Metacognitive therapy versus exposure and response prevention for obsessive-compulsive disorder - A non-inferiority randomized controlled trial

OBJECTIVE

Exposure with response prevention (ERP) is the first-line treatment for obsessive-compulsive disorder (OCD). However, refusals, dropouts and the required high time and logistic effort constitute barriers to the use of ERP. In a non-inferiority randomized controlled trial, we compared metacognitive therapy (MCT) to exposure with response prevention (ERP) as treatments for OCD.

METHOD

74 outpatients received 12 weekly sessions of either manualized MCT or ERP, with primary outcomes assessed by blinded assessors using the Yale-Brown Obsessive Compulsive Scale (Y-BOCS) at pre-treatment, mid-treatment, post-treatment, and 6-month follow-up. Secondary outcomes included measures of depression and anxiety. Non-inferiority margin was specified at no less than d = 0.38 below the improvement reached by ERP, corresponding to a difference of about 3 points on the Y-BOCS.

RESULTS

Drop-out rates were low (<14%) and similar in both groups. Linear models indicated non-inferiority of MCT to ERP at post-treatment, but not at 6-month follow-up. While both groups showed comparable Y-BOCS improvements, the MCT group demonstrated a significantly greater reduction in state anxiety scores at post-treatment and follow-up.

CONCLUSIONS

Overall, MCT was not inferior to ERP, especially at post-treatment, suggesting it could be a treatment alternative. However, further research is needed to explore differential treatment indications.

Dyadic coping and illness adjustment after stroke: A longitudinal prospective study

PURPOSE/OBJECTIVE

To investigate associations between illness appraisals, dyadic coping, and illness adjustment in individuals with stroke and their healthy partners.

METHOD/DESIGN

This longitudinal observational study examined dyadic data in 17 couples (patient and partner) after stroke. Patients and partners completed self-report measures on event centrality of the stroke (appraisal) at 2 months (t₁), common dyadic coping (CDC) at 5 months (t₂), and quality of life (adjustment) at 8 months (t₃) after the stroke. Dyadic data were analyzed using actor-partner interdependence models.

RESULTS

Higher event centrality at t₁ predicted more CDC at t₂ in patients (b = 0.38, p < .05). For partners, the effect of event centrality on dyadic coping differed significantly from the patients' effect but was not significant itself (b = -0.17, p = .601). More CDC at t2 predicted higher physical (b = 3.21, p < .05) and psychological quality of life at t₃ (b = 3.66, p < .05) for partners but not for patients.

CONCLUSIONS/IMPLICATIONS

Preliminary evidence suggests that patients and their healthy partners may endorse event centrality of the stroke differentially. Perceiving dyadic coping processes seems to be especially important to the healthy partners' illness adjustment. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Shame on Me? Love Me Tender! Inducing and Reducing Shame and Fear in Social Anxiety in an Analogous Sample

Background

Shame is considered an important factor in the development and maintenance of many psychological disorders, e.g., social anxiety disorder, and an interesting target point for therapeutic intervention.

Method

In the present experimental study, we used an online-adopted Autobiographical Emotional Memory Task (AEMT) to induce shame and tested different micro-interventions (self-compassion, cognitive reappraisal, and a control intervention) with respect to their potential to reduce shame intensity. One-hundred-and-fifteen healthy subjects participated in the study and completed a series of self-report questionnaires on self-compassion, shame, and social anxiety.

Results

The experimental shame induction was well accepted and successful (with significantly heightened feelings of shame); there were no study drop-outs. There was a significant time*condition interaction, which was due the self-compassion-based intervention resulting in a significantly larger reduction of shame than the control condition (counting fishes). In addition, the main effect of the factor experimental condition was further moderated (enhanced) by trait social anxiety and trait self-compassion.

Conclusion

The findings demonstrate the usefulness of online-adopted AEMT for the experimental induction of shame. They suggest that especially self-compassion interventions can be beneficial in alleviating intense shame experiences, which is in accordance with self-compassion theory. Overall, the results are promising in the context of experimental shame research and its potential clinical impacts call for further replication.

Empathy, compassion, and theory of mind in obsessive-compulsive disorder

OBJECTIVES

Individuals with obsessive-compulsive disorder (OCD) often suffer from impairments in social functioning. This study investigates differences in empathy, compassion, and Theory of Mind (ToM) in individuals with OCD as a possible cause for social functioning deficits.

DESIGN

Sixty-four individuals diagnosed with OCD and 62 healthy individuals completed a naturalistic behavioural task (EmpaToM) and a self-report measure (Interpersonal Reactivity Index, IRI).

METHODS

Three preregistered repeated measures analyses of variance (ANOVAs).

RESULTS

People with OCD exhibited higher empathy levels - namely increased sharing of others' suffering - in the EmpaToM task and reported more distress (IRI) compared with healthy individuals. Furthermore, no differences in compassion (EmpaToM) between both groups emerged, although people with OCD reported more concern for others (IRI) compared with healthy individuals. Concerning the ToM, no group differences were detected, neither in the behavioural task, nor self-report.

CONCLUSION

By investigating OCD with diverse scientific practices we shed light on the higher levels of empathy exhibited by individuals with OCD, which are relevant for clinical practice and our understanding of OCD symptomatology.

