psychiatric conditions and problematic repetitive behaviours. Despite being identified as a clinical- and research-relevant construct, there are limited insights into the internal conceptual structure of compulsivity. To provide a more nuanced understanding of compulsivity, the current study estimated the structure of compulsivity (indexed using the previously validated Cambridge-Chicago Compulsivity Trait Scale, CHI-T) among two large-scale and geographically distinct samples using the network estimation method. The samples consisted of a United Kingdom cohort (n = 122,346, 51.4% female, Mean age = 43.7, SD = 16.5, range = 9-86 years) and a South Africa cohort (n = 2674, 65.6% female, Mean age = 24.6, SD = 8.6, range = 18-65 years). Network community analysis demonstrated that compulsivity was constituted of three interrelated dimensions, namely: perfectionism, cognitive rigidity and reward drive. Further, 'Completion leads to soothing' and 'Difficulty moving from task to task' were identified as core (central nodes) to compulsivity. The dimensional structure and central nodes of compulsivity networks were consistent across the two samples. These findings facilitate the conceptualisation and measurement of compulsivity and may contribute to the early detection and treatment of compulsivity-related disorders., Competing Interests: Declaration of Competing Interest Prof. Grant has received research grants from Otsuka and Biohaven Pharmaceuticals. He receives yearly compensation from Springer Publishing for acting as Editor-in-Chief of the Journal of Gambling Studies and has received royalties from Oxford University Press, American Psychiatric Publishing, Inc., Norton Press, and McGraw Hill. Prof. Chamberlain receives honoraria from Elsevier for editorial work. Prof. Chamberlain and Prof. Grant are copyright holders for the Cambridge-Chicago Trait Compulsivity Scale (CHI-T). Dr. Tiego is supported by a Turner Impact Fellowship from the Turner Institute for Brain and Mental Health. Dr. Ioannidis receives a stipend from Elsevier for editorial work. Dr. Hellyer is, in part, supported by the National Institute for Health Research (NIHR) Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King’s College London. Prof. Lochner is supported by the South African Medical Research Council. Prof. Yücel also receives funding from: government funding bodies such as the NHMRC, Australian Research Council (ARC), Australian Defence Science and Technology (DST), the Department of Industry, Innovation and Science (DIIS), the National Institutes of Health (NIH, USA); philanthropic donations from the David Winston Turner Endowment Fund, Wilson Foundation; sponsored Investigator-Initiated trials including Incannex Healthcare Ltd; and payments in relation to court-, expert witness-, and/or expert review-reports. These funding sources had no role in the data analysis, presentation, or interpretation and write-up of the data. The other authors do not have any disclosures to report., (Copyright © 2023 The Authors. Published by Elsevier Inc. All rights reserved.)

Problematic pornography use (PPU) is a complex and growing area of research. However, knowledge of the PPU lived experience is limited. To address this gap, we conducted an online qualitative study with 67 individuals who self-identified as having problematic pornography use (76% male; M age  = 24.70 years, SD = 8.54). Results indicated several dimensions that have not been fully explored in the literature. These included various mental and physical complaints following periods of heavy pornography use, sexual functioning deficits with real partners, and a subjectively altered state of sexual arousal while using pornography. Moreover, we expanded on current knowledge regarding the inner conflict associated with PPU and clarified the ways that users can progress to increasingly intensified patterns of pornography use, such as tolerance/escalation and pornographic binges. Our study highlights the complex and nuanced nature of PPU and provides suggestions for future research and clinical practice., (© 2023. Springer Nature Limited.)

It is well-established that addiction is typically associated with a distinct pattern of neurocognitive functioning with a consensus that it is typified by impaired top-down executive control and aberrant risk-reward processing. Despite a consensus that neurocognition plays an important role in characterizing and maintaining addictive disorders, there is a lack of systematic, bottom-up synthesis of quantitative evidence showing that neurocognition predicts addictive behaviors, and which neurocognitive constructs have the best predictive validity. This systematic review aimed to assess whether cognitive control and risk-reward processes as defined by the Research Domain Criteria (RDoC) predict the development and maintenance of addictive behaviors specifically, consumption, severity, and relapse. The findings from this review expose the substantial lack of evidence for neurocognition predicting addiction outcomes. However, there is evidence that suggests reward-related neurocognitive processes may be important for the detection of early risk for addiction, as well as a potentially viable target for designing novel, more effective interventions., Competing Interests: Competing interests statement The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Background: Many people with harmful addictive behaviors may not meet formal diagnostic thresholds for a disorder. A dimensional approach, by contrast, including clinical and community samples, is potentially key to early detection, prevention, and intervention. Importantly, while neurocognitive dysfunction underpins addictive behaviors, established assessment tools for neurocognitive assessment are lengthy and unengaging, difficult to administer at scale, and not suited to clinical or community needs. The BrainPark Assessment of Cognition (BrainPAC) Project sought to develop and validate an engaging and user-friendly digital assessment tool purpose-built to comprehensively assess the main consensus-driven constructs underpinning addictive behaviors., Objective: The purpose of this study was to psychometrically validate a gamified battery of consensus-based neurocognitive tasks against standard laboratory paradigms, ascertain test-retest reliability, and determine their sensitivity to addictive behaviors (eg, alcohol use) and other risk factors (eg, trait impulsivity)., Methods: Gold standard laboratory paradigms were selected to measure key neurocognitive constructs (Balloon Analogue Risk Task [BART], Stop Signal Task [SST], Delay Discounting Task [DDT], Value-Modulated Attentional Capture [VMAC] Task, and Sequential Decision-Making Task [SDT]), as endorsed by an international panel of addiction experts; namely, response selection and inhibition, reward valuation, action selection, reward learning, expectancy and reward prediction error, habit, and compulsivity. Working with game developers, BrainPAC tasks were developed and validated in 3 successive cohorts (total N=600) and a separate test-retest cohort (N=50) via Mechanical Turk using a cross-sectional design., Results: BrainPAC tasks were significantly correlated with the original laboratory paradigms on most metrics (r=0.18-0.63, P<.05). With the exception of the DDT k function and VMAC total points, all other task metrics across the 5 tasks did not differ between the gamified and nongamified versions (P>.05). Out of 5 tasks, 4 demonstrated adequate to excellent test-retest reliability (intraclass correlation coefficient 0.72-0.91, P<.001; except SDT). Gamified metrics were significantly associated with addictive behaviors on behavioral inventories, though largely independent of trait-based scales known to predict addiction risk., Conclusions: A purpose-built battery of digitally gamified tasks is sufficiently valid for the scalable assessment of key neurocognitive processes underpinning addictive behaviors. This validation provides evidence that a novel approach, purported to enhance task engagement, in the assessment of addiction-related neurocognition is feasible and empirically defensible. These findings have significant implications for risk detection and the successful deployment of next-generation assessment tools for substance use or misuse and other mental disorders characterized by neurocognitive anomalies related to motivation and self-regulation. Future development and validation of the BrainPAC tool should consider further enhancing convergence with established measures as well as collecting population-representative data to use clinically as normative comparisons., (©Rico S C Lee, Lucy Albertella, Erynn Christensen, Chao Suo, Rebecca A Segrave, Maja Brydevall, Rebecca Kirkham, Chang Liu, Leonardo F Fontenelle, Samuel R Chamberlain, Kristian Rotaru, Murat Yücel. Originally published in the Journal of Medical Internet Research (https://www.jmir.org), 25.08.2023.)

