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Background and Objectives: Patients with obsessive-compulsive disorder (OCD) have reported higher anger and aggression than healthy individuals in previous studies using explicit measures. However, studies using implicit measures have demonstrated mixed results. The aim of the present study was to investigate implicit aggressiveness in OCD using an approach-avoidance task (AAT)., Methods: Seventy-eight patients with OCD and 37 healthy controls underwent structured clinical interviews and measures of anger, OCD, and depressive symptoms as well as a computerized AAT that included aggressive, peaceful, negative, and positive stimuli., Results: In line with previous studies, patients with OCD reported higher scores on explicit anger. With respect to the implicit measure, repeated measures ANOVAs did not show any differences in mean reaction times for pushing compared to pulling aggressive versus peaceful and negative versus positive words. However, analyses of specific OCD symptom dimensions demonstrated significantly faster reaction times for pulling compared to pushing aggressive words for patients with high scores in the OCD symptom dimensions obsessing and hoarding., Limitations: Eighty percent of patients with OCD showed psychiatric comorbidities and all were seeking treatment., Conclusion: The present study supports previous studies reporting the absence of higher aggressiveness in patients with OCD compared to healthy controls using implicit measures. However, in contrast to previous studies, we found an implicit approach bias towards aggressive self-statements for OCD patients scoring high in the symptom dimensions obsessing and hoarding compared to healthy controls. Future studies should further elucidate putative functional relationships between different OCD symptom dimensions and implicit aggressiveness., Competing Interests: Declaration of competing interest The authors declare that they have no conflict of interest. This study did not receive external funding., (Copyright © 2023 Elsevier Ltd. All rights reserved.)

Background and Objectives: Performance on implicit measures of suicidality has been associated with suicidal and nonsuicidal self-injury. Despite the high prevalence of self-harm in patients with borderline personality disorder (BPD), no previous study has assessed implicit measures in this patient group., Methods: Forty patients with BPD and 25 healthy controls completed three implicit association tests (IATs) (Death words - Me/Others words, Self-Harm pictures - Me/Others, and Self-Harm pictures - Good/Bad words) and a subliminal priming task (effect of the primes "dying"/"growing" on the categorization speed of positive/negative adjectives) as well as measures of psychopathology (suicidal ideation, previous nonsuicidal self-injury, borderline symptomatology, depression, and hopelessness)., Results: Patients with BPD had higher scores on all three IATs than healthy controls. The subliminal priming procedure did not reveal group differences. Correlations between implicit measures and psychopathology among patients with BPD were mostly weak and nonsignificant with a few exceptions: Positive correlations were observed between IAT Self-Harm - Good/Bad and lifetime frequency of nonsuicidal self-injury, between IAT Self-Harm - Me/Others and depression, and between IAT Death - Me/Others and depression. Correlations between implicit measures were weak to moderate., Limitations: The study was cross-sectional only, and the study had reduced power as the sample size was limited., Conclusions: As expected, patients with BPD had higher scores than healthy controls on the IATs, which indicates higher implicit self-identification with self-harm and death as well as stronger implicit positive attitudes towards self-harm. The mostly weak correlations between implicit and explicit measures speak against the discriminative value of IATs in patients with BPD., Competing Interests: Declaration of competing interest None., (Copyright © 2023 Elsevier Ltd. All rights reserved.)

Background: Aggressiveness resulting from inappropriately intense anger plays a major role in borderline personality disorder (BPD) and research using self-report measures has consistently found elevated levels of aggression in this condition. However, while self-report assesses explicit dimensions of the self-concept, it cannot elucidate implicit processes that are at least equally important as they guide the perceptions of the self and influence behavioral responses. The present study aimed to extend the research on aggressiveness self-concepts in BPD utilizing an indirect latency-based measure., Methods: Twenty-nine female inpatients with BPD and 21 healthy women were assessed with an aggressiveness self-concept Implicit Association Test (Agg-IAT) using reaction time measurements to determine the relative strengths of associations between the self vs. others and aggression vs. peacefulness. Additionally, participants completed self-report questionnaires capturing aggressiveness and BPD symptoms., Results: Women with BPD had a significantly more aggressive self-concept as indicated by the Agg-IAT than the control group. Moreover, they rated themselves significantly more aggressive on all dimensions than the controls. As expected, correlations between the Agg-IAT and the self-reported aggressiveness dimensions were low (mean r = -.31)., Limitations: The modest sample size and the disregard of a clinical control group limit the generalizability and specificity of our findings., Conclusions: This study extends prior findings on aggression in BPD in that women with BPD do not only explicitly conceive themselves as more aggressive, but also exhibit implicitly more aggressive self-concepts than healthy controls. Because implicit and explicit self-related operations are related, but distinct processes, our results may hold clinical and therapeutic implications., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