PRACTITIONER POINTS

●People with obsessive-compulsive disorder show higher levels of empathy, that is the increased sharing of others' suffering, compared with healthy individuals in both a traditional self-report and a naturalistic task. ●Regarding compassion, that is caring for others, their self-reported compassion was higher in people with OCD. ●In Theory of Mind, that is cognitively understanding the situation of another person, no differences have been found neither at self-report nor in a naturalistic task compared with healthy individuals. ●Independent of traditional interventions, it could prove useful to improve emotion regulation skills so people with OCD learn to cope with empathic distress. Furthermore, it might strengthen the treatment gains and lower dropout rates if the social mind and consequently social relationships become a topic in the treatment and prevention of OCD.

Personality changes after acquired brain injury and their effects on rehabilitation outcomes

Acquired brain injury (ABI) is often associated with personality changes. Pre- as well as post-injury personality traits are related to rehabilitation outcomes. However, it largely remains unclear whether post-injury personality shows any associations with rehabilitation outcomes over and above pre-injury personality. Using a case-control design, this study investigated (1) personality changes after ABI from patients' and significant others' perspective, and (2) relations of pre- and post-ABI personality traits to rehabilitation outcomes in the short- and long-term. 40 patients with ABI (85% stroke, 15% traumatic brain injury), 46 healthy controls and their significant others participated. Personality was assessed with NEO-FFI, rehabilitation outcomes (activities, participation, depression) were measured at two and ten months after ABI. Patient-ratings indicated decreases in extraversion and a trend towards reduced conscientiousness. Significant others reported increases in patients' neuroticism. Pre- as well as post-injury personality traits were associated with depression and activities at both short- and long-term timepoints after ABI. The association was strongest for long-term depressive symptoms where personality trait variables accounted for 49% of variance (Radjusted2). Our results confirm that ABI patients and significant others perceive personality changes, albeit in different dimensions. Pre- and post-ABI personality traits showed associations with rehabilitation outcomes, especially with emotional adjustment after the injury.

Mechanisms and Effectiveness of Imagery Strategies in Reducing Disgust in Contamination-Related Obsessive–Compulsive Disorder: Comparing Imagery Rescripting, Imagery Self-compassion and Mood-Focused Imagery

Background

Strong feelings of disgust and anxiety are maintaining factors in contamination-related obsessive–compulsive disorder (C-OCD). To this day there are not many studies that investigated strategies for changing pathological disgust. In a previous study, it was shown that imagery rescripting could successfully change disgust. However, whether imagery rescripting or more general imagery processing, helps to reduce pathological disgust, remains unclear. Therefore, the aim of the present study was to investigate how successful imagery rescripting is in comparison to imagery self-compassion and a passive positive imagery condition in reducing disgust.

Methods

For this, the three strategies were compared to each other on 2 days (within-subject) in a laboratory experiment. The study included 24 subjects with diagnosed C-OCD, and 24 matched, healthy controls (between-subject).

Results

The results show that all three strategies changed disgust, they do not differ from each other and that different traits appear to influence the strategies’ success or failure. The theoretically derived underlying mechanisms of the strategies were found in an elaborate content analysis.

Conclusions

The present study provides first indications that imagery in general can help to change pathological disgust experience.

Are you looking or looking away? Visual exploration and avoidance of disgust- and fear-stimuli: An eye-tracking study

The present eye-tracking study investigates whether individuals with different levels of contamination fear are more likely to focus their attention on disgusting stimuli to explore them or to pull their attention away to avoid them. Ninety-two nonclinical participants with varying degrees of contamination fear performed a dot probe task. Eye-tracking methodology was employed to record gaze patterns during the task. In each trial participants looked at two pictures (disgust-neutral, fear-neutral, or neutral-neutral). Participants were further asked about the contents of the picture and the confidence of their answer. The results show that reaction times were slower and fixations were longer and more frequent for disgust targets compared with fear and neutral targets, which was further amplified in individuals with high contamination fear. However, image details of disgusting pictures were remembered less correctly than details of fearful pictures. These findings confirm the idea that attention on disgusting stimuli is maintained. Further, the findings indicate that disgust is processed more superficially and might also be related to disgust-associated uncertainty and ambiguity. The results may help to understand the difficult-to-change nature of disgust, which could be relevant to habituation and extinction processes in exposure therapy. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Integrated neuropsychological and cognitive behavioural therapy after acquired brain injury: A pragmatic randomized clinical trial

After acquired brain injury (ABI) many patients suffer from persistent cognitive and emotional disturbances. The aim of this study was to investigate the treatment outcome of an integrated intervention, combining neuropsychological and cognitive behavioural therapy (nCBT), against waitlist (WL) in outpatients with ABI. Individuals seeking outpatient treatment for cognitive and emotional problems after ABI were randomly allocated to nCBT (n = 27) or WL (n = 29) and completed assessments at baseline, post-treatment/WL and at six-month follow-up. The primary outcome measures were general psychopathology and functional activity in daily life. The nCBT group showed significant improvement for general psychopathology post-treatment when compared to WL. nCBT was also superior to WL regarding the secondary outcomes, i.e., the reduction of negative affect and the improvement of quality of life. No significant differences for functional activity and community integration were observed. Significant pre-post effect sizes ranged between small for functional activity and medium for quality of life. The positive effects were maintained at follow-up. The majority of patients with cognitive and emotional problems after ABI benefit from an integrated approach that offers cognitive remediation and psychotherapy. However, the heterogeneous sequelae of ABI and the moderate sample sizes in clinical trials present a methodological challenge to ABI research.