Introduction: Losses disguised as wins (LDWs) are a salient type of losing outcome common to electronic gambling machines (EGMs). These events occur when a gambling payout is less than the amount wagered (i.e., a net loss) but is nonetheless accompanied by the sounds and animations that accompany genuine wins. Previous lab-based studies have reported that participants tend to overestimate genuine wins when LDWs are present. This study reports an independent replication of these findings in a large online sample that included a substantial number of individuals reporting high-risk gambling and frequent EGM users., Methods: This online study recruited a sample of 940 participants who were randomly assigned to view one of two brief videos. Each video displayed a short period of simulated online slot machine gambling and included 2 genuine wins and either 3 or 0 LDWs. Participants were asked to estimate the number of times a win occurred that was more than the amount bet . Participants also completed the Problem Gambling Severity Index., Results: The mean estimated number of genuine wins was significantly larger for the condition displaying LDWs, 3.02 [95% CI = 2.82, 3.21] than the control condition, 2.14 [1.98, 2.30], t (887.66) = 6.78, d  = 0.44, p <.001., Conclusions: We replicated the LDW-triggered win overestimation effect previously reported in lab-based experiments that have recruited smaller samples. This effect was robust in both low-risk and high-risk groups, indicating that even experienced gamblers remain susceptible. Exploratory modelling suggested only a minority of individuals were uninfluenced by LDWs., Competing Interests: The authors declare that they have no conflict of interest in relation to the publication of this article. None of the authors have knowingly received direct research funding from the gambling, tobacco, or alcohol industries, nor from any industry-sponsored organisation, or any other commercial entity that may stand to gain or lose financially through the publication of this manuscript. None of the authors have any personal financial interest in these industries. Dan Myles is supported by an Australian Government Research Training Program PhD Scholarship as well as a Gambling Research Capacity Grant from the New South Wales Office of Responsible Gambling. The New South Wales Department of Health Office of Responsible Gambling derive resources in part through hypothecated taxes on gambling revenue. Daniel Bennett has previously received funding from the National Health and Medical Research Council, the American-Australian Association, and the Monash-Warwick Alliance. Adrian Carter is supported by a National Health and Medical Research Council of Australia Career Development Fellowship and Monash University. Murat Yücel has received funding from the National Health and Medical Research Council of Australia, the Australian Research Council, the David Winston Turner Endowment Fund, and Monash University. He has also received funding from the law firms in relation to expert witness report/statement. Cassandra de Lacy-Vawdon was supported by an Australian Government Research Training Program PhD Scholarship and a Monash Graduate Excellence Scholarship while undertaking this study. Charles Livingstone has received funding from the Victorian Responsible Gambling Foundation, the (former) Victorian Gambling Research Panel, and the South Australian Independent Gambling Authority (the funds for which were derived from hypothecation of gambling tax revenue to research purposes), from the Australian and New Zealand School of Government and the Foundation for Alcohol Research and Education, and from non-government organisations for research into multiple aspects of poker machine gambling, including regulatory reform, existing harm minimisation practices, and technical characteristics of gambling forms. He has received travel and co-operation grants from the Alberta Problem Gambling Research Institute, the Finnish Institute for Public Health, the Finnish Alcohol Research Foundation, the Ontario Problem Gambling Research Committee, the Turkish Red Crescent Society, and the Problem Gambling Foundation of New Zealand. He was a Chief Investigator on an Australian Research Council funded project researching mechanisms of influence on government by the tobacco, alcohol, and gambling industries. He has undertaken consultancy research for local governments and non-government organisations in Australia and the UK seeking to restrict or reduce the concentration of poker machines and gambling impacts and was a member of the Australian government's Ministerial Expert Advisory Group on Gambling in 2010-11. He is a member of the Lancet Public Health Commission into gambling, and of the World Health Organisation expert group on gambling and gambling harm., (© 2023 The Authors.)

Objective: "Subsyndromal" obsessive-compulsive disorder symptoms (OCDSs) are common and cause impaired psychosocial functioning. OCDSs are better captured by dimensional models of psychopathology, as opposed to categorical diagnoses. However, such dimensional approaches require a deep understanding of the underlying neurocognitive drivers and impulsive and compulsive traits (ie, neurocognitive phenotypes) across symptoms. This study investigated inhibitory control and self-monitoring across impulsivity, compulsivity, and their interaction in individuals (n = 40) experiencing mild-moderate OCDSs., Methods: EEG recording concurrent with the stop-signal task was used to elicit event-related potentials (ERPs) indexing inhibitory control (ie, N2 and P3) and self-monitoring (ie, error-related negativity and correct-related negativity (CRN): negativity following erroneous or correct responses, respectively)., Results: During unsuccessful stopping, individuals high in both impulsivity and compulsivity displayed enhanced N2 amplitude, indicative of conflict between the urge to respond and need to stop ( F (3, 33) = 1.48, P < .05, 95% Cl [-0.01, 0.001]). Individuals high in compulsivity and low in impulsivity showed reduced P3 amplitude, consistent with impairments in monitoring failed inhibitory control ( F (3, 24) = 2.033, P < .05, 95% CI [-0.002, 0.045]). Following successful stopping, high compulsivity (independent of impulsivity) was associated with lower CRN amplitude, reflecting hypo-monitoring of correct responses ( F (4, 32) = 4.76, P < .05, 95% CI [0.01, 0.02]), and with greater OCDS severity ( F (3, 36) = 3.32, P < .05, 95% CI [0.03, 0.19])., Conclusion: The current findings provide evidence for differential, ERP-indexed inhibitory control and self-monitoring profiles across impulsive and compulsive phenotypes in OCDSs.

Background: Obsessional slowness (OS) is characterised by debilitating motor slowness during initiation and completion of daily tasks such as washing, dressing, eating or walking. Yet, the clinical features of OS are still poorly understood., Methods: This study aimed to delineate demographics, comorbid disorders and obsessive-compulsive symptoms (OCS) associated with OS. Cross sectional data from 667 OCD outpatients aged 9-82   years ( M   =   37.86 , SD   =   12.78) who underwent comprehensive standardised assessments administered by trained clinicians were analysed. Participants with ( n   =   189) and without ( n   =   478) OS were compared and contrasted., Results: Logistic regression revealed that being single, having tics and displaying higher severity of aggression, contamination, symmetry and hoarding symptoms significantly predicted participants having OS., Conclusions: This is the largest-scale descriptive study of OS, which also provides preliminary evidence that OS may be a more severe form of OCD. Further empirical validation of these findings is required, and future research should focus on developing OS assessment.Key PointsThis was the first large-scale descriptive study of obsessional slowness (OS), that provided preliminary evidence for an OS phenotype within obsessive-compulsive disorderOS is associated with increased severity of aggression, contamination, symmetry and hoarding obsessive-compulsive symptomsIndividuals with OS are more likely to have comorbid tics, suggesting that there may be underlying motor factors contributing to this conditionFuture research would benefit from collecting both qualitative and quantitative data when assessing OS.

