Search

Background and Objectives: We have previously reported that obsessive-compulsive individuals perform more poorly on tasks that require accurate perception of internal states. As these individuals are also characterized by elevated levels of doubt regarding internal states, the causal relationship between doubt and accurate perception remained unclear. The presented study examines whether undermining participants' confidence in their ability to accurately produce a specific internal state would affect their performance on a task that requires accurate perception of this state.Methods: Participants were trained to produce specific levels of forearm muscle tension and then required to produce various tension levels in four experimental phases. The first three alternated in terms of whether the participants viewed a biofeedback monitor while the fourth offered participants several times the choice to view the monitor. Prior to the task, half of the participants received instructions that undermined their confidence in their ability to accurately assess their own muscle tension. We measured participants' accuracy in producing the required muscle tension levels and the number of times they requested to view the monitor in the final phase.Results: Undermined confidence participants were less accurate in producing the required muscle tension levels in the absence of biofeedback, and were also more likely to request the monitor in the final phase.Conclusions: Doubt can affect performance on tasks that require perceiving and experiencing internal states. This finding supports the possibility that access to internal states in OCD is attenuated due to elevated levels of doubt regarding these states. [ABSTRACT FROM AUTHOR]

Individuals with OCD tend to rely on explicit processing when performing implicit learning tasks. However, it is unclear whether this tendency reflects impaired capacity for implicit processing or a preference toward explicit processing. We sought to use a psychometrically valid task to examine the hypothesis that individuals with OCD have intact capacity for implicit learning. Twenty-four participants with OCD and 24 non-psychiatric controls completed a modified artificial grammar learning task where acquisition and retrieval of the underlying grammatical rules are considered strictly implicit. In an exploratory condition designed to examine the effect of nudging participants toward controlled processing, 12 participants in each group were told that the stimuli presented at acquisition were composed according to grammatical rules and were encouraged to identify these rules. As predicted, participants with OCD acquired and expressed knowledge of the grammatical rule, demonstrating intact capacity for implicit learning, with no differences found between the OCD and controls on the extent of implicit learning. The exploratory intentional learning instructions had no effect, as participants in this condition were unable to adhere to the instructions, supporting the robust implicit nature of the artificial grammar learning task. The relatively small sample size did not allow comparisons between OCD symptom subtypes. Our results provide evidence for intact implicit learning in OCD, and challenge previous studies suggesting a general deficiency in implicit learning in OCD. • Previous studies have suggested basic impairments in implicit learning in OCD. • The results of these studies are inconsistent and their interpretation is unclear. • We used an artificial grammar task to examine capacity for implicit learning in OCD. • Results indicate intact ability for implicit learning in OCD. • Previous findings may not reflect a true deficiency in implicit learning in OCD. [ABSTRACT FROM AUTHOR]

The construct of sense of agency (SoA) has proven useful for understanding mechanisms underlying obsessive-compulsive disorder (OCD) phenomenology, especially in explaining the apparent dissociation in OCD between actual and perceived control over one's actions. Paradoxically, people with OCD appear to experience both diminished SoA (feeling unable to control their actions) and inflated SoA (having "magical" control over events). The present review investigated the extent to which the SoA is distorted in OCD, in terms of both implicit (ie, inferred from correlates and outcomes of voluntary actions) and explicit (ie, subjective judgment of one's control over an outcome) measures of SoA. Our search resulted in 15 studies that met the criteria for inclusion in a meta-analysis, where we also examined the potential moderating effects of the type of measure (explicit versus implicit) and of the actual control participants had over the outcome. We found that participants with OCD or with high levels of OCD symptoms show lower implicit measures of SoA and at the same time tend to overestimate their control in situations where they do not actually have it. Together, these findings support the hypothesized dissociation in OCD between actual and perceived control over one's actions.

