Lateralized readiness potentials and sensorimotor activity in adults with obsessive-compulsive disorder

Obsessive-compulsive disorder (OCD) patients are known to have various functional abnormalities in prefrontal and motor areas. Given the presence of compulsions in many OCD patients, impaired response preparation processes could be a core feature of OCD. Yet, these processes remain understudied from a neurophysiological standpoint. Nineteen OCD patients were matched on age and sex to 19 healthy controls. Continuous EEG was recorded in all participants during a stimulus-response compatibility task. EEG from electrodes C3 and C4 was then averaged into stimulus- and response-locked LRPs. We compared both groups on various LRP measures, such as the LRP onset, the Gratton dip, and the maximum LRP peak. OCD patients showed significantly larger LRP peak than healthy controls, as well as larger Gratton dip. However, there was no group difference regarding LRP onset. Among OCD patients, it seems that motor regions are overactive during response preparation. Such overactivity was found for both incorrect responses that are aborted before execution and responses that are truly executed. These results suggest that regulation of sensorimotor activity should be addressed in the treatment of OCD.

Targeting Cognitions, Emotions, and Behaviors in a Complex Case of Tourette Syndrome: Illustration of a Psychophysiological Perspective

Recent research stresses that cognitive and affective processes are implicated in Tourette Syndrome (TS) and might influence treatment. The cognitive-behavioral and psychophysiological (CoPs) approach posits that negative appraisals and maladaptive action-planning elicit negative emotions and behaviors that increase muscular tension and thus the urge to tic in TS. Hence, the CoPs targets cognitive-behavioral and affective processes increasing tension prior to tic onset. This article provides clinically novel information in the implementation and utility of the CoPs approach in a severe case of a young man with TS and a range of comorbidities marked by negative cognitions and emotions as well as planning deficits with a long-term follow-up. He received 14 sessions of CoPs therapy. Tic severity significantly decreased post-treatment with maintenance up to 36-months. The process measure of action-planning improved significantly from pre-treatment to 12-months follow-up. Results support the feasibility and acceptability of the CoPs in treating complex TS cases.

Electrophysiological predictors of cognitive-behavioral therapy outcome in tic disorders

Cognitive-behavioral therapy (CBT) constitutes an empirically based treatment for tic disorders (TD), but much remains to be learned about its impact at the neural level. Therefore, we examined the electrophysiological correlates of CBT in TD patients, and we evaluated the utility of event-related potentials (ERP) as predictors of CBT outcome. ERPs were recorded during a stimulus-response compatibility (SRC) task in 26 TD patients and 26 healthy controls. Recordings were performed twice, before and after CBT in TD patients, and with a similar time interval in healthy controls. The stimulus- and response-locked lateralized readiness potentials (sLRP & rLRP) were assessed, as well as the N200 and the P300. The results revealed that before CBT, TD patients showed a delayed sLRP onset and larger amplitude of both the sLRP and rLRP peaks, in comparison with healthy controls. The CBT induced an acceleration of the sLRP onset and a reduction of the rLRP peak amplitude. Compared to healthy controls, TD patients showed a more frontal distribution of the No-Go P300, which was however not affected by CBT. Finally, a multiple linear regression analysis including the N200 and the incompatible sLRP onset corroborated a predictive model of therapeutic outcome, which explained 43% of the variance in tic reduction following CBT. The current study provided evidence that CBT can selectively normalize motor processes relative to stimulus-response compatibility in TD patients. Also, ERPs can predict the amount of tic symptoms improvement induced by the CBT and might therefore improve treatment modality allocation among TD patients.

A Review of the Neuropsychological Dimensions of Tourette Syndrome

Neurocognitive functioning in Tourette syndrome (TS) has been the subject of intensive research in the past 30 years. A variety of impairments, presumably related to frontal and frontostriatal dysfunctions, have been observed. These impairments were found in various domains, such as attention, memory, executive functions, language, motor and visuomotor functions, among others. In line with contemporary research, other neurocognitive domains have recently been explored in TS, bringing evidence of altered social reasoning, for instance. Therefore, the aims of this review are to give an overview of the neuropsychological dimensions of TS, to report how neuropsychological functions evolve from childhood to adulthood, and to explain how various confounding factors can affect TS patients' performance in neuropsychological tasks. Finally, an important contribution of this review is to show how recent research has confirmed or changed our beliefs about neuropsychological functioning in TS.

P300 Source Localization Contrasts in Body-Focused Repetitive Behaviors and Tic Disorders

Tic disorders (TD) and body-focused repetitive behaviors (BFRB) have similar phenotypes that can be challenging to distinguish in clinical settings. Both disorders show high rates of comorbid psychiatric conditions, dysfunctional basal ganglia activity, atypical cortical functioning in the prefrontal and motor cortical regions, and cognitive deficits. Clinicians frequently confound the two disorders and it is important to find reliable objective methods to discriminate TD and BFRB. Neuropsychological tests and event-related potential (ERP) studies have yielded inconsistent results regarding a possible context updating deficit in TD and BFRB patients. However, most previous studies did not control for the presence of comorbid psychiatric condition and medication status, which might have confounded the findings reported to date. Hence, we aimed to investigate the psychophysiology of working memory using ERP in carefully screened TD and BFRB patients excluding those with psychiatric comorbidity and those taking psychoactive medication. The current study compared 12 TD patients, 12 BRFB patients, and 15 healthy control participants using a motor oddball task (button press). The P300 component was analyzed as an index of working memory functioning. Results showed that BFRB patients had decreased P300 oddball effect amplitudes over the right hemisphere compared to the TD and control groups. Clinical groups presented different scalp distributions compared to controls, which could represent a potential endophenotype candidate of BFRB and TD.