Adult ADHD: Influence of Physical Activation, Stimulation, and Reward on Cognitive Performance and Symptoms

Objective: Models of ADHD consider the influence of situational factors on cognitive performance and symptoms. Method: The influence of acute physical exercise, stimulation through continuous fine motor movement, and performance-related reward on performance and ADHD symptoms was assessed. Thirty-six adults with ADHD and 36 healthy controls performed executive function tasks (EF-tasks) of inhibition, selective attention, and working memory with material close to daily life. Experimental manipulations aimed at increasing cognitive performance. Results: No significant effects were found, but there were indicators for ADHD-specific impacts: Reward resulted in higher reported hyperactivity. Acute physical exercise slightly tended to improve attention performance and subjective inattention. Conclusion: The manipulations may affect performance and especially symptoms in different ways. Potential symptom interactions and identification of factors that determine whether symptoms may be functional or detrimental for task performance could be future research interests.

Attentional Processing of Disgust and Fear and Its Relationship With Contamination-Based Obsessive-Compulsive Symptoms: Stronger Response Urgency to Disgusting Stimuli in Disgust-Prone Individuals

Disgust has recently been characterized as a low-urgency emotion, particularly compared to fear. The aim of the present study is to clarify whether behavioral inhibition during disgust engagement is characteristic of a low-urgency emotion and thus indicates self-imposed attentional avoidance in comparison to fear. Therefore, 54 healthy participants performed an emotional go/no-go task with disgust- and fear-relevant as well as neutral pictures. Furthermore, heart rate activity and facial muscle activity on the fear-specific m. corrugator supercilli and the disgust-specific m. levator labii were assessed. The results partially support the temporal urgency hypothesis of disgust. The emotion conditions significantly differed in emotional engagement and in the facial muscle activity of the m. levator labii as expected. However, contrary to our expectations, no differences between the emotion conditions regarding behavioral inhibition as well as heart rate change could be found. Furthermore, individuals with a higher-trait disgust proneness showed faster reactions and higher activity of the m. levator labii in response to disgust stimuli. The results show that different trait levels influence attentional engagement and physiological parameters but have only a small effect on behavioral inhibition.

Metacognitive Change During Exposure and Metacognitive Therapy in Obsessive-Compulsive Disorder

Metacognitive therapy (MCT) has been shown to be a promising treatment approach for obsessive-compulsive disorder (OCD). The changeability of metacognitions by (metacognitive) treatment and its relevance to treatment outcome is, however, still unclear. The current study investigates, (1) if treatment with MCT or exposure and response prevention (ERP) in a randomized-controlled pilot trial (n = 24 patients with OCD) changes OCD-specific metacognitions of thought fusion beliefs, beliefs about rituals and stop signals, and (2) if these changes are relevant for the treatment outcome in terms of patient- and therapist-rated OCD symptoms. ANOVA with pretest, posttest and follow-up scores could show that all three metacognitions significantly decreased during both treatments. Regarding thought fusion beliefs, a significant interaction effect indicated a higher decrease after MCT than ERP treatment. In hierarchical regression analyses, changes in stop signals from pre- to post-treatment significantly predicted patient-rating OCD symptoms at post-treatment and follow-up at 3 months after treatment. These changes were even predictive of post-treatment outcome after controlling for general metacognitions and dysfunctional cognitive beliefs. These findings support the assumption that metacognitions can change during both treatments and that changes in stop signals might be relevant for the treatment outcome on the symptom level in OCD.

The Behavior Avoidance Test: Association With Symptom Severity and Treatment Outcome in Obsessive-Compulsive Disorder

Behavior therapy of obsessive-compulsive disorder (OCD) aims to reduce avoidance, rituals, and discomfort in OCD-relevant situations. The Behavioral Avoidance Test (BAT) measures these behavior-related outcomes in individually challenging OCD-related situations. The association of the BAT with OCD severity measures and its relevance for treatment outcome is, however, still unclear. The current study investigates with a retrospective analysis of a subsample of a pilot study, (1) if reactions on the BAT are related to OCD severity measures in an OCD sample (n = 28), (2) if treatment with two variants of cognitive-behavior therapy (exposure and response prevention vs. metacognitive therapy) changes the BAT scores and (3) if these changes as well as pretreatment BAT avoidance are relevant for OCD treatment outcome as measured by the Yale-Brown Obsessive Compulsive Scale (Y-BOCS). Participants rated avoidance, ritual, and discomfort in three individually challenging OCD-related situations before and after therapy. For one of these situations, BAT dimensions were rated by the therapist and an independent rater in addition to the patients' ratings. Correlational analyses found significant correlations between BAT discomfort and OCD severity measures like the Y-BOCS. A repeated measures ANOVA with pre- and posttest scores showed that all three BAT dimensions significantly decreased during both treatments. Hierarchical regression analyses (controlling for Y-BOCS pretest scores) revealed that changes in BAT discomfort as well as pretreatment BAT avoidance scores predicted the Y-BOCS posttest score. These findings suggest that the BAT is a distinct measure of behavior-related outcomes partly being relevant for OCD treatment outcome.