Context: Most youths who die by suicide have interfaced with a medical system in the year preceding their death, placing outpatient medical settings on the front lines for identification, assessment, and intervention., Objective: Review and consolidate the available literature on suicide risk screening and brief intervention with youths in outpatient medical settings and examine common outcomes., Data Sources: The literature search looked at PubMed, OVID, CINAHL, ERIC, and PsychInfo databases., Study Selection: Interventions delivered in outpatient medical settings assessing and mitigating suicide risk for youths (ages 10-24). Designs included randomized controlled trials, prospective and retrospective cohort studies, and case studies., Data Extraction: Authors extracted data on rates of referral to behavioral health services, initiation/adjustment of medication, follow-up in setting of assessment, suicidal ideation at follow-up, and suicide attempts and/or crisis services visited within 1 year of initial assessment., Results: There was no significant difference in subsequent suicide attempts between intervention and control groups. Analysis on subsequent crisis service could not be performed due to lack of qualifying data. Key secondary findings were decreased immediate psychiatric hospitalizations and increased mental health service use, along with mild improvement in subsequent depressive symptoms., Limitations: The review was limited by the small number of studies meeting inclusion criteria, as well as a heterogeneity of study designs and risk of bias across studies., Conclusions: Brief suicide interventions for youth in outpatient medical settings can increase identification of risk, increase access to behavioral health services, and for crisis interventions, can limit psychiatric hospitalizations., (Copyright © 2024 by the American Academy of Pediatrics.)

The Seeking Proxies for Internal States (SPIS) model of obsessive-compulsive disorder (OCD) explains symptoms of OCD as stemming from attenuated access to internal states, which is compensated for by using proxies, which are indices of these states that are more discernible or less ambiguous. Internal states in the SPIS model are subjective states that are not accessible to others, encompassing physiological states, motivations, preferences, memories, and emotions. Compensatory proxies in OCD include fixed rules and rituals as well as seeking and relying on external information. In the present review, we outline the SPIS model and describe its basic tenets. We then use the SPIS conceptualization to explain two pivotal OCD-related phenomena - obsessive doubt and compulsive rituals. Next, we provide a detailed overview of current empirical evidence supporting the SPIS in several domains, including physiological states, emotions, sense of understanding, decision-making, and sense of agency. We conclude by discussing possible neural correlates of the difficulty in accessing internal states, focusing on the anterior insular cortex (AIC) and highlighting potential clinical implications of the model to the treatment of OCD., (Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.net.)

Symptoms of obsessive-compulsive disorder are related to atypical sensory processing, particularly sensory over-responsivity, in both children and adults. In adults, obsessive-compulsive symptoms are also associated with the attenuation of access to the internal state and compensatory reliance on proxies for these states, including fixed rules and rituals. We aimed to examine the associations between sensory over-responsivity, the tendency to seek proxies for internal states, and obsessive-compulsive symptoms in children. Parents of 404 children between 5 and 10 years of age completed online measures of obsessive-compulsive symptoms, seeking proxies for internal states, sensory over-responsivity, and anxiety. Linear regression, dominance analysis, and network analysis were used to explore the unique associations between these variables. The tendency to seek proxies for internal states was more strongly associated with obsessive-compulsive symptoms than with anxiety symptoms and uniquely associated with all major obsessive-compulsive symptom dimensions except obsessing. Both the tendency to seek proxies for internal states and sensory over-responsivity were significantly associated with obsessive-compulsive symptoms, but the association was significantly stronger for the tendency to seek proxies for internal states. While limited by the sole reliance on the parent-report, the present study shows that the tendency to seek proxies for internal states could help clarify the developmental processes involved in the onset of obsessive-compulsive symptoms during childhood and that sensory sensitivity may be important to consider in this process.

Introduction: Cognitive models of obsessive-compulsive disorder (OCD) implicate heightened attention allocation to stimuli related to one's obsessions in the disorder. Recently, to overcome several limitations of reaction time-based measures, eye-tracking methodology has been increasingly used in attentional research., Methods: A meta-analysis of studies examining attention allocation towards OCD-related vs. neutral stimuli, using eye-tracking methodology and a group-comparison design, was conducted conforming to Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. Separate meta-analyses were performed for attentional vigilance (both latency and location of first fixations) and maintenance (total dwell time and total fixation count, conjointly). Each meta-analysis was conducted twice - once including all studies (main analysis) and once only including studies using the free-viewing paradigm (secondary analysis)., Results: The systematic search yielded a total of nine studies. Of those, eight provided the needed data to be included in the meta-analysis. No evidence emerged for vigilance via latency to first fixation. Vigilance reflected via first fixation location emerged in the main analysis, but not in the secondary one. Evidence for attentional maintenance was found only when analyzing free-viewing studies exclusively (the secondary analysis)., Limitations: To increase the accuracy of the research question, correlational studies were excluded, resulting in a small number of available studies., Conclusions: OCD may be characterized by vigilance, but mainly in tasks entailing specific demands and/or goals. Conversely, attentional maintenance may be evident only when using tasks that pose no requirements or demands for participants., Competing Interests: Conflict of interest The other authors have no financial disclosures. We wish to confirm that there are no known potential conflicts of interest associated with this publication., (Copyright © 2023 Elsevier B.V. All rights reserved.)

