Avoid jumping to conclusions under uncertainty in Obsessive Compulsive Disorder

Transdiagnostic Anxiety-Related Increases in Information Sampling are Associated With Altered Valuation

Excessive information sampling in psychiatric patients characterized by high trait anxiety has been inconsistently linked with alterations in inferential and valuation processes. Methodological limitations could account in part for these inconsistencies. To address this, computational models of inference and valuation were applied to data collected from a transdiagnostic sample of adults with and without an anxiety or compulsive disorder using a version of the beads task with enhanced experimental controls. Participants diagnosed with an anxiety or compulsive disorder (n = 35) and healthy controls (n = 23) completed the beads task with three majority-to-minority ratios of blue versus green beads (60:40, 75:25, 90:10). First, a Bayesian belief-updating model was fit to quantify the iterative process by which new information (bead color) and prior beliefs were integrated to influence current beliefs about jar identity. Next, a parameterized partially observable Markov decision process model was used to parse the contribution of value-based decisions to sampling behavior and included a relative subjective cost parameter, Csub , for each bead-ratio condition. Higher trait anxiety was associated with more draws-to-decision, most robustly in the 90:10 bead-ratio condition. Only relative subjective cost of sampling decisions, and not inferential differences in weighting of new or old information, satisfactorily accounted for this relation. Specifically, lower Csub(0.9) was associated with more trait anxiety and more draws-to-decision. In a condition with high objective evidence strength, transdiagnostic trait-anxiety-related increases in information sampling were explained by a cost-benefit analysis where relatively higher subjective cost was assigned to an incorrect guess, highlighting valuation as a potential treatment target for future research.

Contamination-Focussed Vignettes as an Analogue of Infectious Pandemics: An Experimental Validation using the State Disgust and Anxiety Responses in OCD

Despite infectious pandemics proving particularly detrimental to those with Obsessive-Compulsive Disorder (OCD), the investigation of analogous experimental paradigms is lacking. To address this gap, we conducted two studies employing vignettes that depicted contamination-related situations commonly experienced during a pandemic (e.g., Coughing into hands and failing to use hand sanitizer). We manipulated the salience of these vignettes across three levels: high contamination, low contamination, and a neutral control condition. Our examination of state anxiety and disgust responses in all participants revealed the successful manipulation of the vignettes' impact. Specifically, individuals with more severe OCD symptoms reported significantly higher levels of state disgust and anxiety for both high and low contamination vignettes, in contrast to the group with lower symptom severity. No significant differences were observed in the neutral vignette condition between the high- and low-scoring groups. Interestingly, for those with higher OCD symptoms, high salience contamination-focused vignettes resulted in similarly elevated state disgust and anxiety, regardless of whether the vignettes were situated in public (Study 1) or domestic (Study 2) settings. This suggests that the heightened sensitivity to contamination-related scenarios observed in individuals with OCD symptoms in the present study is not confined to a specific context. These findings support the use of contamination-focused vignettes as analogues for studying infectious pandemics and provide valuable insights into OCD models, interventions, and future research.

Feeling uncertain despite knowing the risk: Patients with OCD (but not controls) experience known and unknown probabilistic decisions as similarly distressing and uncertain

Patients with obsessive compulsive disorder (OCD) present as risk-averse and avoidant of feared stimuli, yet the literature examining risk aversion in OCD is conflicting. One possible explanation is that patients may exhibit aversion only on ambiguous tasks where the likelihood of possible outcomes is unknown. To test this idea, the current study assigned 30 patients with OCD versus 30 non-psychiatric controls (NPC) to conditions of known versus unknown risk (i.e., probabilities) on the Beads Task. Importantly, the task involved real financial stakes. We also examined self-reported intolerance of uncertainty (IU) as a mechanism. Results revealed a significant risk information x group interaction for certainty about the decision. Specifically, while NPCs felt significantly less certain on the unknown risk (versus known risk) task, the OCD group felt uncertain regardless of risk information. Results also revealed a significant main effect of group for distress after deciding, such that the OCD group was more distressed across all task versions compared to NPCs. Elevated trait IU was associated with higher task-related distress. Results indicate that even when patients with OCD are given information about likelihoods, they still feel uncertain and experience distress. Findings have clinical implications for addressing risk aversion and ambiguity/uncertainty in treatment.

