Hoarding and emotional reactivity: the link between negative emotional reactions and hoarding symptomatology.

Hoarding disorder (HD) is characterized by difficulty discarding, clutter, and frequently excessive acquiring. Theories have pointed to intense negative emotional reactions (e.g., sadness) as one factor that may play a critical role in HD's etiology. Preliminary work with an analogue sample indicated that more intense negative emotions following emotional films were linked with greater hoarding symptoms. Symptom provocation imaging studies with HD patients have also found evidence for excessive activation in brain regions implicated in processing emotions. The current study utilized a sample with self-reported serious hoarding difficulties to examine how hoarding symptoms related to both general and hoarding-related emotional reactivity, taking into account the specificity of these relationships. We also examined how two cognitive factors, fear of decision-making and confidence in memory, modified this relationship. 628 participants with self-identified hoarding difficulties completed questionnaires about general emotional reactivity, depression, anxiety, decision-making, and confidence in memory. To assess hoarding-related emotional reactivity, participants reported their emotional reactions when imagining discarding various items. Heightened general emotional reactivity and more intense emotional reactions to imagined discarding were associated with both difficulty discarding and acquisition, but not clutter, controlling for age, gender, and co-occurring mood and anxiety symptoms. Fear of decision-making and confidence in memory interacted with general emotional reactivity to predict hoarding symptoms. These findings provide support for cognitive-behavioral models of hoarding. Experimental research should be conducted to discover whether emotional reactivity increases vulnerability for HD. Future work should also examine whether emotional reactivity should be targeted in interventions for hoarding.

An exploratory study of the neural mechanisms of decision making in compulsive hoarding.

BACKGROUND: Prior studies have suggested unique patterns of neural activity associated with compulsive hoarding. However, to date no studies have examined the process of making actual decisions about whether to keep or discard possessions in patients with hoarding symptoms. An increasing body of clinical data and experimental psychopathology research suggests that hoarding is associated with impaired decision making; therefore, it is important to understand the neural underpinnings of decision-making abnormalities in hoarding patients. METHOD: Twelve adult patients diagnosed with compulsive hoarding, 17% of whom also met criteria for obsessive-compulsive disorder (OCD), and 12 matched healthy controls underwent functional magnetic resonance imaging (fMRI) while making decisions about whether or not to discard personal paper items (e.g. junk mail) brought to the laboratory as well as control items that did not belong to them. Items were either saved or destroyed following each decision. RESULTS: When deciding about whether to keep or discard personal possessions, compulsive hoarding participants displayed excessive hemodynamic activity in lateral orbitofrontal cortex and parahippocampal gyrus. Among hoarding participants, decisions to keep personal possessions were associated with greater activity in superior temporal gyrus, middle temporal gyrus, medial frontal gyrus, anterior cingulate cortex, precentral gyrus, and cerebellum than were decisions to discard personal possessions. CONCLUSIONS: These results provide partial support for an emerging model of compulsive hoarding based on complications of the decision-making process. They also suggest that compulsive hoarding may be characterized by focal deficits in the processing of reward and changes in reward contingencies, particularly when these are perceived to be punishing.

Thought control strategies in obsessive-compulsive disorder: a replication and extension.

Previous research suggests that individuals with OCD use maladaptive strategies to control their unpleasant thoughts (Behav Res Ther (1977) 35, 775). These include worry and self-punishment strategies. In the present study we replicated and extended the previous findings by comparing thought control strategies used by patients with OCD to strategies used by anxious and non-anxious control participants. We also examined changes in thought control strategies for OCD patients who underwent cognitive-behavioral therapy. Compared to controls, OCD patients reported more frequent use of worry and punishment strategies, and less frequent use of distraction. Following successful treatment, OCD patients evidenced increased use of distraction and decreased use of punishment. Findings are discussed in terms of the cognitive model of OCD.

Case study: bibliotherapy and extinction treatment of obsessive-compulsive disorder in a 5-year-old boy.

Cognitive-behavioral therapy (CBT) is an effective treatment for childhood obsessive-compulsive disorder (OCD). However, no case studies of children younger than 7 years old have been published. This case report describes a 5-year-old boy with severe OCD. Treatment consisted of parent- and teacher-directed extinction of compulsive reassurance-seeking, and bibliotherapy with an age-appropriate book on OCD. Compulsive behavior decreased rapidly and remained at a low level through the remainder of treatment. At posttreatment and at 1- and 3-month follow-up assessments, the patient's OCD symptoms were markedly improved. This report suggests that very young children may respond well to brief CBT.