Background: It is unclear whether there is a specific association between stressful experiences and obsessive-compulsive symptoms or whether this relationship is due to stressful experiences increasing risk for psychopathology generally., Aims: The current study examined the association between stressful experiences and obsessive-compulsive symptom dimensions, while adjusting for coexisting psychiatric symptoms and psychological distress in a young adult transdiagnostic at-risk sample., Methods: Forty-three participants completed self-report measures assessing obsessive-compulsive symptoms, stressful experiences, and a range of other psychiatric symptoms. Regression models examined the relationship between stressful experiences and different obsessive-compulsive symptoms dimensions (i.e., symmetry, fear of harm, contamination, and unacceptable thoughts), adjusting for the influence of coexisting psychiatric symptoms and psychological distress., Results: The results showed that there was an association between stressful experiences and obsessive-compulsive symptoms dimension of symmetry. Symptoms of borderline personality disorder were positively associated with the obsessive-compulsive symptom dimensions of symmetry and fear of harm symptoms. Symptoms of psychosis were found to be negatively associated with the obsessive-compulsive symptoms dimension of fear of harm., Conclusions: These findings have implications for understanding the psychological mechanisms that underlie symmetry symptoms and highlight the need to study OCS dimensions separately to inform more precise, mechanism-targeted interventions., Competing Interests: Conflict of interest To the best of our knowledge, there are no conflict of interests., (Copyright © 2023. Published by Elsevier B.V.)

Objective: Understanding the impact of lifestyle on mental illness symptoms is important for informing psycho-education and developing interventions which target mental and physical comorbidities. Obsessive-compulsive and related disorders can have a significant impact on health-related quality of life and physical health. However, our understanding of the impact of lifestyle on obsessive-compulsive symptoms and broader compulsive and impulsive problematic repetitive behaviours is limited., Aims: We investigated whether lifestyle factors predicted change in obsessive-compulsive symptoms and problematic repetitive behaviours in a general population sample over a 3-month period., Methods: Eight hundred thirty-five participants completed an online questionnaire battery assessing lifestyle and mental health. Of these, 538 participants completed the same battery 3 months later. We conducted negative binomial regressions to analyse the association of lifestyle factors at baseline with future (1) obsessive-compulsive symptoms, (2) compulsive problematic repetitive behaviours and (3) impulsive problematic repetitive behaviours, adjusting for baseline obsessive-compulsive symptoms and problematic repetitive behaviours., Results: Lower vegetable ( p  = 0.020) and oily fish ( p  = 0.040) intake and lower moderate intensity physical activity ( p  = 0.008) predicted higher obsessive-compulsive symptoms at follow-up. Higher intake of high-fat foods ( p  < 0.001) predicted higher compulsive problematic repetitive behaviours at follow-up. No lifestyle factors significantly predicted impulsive problematic repetitive behaviours at follow-up., Conclusion: Our results speak to the potential importance of lifestyle quality screening, education and lifestyle interventions (e.g. an anti-inflammatory diet) for individuals experiencing compulsivity-related behaviours and/or symptoms. Further research into potential mechanisms of action will allow for more targeted approaches to lifestyle interventions for transdiagnostic compulsive behaviours.

Background: Existing research has demonstrated that problematic smartphone use (PSU) may reflect a composition of heterogeneous symptoms, with individual PSU symptoms uniquely related to predisposing variables. The Big Five personality traits represent one of the most frequently examined predisposing variables in relation to PSU. However, no studies to date have examined the trait-to-symptom association between the Big Five personality traits and PSU. Using a network analysis approach, we aimed to understand: 1) specific pathways linking each of the Big Five personality traits to PSU symptoms and 2) the bridging effects of each Big Five personality trait on the PSU symptom cluster., Methods: A regularised graphical Gaussian model was estimated among 1,849 Chinese university students. PSU symptoms were assessed with items from the Problematic Smartphone Use Scale. Facets of the Big Five personality traits were assessed with the subscales of the Chinese Big Five Personality Inventory-15. An empirical index (i.e., bridge expected influence) was used to quantify bridge nodes., Results: Results revealed specific and distinct pathways between the Big Five personality traits and PSU symptoms (e.g., Neuroticism-Escapism/Avoidance, Conscientiousness-Preoccupation and Extraversion-Escapism/Avoidance). Further, Neuroticism showed the highest positive bridge centrality among the Big Five personality traits, while Conscientiousness had the highest negative bridge centrality., Discussion and Conclusions: The current study provided direct empirical evidence concerning specific pathways between the Big Five personality traits and PSU symptoms and highlighted the influential role of Neuroticism and Conscientiousness as potential targets for early detection and treatment of PSU.

Introduction: The ability to perform optimally under pressure is critical across many occupations, including the military, first responders, and competitive sport. Despite recognition that such performance depends on a range of cognitive factors, how common these factors are across performance domains remains unclear. The current study sought to integrate existing knowledge in the performance field in the form of a transdisciplinary expert consensus on the cognitive mechanisms that underlie performance under pressure., Methods: International experts were recruited from four performance domains [(i) Defense; (ii) Competitive Sport; (iii) Civilian High-stakes; and (iv) Performance Neuroscience]. Experts rated constructs from the Research Domain Criteria (RDoC) framework (and several expert-suggested constructs) across successive rounds, until all constructs reached consensus for inclusion or were eliminated. Finally, included constructs were ranked for their relative importance., Results: Sixty-eight experts completed the first Delphi round, with 94% of experts retained by the end of the Delphi process. The following 10 constructs reached consensus across all four panels (in order of overall ranking): (1) Attention; (2) Cognitive Control-Performance Monitoring; (3) Arousal and Regulatory Systems-Arousal; (4) Cognitive Control-Goal Selection, Updating, Representation, and Maintenance; (5) Cognitive Control-Response Selection and Inhibition/Suppression; (6) Working memory-Flexible Updating; (7) Working memory-Active Maintenance; (8) Perception and Understanding of Self-Self-knowledge; (9) Working memory-Interference Control, and (10) Expert-suggested-Shifting., Discussion: Our results identify a set of transdisciplinary neuroscience-informed constructs, validated through expert consensus. This expert consensus is critical to standardizing cognitive assessment and informing mechanism-targeted interventions in the broader field of human performance optimization., Competing Interests: VM was employed by Mindflex Group Ltd. JG is a stockholder in MAP Biotech Pty Ltd. SC has received speakers fees Janssen-Cilag Australia, Lundbeck Otsuka Australia, Servier Australia; Investigator Initiated research funding Janssen-Cilag Australia; Lundbeck Otsuka Australia; Advisory Boards Lundbeck Otsuka Australia. AT has received research funding from BHP, Rio Tinto, and Shell. SD is a Member of the Board of Advisors Eisai Australia Pty Ltd. MY has received payments in relation to court-, expert witness-, and/or expert review-reports. JD was employed by Florida Maxima Corporation. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Albertella, Kirkham, Adler, Crampton, Drummond, Fogarty, Gross, Zaichkowsky, Andersen, Bartone, Boga, Bond, Brunyé, Campbell, Ciobanu, Clark, Crane, Dietrich, Doty, Driskell, Fahsing, Fiore, Flin, Funke, Gatt, Hancock, Harper, Heathcote, Heaton, Helsen, Hussey, Jackson, Khemlani, Killgore, Kleitman, Lane, Loft, MacMahon, Marcora, McKenna, Meijen, Moulton, Moyle, Nalivaiko, O’Connor, O’Conor, Patton, Piccolo, Ruiz, Schücker, Smith, Smith, Sobrino, Stetz, Stewart, Taylor, Tucker, van Stralen, Vickers, Visser, Walker, Wiggins, Williams, Wong, Aidman and Yücel.)