Background and Objectives: Cognitive models of obsessive-compulsive disorder (OCD) highlight the role of cognitive biases for the development of the disorder. One of these biases, an inflated sense of responsibility has been associated with higher anger scores and latent aggression on self-report scales, especially in patients with compulsive checking. Validity of self-report assessment is, however, compromised by inaccuracy, social desirability, and low metacognitive awareness of traits and behaviors in patients. The aim of the present study was to extend the research on latent aggression in individuals with OCD by using an indirect, implicit measure of aggression., Methods: Fifty-eight patients with OCD and 25 healthy controls were assessed with an Aggressiveness-Implicit Association Test (IAT), which is a reaction time task that assesses the strength of associations between the concept of "aggressiveness" and "me" compared to others., Results: Contrary to our expectation, OCD patients with checking symptoms showed a more peaceful implicit self-concept than healthy controls. This result was corroborated by negative correlations between checking symptoms and implicit aggressiveness in the OCD sample., Limitations: No self-report measures on aggression or anger were included in the study., Conclusions: In comparison to previous research using self-report measures, our study indicates that implicit aspects of aggression do indeed differ from controlled aspects in patients with checking compulsions. Future research is necessary to better understand the role of aggressiveness in OCD and to derive implications for therapy., (Copyright © 2017 Elsevier Ltd. All rights reserved.)

Background and Objectives: Post-traumatic stress disorder (PTSD) is accompanied by altered autobiographical memories (AM) of the traumatic incident itself as well as of non-trauma-related events. Several studies have shown that trauma-exposed individuals developing PTSD have a reduced capacity to access specific past events that are not related to the traumatic event compared to those who do not develop PTSD. However, one study including a group of elderly adults did not find significant differences in AM between PTSD and non-PTSD participants. The present study investigated whether PTSD is associated with impaired AM of trauma-related and non-trauma-related memories in the elderly., Method: Forty-four elderly participants, displaced during childhood from former German territories after the end of World War II (WWII), were examined. This group comprised 19 participants with and 25 participants without PTSD. These participants were compared to 23 non-traumatized non-displaced elderly participants., Results: PTSD, non-PTSD and non-traumatized participants do not differ significantly in their ability to recall specific memories of their past. Moreover, participants with PTSD did not recall more trauma-related memories than non-PTSD participants., Limitations: The traumatized participants reached for assessment might represent the most resilient individuals, which might constrain generalizability of our results to other trauma populations., Conclusions: This study confirms preliminary evidence that PTSD is not associated with AM impairment in the elderly. We suggest that aging may alter the relationship between trauma and AM impairment in traumatized participants with PTSD, which need to be confirmed by longitudinal studies., (Copyright © 2016 Elsevier Ltd. All rights reserved.)

Background and Objectives: Many individuals with anxiety disorders do not receive professional treatment. Internet interventions have shown to be effective in the treatment of anxiety. The present randomized controlled trial was designed to examine the effectiveness of a short-term (4-week) Internet intervention in treating panic disorder, agoraphobia, social anxiety disorder, and specific phobias ('ConfID'). We addressed the questions of whether this transdiagnostic program would affect these disorders to varying degrees and whether there would be moderators of effectiveness., Methods: Adults who were recruited in online forums for anxiety underwent an online baseline assessment (N = 179) and were randomized either to the intervention group (ConfID) or the control group (care as usual). Online post-assessment took place 4 weeks later. The primary outcome was assessed with the Beck Anxiety Inventory (BAI); the secondary outcomes targeted the disorder-specific symptoms, depression, and somatization., Results: Participants in the intervention group showed a significantly stronger anxiety reduction compared to participants receiving care as usual (small-to-medium effect size between groups in intention-to-treat analysis). The treatment effect was similar for the different disorders and was moderated by participants' attitudes towards Internet interventions. Secondary outcomes yielded effect sizes in the medium range., Limitations: Moderate treatment adherence, lack of measures beyond online self-reports, and unavailability of long-term results., Conclusions: The study provides further evidence that transdiagnostic Internet interventions are promising in reducing the existing treatment gap in individuals with panic disorder and phobias. Results extend previous findings by showing that significant effects can also be reached by comprehensive short-term programs and that the effects might be moderated by participants' attitudes towards Internet interventions., (Copyright © 2016 Elsevier Ltd. All rights reserved.)