Intolerance of Uncertainty as a Cognitive Vulnerability for Obsessive-Compulsive Disorder: A Qualitative Review

Intolerance of uncertainty (IU) is the tendency to react negatively to uncertain situations. In this review, we critically evaluate the evidence for IU as a cognitive vulnerability for obsessive-compulsive disorder (OCD), including (a) evidence for a robust association between IU and OCD symptoms, (b) evidence that IU is stable and trait-like, (c) evidence for IU as a causal risk factor that influences the development of OCD directly or indirectly, and (d) evidence that IU is malleable to intervention. The available evidence suggests that IU is likely a candidate cognitive vulnerability factor for OCD, though additional research is needed to determine if increasing tolerance for uncertainty is a mechanism of effective OCD treatment. Future research examining IU across multiple levels of analysis and a more rigorous examination of the nomological network of IU may identify specific pathways contributing to the development and maintenance of OCD.

Value priorities and value conflicts in patients with mental disorders compared to a general population sample

Personal values are considered as guiding principles for humans’ attitudes and behavior, what makes them an essential component of mental health. Although these notions are widely recognized, investigations in clinical samples examining the link between values and mental health are lacking. We assessed n = 209 patients with affective disorders, neurotic disorders, reaction to severe stress, and adjustment disorders and personality disorders and compared them to a stratified random sample (n = 209) drawn from the European Social Survey. Personal values were assessed using the Portraits Value Questionnaire. Severity of psychopathology was assessed using the Beck Depression Inventory and the Brief Symptom Inventory. Clinical participants showed a higher preference for the values power, achievement and tradition/conformity and a lower preference for hedonism compared to controls. Patients exhibited more incompatible value patterns than controls. Across diagnostic groups, patients with neurotic disorders reported incompatible values most frequently. Value priorities and value conflicts may have the potential to contribute to a better understanding of current and future actions and experiences in patients with mental disorders.

People with jumping to conclusions bias tend to make context-independent decisions rather than context-dependent decisions

Beads task (BT) uses a probabilistic reasoning paradigm and reveals jumping to conclusions (JTC) bias, the tendency to make premature judgments based on insufficient information (i.e., making fewer draws to decision-DTD). In this study, healthy participants (N = 207) were tested on the 80:20 and 60:40 color ratio versions of BT. We investigated associations of JTC bias with a set of cognitive bias problems and Cognitive Bias Task (CBT), a non-veridical (agent-centered) decision-making task that determines context-dependent and context-independent decision-making bias.Results showed that the converted CBT scores were negatively, and cognitive bias scores were positively correlated with JTC bias (DTD ≤ 2) on both versions of the BT. The CBT demonstrated to have satisfactory convergent and predictive validity for JTC bias. The findings suggest that people with JTC bias fail to solve cognitive bias problems and are more likely to make context-independent response selections than context-dependent response selections.

Elevated levels of hoarding in ADHD: A special link with inattention

Hoarding Disorder (HD) is under recognised and under-treated. Though HD develops by early adulthood, patients present only later in life, resulting in research based largely on samples of predominantly older females. Whilst formerly associated with Obsessive-Compulsive Disorder (OCD), it is now recognised that individuals with HD often have inattention symptoms reminiscent of Attention Deficit/Hyperactivity Disorder (ADHD). Here, we investigated HD in adults with ADHD. Patients in an ADHD clinic (n = 88) reported on ADHD, HD and OCD-related symptoms, and compared with age, gender and education matched controls (n = 90). Findings were assessed independently in an online UK sample to verify replication using a dimensional approach (n = 220). Clinically significant hoarding symptoms were found in ∼20% versus 2% of ADHD and control groups, respectively, with those with hoarding being on average in their thirties and with approximately half being male. Greater hoarding severity was noted even in the remaining patients compared with controls (d = 0.89). Inattention was the only significant statistical predictor of hoarding severity in patients. Similarly, inattention, alongside depression and anxiety were the greatest predictors of hoarding in the independent sample where 3.2% identified as having clinically significant hoarding. Patients with ADHD had a high frequency of hoarding symptoms, which were specifically linked to inattention. HD should be routinely assessed in individuals with ADHD, as they do not typically disclose associated difficulties, despite these potentially leading to impaired everyday functioning. Research in HD should also investigate adults with ADHD, who are younger and with a greater prevalence of males than typical HD samples.