The Seeking Proxies for Internal States (SPIS) model of obsessive-compulsive disorder (OCD) proposes an account of OCD symptoms in terms of two core components: attenuation of access to internal states and seeking proxies for internal states. Specifically, the SPIS model posits that OCD is associated with difficulty in accessing various internal states, including feelings, preferences, memories, and even physiological states. This difficulty drives obsessive-compulsive individuals seek and rely on compensatory proxies, or substitutes, for their internal states. These proxies are perceived by the individual with OCD to be more easily discernible or less ambiguous compared to the internal states for which they substitute, and can take the form of fixed rules, rituals, or reliance on external sources of information. In the present article we first provide a detailed explanation of the SPIS model, and then review empirical studies that examined the model in a variety of domains, including bodily states, emotions, and decision-making. Next, we elaborate on the SPIS model's novel account of compulsive rituals, obsessions and doubt and relate them to extant theoretical accounts of OCD. To conclude, we highlight open questions that can guide future research and discuss the model's clinical implications., (Copyright © 2021 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Individuals with obsessive-compulsive disorder (OCD) tend to report higher levels of disgust, but not much is known about factors that might underlie this relationship. The present study was motivated by the behavioral immune theory, which suggests that disgust has evolved as a protective reaction to potential presence of disease agents in the immediate environment. We examined the relationships between the intensity of experienced physical disgust, perceived vulnerability to disease, and OCD symptoms. The intensity of experienced disgust was assessed with a recent procedure whereby participants rate how disgusted they feel in response to color versus black-and-white pictures that evoke physical disgust. In addition to this procedure, participants (N = 403) completed measures of perceived vulnerability to disease, OCD symptoms, depression and anxiety. OCD symptoms were positively related to the physical disgust evoked by the pictures, and this relationship was mediated by reported emotional discomfort in contexts that connote a potential for pathogen transmission. Replicating previous findings, color pictures were rated as more disgusting than black-and-white pictures overall, and this effect was especially pronounced among people with higher OCD tendencies. These results suggest that, consistent with behavioral immune theory, disgust in OCD is a basic, concrete emotion that is at least partly mediated by fear of pathogens., (Copyright © 2020 Elsevier Ltd. All rights reserved.)

Background and Objectives: The Seeking Proxies for Internal States (SPIS) model of obsessive-compulsive disorder (OCD) postulates that obsessive-compulsive (OC) individuals have reduced access to their internal states and must therefore seek and rely on external proxies for these states. The present study extended this hypothesis to the feeling of understanding, which had not been examined previously in relation to OCD., Methods: We presented 148 participants with a computerized task requiring them to read and understand a text on medieval architecture. Participants were randomly assigned to an ongoing feedback condition (comprehension quiz and answers provided after each text segment) or no-feedback condition (quiz and answers provided only at the end). Throughout, participants were offered proxies in the form of "learning aids," which were unrelated to text comprehension. Participants were divided to high vs. low OC tendencies based on a median split on a measure of OCD symptoms., Results: As predicted, lacking feedback on understanding was associated with higher use of proxies and high OC participants used more proxies than low OC participants in the no-feedback condition. Actual understanding, as assessed by comprehension scores, was unrelated to OC tendencies., Limitations: Among other limitations discussed in the article, our results were obtained on a non-selected sample of students varying on OC tendencies. It would be important to replicate these findings with diagnosed OCD participants as compared to both non-clinical and anxiety disorders control participants., Conclusions: These findings extend the SPIS model to the domain of understanding and may have important clinical implications., (Copyright © 2019. Published by Elsevier Ltd.)