Sorcery of the Self

In this article, we first examine current cognitive and social constructionist (SC) notions of self and we suggest that although `self is central to both approaches, it is not satisfactorily defined by either because the discussion of self remains at an epistemological level. The lack of genuine definition leads to difficulties specifying the properties `self possesses and to dilemmas about how to draw boundaries between public and private experience and explain that discourse is both personalized yet socially constructed. In the second part of the article, we examine phenomenological claims for an ontological position which transcends views of the self as a unit `known about' and which grounds self-knowledge in Being. Being is revealed by projects in the world and does not distinguish a priori between subject and object. Such divisions are invoked by projects such as `knowing the world' which require a temporal and spatial version of the world in order to come about. Projects are always in the process of coming about; therefore, self s defining quality is what it is about to become rather than what it is. Hence the finite self is an illusion; but a necessary one. We draw an analogy between the way the illusion of self is created and revealed through the project of `knowing the self' and the way a conjuror, through his/her lead-up, convinces an audience to see what should be there. Only because sense of self is an illusion, we speculate, can it exert such a powerful sway over our lives.

The buffering power of overt socially supportive and unsupportive behaviors from the significant other on posttraumatic stress disorder individuals' emotional state

BACKGROUND AND OBJECTIVES

Social support is one of the three strongest predictors of posttraumatic stress disorder (PTSD). In the present study, we aimed to assess the buffering power of overt socially supportive and unsupportive behaviors from the significant other, in a group with PTSD and a comparison group.

DESIGN AND METHODS

A total of 46 individuals with PTSD and 42 individuals with obsessive-compulsive disorder (OCD) or panic disorder (PD) completed diagnostic interviews and an anxiety-oriented social interaction with a significant other. Heart rate of participants was continuously measured during this interaction and overt social behaviors from the significant other were recorded on videotape and coded using a validated system.

RESULTS

Changes in heart rate in PTSD participants correlated negatively with changes in overt socially supportive behaviors from their significant other (r from -.36 to -.50, p < .05), while changes in overt unsupportive social behaviors from their significant other did not yield any significant correlation (r from -.01 to .05, p > .05). No such statistically significant association emerged in the group with OCD or PD (r from .01 to -.27, p > .05).

CONCLUSIONS

This study sustain the buffering power of overt supportive behaviors from the significant other on heart rate changes in PTSD.

The Impact of a Cognitive-Behavioral Therapy on Event-Related Potentials in Patients with Tic Disorders or Body-Focused Repetitive Behaviors

CONTEXT

Tic disorders (TD) are characterized by the presence of non-voluntary contractions of functionally related groups of skeletal muscles in one or multiple body parts. Patients with body-focused repetitive behaviors (BFRB) present frequent and repetitive behaviors, such as nail biting or hair pulling. TD and BFRB can be treated with a cognitive-behavioral therapy (CBT) that regulates the excessive amount of sensorimotor activation and muscular tension. Our CBT, which is called the cognitive-psychophysiological (CoPs) model, targets motor execution and inhibition, and it was reported to modify brain activity in TD. However, psychophysiological effects of therapy are still poorly understood in TD and BFRB patients. Our goals were to compare the event-related potentials (ERP) of TD and BFRB patients to control participants and to investigate the effects of the CoPs therapy on the P200, N200, and P300 components during a motor and a non-motor oddball task.

METHOD

Event-related potential components were compared in 26 TD patients, 27 BFRB patients, and 27 control participants. ERP were obtained from 63 EEG electrodes during two oddball tasks. In the non-motor task, participants had to count rare stimuli. In the motor task, participants had to respond with a left and right button press for rare and frequent stimuli, respectively. ERP measures were recorded before and after therapy in both patient groups.

RESULTS

CoPs therapy improved symptoms similarly in both clinical groups. Before therapy, TD and BFRB patients had reduced P300 oddball effect during the non-motor task, in comparison with controls participants. An increase in the P300 oddball effect was observed posttherapy. This increase was distributed over the whole cortex in BFRB patients, but localized in the parietal area in TD patients.

DISCUSSION

These results suggest a modification of neural processes following CoPs therapy in TD and BFRB patients. CoPs therapy seems to impact patients' attentional processes and context updating capacities in working memory (i.e., P300 component). Our results are consistent with a possible role of the prefrontal cortex and corpus callosum in mediating interhemispheric interference in TD.

The Effect of a New Therapy for Children with Tics Targeting Underlying Cognitive, Behavioral, and Physiological Processes

Tourette disorder (TD) is characterized by motor and vocal tics, and children with TD tend to present a lower quality of life than neurotypical children. This study applied a manualized treatment for childhood tics disorder, Facotik, to a consecutive case series of children aged 8-12 years. The Facotik therapy was adapted from the adult cognitive and psychophysiological program validated on a range of subtypes of tics. This approach aims to modify the cognitive-behavioral and physiological processes against which the tic occurs, rather than only addressing the tic behavior. The Facotik therapy lasted 12-14 weeks. Each week 90-min session contained 20 min of parental training. The therapy for children followed 10 stages including: awareness training; improving motor control; modifying style of planning; cognitive and behavioral restructuring; and relapse prevention. Thirteen children were recruited as consecutive referrals from the general population, and seven cases completed therapy and posttreatment measures. Overall results showed a significant decrease in symptom severity as measured by the YGTSS and the TSGS. However, there was a discrepancy between parent and child rating, with some children perceiving an increase in tics, possibly due to improvement of awareness along therapy. They were also individual changes on adaptive aspects of behavior as measured with the BASC-2, and there was variability among children. All children maintained or improved self-esteem posttreatment. The results confirm the conclusion of a previous pilot study, which contributed to the adaptation of the adult therapy. In summary, the Facotik therapy reduced tics in children. These results underline that addressing processes underlying tics may complement approaches that target tics specifically.