Facing the "new normal": How adjusting to the easing of COVID-19 lockdown restrictions exposes mental health inequalities

BACKGROUND

Re-establishing societal norms in the wake of the COVID-19 pandemic will be important for restoring public mental health and psychosocial wellbeing as well as economic recovery. We investigated the impact on post-pandemic adjustment of a history of mental disorder, with particular reference to obsessive-compulsive (OC) symptoms or traits.

METHODS

The study was pre-registered (Open Science Framework; https://osf.io/gs8j2/). Adult members of the public (n = 514) were surveyed between July and November 2020, to identify the extent to which they reported difficulties re-adjusting as lockdown conditions eased. All were assessed using validated scales to determine which demographic and mental health-related factors impacted adjustment. An exploratory analysis of a subgroup on an objective online test of cognitive inflexibility was also performed.

RESULTS

Adjustment was related to a history of mental disorder and the presence of OC symptoms and traits, all acting indirectly and statistically-mediated via depression, anxiety and stress; and in the case of OC symptoms, also via COVID-related anxiety (all p < 0.001). One hundred and twenty-eight (25%) participants reported significant adjustment difficulties and were compared with those self-identifying as "good adjusters" (n = 231). This comparison revealed over-representation of those with a history or family history of mental disorder in the poor adjustment category (all p < 0.05). 'Poor-adjusters' additionally reported higher COVID-related anxiety, depression, anxiety and stress and OC symptoms and traits (all p < 0.05). Furthermore, history of mental disorder directly statistically mediated adjustment status (p < 0.01), whereas OC symptoms (not OC traits) acted indirectly via COVID-related anxiety (p < 0.001). Poor-adjusters also showed evidence of greater cognitive inflexibility on the intra-extra-dimensional set-shift task.

CONCLUSION

Individuals with a history of mental disorder, OC symptoms and OC traits experienced greater difficulties adjusting after lockdown-release, largely statistically mediated by increased depression, anxiety, including COVID-related anxiety, and stress. The implications for clinical and public health policies and interventions are discussed.

Electroencephalographic Correlates of Obsessive-Compulsive Disorder

This chapter reviews EEG research in Obsessive-Compulsive Disorder (OCD), focusing on Event-Related Potentials (ERPs) such as the Contingent Negative Variation, N2, Error-Related Negativity, the feedback Error-Related Negativity and the Readiness Potential and their neural bases. The functional significance, utility and correlation of these ERPs with OCD symptoms will be discussed, alongside novel theories for integrating the research findings. I will consider hypotheses including goal-directed behaviour, overreliance on habits, dissociations between action and knowledge, and excessive intolerance of uncertainty in the context of EEG studies, thus providing a comprehensive framework of the electroencephalographic literature concerning OCD.

What Happened to Patients With Obsessive Compulsive Disorder During the COVID-19 Pandemic? A Multicentre Report From Tertiary Clinics in Northern Italy

After the outbreak of Coronavirus disease was declared a pandemic by the World Health Organization, this resulted in extraordinary public health measures to control the infection, such as entire countries being placed under quarantine. The psychopathological consequences of the pandemic and quarantine were anticipated to be of particular relevance, especially in patients with psychiatric disorders such as Obsessive Compulsive Disorder (OCD). Aim of the present report was to describe the impact of COVID-19 pandemics within a sample of Italian patients affected by OCD. Sociodemographic and clinical variables of a sample of 123 OCD outpatients, currently attending three OCD tertiary clinics in Northern Italy, were assessed through telephone and in-person interviews. Patients showing a clinical worsening of OCD represented more than one third of the sample and reported a significant emergence of new obsessions and compulsions phenotypes along with a significant exacerbation of past ones. Moreover, they were more frequently found to experience suicidal ideation, increased Internet checking, sleep disturbances, avoidance behaviors, and work difficulties. A significantly increased need of therapy adjustment and family accommodation was also observed. Further research is warranted to clarify the potential risk and related consequences of the current COVID-19 pandemic on OCD patients.