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.

[Psychodermatology: Foundations for new developments in integrated care]. / Psychodermatologie: Grundlagen für den Aufbruch zu neuen Versorgungsformen.

The burden of a skin disease is easily understood by any observer due to its visibility: psychosocial issues are therefore ubiquitous in dermatology. Current evidence now shows that this relationship is two-way, as psychosocial stress can cause skin disease and its worsening. This interrelationship poses a major challenge.

Determining prognostic variables of treatment outcome in obsessive-compulsive disorder: effectiveness and its predictors in routine clinical care.

The objectives of this study were to investigate the naturalistic effectiveness of routine inpatient treatment for patients with obsessive-compulsive disorder (OCD) and to identify predictors of treatment outcome. A routinely collected data set of 1,596 OCD inpatients (M = 33.9 years, SD = 11.7; 60.4% female) having received evidence-based psychotherapy based on the cognitive-behavioral therapy (CBT) in five German psychotherapeutic clinics was analyzed. Effect sizes (Hedges' g) were calculated for several outcome variables to determine effectiveness. Predictor analyses were performed on a subsample (N = 514; M = 34.3 years, SD = 12.2; 60.3% female). For this purpose, the number of potential predictors was reduced using factor analysis, followed by multiple regression analysis to identify robust predictors. Effect sizes of various outcome variables could be classified as large (g = 1.34 of OCD-symptom change). Predictors of changes in OCD and depressive symptoms were symptom severity at admission and general psychopathological distress. In addition, patients with higher social support and more washing compulsions benefited more from treatment. Subgroup analyses showed a distinct predictor profile of changes in compulsions and obsessions. The results indicate that an evidence-based psychotherapy program for OCD can be effectively implemented in routine inpatient care. In addition to well-established predictors, social support, and washing compulsions in particular were identified as important positive predictors. Specific predictor profiles for changes in obsessions and compulsions are discussed.

Rumination about obsessive symptoms and mood maintains obsessive-compulsive symptoms and depressed mood: An experimental study.

Rumination is common in individuals diagnosed with obsessive-compulsive disorder (OCD). We sought to clarify the causal role of rumination in the immediate and intermediate maintenance of obsessive-compulsive symptoms and depressed mood. In total, 145 individuals diagnosed with OCD were asked to read aloud their most distressing obsessive thought (OT). OT activation was followed by a thought-monitoring phase in which frequency of the OT was assessed. Participants were randomly allocated to one of three experimental conditions: rumination about obsessive-compulsive symptoms, rumination about mood, or distraction. Ratings of distress, urge to neutralize, and depressed mood and frequency ratings of the OTs were taken before and after the experimental manipulation. Obsessive-compulsive symptom severity and affect were assessed 2, 4, and 24 hr after the laboratory experiment using ecological momentary assessment. Compared to distraction, both types of rumination resulted in an immediate reduced decline of distress, urge to neutralize, depressed mood, and frequency of OTs, with medium to large effect sizes. Rumination about obsessive-compulsive symptoms did not have a stronger immediate effect than rumination about mood. Rumination about obsessive-compulsive symptoms increased obsessive-compulsive symptom severity and reduced positive affect compared to rumination about mood 24 hr later. Regarding negative affect, there was no difference in effect between the two types of rumination in the intermediate term. To conclude, rumination in OCD has an immediate and intermediate maintaining effect on obsessive-compulsive symptoms and mood and may require additional psychological interventions that supplement cognitive behavioral therapy. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

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.

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.

Change in obsessive beliefs as predictor and mediator of symptom change during treatment of obsessive-compulsive disorder - a process-outcome study.

BACKGROUND: Cognitive models of obsessive-compulsive disorder suggest that changes in obsessive beliefs are a key mechanism of treatments for obsessive-compulsive disorder. Thus, in the present process-outcome study, we tested whether changes in obsessive beliefs during a primarily cognitive behavioral inpatient treatment predicted treatment outcome and whether these changes mediated symptom changes over the course of treatment. METHODS: Seventy-one consecutively admitted inpatients with obsessive-compulsive disorder were assessed with the Yale-Brown Obsessive-Compulsive Scale and the Obsessive Beliefs Questionnaire at treatment intake, after six weeks of treatment and at discharge, and with the Beck-Depression-Inventory-II at intake and discharge. RESULTS: Changes in obsessive beliefs during the first six weeks of treatment predicted obsessive-compulsive symptoms at discharge when controlling for obsessive-compulsive and depressive symptoms at intake in a hierarchical regression analysis. Multilevel mediation analyses showed that reductions in obsessive beliefs partially mediated improvements in obsessive-compulsive symptoms over time. CONCLUSIONS: Our findings indicate that decreasing obsessive beliefs in inpatient cognitive behavioral therapy for obsessive-compulsive disorder might be a promising treatment approach.