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Dar R, Lazarov A, Liberman N. Seeking proxies for internal states (SPIS): Towards a novel model of obsessive-compulsive disorder. Behav Res Ther 2021; 147:103987. [PMID: 34688103 DOI: 10.1016/j.brat.2021.103987] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 10/04/2021] [Accepted: 10/07/2021] [Indexed: 12/17/2022]
Abstract
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.
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Affiliation(s)
- Reuven Dar
- School of Psychological Sciences, Tel Aviv University, Israel.
| | - Amit Lazarov
- School of Psychological Sciences, Tel Aviv University, Israel
| | - Nira Liberman
- School of Psychological Sciences, Tel Aviv University, Israel
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Ferreira S, Pêgo JM, Morgado P. A Systematic Review of Behavioral, Physiological, and Neurobiological Cognitive Regulation Alterations in Obsessive-Compulsive Disorder. Brain Sci 2020; 10:E797. [PMID: 33138023 PMCID: PMC7692269 DOI: 10.3390/brainsci10110797] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 10/24/2020] [Accepted: 10/27/2020] [Indexed: 01/20/2023] Open
Abstract
Obsessive-compulsive disorder (OCD) is characterized by cognitive regulation deficits. However, the current literature has focused on executive functioning and emotional response impairments in this disorder. Herein, we conducted a systematic review of studies assessing the behavioral, physiological, and neurobiological alterations in cognitive regulation in obsessive-compulsive patients using the PubMed database. Most of the studies included explored behavioral (distress, arousal, and frequency of intrusive thoughts) and neurobiological measures (brain activity and functional connectivity) using affective cognitive regulation paradigms. Our results pointed to the advantageous use of reappraisal and acceptance strategies in contrast to suppression to reduce distress and frequency of intrusive thoughts. Moreover, we observed alterations in frontoparietal network activity during cognitive regulation. Our conclusions are limited by the inclusion of underpowered studies with treated patients. Nonetheless, our findings support the OCD impairments in cognitive regulation of emotion and might help to improve current guidelines for cognitive therapy.
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Affiliation(s)
- Sónia Ferreira
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, 4710-057 Braga, Portugal; (S.F.); (J.M.P.)
- ICVS-3B’s PT Government Associate Laboratory, 4710-057 Braga/Guimarães, Portugal
| | - José Miguel Pêgo
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, 4710-057 Braga, Portugal; (S.F.); (J.M.P.)
- ICVS-3B’s PT Government Associate Laboratory, 4710-057 Braga/Guimarães, Portugal
| | - Pedro Morgado
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, 4710-057 Braga, Portugal; (S.F.); (J.M.P.)
- ICVS-3B’s PT Government Associate Laboratory, 4710-057 Braga/Guimarães, Portugal
- Clinical Academic Center-Braga (2CA), 4710-243 Braga, Portugal
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Vik P, Legarreta M, Riffel S. Visual-Spatial Memory and Recall Test (V-SMART): validity and reliability. Clin Neuropsychol 2017; 32:1454-1474. [PMID: 28956495 DOI: 10.1080/13854046.2017.1380845] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE Nonverbal memory decline is a concern associated with aging. Visuospatial memory tests often do not distinguish between learning, recall, or retrieval, yet such distinctions may help clarify the nature of memory difficulties. Further, many visuospatial tests rely on abilities not directly related to memory (e.g. graphomotor skill). The present study examined the feasibility and initial psychometric evidence of the Visual-Spatial Memory and Recall Test (V-SMART). METHOD Ninety-nine adults (71% women) were recruited from two sources: undergraduate students (n = 37) and healthy older adults (n = 62). Volunteers completed a brief battery of cognitive tests. RESULTS Internal consistency and interrater reliability were strong. Principal Components Analysis supported the hypothesized learning and recall structure, and correlations with other memory tests supported external validity of the V-SMART as a visuospatial learning measure. Correlations with recall scores were less compelling yet likely reflected the intact recall among this generally healthy sample. CONCLUSIONS These preliminary findings support the V-SMART as a visuospatial memory test. Evidence for validity was acceptable for learning indices; further examination of recall measures is needed.