Background and Objectives: Attentional biases (AB) for trauma-related stimuli have been examined in many studies assessing different trauma samples. In emotional Stroop tasks (EST), blocked and single-trial formats are used almost interchangeably in clinical research. There is reason to believe that different designs yield different results and assess different processes, which, however, has been hardly examined in studies. Furthermore, there is a dearth of information about AB in older trauma survivors with posttraumatic stress symptoms., Methods: Older adults with (n = 20) and without PTSD symptoms (n = 26) as well as non-traumatized controls (n = 21) completed an EST, in which words were presented both blocked and randomized., Results: Analyses revealed that individuals with PTSD symptoms showed AB for trauma- and depression-related words; however, mode of administration did not significantly influence reaction times., Limitations: The emotional Stroop task cannot disentangle the underlying cognitive mechanism (i.e., facilitation, interference, avoidance)., Conclusions: PTSD symptoms in older trauma survivors are associated with AB. Overall, participants with PTSD symptoms did not show greater impairment of cognitive control in comparison to both control groups. Results also illustrate that methodological differences between task versions need to be considered more thoroughly., (Copyright © 2016 Elsevier Ltd. All rights reserved.)

Background and Objectives: Semantic network models suggest that individuals with obsessive-compulsive disorder (OCD) process words with multiple meanings (e.g., "knife") more likely in an OC-related (i.e., "weapon") than in a neutral way (i.e., "cutlery"). Initial evidence was found in an online study. The aim of the current study was to investigate semantic networks in a clinical OCD sample and particularly to identify whether changes in semantic networks following the add-on intervention association splitting (AS) exceeded changes expected through cognitive behavioral therapy (CBT) alone., Methods: An association task was presented to 36 healthy controls and 70 OCD patients over a period of eight weeks with OCD patients receiving CBT and an add-on intervention (randomized allocation to either AS or a computerized cognitive training). Participants were asked to generate up to five associations to standardized (OC-relevant, negative, neutral) and individual cue words. Associations were rated with regard to OC-relevance and valence., Results: Analyses revealed that OCD participants produced a) significantly more OC-relevant associations and b) more negative associations than controls for cue words. In the OCD sample, the OC-relevance and valence of associations changed after therapy for personal cue words. This effect was associated with AS at statistical trend level., Limitations: No clinical control group was recruited; no inter-rater reliability was assessed for the association task., Conclusions: Further evidence for biased associative networks in OCD was found. Associations of individually chosen cue words proved to be modifiable by therapy., (Copyright © 2014 Elsevier Ltd. All rights reserved.)

Background and Objectives: A vast amount of memory and meta-memory research in schizophrenia shows that these patients perform worse on memory accuracy and hold false information with strong conviction compared to healthy controls. So far, studies investigating these effects mainly used traditional static stimulus material like word lists or pictures. The question remains whether these memory and meta-memory effects are also present in (1) more near-life dynamic situations (i.e., using standardized videos) and (2) whether emotionality has an influence on memory and meta-memory deficits (i.e., response confidence) in schizophrenia compared to healthy controls., Method: Twenty-seven schizophrenia patients and 24 healthy controls were administered a newly developed emotional video paradigm with five videos differing in emotionality (positive, two negative, neutral, and delusional related). After each video, a recognition task required participants to make old-new discriminations along with confidence ratings, investigating memory accuracy and meta-memory deficits in more dynamic settings., Results: For all but the positively valenced video, patients recognized fewer correct items compared to healthy controls, and did not differ with regard to the number of false memories for related items. In line with prior findings, schizophrenia patients showed more high-confident responses for misses and false memories for related items but displayed underconfidence for hits when compared to healthy controls, independent of emotionality., Limitations: Limited sample size and control group; combined valence and arousal indicator for emotionality; general psychopathology indicator., Conclusions: Emotionality differentially moderated memory accuracy, biases in schizophrenia patients compared to controls. Moreover, the meta-memory deficits identified in static paradigms also manifest in more dynamic settings near-life settings and seem to be independent of emotionality., (Copyright © 2012 Elsevier Ltd. All rights reserved.)