Background: The obsession of turning into another person (transformation obsessions [TO]), and its related compulsions have been initially conceptualised as a form of mental contamination. Nevertheless, it has remained understudied in the current obsessive-compulsive disorder (OCD) literature. In parallel, disturbances of the self have been identified as markers of prodromal psychosis in patients with schizophrenia. Based on the later association, this study aimed to investigate the sociodemographic and clinical correlates of TO., Methods: In all, 1001 OCD outpatients from the Brazilian OCD Research Consortium were included in this study. Several semi-structured and structured instruments were used to compare 48 OCD patients with TO with 953 OCD patients without TO. A repression model investigated the relationships between the presence of current TO and statistically significant univariate test outcomes., Results: Participants with TO presented an overall younger age, a longer period of time between the onset of the OCD symptoms and an OCD diagnosis, greater severity of the sexual/religious dimension and increased suicidality symptoms., Conclusions: These results indicate that TO may be better conceptualised as a form of forbidden/taboo thoughts rather than contamination. While no significant associations with psychotic features (e.g. decreased insight) were observed, TO patients displayed increased suicidality, overall younger age and a significantly larger disparity between seeking treatment and OCD diagnosis. This demonstrates that further clinical awareness and research into TO as an OCD symptom is most needed.

Background: The present study explored the influence of romantic love on the expression of several obsessive-compulsive disorder (OCD) characteristics, including symptom severity, symptom dimensions, age at onset, sensory phenomena (SP), and developmental course, as well as other related comorbid disorders. It was hypothesized that love-precipitated OCD would be associated with a set of distinct characteristics and exhibit greater rates of comorbid disorders., Methods: The analyses were performed using a large sample (n = 981) of clinical patients with a primary diagnosis of OCD (Females = 67.3%, M age = 35.31)., Results: Love-precipitated OCD was associated with greater severity of SP and later age at onset of obsessions. However, symptom severity, symptom dimension, developmental course, and psychiatric comorbidities were not associated with love-precipitated OCD., Conclusion: It was concluded that romantic love does shape the expression of OCD, especially with regard to SP and onset age. These findings encourage further exploration to determine its clinical significance as a phenotype.

Objective: Problematic drinking is highly prevalent among the general population, oftentimes leading to significant negative consequences, including physical injury, psychological problems and financial hardship. In order to design targeted early interventions for problematic drinking, it is important to understand the mechanisms that render individuals at risk for and/or maintain this behavior. Two candidate drivers of problematic drinking are distress-driven impulsivity and trait compulsivity, with recent research suggesting these constructs may interact to enhance risk for addictive behaviors. The current study examined whether individual differences in distress-driven impulsivity and trait compulsivity interact in relation to problematic drinking., Method: Distress-driven impulsivity (indexed by the S-UPPS-P negative urgency subscale), trait compulsivity (indexed by the CHIT scale) and problematic drinking (indexed by the BATCAP alcohol scale) were assessed in two independent online samples (Sample 1, n = 117; Sample 2, n = 474). Bootstrapped moderation analysis was conducted to examine whether trait compulsivity moderated the relationship between distress-driven impulsivity and problematic drinking., Results: In both samples, there was a significant interaction between distress-driven impulsivity and trait compulsivity in relation to problematic drinking. Follow-up tests revealed that, in both samples, higher distress-driven impulsivity was associated with more problematic drinking behaviors among participants with high trait compulsivity only., Conclusions: The current findings add to the growing literature supporting an interactive relationship between impulsivity and compulsivity-related traits in relation to addictive behaviors and have implications for informing early detection of risk and targeted early interventions., Competing Interests: Author MY has received payment from law firms in relation to court and/or expert witness reports. Author SC consults for Promentis and receives a stipend/honoraria from Elsevier for editorial work. Author JG has received research grants from Biohaven, Promentis, and Otsuka Pharmaceuticals. He also receives yearly compensation from Springer Publishing for acting as Editor-in-Chief of the Journal of Gambling Studies and has received royalties from Oxford University Press, American Psychiatric Publishing, Inc., Norton Press, and McGraw Hill. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Liu, Rotaru, Chamberlain, Yücel, Grant, Lee, Wulandari, Suo and Albertella.)

Background: The coronavirus disease 19 (COVID-19) has led to increased reliance on the internet. How problematic usage of the internet (PUI) and COVID-19 related stress and other clinical variables relate, is unknown. We hypothesised that higher PUI level would be significantly associated with higher levels of: (i) pandemic-related stress; and (ii) impulsive and compulsive symptoms and traits., Methods: An online community-based cross-sectional survey was used for data collection. Relationships between PUI level and other variables were characterised using correlational analyses. Regression analyses determined the cumulative explanatory power of variables, with partial least squares structural equation modelling (PLS-SEM) to explore path loadings. ANOVA was used to investigate PUI level at varying lockdown levels., Results: Data from 2110 participants (64.5% female), aged 18-64 years (mean: 24.3, SD: 8.1) suggested that approximately a quarter (n = 489, 23.2%) had medium to high level internet use problems. Impulsive and compulsive symptoms and traits, pandemic-stress, and age were all significantly related to PUI (p < 0.01). These associations (medium effect sizes) cumulatively explained 29% of PUI variance. PLS-SEM indicated significant contributory effects, with the association between age and PUI level mediated by impulsivity, pandemic-stress and compulsivity., Discussion: Pandemic-stress, impulsive-compulsive symptoms and traits and age were related to PUI level. Enhancing resilience to stress, particularly in vulnerable populations, through lifestyle changes and implementation of adaptive coping strategies, is key to reduce risk for PUI during the COVID-19 pandemic and beyond., (Copyright © 2022 Elsevier Ltd. All rights reserved.)

Background: Adolescents and young adults have health needs that are distinctly different from children and adults. A lack of education and training is reported by clinicians to be one of the main barriers to providing comprehensive developmentally appropriate care to young people, including the provision of confidential healthcare and taking a holistic approach., Aim: This study documents the current provision of care to young people on an adult inpatient medical ward at a large tertiary teaching hospital in Auckland., Methods: Forty-three staff and 40 patients aged 16-24 years on an adult medical ward completed surveys, which were based on the Northern Regional Alliance, Northern Regional Youth Health Network Standards for Quality Care for Adolescents and Young Adults in Secondary or Tertiary Care., Results: Few (12%) staff had completed any specific training in looking after adolescent and young adult patients. Confidentiality was not routinely discussed with young people by 50% of clinicians, and only 23% of staff reported that they see a young person alone as part of their consultation or admission. Less than half of young people reported receiving a comprehensive psychosocial assessment that included sexual health, mental health and suicide, and safety., Conclusions: Key components of comprehensive developmentally appropriate healthcare were not regularly carried out by staff on an adult medical ward. These findings suggest that further education and training, and service improvements are needed in tertiary adult hospital settings., (© 2021 Royal Australasian College of Physicians.)