Die Validierung der Dimensional Obsessive-Compulsive Scale (DOCS) an einer deutschsprachigen Stichprobe

<b><i>Hintergrund:</i></b> PatientInnen mit Zwangsstörungen werden in klinischer Forschung und Praxis häufig nicht erkannt oder fehldiagnostiziert, wodurch es zu verzögerten und unzureichenden Behandlungen kommt. Ein Aspekt, der maßgeblich dazu beiträgt, sind unter anderem unzureichende Screening- und Diagnostikinstrumente, da bestehende Fragebögen zur Erfassung von Zwangsstörungen zu einem großen Teil Limitationen hinsichtlich ihrer psychometrischen Qualitäten und ihrer Aktualität unterliegen. Mit der Dimensional Obsessive-Compulsive Scale (DOCS) steht im englischsprachigen Raum seit mehreren Jahren bereits ein vielversprechendes Instrument zur Erfassung von Zwangsstörungen zur Verfügung. <b><i>Patienten und Methoden:</i></b> Ziel der vorliegenden Arbeit war es, erstmalig die Faktorstruktur sowie die psychometrischen Eigenschaften der deutschsprachigen DOCS-Version zu überprüfen. Hierzu wurden 177 PatientInnen (107 mit Zwangsstörung, 30 mit Angststörungen und 40 mit Depression) sowie eine nicht-klinische Kontrollgruppe mit 223 Probanden untersucht. <b><i>Ergebnisse:</i></b> Die vierfaktorielle Originalstruktur der DOCS konnte in explorativen und konfirmatorischen Faktoranalysen repliziert werden. Interne Konsistenzen und die zeitliche Stabilität der DOCS fielen akzeptabel bis sehr gut aus. Die Konstruktvalidität der DOCS-Gesamtskala fiel zufriedenstellend bis gut aus. Die Kriteriumsvaliditäten fielen bedingt zufriedenstellend aus. Die diagnostische Genauigkeit der DOCS fiel befriedigend aus. <b><i>Schlussfolgerung:</i></b> Die deutsche Version der DOCS ist ein robustes, reliables und erstmals validiertes Instrument zur dimensionalen Beschreibung des Schweregrads von Zwangsstörungen.

Cognitive deficits and psychosocial functioning in adult ADHD: Bridging the gap between objective test measures and subjective reports

INTRODUCTION

Self-reported cognitive deficits in adult Attention-Deficit/Hyperactivity-Disorder (ADHD) are often not corroborated by standardized tests. Tests and reports also differ in their correspondence to aspects of psychosocial functioning. Executive function tasks (EF-tasks) using material close to daily life, may provide a more ecologically-valid assessment of cognitive deficits.

METHOD

36 adults with ADHD and 36 healthy controls performed standardized EF-tasks and corresponding EF-tasks using material close to daily life and gave self-reports on cognitive functioning. The study investigated performance differences and the predictive utility of cognitive measures for psychosocial functioning.

RESULTS

While all the self-reports showed substantial cognitive impairments for the ADHD group, this was only shown in some of task measures. For two domains, the deficits in EF-tasks with material close to daily life were similar or smaller than assessed with traditional measures. However, three tasks, which used material of daily life, revealed more deficits than the corresponding more standardized tasks. Beyond cognitive self-reports the new tasks did not contribute substantial to psychosocial functioning, similar to the standardized tasks.

CONCLUSIONS

Tasks using material close to daily life have the potential to objectify reported everyday life deficits better than more standardized tests, at least in single EF-domains. When relevant methodical aspects of these tasks will be more targeted and considered systematically in future research, the tasks might contribute to assessments of psychosocial functioning. Then they could also be used as outcome measures in intervention studies.

Interpretation bias and contamination-based obsessive-compulsive symptoms influence emotional intensity related to disgust and fear

Biased processing of disgust-related stimuli is increasingly discussed in addition to fear-related processing as a maintenance factor for contamination-based obsessive-compulsive disorder (C-OCD). However, the differential impact of fear and disgust on biased processing in C-OCD is not yet completely understood. Because it is difficult to distinguish the two emotions in self-report assessment by directly addressing the specific emotions, a text paragraph-based interpretation bias paradigm was applied to more implicitly assess emotions. For the text-based interpretation bias paradigm, disgust-related, fear-related, disgust-fear-ambiguous and neutral text paragraphs describing everyday life situations were developed and validated in a pre-study (N = 205). Fifty-nine healthy participants watched either disgust- or fear-inducing movies and afterwards rated their experienced emotional response to the text paragraphs. The results show that fear and disgust components of an emotional response to mixed-emotional situations are strongly influenced by the situational context, and across the levels of trait contamination fear people did not differ in their fear experiences to everyday situations (which was overall strong), but in their disgust experiences. These findings highlight the strength of situational context on interpretation bias for mixed-emotional disorders and the important role of disgust for C-OCD.

P5615A randomised study comparing FFR-guided paclitaxel-coated balloon angioplasty vs. drug-eluting bioresorbable scaffolds with 9 months invasive follow-up

Background

Elimination of a permanent metallic stent from standard PCI techniques is desirable since mid- and longterm adverse reactions are attributed to an intracoronary foreign body.

Purpose

To investigate two “metal-free” PCI techniques using either drug-coated balloons (DCB) or bioresorbable scaffolds (BRS) in stable coronary artery disease regarding their safety and efficacy (NCT02607241) and clinical course.

Methods

59 patients (table 1) were prospectively randomized for elective PCI of de novo stenosis with either BRS implantation (N=28) or with DCB only angioplasty (N=31). The DCB only arm was treated by a previously implemented protocol including sequential balloon predilations and repetitive FFR (fractional flow reserve) measurements. Stenting was deferred if FFR was >0.80 and in the absence of flow-limiting dissections after final DCB dilatation. All BRS were post-dilated using a non-compliant balloon. All BVS were post-dilated (non-compliant balloon). Optical coherence tomography (OCT) was performed during index procedure and at 9-month f/u.