Cognitive-behavioral therapy induces sensorimotor and specific electrocortical changes in chronic tic and Tourette's disorder

BACKGROUND

Tic disorders, such as the Gilles de la Tourette syndrome and persistent tic disorder, are neurodevelopmental movement disorders involving impaired motor control. Hence, patients show repetitive unwanted muscular contractions in one or more parts of the body. A cognitive-behavioral therapy, with a particular emphasis on the psychophysiology of tic expression and sensorimotor activation, can reduce the frequency and intensity of tics. However, its impact on motor activation and inhibition is not fully understood.

METHODS

To study the effects of a cognitive-behavioral therapy on electrocortical activation, we recorded the event-related potentials (ERP) and lateralized readiness potentials (LRP), before and after treatment, of 20 patients with tic disorders and 20 healthy control participants (matched on age, sex and intelligence), during a stimulus-response compatibility inhibition task. The cognitive-behavioral therapy included informational, awareness training, relaxation, muscle discrimination, cognitive restructuration and relapse prevention strategies.

RESULTS

Our results revealed that prior to treatment; tic patients had delayed stimulus-locked LRP onset latency, larger response-locked LRP peak amplitude, and a frontal overactivation during stimulus inhibition processing. Both stimulus-locked LRP onset latency and response-locked LRP peak amplitude normalized after the cognitive behavioral therapy completion. However, the frontal overactivation related to inhibition remained unchanged following therapy.

CONCLUSIONS

Our results showed that P300 and reaction times are sensitive to stimulus-response compatibility, but are not related to tic symptoms. Secondly, overactivity of the frontal LPC and impulsivity in TD patients were not affected by treatment. Finally, CBT had normalizing effects on the activation of the pre-motor and motor cortex in TD patients. These results imply specific modifications of motor processes following therapy, while inhibition processes remained unchanged. Given that LRPs are partially generated within the sensorimotor and supplementary motor area, the reported reduction in tic frequency and improvements of LRPs components suggest that CBT induced a physiological change in patients' motor area.

Effect of emotional valence on episodic memory stages as indexed by event-related potentials

Several investigations have shown that emotional events show superior recall than non-emotional ones. However, the cortical mechanisms underlying the episodic recall of emotional scenes are still poorly understood. Our main aim was to compare the magnitude of the Event-Related brain Potentials (ERP) old-new effect related to emotionally unpleasant, pleasant and neutral photographic images. As expected, correct recognition of all types of images elicited three topographically distinct ERP components sensitive to the classical old-new recognition effect. The results revealed that the behavioral performances were mainly sensitive to arousal, while the ERP old/new effect over posterior regions (300 – 1000 ms) was exclusively affected by unpleasantness. A later component (1000 – 1400 ms) showed an inverted old/ new effect at parietal sites, which was also sensitive to unpleasantness. These results imply that ERP reflecting episodic conscious recollection and post-retrieval monitoring are clearly affected both by valence and arousal.

How Do Social Interactions with a Significant Other Affect PTSD Symptoms? An Empirical Investigation with a Clinical Sample

Social support and coping are both related to posttraumatic stress disorder (PTSD) symptoms, but the mechanisms underlying their relationships remain unclear. This study explores these relationships by examining the perceived frequency of supportive and countersupportive interactions with a significant other in PTSD patients. Ninety-six participants with PTSD were recruited and completed questionnaires assessing social interactions, ways of coping, and PTSD symptoms. Associations of social interactions (r² = 4.1%-7.9%, p < .05) and coping (r² = 15.9%-16.5%, p < .001) with symptoms were independent, and suggested a direct association between social interactions and PTSD. Countersupportive interactions were more associated to symptoms than supportive interactions. Our findings suggest the development of psychotherapies that integrate social support interventions.

Belief in the obsessional doubt as a real probability and its relation to other obsessive-compulsive beliefs and to the severity of symptomatology

OBJECTIVES

Despite the important role of doubt in understanding obsessive-compulsive disorder (OCD), current cognitive models of OCD usually do not separate this initial doubt from the anticipated consequence of not ritualizing. The current study evaluates belief in the obsessional doubt as a real probability as an additional cognitive dimension of obsessive-compulsive (OC) beliefs.

METHODS

One hundred and fifteen participants with OCD completed four clinical scales measuring different OC beliefs in: (a) the real probability of obsessional doubt; (b) the realism of anticipated consequences; (c) the degree of conviction in the need to perform rituals; and (d) the perceived ability to resist rituals. The severity of symptomatology was also evaluated.

DESIGN

Using cross-sectional and longitudinal data, correlational analyses were performed to determine the relationship between OC beliefs as well as to observe how these beliefs may be related to the severity of symptomatology and how they fluctuated over time. Regression analyses were also employed to verify which OC beliefs better predicted the perceived ability to resist rituals.

RESULTS

Belief in the obsessional doubt as a real probability was significantly related to other OC beliefs. Also, levels of belief for the same doubt remained stable for a period of two weeks, but different levels of belief were observed for distinct obsessional doubts measured at the same time. Finally, belief in the obsessional doubt as a real probability better predicted the perceived ability to resist rituals than other OC beliefs.

CONCLUSIONS

Belief in the obsessional doubt as a real probability may be an important dimension to consider when evaluating OC beliefs in treatment resistant OCD, particularly in people who have low perceived ability to resist rituals.