Background: Problematic internet use is receiving increasing attention in the addiction field, yet the mechanisms driving such behaviours remain unclear. Previous research has shown that impulsivity- and compulsivity-related constructs may interactively contribute to a range of problematic behaviours. The current study examined whether distress-driven impulsivity and psychological flexibility may interactively contribute to problematic internet use, which has not been addressed in prior literature., Method: Two hundred and one participants completed an online survey. Bootstrapped moderation analysis was conducted to examine the collected data on distress-driven impulsivity, psychological flexibility, and their interaction in relation to problematic internet use., Results: The interaction between distress-driven impulsivity and psychological flexibility was significantly related to problematic internet use. Simple slope tests confirmed that distress-driven impulsivity was associated with problematic internet use among individuals with low flexibility levels., Conclusions: Our findings highlight the moderating role of psychological inflexibility in the association between distress-driven impulsivity and problematic internet use. Prevention and/or early interventions for problematic internet use should consider targeting psychological inflexibility and distress-driven impulsivity.

Background: Existing research has demonstrated that intolerance of uncertainty (IU) is associated with problematic smartphone use (PSU). However, little is known about how different IU components such as uncertainty-related beliefs, emotions, and behaviors may impact on different PSU symptoms., Methods: Extending previous research, the current study examined the specific associations between IU components and PSU symptoms via a symptom-level network approach. A regularized partial correlation network consisting of different IU components and PSU symptoms was estimated among 1,849 Chinese university students. We examined pathways and influential nodes (i.e. central components/symptoms and bridge components/symptoms) within the IU-PSU network., Results: The strongest pathway linking IU and PSU was between emotional reactions to uncertainty and coping-motivated smartphone use. Importantly, emotional reactions toward not having enough information (a reflection of emotional reactions to uncertainty) may act as both a central and a bridge component in maintaining the whole IU-PSU network., Conclusions: The results are in line with the I-PACE model and highlight that PSU may be a coping response for negative emotions derived from uncertainty. Finally, the current findings highlight the potential of interventions targeting intolerance of uncertainty for reducing PSU., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Liu, Ren, Li, Yang, Li, Rotaru, Wei, Yücel and Albertella.)

Background: Since the onset of the COVID-19 pandemic, concerns regarding its psychological effects on people with preexisting psychiatric disorders have been raised, particularly obsessive-compulsive disorder (OCD). Nevertheless, only a few longitudinal studies have been performed, and a more longstanding follow-up of a clinical sample is needed. In this study, our aim was to investigate the influence of the COVID-19 pandemic on symptom changes in a sample of Brazilian OCD patients for about a one-year period., Methods: Thirty OCD outpatients seen in a specialized OCD clinic in Rio de Janeiro were evaluated at baseline and after one year (during the pandemic). Sociodemographic and clinical variables were collected along with a questionnaire aimed at quantifying the number of stressful events related to the COVID-19 pandemic. Comparisons between two time points (pre vs. during COVID-19) and two subgroups (patients with vs without worsening of symptoms) were carried out., Results: As a group, OCD patients treated with SRIs had an overall stabilization of symptoms throughout the follow-up period, regardless of the number of stressful experiences related to coronavirus (median baseline YBOCS remained 22.0 at follow-up). In addition, when individually analyzed, even those who reported an increase in their symptoms did not describe a greater number of COVID-19 related events., Conclusions: Patients with OCD, who were under treatment, did not show significant symptom deterioration as a result of the COVID-19 pandemic. Individual variations in OCD symptom severity did not seem to be related to experiences linked to coronavirus., (Copyright © 2022 Elsevier Ltd. All rights reserved.)

Compulsivity is a poorly understood transdiagnostic construct thought to underlie multiple disorders, including obsessive-compulsive disorder, addictions, and binge eating. Our current understanding of the causes of compulsive behavior remains primarily based on investigations into specific diagnostic categories or findings relying on one or two laboratory measures to explain complex phenotypic variance. This proof-of-concept study drew on a heterogeneous sample of community-based individuals (N = 45; 18-45 years; 25 female) exhibiting compulsive behavioral patterns in alcohol use, eating, cleaning, checking, or symmetry. Data-driven statistical modeling of multidimensional markers was utilized to identify homogeneous subtypes that were independent of traditional clinical phenomenology. Markers were based on well-defined measures of affective processing and included psychological assessment of compulsivity, behavioral avoidance, and stress, neurocognitive assessment of reward vs. punishment learning, and biological assessment of the cortisol awakening response. The neurobiological validity of the subtypes was assessed using functional magnetic resonance imaging. Statistical modeling identified three stable, distinct subtypes of compulsivity and affective processing, which we labeled "Compulsive Non-Avoidant", "Compulsive Reactive" and "Compulsive Stressed". They differed meaningfully on validation measures of mood, intolerance of uncertainty, and urgency. Most importantly, subtypes captured neurobiological variance on amygdala-based resting-state functional connectivity, suggesting they were valid representations of underlying neurobiology and highlighting the relevance of emotion-related brain networks in compulsive behavior. Although independent larger samples are needed to confirm the stability of subtypes, these data offer an integrated understanding of how different systems may interact in compulsive behavior and provide new considerations for guiding tailored intervention decisions., (© 2021. The Author(s).)

Background: Poor mental health is a state of psychological distress that is influenced by lifestyle factors such as sleep, diet, and physical activity. Compulsivity is a transdiagnostic phenotype cutting across a range of mental illnesses including obsessive-compulsive disorder, substance-related and addictive disorders, and is also influenced by lifestyle. Yet, how lifestyle relates to compulsivity is presently unknown, but important to understand to gain insights into individual differences in mental health. We assessed (a) the relationships between compulsivity and diet quality, sleep quality, and physical activity, and (b) whether psychological distress statistically contributes to these relationships., Methods: We collected harmonized data on compulsivity, psychological distress, and lifestyle from two independent samples (Australian n = 880 and US n = 829). We used mediation analyses to investigate bidirectional relationships between compulsivity and lifestyle factors, and the role of psychological distress., Results: Higher compulsivity was significantly related to poorer diet and sleep. Psychological distress statistically mediated the relationship between poorer sleep quality and higher compulsivity, and partially statistically mediated the relationship between poorer diet and higher compulsivity., Conclusions: Lifestyle interventions in compulsivity may target psychological distress in the first instance, followed by sleep and diet quality. As psychological distress links aspects of lifestyle and compulsivity, focusing on mitigating and managing distress may offer a useful therapeutic approach to improve physical and mental health. Future research may focus on the specific sleep and diet patterns which may alter compulsivity over time to inform lifestyle targets for prevention and treatment of functionally impairing compulsive behaviors.