Results

Both groups were well balanced without significant differences in clinical characteristics (table 1). Procedural success was achieved in 89.3% in the BRS and 77.4% in the DCB group. Parameter of quantitative coronary angiography are shown in the table 2. The predefined primary end point (efficacy) net luminal gain was significantly larger in the DCB group (noninferiority t-Test, margin: 0.2mm, 80% power). Accordingly, the secondary endpoint late lumen loss indicated with −0.20±0.73 vessel enlargement at the stenotic site in the DCB group at 9-month f/u. Target lesion failure during 9-month f/u occurred much more in the BRS group (14.3% (N=4) vs. 3.2% (N=1), p=0.180) but did not reach significance in this small sample size. In detail, there were 2 scaffold thrombosis despite OCT-guided index procedure in the BRS group with subsequent myocardial infarction, and 2 restenosis in the BRS vs. 1 restenosis in the DCB group requiring repeat target lesion revascularization. Due to safety concerns of BRS and the worldwide recall of Absorb BRS the study was prematurely terminated.

Conclusion

Our data add evidence for FFR-guided “DCB only” PCI as an attractive, safe and feasible alternative by showing a favorable longterm course contrary to the late lumen loss of conventional coronary stents. The Absorb BRS is potentially harmful with a high percentage of target lesion failure including scaffold thrombosis despite OCT-guided implantation and should be avoided.

Does Transcranial Direct Current Stimulation (tDCS) Improve Disgust Regulation Through Imagery Rescripting?

The first pilot studies have shown the potential of imagery rescripting (ImR) for reducing contamination-related pathological disgust, although the effects were rather small. The aim of the present study is to investigate whether the effects of ImR in reducing disgust can be further increased by transcranial direct current stimulation (tDCS). tDCS is a non-invasive method of brain stimulation that has been successfully used multiple times to support emotion-regulation strategies. In the present study, disgust was induced via images related to individualized sources of disgust. Fifty-eight healthy volunteers took part in two parallel experiments. The two groups were matched by age, highest educational level and gender, and were tested under two emotion-regulation conditions, namely an ImR condition and a control condition. Participants performed three trials on the first day and three trials on the second day. Across both days they performed three trials under each of the two emotion-regulation conditions in a randomized order. On one day active stimulation was applied, while on the other day participants were sham stimulated. The combination of emotion-regulation and stimulation condition was balanced across subjects. The only difference between the two groups was the localization of tDCS stimulation: one group was stimulated over the dorsolateral prefrontal cortex and the other group was stimulated over the visual cortex (VC). This experimental manipulation was implemented to gain further insights into the underlying neuropsychological mechanisms of imagery. ImR was conducted via a previously-recorded audio file. The results confirm the effect of ImR on the reduction of disgust. However, with the present experimental design we were not able to show that supplementary tDCS of the VC or the dorsolateral prefrontal cortex lead to improvement.

[Attention deficit-hyperactivity disorder (ADHD) and comorbid mental disorders : ADHD-specific self-rating scales in differential diagnostics]

BACKGROUND

It is still unclear how well the established attention deficit-hyperactive disorder (ADHD)-specific rating scales can differentiate between ADHD symptoms and symptoms of other mental disorders.

METHODS

A total of 274 patients with suspected adult ADHD were extensively examined clinically and guideline-conform in an ADHD outpatient clinic. In 190 patients the diagnosis of ADHD could be made with certainty. The patients were also subsequently assessed according to the DSM IV criteria by self-rating scales on current (ADHS-SB, ASRS, CAARS) and retrospective (WURS-K) complaints. A binary logistic regression analysis was performed in order to extract from the questionnaires, which could best distinguish the diagnosis of ADHD from other mental disorders.

RESULTS

The results showed that two self-rating scales (WURS-K and ADHS-SB) were sufficient to correctly diagnose ADHD in 83% of the patients examined with a sensitivity of 94% and specificity of 56%.

CONCLUSION

The ADHD-specific self-rating scales are additionally useful for the diagnostic differentiation between ADHD-specific and other psychiatric symptoms in the clinical practice and can improve the safety of the diagnosis.

Changing disgust through imagery rescripting and cognitive reappraisal in contamination-based obsessive-compulsive disorder

Contamination-related obsessive-compulsive disorder (C-OCD) is characterized by strongly experienced disgust and fear, in response to potentially contaminating stimuli. Both emotions differ in their susceptibility for change by habituation and extinction, which are important processes for the success of exposure therapy. Even though the response rates for exposure therapy for C-OCD are very good, it seems promising to test additional therapeutic techniques which target disgust more directly. Therefore, imagery rescripting and cognitive reappraisal were evaluated for their potential to change levels of disgust (within-subject), in the two-session laboratory study with 30 participants, with diagnosed C-OCD, and 30 matched, healthy controls (between-subject), presented. The results show that both emotion-regulation strategies reduced disgust better than a non-intervention control task (counting fishes), across all the participants. Therefore, both strategies seem to be applicable and effective for reducing disgust, in the short term, in participants with diagnosed C-OCD. The implications of these findings for the experimental approach and for the clinical treatment of C-OCD, are discussed.