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Affiliation(s)
- Peter Vik
- a School of Graduate Psychology , Pacific University , Hillsboro, OR , USA
| | | | - Sarah Riffel
- a School of Graduate Psychology , Pacific University , Hillsboro, OR , USA
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Fink J, Hendrikx F, Stierle C, Stengler K, Jahn I, Exner C. The impact of attentional and emotional demands on memory performance in obsessive-compulsive disorder. J Anxiety Disord 2017; 50:60-68. [PMID: 28577416 DOI: 10.1016/j.janxdis.2017.05.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2016] [Revised: 05/11/2017] [Accepted: 05/18/2017] [Indexed: 11/20/2022]
Abstract
Lower performance on memory tests in obsessive-compulsive disorder (OCD) has been repeatedly observed. However, the origins of these performance deficits are not sufficiently explained. In this study we tested if OCD-related extensive focus of attention on thoughts (heightened self-consciousness) could be an explanatory mechanism for lower memory performance. Heightened situational self-consciousness was manipulated by instructing participants to either monitor neutral thoughts or to monitor OCD-related thoughts. We included a Behavioral Avoidance Task based on individual obsessions and compulsions to induce OCD-related thoughts. Participants were asked to perform these monitoring tasks in parallel to a taxing verbal memory task, resulting in learning under divided attention. The two conditions of learning under divided attention were compared to a single-task condition. Twenty-four participants with OCD and 24 healthy controls took part in these three learning conditions. The results indicate that in both groups memory performance deteriorated in the two conditions with divided attention compared to the single task condition. In the OCD-related thought monitoring condition (OTM) self-consciousness and Behavioral Avoidance Task-induced stress and fear were particularly increased and memory performance further deteriorated in the OCD group. This finding highlights an important and underestimated mechanism (personal involvement) which might serve to better understand lower memory performance in OCD.
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Affiliation(s)
- Jakob Fink
- University of Leipzig, Clinical Psychology and Psychotherapy, Neumarkt 9-19, 04081 Leipzig, Germany.
| | - Friederike Hendrikx
- University of Leipzig, Clinical Psychology and Psychotherapy, Neumarkt 9-19, 04081 Leipzig, Germany.
| | - Christian Stierle
- Schön-Kliniken Bad Bramstedt, Birkenweg 10, 24576 Bad Bramstedt, Germany.
| | - Katarina Stengler
- University of Leipzig, Faculty of Medicine, Semmelweisstraße 10, 04103 Leipzig, Germany.
| | - Ina Jahn
- University of Leipzig, Faculty of Medicine, Semmelweisstraße 10, 04103 Leipzig, Germany.
| | - Cornelia Exner
- University of Leipzig, Clinical Psychology and Psychotherapy, Neumarkt 9-19, 04081 Leipzig, Germany.
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Sun X, Zhu C, So SHW. Dysfunctional metacognition across psychopathologies: A meta-analytic review. Eur Psychiatry 2017; 45:139-153. [PMID: 28763680 DOI: 10.1016/j.eurpsy.2017.05.029] [Citation(s) in RCA: 133] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Revised: 05/19/2017] [Accepted: 05/22/2017] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Dysfunctions in metacognition have been reported in individuals with anxiety disorders. Although recent studies have examined metacognition in other disorders, how dysfunctional metacognition compares across disorders is not clear. This review aimed to ascertain the importance of dysfunctional metacognition in various psychopathologies, and to identify similarities and differences in metacognitive profiles across disorders. METHODS Forty-seven studies were selected from 586 articles published between 1990 and August 2015, including a total sample of 3772 patients and 3376 healthy individuals. Studies that measured metacognition using the Meta-Cognitions Questionnaire (MCQ) and its variants were included. We conducted five meta-analyses including 49 to 55 effect sizes, comparing psychiatric patients to healthy individuals on respective metacognitive dimensions of the MCQ. RESULTS We found elevated metacognitive dysfunctions in patients, as a group, on all MCQ dimensions. Group effects were large and robust for the two negative beliefs (i.e., beliefs about the uncontrollability and danger of thoughts, and beliefs about the need to control thoughts), and moderate and unstable for the positive beliefs. Patients showed decreased cognitive confidence and heightened cognitive self-consciousness on moderate to large levels. Moderator analyses revealed that negative beliefs about uncontrollability and danger of thoughts were most prevalent in generalized anxiety disorder, whereas heightened cognitive self-consciousness was more characteristic in obsessive-compulsive disorder. Generalized anxiety disorder, obsessive-compulsive disorder and eating disorders manifested more similar metacognitive profiles than other disorders. CONCLUSIONS Our findings supported dysfunctional metacognition as common processes across psychopathologies, with certain dimensions being more prevalent in particular disorders.
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Affiliation(s)
- X Sun
- Department of psychology, Wong Foo Yuan building, The Chinese university of Hong Kong, Shatin, New Territories, Room 321, 3/F, 999077 Hong Kong, SAR, Taiwan
| | - C Zhu
- Department of psychology, Wong Foo Yuan building, The Chinese university of Hong Kong, Shatin, New Territories, Room 321, 3/F, 999077 Hong Kong, SAR, Taiwan
| | - S H W So
- Department of psychology, Wong Foo Yuan building, The Chinese university of Hong Kong, Shatin, New Territories, Room 321, 3/F, 999077 Hong Kong, SAR, Taiwan.