Background and Objectives: Along with other cognitive biases overestimation of threat (OET) has been implicated in the pathogenesis of obsessive-compulsive disorder (OCD). The present study investigated whether OET would not only manifest in cognitive distortions but, also in overestimations of the object size of disorder-related visual objects., Methods: A total of 65 participants with OCD and 55 healthy controls who were recruited via OCD online forums underwent an incidental learning paradigm consisting of two blocks. In Block 1, participants were asked to rate the valence and the personal relevance for individual OCD concerns of 40 pictures which varied in size. Differences in size, however, were not explicitly communicated to the participants. Stimuli were selected from four categories: 1. neutral, 2. fear-related but OCD-unrelated, 3. washing (OCD-related), and 4. checking (OCD-related). In Block 2, participants were asked to recollect the original size of each stimulus (depicted as a small thumbnail) on a seven point scale., Results: Whereas few group differences emerged for pre-defined OCD items, OCD-relevant items (individual judgments) were judged as significantly larger by patients with OCD relative to controls. The opposite pattern emerged for neutral items., Limitations: The sample was recruited via online forums and had probable but not externally validated diagnoses of OCD. No psychiatric control group was recruited., Conclusions: The present study indicates that OET may extend to neuropsychological tasks. Further research is needed to pinpoint whether OET occurs at the level of encoding suggesting a perceptual bias and/or occurs at the level of retrieval suggesting a memory bias., (Copyright © 2011 Elsevier Ltd. All rights reserved.)

Meridian-tapping (MT) is a body-oriented therapeutic technique which among other psychological problems targets anxiety disorders. Despite bold claims by some of its advocates that it brings lasting success in the vast majority of patients with anxiety disorders, solid empirical evidence for its effectiveness is scarce and its theoretical foundations are refuted by many scientists. The present study tested the effectiveness of a published MT self-help approach for obsessive-compulsive disorder (OCD). Following a baseline assessment over the internet including standard outcome measures for OCD (Y-BOCS, OCI-R) and depression (BDI-SF), 70 participants with OCD were randomly allocated to MT or to progressive muscle relaxation (PMR). Four weeks after the dispatch of the self-help manuals (including video demonstrations of the technique), participants were requested to take part in a post assessment. Whereas subjects found MT more helpful than PMR in retrospect (39% versus 19%) and would continue to use it in the future (72% versus 48%) there was no evidence for a stronger decline of OCD symptoms under MT on any of the psychometric measures. Moreover, Y-BOCS scores did not significantly change across time for both interventions. The present study does not support bold claims about the effectiveness of MT as a stand-alone technique. Cognitive-behavioral therapy remains the treatment of choice for OCD. While self-help MT may enhance the well-being of a subgroup of participants, its potential for OCD appears to be small. Exaggerated success claims on the effectiveness of MT in conjunction with degrading appraisals of conventional psychotherapy as made by some of its leading figures may in our view foster fatalism in patients not experiencing major symptom relief by MT., (Copyright © 2010 Elsevier Ltd. All rights reserved.)

Cognitive disinhibition has been implicated in the pathogenesis of obsessive-compulsive disorder (OCD). Negative priming (NP) is regarded to tap into this function. While early studies indeed found reduced negative priming in OCD, attempts to replicate are both scarce and equivocal. Moreover, several studies in favor of the disinhibition hypothesis are plagued by methodological limitations. For the present investigation, 18 participants with OCD and 28 healthy controls underwent a computerized NP experiment with varying response-stimulus intervals. In addition, a variant of the paradigm with concurrent item presentation was employed to rule out the confounding impact of memory. Negative priming was comparable between groups yielding small between-group effect sizes. The present study challenges broad claims of disinhibition in OCD. In our view, the disinhibition account faces theoretical problems. Instead, theories implicating cognitive biases as well as metacognitive problems may more parsimoniously explain the idiosyncratic nature of OCD symptoms.

There is an ongoing debate whether or not patients with post-traumatic stress disorder (PTSD) are more prone to produce false memories. The present study investigated this question using a visual variant of the Deese-Roediger-McDermott (DRM) paradigm, additionally addressing underlying mechanisms of false memory production (e.g., depression, dissociation, emotional valence, arousal). The visual paradigm was administered to 48 traumatized individuals with (n=20) and without PTSD (n=28) and 28 non-traumatized controls. Groups did not differ with regard to memory performance and memory confidence. False memories were correlated with depression. We recommend that future studies employ trauma-related material to further explore memory aberrations in PTSD.