Cognitive behavioral management of Tourette's syndrome and chronic tic disorder in medicated and unmedicated samples

OBJECTIVE

Cognitive behavior therapy (CBT) and medication can be administered in combination in treating tic disorders but there are no studies evaluating the effectiveness of CBT with and without medication. The current study compares the efficacy of CBT in combination with medication and without medication.

METHOD

CBT was administered in a consecutively referred sample of 76 people diagnosed either with Gilles de la Tourette Syndrome or chronic tic disorder. The sample was divided into a medicated and a non-medicated group. Twenty three were stabilized on medication and 53 were not receiving medication. Measures administered pre- and post-CBT in both groups included: main outcome measure of Tourette Syndrome Global Scale and measures of mood.

RESULTS

Repeated measures analysis of variance on the initial sample revealed no difference between medicated and non-medicated groups in outcome. A further analysis comparing the 23 receiving medication with 23 not receiving medication matched on baseline clinical variables also yielded no significant group differences, either in treatment outcome on main tic outcome measures or on other clinically relevant questionnaires.

DISCUSSION

CBT for tic disorders is an effective treatment administered either in combination with medication or alone.

Inferential confusion, obsessive beliefs, and obsessive-compulsive symptoms: a replication and extension

This study replicated and extended previous research regarding utility of an inference-based approach (IBA) to the study of Obsessive-Compulsive Disorder (OCD). The IBA is a model for the development of OCD symptoms through false reasoning. One of its key features is inferential confusion-a form of processing information in which an individual accepts a remote possibility based only on subjective evidence. In a nonclinical sample, this study examined the specificity of relations between the expanded Inferential Confusion Questionnaire (ICQ-EV) and OC symptoms. Results were that the ICQ-EV significantly predicted OC symptoms after controlling for general distress, anxiety, and depression. This finding supports the unique association between inferential confusion and OCD. Further, the ICQ-EV was a stronger predictor of certain OC symptoms than scales from the Obsessive Beliefs Questionnaire, which itself has shown strong relations with OC symptoms. Thus, both inference-based and cognitive appraisal models appear useful for understanding OCD.

Intrusions related to obsessive-compulsive disorder: a question of content or context?

The aim of the current study was to investigate whether intrusions of individuals with obsessive-compulsive disorder (OCD) and nonclinical individuals differed in content and in context of occurrence. The results suggest that although the intrusions of OCD and nonclinical individuals are similar in content, they differ in their context of occurrence. Chi square analyses revealed that the intrusions of nonclinical participants were more likely to be directly linked than indirectly linked to observations in the here and now, whereas the intrusions of participants with OCD were more prone to be indirectly linked than directly linked to triggers in the environment at the time they occurred. The implications of the results for cognitive models of OCD are discussed.

When doubting begins: exploring inductive reasoning in obsessive-compulsive disorder

The objective of this study was to test the hypothesis that inductive reasoning plays a role in obsessional doubting by comparing an OCD sample with a non-OCD control group in performance of an inductive reasoning task. The 'Reasoning with Inductive Arguments Task' (RIAT) measures inductive performance using arguments drawn from both given vs. self-generated sources and containing neutral vs. OCD-related content. Both an OCD group recruited from clinical referrals and a control group recruited from the general population were compared on performance of the RIAT. People with OCD tended to doubt an initial conclusion much more than controls in the light of subsequent alternative conclusions given by the experimenter. There were no significant differences between the two groups in the self-generated condition. The OCD group doubted more regardless of whether the items were OCD-relevant or neutral. The control group also doubted the initial conclusions but not to the same extent as the OCD group in the 'given' condition and their degree of doubting did not differ between self-generated or given items. People with OCD may create doubt because they are giving too much credit to mental models given from external sources.

Specificity of belief domains in OCD: validation of the French version of the Obsessive Beliefs Questionnaire and a comparison across samples

This paper assesses the psychometric properties of the French version of the Obsessive Beliefs Questionnaire (OBQ-44) and investigates whether the questionnaire discriminates between obsessive-compulsive disorder (OCD), anxious control (AC), and non-clinical control (NCC) participants. A confirmatory factor analysis suggested a poor fit of the model. An exploratory factor analysis replicated the original factor structure. The subscales were moderately intercorrelated and highly correlated with the total score. There was partial support for convergent/divergent validity of the OBQ-44. In analyses of variance comparing the three samples, the participants in the OCD sample scored significantly higher than the participants in the AC and NCC samples on all of the OBQ-44 scores. In analyses of covariance comparing the OCD and NCC samples while controlling for general distress and age, the participants with OCD scored significantly higher than the NCC participants on all of the OBQ-44 scores. Implications of the current study are discussed.

Cognitive-behaviour therapy and skilled motor performance in adults with chronic tic disorder

The first aim of the present study was to compare performance of people with tic disorders (TD) and controls on executive function and a range of skilled motor tests requiring complex performance, guided movements, hand co-ordination, and fine control of steadiness. The second aim was to investigate the effect of cognitive behaviour therapy (CBT) on motor performance. A total of 55 patients with TD were recruited at baseline from participants in a behavioural management programme. A comparison group of 55 patients suffering from a variety of habit disorders (HD) involving complex manual movements, were matched on age and level of education to 34 non-psychiatric controls. Participants were evaluated pre- and post-treatment and post-waitlist with a neuropsychological evaluation focusing on executive function (Wisconsin Card Sorting Test, WCST) and skilled motor performance (Purdue Pegboard, Hole Steadiness Test, and the Groove Test). Results revealed WCST scores in the normal range, while motor performance differed significantly on the Purdue Pegboard Tests in both TD and HD as compared to the control group. Cognitive-behavioural treatment selectively improved motor performance in both clinical groups compared to waitlist control, and this improvement related to clinical outcome measures.