We aimed at investigating the impact of the coronavirus pandemic on individuals with problematic hoarding behaviors. One hundred seventeen subjects with hoarding problems responded to the Coronavirus Stressful and Traumatic Rating Scale (COROTRAS), an instrument that quantified the number of coronavirus-related events, whether they were experienced as stressful, and the range of emotions resulting from them. The research subjects also answered self-report tools to evaluate the severity of hoarding, hoarding beliefs/motivations, social support, self-efficacy, internalized stigma, and other psychopathological symptoms. The number of stressful coronavirus-related events was predicted by lower age at onset of hoarding, decreased social support, greater severity of obsessive-compulsive symptoms, and lower intensity of concerns over memory as drivers of hoarding. Two emotional states experienced in the aftermath of trauma, namely greater helplessness and lower sadness, and higher depression, anxiety and distress, predicted greater severity of hoarding. In conclusion, we were able to find significant associations between hoarding disorder phenotypes and covid-19 related stressful events., (Copyright © 2021 Elsevier Ltd. All rights reserved.)

We investigated changes in the severity of obsessive-compulsive and related disorders (OCRDs) symptoms as a result of the COVID-19 pandemic. An Amazon Mechanical Turk sample of 829 individuals was evaluated with a series of instruments assessing the severity of the OCRDs before and during the pandemic. Additional questionnaires about sociodemographic factors, personal and family histories of OCRD, COVID-19 related events, compulsivity and impulsivity traits, schizotypal symptoms, and the severity of depression, anxiety and stress levels, were also used. Participants reported that OCD, hoarding disorder (HD) and skin picking disorder (SPD) symptoms significantly worsened during the pandemic along with increased disability, more affective symptoms and reduced quality of life. Female gender, a higher number of COVID-19 related stressful events, and higher pre-COVID-19 fear of harm and symmetry symptoms predicted more severe OCD symptoms during the pandemic, whereas lack of a HD diagnosis by a mental health professional and more severe schizotypal symptoms predicted worsened hoarding symptoms. Greater compulsivity traits were associated with more severe COVID-19 pandemic obsessive-compulsive and hoarding symptoms. These data indicate that the immense distress resulting from the COVID-19 included significant deterioration of OCRDs' symptoms, particularly of OCD, HD and SPD. It was also possible to identify a pre-pandemic profile of people most at risk of pandemic-related deterioration in OCRDs' symptoms, which may prove valuable for preventative initiatives in relation to the likely future waves of COVID-19 or of other communicable diseases. Future studies should follow up these findings longitudinally., (Copyright © 2021 Elsevier Ltd. All rights reserved.)

Background: Daily routine and situations may worsen, stabilise, or improve symptoms of obsessive-compulsive disorder (OCD). We investigated which factors OCD patients perceived to be related to the worsening of their OCD symptoms and their relationship to patients' OCD symptom severity., Methods: Seven-hundred and forty-two OCD patients completed the Yale-Brown Obsessive-Compulsive Scale as a measure of OCD symptom severity and the Yale OCD Natural History Questionnaire assessing perception of impact of environmental and routine factors on symptoms. We conducted univariate exploratory analyses and a multivariate regression., Results: Reporting of worsening OCD symptoms when having a meal (B = 0.093, p = 0.008), during hot weather (B = 0.153, p < 0.001) and while watching television (B = 0.080, p = 0.039) was associated with more severe OCD symptoms., Conclusion: People with more severe OCD report symptom worsening while having a meal, when exposed to higher temperatures, and whilst watching television. While our study may be limited by its cross-sectional design (limiting inferences of causality) and analysis of broad (rather than specific) OCD symptoms, our findings point to a potential common biological abnormality that is disturbed by certain events in OCD. We present clinical implications of our findings and areas for further exploration., (Copyright © 2021 Elsevier Ltd. All rights reserved.)

Objective: Lifestyle medicine is increasingly important in psychiatry for its efficacy as a transdiagnostic treatment, its preventative potential, and its increased tolerability compared with first-line strategies. Although the impact of lifestyle medicine is strong across many psychiatric illnesses, our understanding of the effectiveness of lifestyle interventions in treating obsessive-compulsive and related disorders (OCRDs) is minimal. We aimed to conduct a systematic review examining the effect of lifestyle interventions (targeting diet, exercise, sleep, stress management, and tobacco/alcohol use) on OCRD symptoms., Methods: We systematically searched four electronic databases for published randomized controlled trials reporting on lifestyle interventions for OCRDs. We qualitatively synthesized results of eligible studies and calculated mean changes in symptom severity from baseline to end point and standardized between-group effect sizes., Results: We identified 33 eligible studies. Poor efficacy was noted across a number of rigorous dietary supplement interventions with some promising data in four (of six) studies regarding N-acetylcysteine for trichotillomania, skin picking, and obsessive-compulsive disorder. Stress management interventions, generally characterized by high risk of bias, reported mild effectiveness with greater effects noted for mind-body exercises (yoga) for obsessive-compulsive disorder. Greater improvements may be achieved when lifestyle intervention is adjunct to first-line treatments and delivered by facilitators., Conclusions: Diet (particularly N-acetylcysteine) and stress management interventions seem promising avenues for OCRDs treatment. We present an action plan to move the lifestyle interventions for OCRDs field forward. Further high-quality lifestyle interventions are required to improve the certainty of findings and to inform clinical treatment guidelines.Review Registration Number: CRD42020151407., (Copyright © 2021 by the American Psychosomatic Society.)

Background: Childhood trauma is associated with a range of psychiatric disorders, including obsessive-compulsive disorder (OCD). However, our understanding of the different types of childhood trauma and its impact on the different types and severity of obsessive-compulsive symptoms (OCS) is still in its infancy., Aims: We conducted a systematic review to synthesise the current knowledge on the possible relationships between childhood trauma and obsessive-compulsive symptoms in clinical and non-clinical populations., Methods: We systematically searched four electronic databases for studies reporting on childhood trauma and OCS severity. Subsequently, we qualitatively synthesised results of eligible studies and effect sizes were also calculated., Results: Twenty-four studies were included in this systematic review. Most studies used OCD samples (k = 16), with a few studies using a sample comprising of a range of psychiatric disorders (k = 6) and some studies using a general community sample (k = 2). Overall, there was support for a significant relationship between childhood trauma and OCS severity (8 out of 16 of the studies using OCD clinical samples, both studies using general population samples, and 5 out of 6 studies used mixed psychiatric samples)., Conclusions: We found evidence of a significant relationship between exposure to childhood trauma and OCS severity across clinical and non-clinical populations. Our results also suggest that a range rather than a single type of childhood trauma was associated with OCD., (Copyright © 2021 Elsevier Ltd. All rights reserved.)

Laboratory stress-induction procedures have been critical in illuminating the effects of stress on human health, cognition, and functioning. Here, we present a novel stress induction procedure, the Simple Singing Stress Procedure (SSSP), that overcomes some of the practical challenges and conceptual limitations of existing procedures in measuring the causal influence of stress on psychological variables. In the stress condition of the SSSP, participants were instructed to sing a song in front of the experimenter while being video- and audio-recorded. Participants were also informed that they would have to sing again at the end of the experiment, and that this second performance would later be assessed by a panel of experimenters. Participants in a no-stress condition instead read lyrics in each phase. Our findings revealed that participants in the stress condition showed significantly higher blood pressure immediately following the initial singing session, as well as heightened salivary cortisol at a latency consistent with the initial singing session, than those in the no-stress condition. Our stress procedure also generated elevations in self-reported stress ratings immediately after the first singing session and subsequently in anticipation of the second singing session, relative to the no-stress condition. Collectively, these findings suggest that the SSSP is a simple and effective stress induction procedure that may be a promising alternative to existing protocols., (© 2020. The Psychonomic Society, Inc.)