Differential response patterns to disgust-related pictures

In the present study, attentional bias was investigated as a potential predisposing mechanism for the contamination-related subtype of obsessive-compulsive disorder (C-OC disorder). Fifty healthy participants with varying degrees of subclinical C-OC symptoms performed a visual search task to measure differential attentional biases elicited by neutral, disgust-, and fear-specific pictorial material. Participants had to find a target picture within five neutral distractor pictures randomly presented on different locations in an array. The task was to decide whether the array contained an unpleasant target picture or not. In randomly-selected emotional trials, participants were further asked about the content of the picture and the confidence of their answer. The results show that the reaction times significantly differed between the emotional and neutral pictures. Participants were significantly more confident in answering questions referring to fear compared to disgust pictures. This effect was marginally amplified in participants with higher C-OC symptoms. We discuss the results within the framework of the cost and benefit hypothesis, which postulates that disgust evolutionarily elicits stronger uncertainty compared to fear, owing to the ambiguous nature of the stimuli. Increased uncertainty might be an important but underestimated factor for pathological disgust experience, such as in obsessive-compulsive disorder.

The Neural Correlates of Probabilistic Classification Learning in Obsessive-Compulsive Disorder: A Pilot Study

Individuals suffering from obsessive-compulsive disorder (OCD) have been found to show deficits in implicitly learning probabilistic associations between events. Neuroimaging studies have associated these implicit learning deficits in OCD individuals with aberrant activation of the striatal system. Recent behavioral studies have highlighted that probabilistic classification learning (PCL) deficits in OCD individuals only occur in a disorder-specific context, while PCL remains intact in a neutral context. The neural correlates of implicit learning in an OCD-specific context, however, have not yet been investigated. Using functional magnetic resonance imaging during a neutral (prediction of weather) and an OCD-specific variant (prediction of a virus epidemic) of a PCL paradigm, we assessed brain activity associated with implicit learning processes in 10 participants with OCD and 10 matched healthy controls. Regions of interest (ROIs) were the striatum and the medial temporal lobe. ROI analyses revealed a significantly higher activity in the bilateral putamen and the left hippocampus of OCD participants as compared to healthy controls during both PCL tasks. The group differences could partly be subsumed under a group × task interaction effect with OCD participants showing a significantly higher activity than healthy controls in the left putamen and the left hippocampus in the OCD-specific task variant only. These results suggest a compensation of aberrant striatal activity by an augmented engagement of the explicit memory system particularly in a disorder-relevant context in OCD participants.

The impact of attentional and emotional demands on memory performance in obsessive-compulsive disorder

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.

Evaluation of an Executive Functioning Test Battery in Two Versions with Material Close to Daily Life

Abstract. The assessment of executive functions (EF) often yields conflicting results between standardized tests and self-ratings (e. g., in depression or adult ADHD). For the present investigation, standardized EF-tasks were enriched in order to better represent executive demands of daily life. In the future this may improve the assessment and prediction of reported performance deficits in daily life. An EF-test battery was designed with material close to daily life; tasks were matched to basic executive functions. Healthy students took part in two preliminary studies to evaluate the reliability, validity, and comparability of five tasks. In the end, four tasks seem suitable, whereas one task underlies several limitations. The tasks can reliably be used and should be re-evaluated in further studies with adult ADHD participants and healthy controls.

Therapy of calcium oxalate urolithiasis in a rhesus macaque (Macaca mulatta)

A rhesus macaque (Macaca mulatta) was presented for anuria. Examination revealed calcium oxalate concrements in the bladder. A cystotomy was performed, and a therapy with alfuzosin was conducted. Over 1 year after the treatment, the rhesus macaque had not shown any more signs of stranguria. This is the first case reporting the successful treatment of urolithiasis in a rhesus macaque.

Memory impairment is associated with the loss of regular oestrous cycle and plasma oestradiol levels in an activity-based anorexia animal model

OBJECTIVES

Patients with anorexia nervosa (AN) suffer from neuropsychological deficits including memory impairments. Memory partially depends on 17β-oestradiol (E2), which is reduced in patients with AN. We assessed whether memory functions correlate with E2 plasma levels in the activity-based anorexia (ABA) rat model.

METHODS

Nine 4-week-old female Wistar rats were sacrificed directly after weight loss of 20-25% (acute starvation), whereas 17 animals had additional 2-week weight-holding (chronic starvation). E2 serum levels and novel object recognition tasks were tested before and after starvation and compared with 21 normally fed controls.

RESULTS

Starvation disrupted menstrual cycle and impaired memory function, which became statistically significant in the chronic state (oestrous cycle (P < 0.001), E2 levels (P = 0.011) and object recognition memory (P = 0.042) compared to controls). E2 reduction also correlated with the loss of memory in the chronic condition (r = 0.633, P = 0.020).

CONCLUSIONS

Our results demonstrate that starvation reduces the E2 levels which are associated with memory deficits in ABA rats. These effects might explain reduced memory capacity in patients with AN as a consequence of E2 deficiency and the potentially limited effectiveness of psychotherapeutic interventions in the starved state. Future studies should examine whether E2 substitution could prevent cognitive deficits and aid in earlier readiness for therapy.

Evidence of Big-Five personality changes following acquired brain injury from a prospective longitudinal investigation

OBJECTIVE

Many studies using different assessment methods have reported personality changes after acquired brain injury (ABI). However, to our knowledge, no prospective study has yet been conducted to examine whether previous cross-sectional and retrospective results can be replicated in a longitudinal prospective design. Further, because clinical control groups were only rarely used, it remains debatable if the personality changes found are unique to patients with ABI or if they also affect patients with other disabilities.

METHODS

This study examined personality change in 114 participants with different kinds of ABI, 1321 matched controls (general control, GC), and 746 matched participants with restrictive impairments other than brain injury (clinical control, CC) in a prospective longitudinal design using data from the panel survey Household, Income and Labour Dynamics in Australia (HILDA).