Intrusive thoughts, obsessions, and appraisals in obsessive–compulsive disorder: A critical review

This article reviews empirical findings on two key premises of the appraisal model of obsessive-compulsive disorder (OCD): (a) non-clinical populations experience intrusive thoughts (ITs) that are similar in form and in content to obsessions; and (b) ITs develop into obsessions because they are appraised according to dysfunctional beliefs. There is support for the universality of ITs. However, the samples used are not representative of the general population. IT measures do not relate systematically or exclusively to OCD symptom measures, and are not specific enough to exclude other types of intrusive thoughts such as negative automatic thoughts or worries, nor are they representative of all types of obsessions. When general distress is controlled, there is so far no evidence that participants with OCD endorse obsessive belief domains more strongly than anxious participants, and inconclusive evidence that OCD and non-clinical samples differ on the belief domains. Some OCD symptom subtypes are associated with belief domains. Currently, there is no coherent model to offer strong predictions about the specificity of the empirically derived belief domains in OCD symptom subtypes. Cognitive therapy based on the appraisal model is an effective treatment for OCD, although it does not add to the treatment efficacy of behaviour therapy. It is unclear how appraisals turn ITs into obsessions. Implications for future research are discussed.

Memory and executive functions in adults with Gilles de la Tourette syndrome and chronic tic disorder

INTRODUCTION

The main aim of the current study was to assess whether adults with either Tourette syndrome (TS) or chronic tic disorder (CTD) show a similar neuropsychological profile. Neuropsychological investigations of tic disorders have been mostly focused on children, mainly because symptoms peak during that period. Little has been carried out on adults, even if a significant proportion of the tic population experience moderate or marked levels of tic frequency throughout adulthood. Still, it is not clear whether neuropsychological performances are affected to the same degree in adults with TS and CTD.

METHOD

Patients diagnosed with TS were compared with a CTD group and a control group free of psychiatric or neurological diagnosis, comparable in terms of age, gender, and intelligence. All participants completed two tests of memory (Rey-Osterreich Complex Figure, California Verbal Learning Test), one test of motor dexterity (Purdue pegboard), and four tasks of executive function (Stroop, Color Trail Test, Tower of London, Wisconsin Card Sorting Test).

RESULTS

TS and CTD patients showed nonverbal memory impairments while verbal memory and executive functioning remained intact. Results also indicated that nonverbal memory performances decrease as a function of tic severity.

CONCLUSION

Both TS and CTD patients present a specific nonverbal deficit whilst the executive and motor functions are relatively intact. The two tic disorder subgroups might be part of a spectrum implicating mainly nonverbal memory.

Le traitement du trouble délirant et ses aspects cognitifs

Cet article fait état de la phénoménologie cognitive du trouble délirant (TD) et examine les modèles cognitifs actuels. Des études de cas ont mis à jour des résultats forts prometteurs concernant l'utilisation de la thérapie cognitivo-comportementale (TCC) pour traiter le TD, même si cette dernière n'en est qu'à ses débuts dans ce domaine. Bien que les étapes de la TCC pour traiter le TD soient très similaires à ceux de la TCC pour les autres troubles psychotiques, son approche comporte des différences considérables. Toutefois, il est primordial de combiner plusieurs stratégies afin de pouvoir modifier les inférences propres au TD. L'évaluation clinique des délires ainsi que l'application de la TCC comme traitement seront illustrées par deux études de cas comportant des diagnostics de TD à thème prédominant de persécution. Les cas ont requis des périodes de temps différentes lors des diverses étapes de la TCC, suggérant l'importance de poursuivre la TCC au besoin.

Psychometric properties of the French and English versions of the Claustrophobia Questionnaire (CLQ)

Research suggests that Claustrophobia, defined as the fear of enclosed spaces, may be better conceptualized as two separate, but related fears: (1) the fear of suffocation, and (2) the fear of restriction. The Claustrophobia Questionnaire (CLQ) is a self-report measure designed to assess these two fears. The original English version of the CLQ has demonstrated excellent psychometric properties. The purpose of the present study was to evaluate a French version of the CLQ for use in clinical and research settings and to replicate the psychometric findings of previous investigations of the English CLQ. Language-appropriate versions of the CLQ, as well as self-report measures of phobic, anxious and depressive symptomatology were distributed to undergraduate students at three Montréal, Québec universities. Results show that the CLQ possesses strong psychometric properties in both languages, and that the English and French versions of the CLQ appear to measure identical constructs. These findings are discussed in terms of proposed applications of the CLQ.

Inferential Confusion and Obsessive Beliefs in Obsessive‐Compulsive Disorder

The goal of the present study was to investigate whether inferential confusion could account for the relationships between obsessional beliefs and obsessive-compulsive disorder (OCD). The Inferential Confusion Questionnaire and the Obsessive Beliefs Questionnaire were administered to a sample of 85 participants diagnosed with OCD. Results showed that the relationship between obsessive beliefs and obsessive-compulsive symptoms decreased considerably when controlling for inferential confusion. Conversely, the relationship between inferential confusion and obsessive-compulsive symptoms was not substantially affected when controlling for obsessive beliefs. Since inferential confusion has an overlap with overestimation of threat, a competing hypothesis for the results was investigated. Results indicated that inferential confusion was factorially distinct from overestimation of threat, and that the independent construct of inferential confusion remains significantly related to obsessive-compulsive symptoms when controlling for anxious mood. These results are consistent with the claim that inferential confusion may be a more critical factor in accounting for OCD symptoms than are obsessive beliefs and appraisals.