The Yale-Brown Obsessive Compulsive Scale (Y-BOCS) is the most common measure of Obsessive-Compulsive symptom severity. The Y-BOCS interview is considered gold standard, but its self-rating format is increasingly used in clinical trials. Few studies investigated congruency and potential changes over treatment. This question is highly relevant, as a systematic bias might obscure results of clinical trials. We examined the relationship of self- and clinician-rated Y-BOCS scores in participants with obsessive-compulsive disorder in pre (N = 128), post, (4 weeks, n = 104) and follow-up (6 months, n = 98) assessments of a randomized-controlled clinical trial. We administered Y-BOCS interview via telephone paralleling online administration of the self-report form. Analyses showed medium-to-strong correlations of Y-BOCS interview and self-rating scores at pre-assessment. Patients rated symptoms lower than clinicians. Larger discrepancies were associated with hoarding and age. Congruency was inferior for obsessions relative to compulsions, largely owing to the "resistance against obsessions" item. Agreement strongly increased at post and follow-up. Though overall congruency between the two Y-BOCS forms was satisfactory, results suggest a "correction over time" effect. Such bias may distort the precise interpretation of treatment effects. Therefore, we made several suggestions to improve the reliability of change scores assessed with the Y-BOCS self-rating., (Copyright © 2019. Published by Elsevier B.V.)

Background and Objectives: In recent years we have proposed and investigated the Seeking Proxies for Internal States (SPIS) model of obsessive-compulsive disorder (OCD), which postulates that deficient access to internal states is a key feature of the disorder. According to this model, rules and rituals that often characterize people with OCD can be understood as proxies for deficiently accessible internal states. Here we compliment this earlier experimental work by examining whether reliance on proxies for internal states in everyday life is associated with OCD., Methods: We developed an inventory for assessing reliance on proxies in everyday life and examined its relationship with obsessive-compulsive tendencies in two internet panel studies. The internal states included hunger, enjoyment, interpersonal liking, preferences, a sense of understanding, and intuitions about correct solutions to problems. The proxies included one's own behavior, the opinion of others, and objective indices such as grades and elapsed time since eating., Results: In both studies, participants with obsessive-compulsive tendencies reported relying more on external, discernible proxies for a variety of internal states. These results remained significant after controlling for concurrent anxiety and depression., Limitations: Our inventory is by necessity limited in its sampling of internal states and proxies and further correlational and experimental studies will be needed to examine additional areas of application, such as decision making and interpersonal liking., Conclusions: These results are consistent with and expand the Seeking Proxies for Internal States (SPIS) model and may have implications for understanding and treating individual with OCD., (Copyright © 2018 Elsevier Ltd. All rights reserved.)

Introduction: Smartphone applications (apps) for smoking cessation are becoming increasingly available, but their efficacy remains to be demonstrated. We conducted a pilot study of SmokeBeat, a novel app designed for use with smartwatches and wristbands. SmokeBeat is powered by a data analytics software platform that processes information from the sensors embedded in wearables. It relies on an original algorithm to identify in real time the hand-to-mouth gestures that characterize smoking a cigarette. We examined whether merely monitoring and notifying smokers on smoking episodes in real time via the SmokeBeat app would lead to reduction in smoking., Methods: Forty smokers (9 women and 31 men) who expressed a wish to reduce or quit smoking were randomly assigned to using the SmokeBeat app for 30 days or to a wait-list control group. All participants completed questionnaires at baseline and at the end of the study, including their level of smoking. Smokers in the experimental condition were notified whenever the SmokeBeat system detected a smoking episode and were asked to confirm or deny it., Results: The SmokeBeat algorithm correctly detected over 80% of the smoking episodes and produced very few false alarms. According to both self-report and detection of smoking episodes by the SmokeBeat system, smokers in the experimental condition showed a significant decline in smoking rate over the 30-day trial (p < .001). There was no change in the smoking rate of the control group., Conclusion: These preliminary results suggest that automatic monitoring of smoking episodes and alerting the smoker in real time may facilitate smoking reduction in motivated smokers., Implications: Raising the awareness of smokers to the act of smoking in real time, as the SmokeBeat app is able to do, can counter the automaticity of the smoking habit. Bringing smoking under conscious awareness may benefit smokers who are motivated to reduce or quit smoking to gain better control of their smoking behavior and reduce cigarette intake.