RESULTS

Participants with ABI showed significantly larger declines in Extraversion and Conscientiousness compared with the GC group. When the ABI participants were compared with the CC group, only the difference in Conscientiousness remained significant.

CONCLUSION

Our prospective data corroborate evidence from previous cross-sectional studies that patients with ABI experience larger declines in Extraversion and Conscientiousness than the general population. Whereas the effect on Conscientiousness was unique to patients with ABI, the decline in Extraversion was also observed in participants with other impairments.

Individuals With OCD Lack Unrealistic Optimism Bias in Threat Estimation

Overestimating the occurrence of threatening events has been highlighted as a central cognitive factor in the maintenance of obsessive-compulsive disorder (OCD). The present study examined the different facets of this cognitive bias, its underlying mechanisms, and its specificity to OCD. For this purpose, threat estimation, probabilistic classification learning (PCL) and psychopathological measures were assessed in 23 participants with OCD, 30 participants with social phobia, and 31 healthy controls. Whereas healthy participants showed an optimistic expectation bias regarding positive and negative future events, OCD participants lacked such a bias. This lack of an optimistic expectation bias was not specific to OCD. Compared to healthy controls, OCD participants overestimated their personal risk for experiencing negative events, but did not differ from controls in their risk estimation regarding other people. Finally, OCD participants' biases in the prediction of checking-related events were associated with their impairments in learning probabilistic cue-outcome associations in a disorder-relevant context. In sum, the present results add to a growing body of research demonstrating that cognitive biases in OCD are context-dependent.

Differential memory effects for encoding and retrieving disorder-relevant contents in relation to checking

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.

Selective attention deficits in obsessive-compulsive disorder: the role of metacognitive processes

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.

[An interdisciplinary concept to optimize patient safety--a pilot study]

OBJECTIVE

Which effects has the interdisciplinary collaboration including pharmacists and psychologists in depressive patients?

METHODS

In a 3-arm (each N = 10) randomized pilot study, we compared SC (standard care by specialized physicians in a tertiary care center) with SC + pharmaceutical medication management and SC + psychological counselling in respect to the number of drug-drug interactions, guideline conformity, patient knowledge, and medication adherence (according to MARS).

RESULTS

The number of drug-drug interactions decreased by the MM up to 67 % (p < 0.05). Guideline conformity was fulfilled in all groups before and after intervention. Patient knowledge and medication adherence were not influenced by additional medication management or psychological counselling.

CONCLUSION

In a greater patient group, these explorative results should now be verified.

Does "thinking about thinking" interfere with memory? An experimental memory study in obsessive-compulsive disorder

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.

Gedanken-Handlungs-Fusion und Zwangssymptome–eine Validierungsstudie der Thought Action Fusion-Skala (TAF-Skala) für den deutschen Sprachraum

Theoretischer Hintergrund: Dysfunktionale Annahmen über die Beziehung zwischen mentalen Ereignissen und Verhaltensweisen, sogenannte Gedanken-Handlungs-Fusionen, nehmen eine wichtige Rolle insbesondere in der Erforschung von Zwangssymptomen ein. Fragestellung: Struktur und psychometrische Eigenschaften der deutschen Version der „Thought Action Fusion Skala” (TAF-Skala) zur Erfassung von Gedanken-Handlungs-Fusionen wurden untersucht. Methode: Überprüft wurden verschiedene Gütekriterien an einer klinischen Stichprobe von 203 Probanden (davon 71 mit Zwangsstörung, 51 mit Angststörungen und 81 mit einer Major Depression) und einer nicht-klinschen Stichprobe (n = 300). Ergebnisse: Die Originalstruktur mit drei Skalen konnte in explorativen und konfirmatorischen Faktoranalysen bestätigt werden. Interne Konsistenzen und Retest-Reliabilitäten waren zufriedenstellend bis sehr gut, die diskriminate und konvergente Validität bedingt zufriedenstellend. Die TAF-Skala konnte gut zwischen klinischen und nicht-klinischen Probanden unterscheiden, allerdings nicht zwischen verschiedenen klinischen Stichproben. Schlussfolgerungen: Die deutsche Version der TAF-Skala ist ein zu großen Teilen valides und reliables, aber nicht zwangsspezifisches Messinstrument zur Erfassung von Gedanken-Handlungs-Fusionen und für den Einsatz in Forschung und Praxis geeignet.

(Re-)defining the self - Enhanced posttraumatic growth and event centrality in stroke survivors: A mixed-method approach and control comparison study

Growing evidences highlight the co-existence of negative and positive (e.g. posttraumatic growth) identity changes following stroke. Identity changes were assessed by comparing 42 survivors 21 months after stroke and healthy controls. A total of 26 stroke survivors participated in a semi-structured interview. Stroke survivors showed significantly higher posttraumatic growth (F(1, 75) = 9.79, p = .003) and integrated the critical life event to a higher extent into their identity (event centrality) (F(1, 74) = 37.54, p < .001). Qualitative analysis revealed increased appreciation of life and more intense/selective relationships as the most common positive changes. Considering positive changes might provide additional perspectives for rehabilitation.

Quality of life in cancer rehabilitation: the role of life goal adjustment

OBJECTIVE

A cancer diagnosis affects patients' quality of life (QOL) as well as their pursuit of life goals. However, numerous studies have shown surprisingly stable QOL measures in cancer patients over time. We propose that life goal adjustment can act as the missing link in explaining this response shift. Thus, the aim of this study was to examine associations between life goal adjustment and patients' QOL at baseline and over the course of 20 months.