Memory and memory confidence in obsessive-compulsive disorder.

Pathological doubt, often found in individuals with obsessive-compulsive disorder (OCD), has been theoretically linked to memory deficits, but empirical evidence for such deficits has been mixed. In contrast, many studies suggest that individuals with OCD have low confidence in their memories. The present study aimed to build upon previous research by measuring memory accuracy and confidence in OCD using ecologically valid, idiographically-selected stimuli. Individuals with OCD (OCs), anxious controls (ACs), and nonanxious controls (NACs) were exposed to a set of objects that the OCs had identified as safe, unsafe, or neutral. Participants were then asked to recall as many objects as possible and to rate their confidence in each memory. This process was repeated 6 times, using the same stimuli for each trial. Contrary to hypothesis, no group differences emerged in memory accuracy. However, OCs' memory confidence for unsafe objects showed a progressive decline over repeated trials. This pattern was not observed among NACs or ACs. Furthermore, OCs with primary checking reported lower confidence in long-term memory than did OCs without primary checking. These results suggest that when OCs are repeatedly exposed to threat-related stimuli (such as repeated checking), their level of confidence in remembering these stimuli paradoxically decreases.

Paradoxical effects of thought suppression: a meta-analysis of controlled studies.

Research has shown that attempts to suppress a thought can cause an increase in the frequency of the thought. These paradoxical effects of thought suppression play a key role in cognitive-behavioral models of several emotional disorders. Laboratory studies of this phenomenon, however, have yielded mixed results; and narrative summaries of the literature have not been able to draw firm conclusions about the effects of thought suppression. We used meta-analysis to quantitatively examine the magnitude of thought suppression effects across controlled studies. Moreover, we explored whether the variability in effect sizes could be explained by methodological differences within and between studies. Results indicated a small to moderate rebound effect of thought suppression that varied in magnitude depending on the nature of the target thought and the method by which thought frequency was measured. Participants with clinical diagnoses did not show larger rebound effects than nonclinical or analogue participants, however, only a few studies included clinical samples. Findings are discussed in terms of implications for the ironic process theory of thought suppression, and avenues for future research on this phenomenon.

Fixity of belief, perceptual aberration, and magical ideation in obsessive-compulsive disorder.

Clinicians and researchers have pondered the intersection of obsessive-compulsive disorder (OCD) and psychosis. We examined the records of 395 individuals seeking treatment for OCD and classified participants according to their most frequent or distressing obsession and compulsion. All participants completed measures of fixity of belief, perceptual distortions, magical ideation, and psychotic symptoms. Results indicated that individuals who reported fear of harming self or others via overwhelming impulse or by mistake, and those with religious obsessions, had poorer insight and more perceptual distortions and magical ideation than did individuals with other types of obsessions. These results did not appear to reflect mere differences in OCD severity. Results are discussed in light of previous findings showing that psychotic-like symptoms are associated with attenuated treatment outcome in OCD. More research is needed to assess the absolute magnitude of psychotic-like features in OCD patients with impulse/mistake and religious obsessions and to examine whether these features interfere with standard cognitive-behavioral therapy.

Science and pseudoscience in the development of eye movement desensitization and reprocessing: implications for clinical psychology.

The enormous popularity recently achieved by Eye Movement Desensitization and Reprocessing (EMDR) as a treatment for anxiety disorders appears to have greatly outstripped the evidence for its efficacy from controlled research studies. The disparity raises disturbing questions concerning EMDR's aggressive commercial promotion and its rapid acceptance among practitioners. In this article, we: (1) summarize the evidence concerning EMDR's efficacy; (2) describe the dissemination and promotion of EMDR; (3) delineate the features of pseudoscience and explicate their relevance to EMDR; (4) describe the pseudoscientific marketing practices used to promote EMDR; (5) analyze factors contributing to the acceptance of EMDR by professional psychologists; and (6) discuss practical considerations for professional psychologists regarding the adoption of EMDR into professional practice. We argue that EMDR provides an excellent vehicle for illustrating the differences between scientific and pseudoscientific therapeutic techniques. Such distinctions are of critical importance for clinical psychologists who intend to base their practice on the best available research.