Psychometric Properties of the French and English Versions of the Vancouver Obsessional‐Compulsive Inventory and the Symmetry Ordering and Arranging Questionnaire

The Vancouver Obsessional-Compulsive Inventory (VOCI) and the Symmetry Ordering and Arranging Questionnaire (SOAQ) are self-report measures that assess a wide variety of symptoms and features of obsessive-compulsive disorder (OCD) including checking, contamination, obsessions, hoarding, "just right", indecisiveness, and symmetry, ordering and arranging obsessions and compulsions. The original English versions of the VOCI and SOAQ have been shown to demonstrate excellent psychometric properties. The present study examined the reliability and validity of French translations of these measures in a non-clinical sample, and also involved the collection of supplementary psychometric information about the English versions of the scales from a new sample. Volunteer undergraduate students completed questionnaire packages including the VOCI and SOAQ, as well as measures of obsessive-compulsive, phobic and depressive symptomatology in their native language of either French or English. Results indicate that the French versions of the VOCI and SOAQ demonstrate similar and excellent psychometric properties to the English versions and that these measures are highly valid and reliable assessment tools for use in clinical and research applications in both languages.

Cognitive behaviour therapy and medication in the treatment of obsessive-compulsive disorder

OBJECTIVE

To compare cognitive behaviour therapy (CBT) with CBT plus medication; medication alone; and placebo in the treatment of adult obsessive-compulsive disorder (OCD).

METHOD

Forty-eight participants (43 completers) were recruited into two protocols. In the first protocol, 21 people with OCD were randomly allocated to either a standard medication (fluvoxamine) or standard placebo condition for a 5-month period. Both these groups subsequently received CBT for a further 5 months. In the second protocol, 22 people with OCD received CBT, one group was already stabilized on an antidepressant of choice; the second group was drug naïve.

RESULTS

All active treatments, but not the placebo, showed clinical improvement. There was no difference in treatment response to CBT regardless of whether participants had previously received medication or placebo.

CONCLUSION

CBT has a more specific antiobsessional effect than medication but CBT plus medication shows greatest overall clinical improvement in mood.

Evaluation of an Inference‐Based Approach to Treating Obsessive‐Compulsive Disorder

This study evaluated an inference-based approach (IBA) to the treatment of obsessive-compulsive disorder (OCD) by comparing its efficacy with a treatment based on the cognitive appraisal model (CAM) and exposure and response prevention (ERP). IBA considers initial intrusions in OCD (e.g. "Maybe the door is open", "My hands could be dirty") as idiosyncratic inferences about possible states of affairs arrived at through inductive reasoning. In IBA such primary inferences represent the starting point of obsessional doubt, and the reasoning maintaining the doubt forms the focus for therapy. This is unlike CAM, which regards appraisals of intrusions as the maintaining factors in OCD. Fifty-four OCD participants, of whom 44 completed, were randomly allocated to CAM, ERP or IBA. After 20 weeks of treatment all groups showed a significant reduction in scores on the Yale-Brown Obsessive Compulsive Scale (Y-BOCS) and the Padua Inventory. Participants with high levels of obsessional conviction showed greater benefit from IBA than CAM. Appraisals of intrusions changed in all treatment conditions. Strength of primary inference was not correlated with symptom measures except in the case of strong obsessional conviction. Strength of primary inference correlated significantly with the Y-BOCS insight item. Treatment matching for high and low conviction levels to IBA and CAM, respectively, may optimize therapy outcome.

Brain-behavior relations during motor processing in chronic tic and habit disorder

OBJECTIVE

This study examined electrophysiological indices of preparation (readiness potential, RP) and execution (movement-associated potential, MAP) during automated and controlled reaction time (RT) in 13 chronic tic disorder, 17 habit disorder, and 14 control participants.

BACKGROUND

Both tic and habit disorders are hypothesized to involve states of heightened activation, which could impede initiation and the control of complex motor actions.

METHOD

The electrophysiological signal was recorded from 4 electrodes (Fz, C3, C4, Pz) during a fixed 4-second foreperiod reaction time task.

RESULTS

During automated responses, controls showed a shorter RP peak onset, and during controlled responses a longer MAP peak onset, compared with both clinical groups. The controls were the only group who showed a consistent linear relationship between RP and RT.

CONCLUSIONS

Patients with chronic tic as well as habit disorder may not modulate cortical activation optimally in planning and executing both automated and controlled responses.

The imagination: Cognitive, pre-cognitive, and meta-cognitive aspects

This article is an attempt to situate imagination within consciousness complete with its own pre-cognitive, cognitive, and meta-cognitive domains. In the first sections we briefly review traditional philosophical and psychological conceptions of the imagination. The majority have viewed perception and imagination as separate faculties, performing distinct functions. A return to a phenomenological account of the imagination suggests that divisions between perception and imagination are transcended by precognitive factors of sense of reality and non-reality where perception and imagination play an indivisible role. In fact, both imagination and perception define sense of reality jointly according to what is possible and not possible. Absorption in a possible world depends on the strengths of alternative possibilities, and the relationship between core and marginal consciousness. The model may offer a parsimonious account of different states and levels of imaginal consciousness, and of how "believed-in imaginings" develop and become under some circumstances "lived-in experiences."

Inferential confusion in obsessive–compulsive disorder: the inferential confusion questionnaire

The current article represents the further validation of the construct of inferential confusion amongst clinical samples. Inferential confusion is proposed to be a meta-cognitive confusion particularly relevant to obsessive compulsive disorder (OCD) that leads a person to confuse an imagined possibility with an actual probability. As such, it conceptualizes OCD as a form of belief disorder similar to a delusion or overvalued idea that is a product of distorted reasoning processes. In contrast, other cognitive models of OCD emphasize a phobic model of development in OCD, and thus consider the exaggerated interpretation of intrusions as an essential element in OCD. The present study administered a revised version of the Inferential Confusion Questionnaire, and the Obsessive Belief Questionnaire (OBQ), to a total of 183 participants in three clinical groups and a non-clinical control group. Results suggest that OCD, at least in part, follows a non-phobic model of development with inferential confusion significantly related to obsessive-compulsive symptoms independently of cognitive domains as measured by the OBQ, and mood states. Further, scores on inferential confusion were particularly high in those with OCD and delusional disorder as compared to anxious and non-clinical controls.