Background: Although past research shows hoarding to be associated with stressful life events involving loss and/or deprivation, the temporal relationship between the onset of symptoms and these events is not completely clear., Objectives: In a cross-sectional online study, we examined the relationship between the number of events involving loss or deprivation before/simultaneously vs. after the onset of hoarding and various hoarding-related beliefs, such as emotional attachment to possessions, and symptom severity. Further, we examined whether perceived social support moderated the influence of these events on emotional attachment to objects., Methods: One hundred seventeen subjects with hoarding problems responded to a series of instruments to assess the history and timing of traumatic and stressful loss and/or deprivation in relation to the onset of hoarding, and self-report tools evaluating the severity of hoarding, beliefs/motivations, depression, anxiety, general distress, and perceived social support., Results: The number of events involving loss or deprivation occurring before hoarding was related to increased emotional attachment to possessions, whereas events happening after the onset of hoarding were related to increased concerns about memory as drivers of hoarding symptoms. Events happening before hoarding did not interact with perceived social support to influence emotional attachment to objects., Conclusions: The timing of traumatic and stressful life events related to loss and deprivation is associated with different hoarding phenotypes, including beliefs/motivations for hoarding. If confirmed by longitudinal studies, these findings may be relevant for therapeutic and preventive measures., Competing Interests: No potential conflict of interest was reported by the author(s)., (© 2021 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group.)

Despite generalized anxiety disorder (GAD) being one of the most prevalent comorbidities in obsessive-compulsive disorder (OCD), few studies have researched its impact on the OCD phenotype. The present study investigated how the sociodemographic and clinical profile of people with OCD with comorbid GAD differs from people with OCD without comorbid GAD. We hypothesised that the phenotype of the comorbid group would be closely related to GAD, in that it would more likely be female, have an earlier age at onset of OCD, and show an increased severity of fear-related OCD symptoms (aggressive, sexual/religious, and contamination dimensions), more avoidant behaviours, greater suicidality, more severe anxiety symptoms, and increased rates of comorbid anxiety and mood disorders. The study included 867 participants with OCD, with GAD being comorbid in 33.56%. Mann-Whitney U tests, chi-square tests with continuity correction, and logistic regressions were performed. Results showed that comorbid GAD was uniquely associated with an increased number of avoidant behaviours, greater anxiety severity, panic disorder without agoraphobia, social phobia, specific phobia, and type II bipolar disorder. These results illustrate the clinical severity associated with this comorbidity and highlight markers that can aid diagnosis of GAD in OCD. Future studies should investigate whether this comorbidity has an impact on the treatment of OCD., (Copyright © 2021. Published by Elsevier B.V.)

Objective: To (1) confirm whether the Habit, Reward, and Fear Scale is able to generate a 3-factor solution in a population of obsessive-compulsive disorder and alcohol use disorder (AUD) patients; (2) compare these clinical groups in their habit, reward, and fear motivations; and (3) investigate whether homogenous subgroups can be identified to resolve heterogeneity within and across disorders based on the motivations driving ritualistic and drinking behaviors., Methods: One hundred and thirty-four obsessive-compulsive disorder (n = 76) or AUD (n = 58) patients were assessed with a battery of scales including the Habit, Reward, and Fear Scale, the Yale-Brown Obsessive-Compulsive Scale, the Alcohol Dependence Scale, the Behavioral Inhibition/Activation System Scale, and the Urgency, (lack of ) Premeditation, (lack of ) Perseverance, Sensation Seeking, and Positive Urgency Impulsive Behavior Scale., Results: A 3-factor solution reflecting habit, reward, and fear subscores explained 56.6% of the total variance of the Habit, Reward, and Fear Scale. Although the habit and fear subscores were significantly higher in obsessive-compulsive disorder (OCD) and the reward subscores were significantly greater in AUD patients, a cluster analysis identified that the 3 clusters were each characterized by differing proportions of OCD and AUD patients., Conclusions: While affective (reward- and fear-driven) and nonaffective (habitual) motivations for repetitive behaviors seem dissociable from each other, it is possible to identify subgroups in a transdiagnostic manner based on motivations that do not match perfectly motivations that usually described in OCD and AUD patients.

Background: Researchers are only just beginning to understand the neurocognitive drivers of addiction-like eating behaviours, a highly distressing and relatively common condition. Two constructs have been consistently linked to addiction-like eating: distress-driven impulsivity and cognitive inflexibility. Despite a large body of addiction research showing that impulsivity-related traits can interact with other risk markers to result in an especially heightened risk for addictive behaviours, no study to date has examined how distress-driven impulsivity interacts with cognitive inflexibility in relation to addiction-like eating behaviours. The current study examines the interactive contribution of distress-driven impulsivity and cognitive inflexibility to addiction-like eating behaviours., Method: One hundred and thirty-one participants [mean age 21 years (SD = 2.3), 61.8% female] completed the modified Yale Food Addiction Scale, the S-UPPS-P impulsivity scale, and a cognitive flexibility task. A bootstrap method was used to examine the associations between distress-driven impulsivity, cognitive inflexibility, and their interaction with addiction-like eating behaviours., Results: There was a significant interaction effect between distress-driven impulsivity and cognitive flexibility (P = 0.03). The follow-up test revealed that higher distress-driven impulsivity was associated with more addiction-like eating behaviours among participants classified as cognitively inflexible only., Conclusion: The current findings shed light on the mechanisms underlying addiction-like eating behaviours, including how traits and cognition might interact to drive them. The findings also suggest that interventions that directly address distress-driven impulsivity and cognitive inflexibility might be effective in reducing risk for addiction-like eating and related disorders.

Background: The extent to which obsessive-compulsive and related disorders (OCRDs) are impulsive, compulsive, or both requires further investigation. We investigated the existence of different clusters in an online nonclinical sample and in which groups DSM-5 OCRDs and other related psychopathological symptoms are best placed., Methods: Seven hundred and seventy-four adult participants completed online questionnaires including the Cambridge-Chicago Compulsivity Trait Scale (CHI-T), the Barratt Impulsiveness Scale (BIS-15), and a series of DSM-5 OCRDs symptom severity and other psychopathological measures. We used K-means cluster analysis using CHI-T and BIS responses to test three and four factor solutions. Next, we investigated whether different OCRDs symptoms predicted cluster membership using a multinomial regression model., Results: The best solution identified one "healthy" and three "clinical" clusters (ie, one predominantly "compulsive" group, one predominantly "impulsive" group, and one "mixed"-"compulsive and impulsive group"). A multinomial regression model found obsessive-compulsive, body dysmorphic, and schizotypal symptoms to be associated with the "mixed" and the "compulsive" clusters, and hoarding and emotional symptoms to be related, on a trend level, to the "impulsive" cluster. Additional analysis showed cognitive-perceptual schizotypal symptoms to be associated with the "mixed" but not the "compulsive" group., Conclusions: Our findings suggest that obsessive-compulsive disorder; body dysmorphic disorder and schizotypal symptoms can be mapped across the "compulsive" and "mixed" clusters of the compulsive-impulsive spectrum. Although there was a trend toward hoarding being associated with the "impulsive" group, trichotillomania, and skin picking disorder symptoms did not clearly fit to the demarcated clusters.