METHODS

Eighty-six cancer patients were recruited during rehabilitation and reassessed at follow-up 20 months later. Life goals were measured using the Life Goals Questionnaire and analyzed in relation to global QOL as assessed with the World Health Organization Quality of Life Questionnaire - Short Form.

RESULTS

The overall attainment of life goals was associated with QOL. Moreover, over a period of 20 months, perceived QOL and goal attainment remained stable, whereas importance of life goals decreased. Lesser importance and improved goal attainment were predictors of increases in QOL.

CONCLUSIONS

Results suggest that downgrading unattainable goals and making more progress in accomplishing attainable goals may be possible mechanisms of response shift as an adaption to illness. Thus, integrating life goal adjustment into rehabilitation services for cancer patients seems to be worthwhile to enhance an adaptive self-regulation and QOL.

Imminent danger? Probabilistic classification learning of threat-related information in obsessive-compulsive disorder

A tendency to overestimate threat has been shown in individuals with OCD. We tested the hypothesis that this bias in judgment is related to difficulties in learning probabilistic associations between events. Thirty participants with OCD and 30 matched healthy controls completed a learning experiment involving 2 variants of a probabilistic classification learning task. In the neutral weather-prediction task, rainy and sunny weather had to be predicted. In the emotional task danger of an epidemic from virus infection had to be predicted (epidemic-prediction task). Participants with OCD were as able as controls to improve their prediction of neutral events across learning trials but scored significantly below healthy controls on the epidemic-prediction task. Lower performance on the emotional task variant was significantly related to a heightened tendency to overestimate threat. Biased information processing in OCD might thus hamper corrective experiences regarding the probability of threatening events.

Die metakognitive Therapie nach Wells – theoretischer Hintergrund, Behandlungskomponenten und Evidenz

Die Metakognitive Therapie nach Wells wird den neueren Entwicklungen der kognitiven Verhaltenstherapie zugerechnet und befasst sich mit metakognitiven Überzeugungen und Regulationsprozessen, welchen eine zentrale Rolle bei der Pathogenese psychischer Störungen beigemessen wird. Die vorliegende Arbeit stellt zunächst das Self-Regulatory Executive Function-Modell (S-REF-Modell) vor, das den theoretischen Hintergrund der Metakognitiven Therapie bildet, und gibt einen Überblick über zentrale Komponenten dieses Therapieansatzes. Empirische Befunde zum S-REF-Modell sowie zur Metakognitiven Therapie werden vorgestellt. Es wurden Arbeiten eingeschlossen, welche sich mit der vollständigen Metakognitiven Therapie oder der Aufmerksamkeitstrainingstechnik, einer Komponente der Metakognitiven Therapie, befassen.

Metabolic depression during warm torpor in the Golden spiny mouse (Acomys russatus) does not affect mitochondrial respiration and hydrogen peroxide release

Small mammals actively decrease metabolism during daily torpor and hibernation to save energy. Recently, depression of mitochondrial substrate oxidation in isolated liver mitochondria was observed and associated to hypothermic/hypometabolic states in Djungarian hamsters, mice and hibernators. We aimed to clarify whether hypothermia or hypometabolism causes mitochondrial depression during torpor by studying the Golden spiny mouse (Acomys russatus), a desert rodent which performs daily torpor at high ambient temperatures of 32°C. Notably, metabolic rate but not body temperature is significantly decreased under these conditions. In isolated liver, heart, skeletal muscle or kidney mitochondria we found no depression of respiration. Moderate cold exposure lowered torpor body temperature but had minor effects on minimal metabolic rate in torpor. Neither decreased body temperature nor metabolic rate impacted mitochondrial respiration. Measurements of mitochondrial proton leak kinetics and determination of P/O ratio revealed no differences in mitochondrial efficiency. Hydrogen peroxide release from mitochondria was not affected. We conclude that interspecies differences of mitochondrial depression during torpor do not support a general relationship between mitochondrial respiration, body temperature and metabolic rate. In Golden spiny mice, reduction of metabolic rate at mild temperatures is not triggered by depression of substrate oxidation as found in liver mitochondria from other cold-exposed rodents.

Hoarding and the multi-faceted construct of impulsivity: a cross-cultural investigation

The proposed hoarding disorder represents a serious psychiatric condition and considerable public health burden. Although tremendous strides have been made in understanding the phenomenology and treatment of this condition, many features regarding the etiology and nosology remain unclear. In particular, the association between impulsivity and hoarding, as well as the differential role of impulsivity versus compulsivity has yet to be fully considered. The current investigation sought to fill this gap in the literature by examining the relationship between hoarding and impulsivity across two independent, cross-cultural investigations. Two separate conceptualizations of the impulsivity construct were considered, including the Barratt Impulsivity Scale and the UPPS Impulsive Behavior Scale. Across Study 1 (US young adult sample; N = 372) and Study 2 (German young adult sample; N = 160) results revealed that hoarding was associated with greater rates of impulsivity, despite controlling for theoretically relevant covariates. More fined-grained analyses revealed a differential relationship with respect to the various facets of impulsivity, such that hoarding was most strongly linked with attentional and motor impulsivity, as well as urgency (i.e., impulsive behaviors in response to negative affect) and lack of perseverance. When considered simultaneously, both impulsivity and non-hoarding OCD symptoms explained unique variance in hoarding. The implications of impulsivity for hoarding are discussed from a classification perspective, as well as from a vulnerability standpoint.

Underlying mechanisms of verbal memory deficits in obsessive-compulsive disorder and major depression--the role of cognitive self-consciousness

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.