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Hezel DM, McNally RJ. A Theoretical review of cognitive biases and deficits in obsessive–compulsive disorder. Biol Psychol 2016; 121:221-232. [DOI: 10.1016/j.biopsycho.2015.10.012] [Citation(s) in RCA: 62] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2015] [Revised: 10/29/2015] [Accepted: 10/29/2015] [Indexed: 11/28/2022]
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Hansmeier J, Glombiewski JA, Rief W, Exner C. Differential memory effects for encoding and retrieving disorder-relevant contents in relation to checking. J Behav Ther Exp Psychiatry 2015; 46:99-106. [PMID: 25302658 DOI: 10.1016/j.jbtep.2014.09.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2014] [Revised: 09/15/2014] [Accepted: 09/16/2014] [Indexed: 11/25/2022]
Abstract
BACKGROUND AND OBJECTIVES Obsessive-compulsive (OC) checkers have been shown to be impaired in memory. However, when encoding OC-related material, OC checkers exhibit superior recall. This study aims to investigate emotion-related memory performance in relation to checking using newly developed OC-specific material. Additionally, metacognitive characteristics such as cognitive confidence were considered. METHOD In a sample of 63 participants (including 26 participants with obsessive-compulsive disorder), immediate and delayed recall for neutral stories and for OC-specific stories containing checking- and washing-related content were assessed. Regression analyses were applied to investigate the relationship to checking symptoms. The influence of metacognitive characteristics on recall was also examined. RESULTS Higher checking was related to significantly better memory performance for a checking-related story as compared to two neutral stories. However, higher checking was also related to higher rates of forgetting of the OC-specific material over the delay period. Rates of forgetting in relation to checking were mediated by cognitive confidence. Diagnostic status was not predictive of any outcome variables. LIMITATIONS The use of typical and not idiosyncratic verbal material may limit the ecological validity of these findings. CONCLUSIONS In relation to high checking, different disorder-related cognitive and affective processes seem to interfere with memory encoding and retrieval at different stages. Metacognitive therapy methods might address these processes and thereby lead to a reduction of both cognitive impairment and OC symptoms.
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Affiliation(s)
- J Hansmeier
- Department of Clinical Psychology, University of Marburg, Marburg, Germany.
| | - J A Glombiewski
- Department of Clinical Psychology, University of Marburg, Marburg, Germany
| | - W Rief
- Department of Clinical Psychology, University of Marburg, Marburg, Germany
| | - C Exner
- Department of Clinical Psychology, University of Leipzig, Leipzig, Germany
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Koch J, Exner C. Selective attention deficits in obsessive-compulsive disorder: the role of metacognitive processes. Psychiatry Res 2015; 225:550-5. [PMID: 25554356 DOI: 10.1016/j.psychres.2014.11.049] [Citation(s) in RCA: 58] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2013] [Revised: 11/18/2014] [Accepted: 11/25/2014] [Indexed: 11/30/2022]
Abstract
While initial studies supported the hypothesis that cognitive characteristics that capture cognitive resources act as underlying mechanisms in memory deficits in obsessive-compulsive disorder (OCD), the influence of those characteristics on selective attention has not been studied, yet. In this study, we examined the influence of cognitive self-consciousness (CSC), rumination and worrying on performance in selective attention in OCD and compared the results to a depressive and a healthy control group. We found that 36 OCD and 36 depressive participants were impaired in selective attention in comparison to 36 healthy controls. In all groups, hierarchical regression analyses demonstrated that age, intelligence and years in school significantly predicted performance in selective attention. But only in OCD, the predictive power of the regression model was improved when CSC, rumination and worrying were implemented as predictor variables. In contrast, in none of the three groups the predictive power improved when indicators of severity of obsessive-compulsive (OC) and depressive symptoms and trait anxiety were introduced as predictor variables. Thus, our results support the assumption that mental characteristics that bind cognitive resources play an important role in the understanding of selective attention deficits in OCD and that this mechanism is especially relevant for OCD.