Background: While it is generally recognised that cognitive attributes can predict behaviour change outcomes in the field of addiction this question is typically studied in treatment seeking samples (to predict treatment outcomes and relapse). However the concept of behaviour change applies to the entire spectrum of addiction-like behaviours and initiatives such as temporary abstinence challenges offer insight into an understudied but equally relevant point of the spectrum. Thus the current study examined whether reward-related attentional capture predicted non-abstinence during IkPas (the Dutch national dry January campaign translated: NoThanks!)., Method: Participants included 1130 adults who had complete baseline data and performed above chance level on the cognitive task. Of these 683 participants completed the post-IkPas assessment and were included in the primary analysis. A binary logistic regression examined whether reward-related attentional capture predicted drinking during IkPas controlling for alcohol use at baseline (among other potential confounders)., Results: Participants who showed greater reward-related attentional capture before IkPas were more likely to not remain abstinent from drinking during IkPas (p = .014). Findings were replicated using multiple imputation to replace missing data (p = .013)., Conclusion: These findings provide important insights into the cognitive mechanisms that support successful behaviour change such as the ability to ignore task-irrelevant reward cues and may inform the development of tools that individuals could use to maximise their likelihood of achieving successful behaviour change., (Copyright © 2020 Elsevier Ltd. All rights reserved.)

Internet-based acceptance and commitment therapy (iACT) primarily targets the process of psychological flexibility. Its accessibility and low-intensity delivery are applicable across different treatment and prevention scenarios. This transdiagnostic meta-analysis reviews the effectiveness of iACT on anxiety, depression, quality of life, and psychological flexibility across individuals with different psychological and somatic conditions/complaints, or undiagnosed complaints. Seven databases were searched for randomized controlled trials that reported on anxiety, depression, quality of life, and psychological flexibility outcomes from iACT in any adult population. Engagement with iACT was summarized and methodological and population-related variables were investigated as potential moderators of effectiveness. Across 25 studies, small pooled effects were found for all outcomes at post-assessment and maintained at follow-up time-points. Interventions with therapist guidance demonstrated greater effectiveness in improving depression and psychological flexibility outcomes compared to nonguided iACT, and populations defined by a psychological condition or symptoms (e.g., depressed samples) demonstrated greater improvements in anxiety compared to nonclinical or somatic populations (e.g., chronic pain samples or students). Participants completed on average 75.77% of iACT treatments. While we found iACT to be effective in improving and maintaining mental health outcomes across diverse populations, there was limited evidence of reliable, clinically significant effects. PROSPERO registration number: CRD42020140086., (Copyright © 2020. Published by Elsevier Ltd.)

Background: The COVID-19 pandemic has resulted in high levels of psychological distress worldwide, with experts expressing concern that this could result in corresponding increases in addictive behaviors as individuals seek to cope with their distress. Further, some individuals may be at greater risk than others for developing problematic addictive behaviors during times of high stress, such as individuals with high trait impulsivity and compulsivity. Despite the potential of such knowledge to inform early detection of risk, no study to date has examined the influence of trait impulsivity and compulsivity on addictive behaviors during COVID-19. Toward this aim, the current study examined the association between impulsive and compulsive traits and problematic addictive and compulsive behaviors during the first COVID-19 lockdown in Australia. Methods: Eight hundred seventy-eight adults completed a cross-sectional online survey during the first lockdown, between late May to June 2020. Participants completed scales for addictive and compulsive behaviors for the period prior to and during lockdown for problematic eating, pornography, internet use, gambling, drinking, and obsessive-compulsive behaviors. Negative binomial regressions examined the associations between impulsivity, compulsivity, and their interaction with problematic behaviors during lockdown, controlling for age, gender, sample, psychological distress, exposure to COVID-related stressors, and pre-COVID problems. Results: Greater trait compulsivity was associated with more problematic obsessive-compulsive behaviors ( p < 0.001) and less problematic drinking ( p = 0.038) during lockdown. Further, trait compulsivity interacted with trait impulsivity in relation to problematic eating behaviors ( p = 0.014) such that greater trait compulsivity was associated with more problems among individuals with low impulsivity only ( p = 0.030). Finally, psychological distress and/or exposure to COVID-related stressors were associated with greater problems across all addictive and compulsive behaviors, as was severity of pre-COVID problems. Discussion: Trait compulsivity was associated with addictive and compulsive behaviors in different ways. Further, the finding that stress-related variables (psychological distress and COVID-related stressors) were associated with greater problems across all lockdown behaviors supports the idea that stress may facilitate, or otherwise be associated with, problematic behaviors. These findings highlight the need for interventions that enhance resilience to stress, which in turn may reduce risk for addictive and compulsive disorders., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 Albertella, Rotaru, Christensen, Lowe, Brierley, Richardson, Chamberlain, Lee, Kayayan, Grant, Schluter-Hughes, Ince, Fontenelle, Segrave and Yücel.)

Background: To date, there has been little investigation on how motivational and cognitive mechanisms interact to influence problematic drinking behaviours. Towards this aim, the current study examined whether reward-related attentional capture is associated with reward, fear (relief), and habit drinking motives, and further, whether it interacts with these motives in relation to problematic drinking patterns., Methods: Ninety participants (mean age = 34.8 years, SD = 9.1, 54% male) who reported having consumed alcohol in the past month completed an online visual search task that measured reward-related attentional capture as well as the Habit Reward Fear Scale, a measure of drinking motives. Participants also completed measures of psychological distress, impulsivity, compulsive drinking, and consumption items of Alcohol Use Disorders Identification Test. Regression analyses examined the associations between motives for alcohol consumption and reward-related attentional capture, as well as the associations between reward-related attentional capture, motives, and their interaction, with alcohol consumption and problems., Results: Greater reward-related attentional capture was associated with greater reward motives. Further, reward-related attentional capture also interacted with fear motives in relation to alcohol consumption. Follow-up analyses showed that this interaction was driven by greater fear motives being associated with heavier drinking among those with lower reward-related attentional capture (i.e., "goal-trackers")., Conclusion: These findings have implications for understanding how cognition may interact with motives in association with problematic drinking. Specifically, the findings highlight different potential pathways to problematic drinking according to an individual's cognitive-motivational profile and may inform tailored interventions to target profile-specific mechanisms. Finally, these findings offer support for contemporary models of addiction that view excessive goal-directed behaviour under negative affect as a critical contributor to addictive behaviours., (© 2021 S. Karger AG, Basel.)

Single ( N  = 472, 51.7%), married or living in stable cohabitation ( N  = 375, 41.1%) and divorced or separated ( N  = 66, 7.2%) patients with obsessive-compulsive disorder (OCD) were compared in terms of their sociodemographic features, OCD phenotypes, and comorbidity profile. Using single status as a reference group, a multinominal regression analysis found increased age, lower severity of hoarding, increased rates of panic disorder without agoraphobia, and lower rates of dysthymic disorder to be associated with married or stable cohabitation status. Concomitantly, increased age, higher severity of symmetry symptoms, and increased rates of skin picking disorder were found to be associated with divorced status. These findings suggest that there is a relationship between marital status and different OCD phenotypes.