Les troubles obsessionnels-compulsifs : appartiennent-ils aux troubles anxieux ou à une autre famille de troubles mentaux ?

Cet article passe en revue les quatre conceptions du trouble obsessionnel-compulsif (TOC) : la première conception présuppose que le TOC est un trouble du mouvement, la deuxième soutient que cette maladie fait partie du spectre TOC incluant, à la fois, les troubles impulsifs et compulsifs, la troisième fait référence à la classification actuelle (DSM-IV-TR) qui répartit le TOC dans la famille des troubles anxieux et la dernière conception suggère qu’il est, en fait, un trouble du raisonnement qui pourrait s’inscrire sur un continuum avec, par exemple, le trouble délirant. Même s’il existe des arguments en faveur des quatre conceptions, le TOC semble se différencier des troubles du mouvement, des troubles impulsifs et des troubles anxieux. En effet, il serait plus juste et raisonnable de concevoir le TOC comme un trouble du raisonnement qui provoque de l’anxiété associée aux croyances obsessionnelles.

Psychological distress and adaptational problems associated with benzodiazepine withdrawal and outcome: a replication

The aim of this study was to replicate and extend the findings of O'Connor, Bélanger, Marchand, Dupuis, Elie, and Boyer [Addict. Behav. 24 (1999) 537], which had established a psychosocial profile associated with psychological distress in benzodiazepine (BZD) use. Forty-one participants with anxiety or insomnia, receiving maintenance therapy of BZD for at least 8 weeks, participated in a 20-week, tapered discontinuation protocol with physician counselling. Drug type and use was monitored throughout. Questionnaire measures of anxiety, behavioural inhibition, neuroticism, withdrawal complaints, social support, psychological distress, self-efficacy in coping without BZD, quality of life, positive and negative life events, were completed at baseline, postdiscontinuation, and at 3-month follow-up. Measures of baseline psychological distress and anxiety inhibition were consistently associated with both discontinuation and the emergence of withdrawal complaints. Successful withdrawal was characterized by low baseline neuroticism, low behavioural inhibition, higher number of positive events, and higher level of social support satisfaction. Higher dosage (in diazepam equivalent dose) was associated with both poorer outcome and the emergence of withdrawal symptoms. Self-efficacy in coping was negatively associated with relapse but not with outcome. Psychosocial factors play a role at different stages of the BZD withdrawal process and could be targeted in treatment.

[Evaluation of a program to help discontinuation of benzodiazepines]

The efficacy of a new cognitive-behavioral group program to help discontinuation of benzodiazepines (PASSE) was evaluated by comparison to a group receiving only social support. Both programs lasted 20 weeks commencing with a preparatory period of one month and then tapering continually during 16 subsequent weeks until discontinuation. Forty-eight participants (24 in each condition) with a diagnosis of anxiety disorder took part in the study. These two active conditions were compared with a separate group of 41 people receiving standard tapering with physician counselling only. The results post-treatment supported the hypothesis that those receiving either of the two active treatments succeeded better in discontinuing benzodiazepines than those receiving the standard treatment. Among those completing the two active programs there was no difference in outcome between the social support and the cognitive behavioral (PASSE) group. However, when the rate of dropout was considered, the cognitive-behavioral group proved significantly superior than the social support group. The results suggest that a cognitive-behavioral program can help people wishing to discontinue benzodiazepines to psychologically tolerate the immediate effects of discontinuation.

A dialogical approach to obsessions

Cognitive conceptualizations of obsessions based on the information-processing metaphor are contrasted with a dialogical approach to understanding obsessive compulsive disorder (OCD). The dialogical approach views obsessions as one-sided conversations. The unit of analysis is the narrative or 'voice', which engages the person in the neutralizing behaviour. The dialogical approach accommodates well the apparent paradox that obsessions are both self and other generated, and that people can be positioned differently regarding the senselessness of their obsessions at different times. Also, people themselves characterize their obsessions in dialogical terms as: voice, conversation, or argument. The focus of therapy is the language and power of the narrative rather than discrete cognitive biases or representations, and dialogical therapy emphasizes role-play and narrative techniques. Cognitive therapy has already shown signs of adopting a narrative turn, and cognitive and dialogical conceptualizations of OCD are alternative perspectives rather than competing explanations.

Recollections of parent-child relationships in patients with obsessive-compulsive disorder and panic disorder with agoraphobia

OBJECTIVE

In previous studies, patients with different psychiatric conditions, as compared with matched controls, have reported that their parents were more protective and less caring towards them when they were children. However, studies investigating associations between parental behaviours and anxiety disorders have yielded inconsistent results. The aim of this study was to compare recalled parental behaviours in out-patients with obsessive-compulsive disorder (OCD), in out-patients with panic disorder with agoraphobia (PDA), and in non-anxious controls.

METHOD

The sample included 43 out-patients with OCD, 38 with PDA, and 120 controls. Participants completed the Parental Bonding Instrument and the Egna Minnen Beträffande Uppfostran or Own Memories of Parental Rearing Experiences in Childhood.

RESULTS

No differences were found between the two anxious groups. However, compared with the control group, anxious patients recalled their parents as more protective.