Background: Obsessive Compulsive Disorder (OCD) is a chronic and disabling disorder with poor response to pharmacological treatments. Converging evidences suggest that OCD patients suffer from dysfunction of the cortico-striato-thalamo-cortical (CSTC) circuit, including in the medial prefrontal cortex (mPFC) and the anterior cingulate cortex (ACC)., Objective: To examine whether modulation of mPFC-ACC activity by deep transcranial magnetic stimulation (DTMS) affects OCD symptoms., Methods: Treatment resistant OCD participants were treated with either high-frequency (HF; 20 Hz), low-frequency (LF; 1 Hz), or sham DTMS of the mPFC and ACC for five weeks, in a double-blinded manner. All treatments were administered following symptoms provocation, and EEG measurements during a Stroop task were acquired to examine changes in error-related activity. Clinical response to treatment was determined using the Yale-Brown-Obsessive-Compulsive Scale (YBOCS)., Results: Interim analysis revealed that YBOCS scores were significantly improved following HF (n = 7), but not LF stimulation (n = 8), compared to sham (n = 8), and thus recruitment for the LF group was terminated. Following completion of the study, the response rate in the HF group (n = 18) was significantly higher than that of the sham group (n = 15) for at least one month following the end of the treatment. Notably, the clinical response in the HF group correlated with increased Error Related Negativity (ERN) in the Stroop task, an electrophysiological component that is attributed to ACC activity., Conclusion: HF DTMS over the mPFC-ACC alleviates OCD symptoms and may be used as a novel therapeutic intervention. Notwithstanding alternative explanations, this may stem from DTMS ability to directly modify ACC activity., (Copyright © 2017 The Authors. Published by Elsevier Inc. All rights reserved.)

This paper presents a theoretical model suggesting that doubt and certainty are two extremes of a continuum. Different people can be located in different locations on this continuum, according to how much they tend to seek refutation vs. confirmation. In both ends of the continuum lay mental disorders, which can be seen as extreme deviations from the usual relatively stable equilibrium between the two thinking processes. One end is defined by excessive skepticism and manifested as obsessive compulsive disorder (OCD), a disorder characterized by incessant doubt. The other end is defined by excessive certainty and lack of doubt, manifested as delusional disorders. Throughout this article, we demonstrate that the differences between normative thoughts and delusional thoughts are relatively vague, and that in general, the human default tendency is to prefer certainty over doubt. This preference is reflected in the confirmation bias as well as in other cognitive constructs such as overconfidence and stereotypes. Recent perspectives on these biases suggest that the human preference for confirmation can be explained in evolutionary terms as adaptive and rational. A parallel view of the scientific enterprise suggests that it also requires a certain equilibrium between skepticism and confirmation. We conclude by discussing the importance of the dialectic relationship between confirmation and refutation in both lay thinking and scientific thought., (Copyright © 2015 Elsevier Ltd. All rights reserved.)

Background and Objective: People's feelings are not always accessible to them, and this might be especially the case for some individuals and in some situations. Based on our model of obsessive-compulsive disorder, we predicted that obsessive-compulsive (OC) tendencies and situationally induced doubt would be associated with decreased access to one's own emotions., Methods: In the first two studies we examined the relationships between OC tendencies and performance on the Mayer-Salovey-Caruso Emotional Intelligence Test (MSCEIT). In Study 3 we undermined participants' confidence in their ability to accurately assess their own emotions and assessed the effect of this manipulation on MSCEIT performance., Results: As predicted, OC tendencies were associated with lower scores on the Experiential area of the MSCEIT, which relies on access to experienced emotions, but not on the Strategic area, which relies on semantic knowledge about emotions. Similarly, undermining participants' confidence in their own emotions reduced their scores on the Experiential, but not on the Strategic area of the MSCEIT., Limitations: The findings should be replicated with a clinical OCD population and with other measures of emotional experience., Conclusion: These studies suggest that impaired access to emotional states may be caused by doubting those states, that it characterizes people with high OC tendencies, and that it might be a manifestation of a more general difficulty in accessing internal states., (Copyright © 2016 Elsevier Ltd. All rights reserved.)

The study examined the prediction that obsessive-compulsive tendencies are related to an attenuated sense of agency (SoA). As most explicit agency judgments are likely to reflect also motivation for and expectation of control, we examined agency in sentence production. Reduced agency can be expressed linguistically by omitting the agent or by using grammatical framings that detach the event from the entity that caused it. We examined the use of agentic language of participants with high vs. low scores on a measure of obsessive-compulsive (OC) symptoms, using structured linguistic tasks in which sentences are elicited in a conversation-like setting. As predicted, high OC individuals produced significantly more non-agentic sentences than low OC individuals, using various linguistic strategies. The results suggest that OC tendencies are related to attenuated SoA. We discuss the implications of these findings for explicating the SoA in OCD and the potential contribution of language analysis for understanding psychopathology., (Copyright © 2016 Elsevier Inc. All rights reserved.)