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Affiliation(s)
- Julia Koch
- Schoen Klinik Bad Arolsen, Hofgarten 10, D-34454 Bad Arolsen, Germany.
| | - Cornelia Exner
- Department of Clinical Psychology and Psychotherapy, University of Leipzig, Seeburgstr. 14-20, D-04103 Leipzig, Germany
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Weber F, Hauke W, Jahn I, Stengler K, Himmerich H, Zaudig M, Exner C. Does "thinking about thinking" interfere with memory? An experimental memory study in obsessive-compulsive disorder. J Anxiety Disord 2014; 28:679-86. [PMID: 25127176 DOI: 10.1016/j.janxdis.2014.07.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2014] [Revised: 06/12/2014] [Accepted: 07/04/2014] [Indexed: 11/15/2022]
Abstract
Neuropsychological assessments of participants with obsessive-compulsive disorder (OCD) indicate impaired verbal memory if to be remembered material has to be organized. People with OCD also tend to focus their attention on their thoughts (heightened cognitive self-consciousness). We tested the hypothesis that cognitive self-consciousness causes verbal memory deficits by provoking a division of attention between study task and thoughts. Thirty-six participants with OCD, 36 matched healthy controls and 36 participants with major depressive disorder (MDD) learned under proactive interference in three study conditions: single-task condition, condition with heightened cognitive self-consciousness and condition with an external secondary task. Memory was impaired in the cognitive self-consciousness condition compared to both other conditions. Independent of condition, participants with OCD showed a reduced memory performance compared to healthy controls, but did not differ from participants with MDD. Our results are in line with the hypothesis that cognitive self-consciousness causes memory impairment.
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Affiliation(s)
- Friederike Weber
- Department of Clinical Psychology and Psychotherapy, University of Leipzig, Neumarkt 9-19, D-04081 Leipzig, Germany.
| | - Walter Hauke
- Psychosomatic Clinic, Schützenstraße 100, 86949 Windach, Germany
| | - Ina Jahn
- Department of Psychiatry and Psychotherapy, University Hospital Leipzig, Semmelweisstraße 10, 04103 Leipzig, Germany
| | - Katarina Stengler
- Department of Psychiatry and Psychotherapy, University Hospital Leipzig, Semmelweisstraße 10, 04103 Leipzig, Germany
| | - Hubertus Himmerich
- Department of Psychiatry and Psychotherapy, University Hospital Leipzig, Semmelweisstraße 10, 04103 Leipzig, Germany
| | - Michael Zaudig
- Psychosomatic Clinic, Schützenstraße 100, 86949 Windach, Germany
| | - Cornelia Exner
- Department of Clinical Psychology and Psychotherapy, University of Leipzig, Neumarkt 9-19, D-04081 Leipzig, Germany
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Abstract
Obsessive compulsive disorder (OCD) and attention deficit hyperactivity disorder (ADHD) are two of the most common neuropsychiatric diseases in paediatric populations. The high comorbidity of ADHD and OCD with each other, especially of ADHD in paediatric OCD, is well described. OCD and ADHD often follow a chronic course with persistent rates of at least 40–50 %. Family studies showed high heritability in ADHD and OCD, and some genetic findings showed similar variants for both disorders of the same pathogenetic mechanisms, whereas other genetic findings may differentiate between ADHD and OCD. Neuropsychological and neuroimaging studies suggest that partly similar executive functions are affected in both disorders. The deficits in the corresponding brain networks may be responsible for the perseverative, compulsive symptoms in OCD but also for the disinhibited and impulsive symptoms characterizing ADHD. This article reviews the current literature of neuroimaging, neurochemical circuitry, neuropsychological and genetic findings considering similarities as well as differences between OCD and ADHD.
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Kikul J, Van Allen TS, Exner C. Underlying mechanisms of verbal memory deficits in obsessive-compulsive disorder and major depression--the role of cognitive self-consciousness. J Behav Ther Exp Psychiatry 2012; 43:863-70. [PMID: 22269252 DOI: 10.1016/j.jbtep.2011.12.009] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2011] [Revised: 12/16/2011] [Accepted: 12/22/2011] [Indexed: 11/25/2022]
Abstract
BACKGROUND AND OBJECTIVES Previous studies have demonstrated that some individuals suffering from obsessive-compulsive disorder (OCD) are impaired in verbal memory performance. This study was designed to investigate the role of cognitive self-consciousness (CSC) as a putative underlying mechanism of these cognitive deficits. METHODS Verbal memory performance of 36 participants with OCD, 36 individuals with major depression disorder (MDD) and 36 healthy controls was assessed with the California Verbal Learning Test under three different experimental conditions: (1) single-task condition, (2) while simultaneously focusing on their thoughts (CSC condition), (3) while simultaneously focusing on external stimuli (dual-task condition). RESULTS Memory performance in the CSC condition and in the dual-task condition was reduced compared to single-task condition but no interaction effect was found. LIMITATIONS It remains unclear whether CSC and other concepts with an inward self-referential focus of attention (e.g. rumination) differ in the way they influence cognitive performance. CONCLUSIONS These results confirm the deteriorating influence of heightened CSC on verbal memory encoding but suggest that the effect is not specific to OCD.
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Affiliation(s)
- Julia Kikul
- Schoen Klinik Bad Arolsen, Hofgarten 10, D-34454 Bad Arolsen, FRG, Germany.
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