CONCLUSION

Our findings suggest that child rearing practices such as overprotection may be a risk factor in the development of anxiety disorders.

Deductive and inductive reasoning in obsessive-compulsive disorder

OBJECTIVES

This study tested the hypothesis that people with obsessive-compulsive disorder (OCD) show an inductive reasoning style distinct from people with generalized anxiety disorder (GAD) and from participants in a non-anxious (NA) control group.

DESIGN

The experimental procedure consisted of administering a range of six deductive and inductive tasks and a probabilistic task in order to compare reasoning processes between groups.

METHODS

Recruitment was in the Montreal area within a French-speaking population. The participants were 12 people with OCD, 12 NA controls and 10 people with GAD. Participants completed a series of written and oral reasoning tasks including the Wason Selection Task, a Bayesian probability task and other inductive tasks, designed by the authors.

RESULTS

There were no differences between groups in deductive reasoning. On an inductive "bridging task", the participants with OCD always took longer than the NA control and GAD groups to infer a link between two statements and to elaborate on this possible link. The OCD group alone showed a significant decrease in their degree of conviction about an arbitrary statement after inductively generating reasons to support this statement. Differences in probabilistic reasoning replicated those of previous authors.

CONCLUSIONS

The results pinpoint the importance of examining inference processes in people with OCD in order to further refine the clinical applications of behavioural-cognitive therapy for this disorder.

Evaluation of a cognitive-behavioural program for the management of chronic tic and habit disorders

The aim was to evaluate the efficacy of a manualized cognitive-behavioural program based on habit reversal for the management of chronic tic disorder (CTD) and habit disorder (HD). Forty-seven CTD and 43 HD received a 4-month treatment program. Thirty-eight (22 CTD, 16 HD) were placed on a waitlist control group, which subsequently received treatment. The treatment approach combined awareness training, relaxation (including modification of a tension-producing style of action), and habit-reversal training, with more general cognitive restructuring of anticipations linked to ticcing. Sixty-five percent of completers reported between 75 and 100% control over the tic. At 2-year follow-up, 52% rated 75-100% control. There were also significant changes post-treatment in measures of self-esteem, anxiety, depression and style of planning action. Successful tic/habit modification was associated in CTD and HD groups with successful change in style of planning action. There were no consistent differences in any outcome measures between CTD and HD groups.

Clinical and psychological features distinguishing obsessive-compulsive and chronic tic disorders

Medical and biogenetic research has suggested that obsessive-compulsive disorder and chronic (multiple) tic disorder may share a common etiology. This article reviews corresponding evidence for psychological similarities and differences between the two disorders. There are similarities in self-management strategies, psychological traits (both report high scores on different aspects of perfectionism) and in the ego-syntonic-ego-dystonic cycle of the impulsive-compulsive behavior. Situational cues likely to elicit or worsen the problem differ between the disorders as do associated emotions, comorbidity and background styles of action. In both disorders, cognitive factors, such as anticipations and appraisals of the problem, can play a role in onset and maintenance of the problem, and this raises the question as to whether cognitive or behavioral factors are best addressed in treatment. Psychological characteristics, such as lack of confidence, may contribute to apparent performance deficit. Psychological evaluation, particularly functional analysis, may aid in differential diagnosis between the two disorders, lead to improvement in treatment matching, and in understanding of the multidetermined etiology.

[Cognitive aspects and treatment of delusional disorders.]

This article reviews the cognitive phenomenology of delusional disorders (DD) and examines the current cognitive models. Some case studies have shown considerable promise concerning the utilisation of cognitive behavioral therapy (CBT) for the treatment of DD, even if this approach is in its infancy. Although the stages of CBT to treat DD are very similar to that of other psychotic disorders, there are also considerable differences. However, it is essential to combine several strategies in order to modify inferences specific to DD. The clinical evaluation of delusions as well as the application of CBT as a treatment is illustrated in two cases with a diagnosis of DD with persecutory subtype. The cases required different time periods for different stages of CBT and highlight the importance of tailoring CBT according to need.

Construing contexts: problems and prospects of George Kelly's personal construct psychology

Kelly's concept of man is that of a scientist formulating hypotheses about the world and revising them in the light of their predictive utility. His position is one of subjective realism by which each of us interprets the world according to personal dimensions termed constructs. Establishing knowledge about how others construe the world is made possible in clinical situations by recourse to two Kellyan methods: the character sketch and the role construct repertory test. The former relies on clinical observation, the latter on statistical sophistication. This divergence in methods has led to an ideological split in the following that Kelly spawned, which need not, however, be a barrier to clinical research in this field. Although not all cognitive therapists are constructivists, they share with the latter the desire to look for core patterns underlying individual maladaptive thoughts and actions. Kelly's methods can be applied to the functional analysis favoured by cognitive behaviourists, with clinical gains resulting from the quicker access this provides to personal meaning. But cognitive psychology's schematic approach to organization is a challenge to Kelly's, which conceives of everyday experience solely in terms of the logical nature of construing. Some constraints and assumptions of Kelly's dialectical logic may be avoided by adopting a more phenomenological approach to construing.

Personal constructs associated with tics

Thirteen subjects experiencing chronic tics kept diaries noting frequency, intensity and degree of control of their tic during their daily routines for one week. Three examples of high-, medium- and low-risk situations were chosen as elements and, using a modified form of Kelly's repertory grid, bipolar constructs were elicited by comparing the three types of situations. Principal dimensions extracted from INGRID analyses differed across individuals but related to three principal areas; self-image, degree of task involvement and type of task demand. Feelings of impatience and frustration frequently accompanied tic onset. Subjects' cognitive evaluations of their tic situations may be important in tic management.