Disgust sensitivity and contamination fears in spider and blood-injection-injury phobias.

Disgust has been implicated in the onset and maintenance of blood-injection-injury (BII) and animal phobias. Research suggests that people with these phobias are characterized by an elevated sensitivity to disgust-evoking stimuli separate from their phobic concerns. The disgust response has been described as the rejection of potential contaminants. Disgust-motivated avoidance of phobic stimuli may therefore be related to fears of contamination or infection. The present study compared BII phobics, spider phobics and nonphobics on two measures of disgust sensitivity and two measures of contamination fears. Positive correlations were found between disgust sensitivity and contamination fear. Specific phobics scored higher than nonphobics on all scales and BII phobics scored higher than spider phobics on contamination fear measures. Furthermore, the contamination fear scales were correlated with the blood phobia measure, but not correlated with the spider phobia measure. The results suggest that while both phobias are characterized by elevated disgust sensitivity, contamination fear is more prominent in BII than spider phobia.

Comparison of the PTSD Symptom Scale-Interview Version and the Clinician-Administered PTSD scale.

The Clinician-Administered PTSD Scale (CAPS) is one of the most frequently used measures of posttraumatic stress disorder (PTSD). It has been shown to be a reliable and valid measure, although its psychometric properties in nonveteran populations are not well known. One problem with the CAPS is its long assessment time. The PTSD Symptom Scale--Interview Version (PSS-I) is an alternative measure of PTSD severity, requiring less assessment time than the CAPS. Preliminary studies indicate that the PSS-I is reliable and valid in civilian trauma survivors. In the present study we compared the psychometric properties of the CAPS and the PSS-I in a sample of 64 civilian trauma survivors with and without PTSD. Participants were administered the CAPS, the PSS-I, and the Structured Clinical Interview for DSM-IV (SCID) by separate interviewers, and their responses were videotaped and rated by independent clinicians. Results indicated that the CAPS and the PSS-I showed high internal consistency, with no differences between the two measures. Interrater reliability was also high for both measures, with the PSS-I yielding a slightly higher coefficient. The CAPS and the PSS-I correlated strongly with each other and with the SCID. Although the CAPS had slightly higher specificity and the PSS-I had slightly higher sensitivity to PTSD, overall the CAPS and the PSS-I performed about equally well. These results suggest that the PSS-I can be used instead of the CAPS in the assessment of PTSD, thus decreasing assessment time without sacrificing reliability or validity.

Eye Movement Desensitization and Reprocessing: an analysis of specific versus nonspecific treatment factors.

Incremental validity and incremental efficacy have become important issues in the evaluation of psychological assessment and intervention procedures. Incremental validity in assessment is that shown by novel measures over and above established ones. Incremental efficacy is that shown by novel treatments over and above nonspecific and established treatment effects. In this paper, we critically examine the question of whether Eye Movement Desensitization and Reprocessing (EMDR) possesses efficacy above and beyond nonspecific treatment effects and components that are shared with well-established interventions. A review of recently published efficacy studies reveals that (a) the effects of EMDR are largely limited to verbal report indices, (b) eye movements and other movements appear to be unnecessary, and (c) reported effects are consistent with nonspecific treatment features. Examination of individual studies shows that control procedures for nonspecific features have been minimal. We analyze EMDR for nonspecific treatment features and suggest experimental controls to examine the incremental efficacy of EMDR.

Exposure to disgust-evoking imagery and information processing biases in blood-injection-injury phobia.

Biased processing of threat-relevant information is a central construct among contemporary theories of anxiety. However, biases in attentional and memory processes have not been systematically investigated in blood-injection-injury (BII) phobia. Theory has suggested that disgust rather than fear characterizes BII phobia and may mediate processing biases differently. We investigated the effects of a disgust mood induction on attention and memory in BII phobic and nonphobic participants. The Stroop task failed to demonstrate an attentional bias toward medical and disgust words, even under conditions of disgust provocation. However, an implicit memory task showed that BII phobics completed more medical and disgust word stems than nonphobics. These results suggest that BII phobia may be characterized by a similar implicit memory, but not an attentional, bias found in other anxiety disorders. As such, information processing in BII phobia may be qualitatively different from other anxiety disorders. Implications for further research regarding information processing biases in BII phobia are discussed.

Visual avoidance in specific phobia.

Cognitive models of anxiety postulate that fear and anxiety serve as programs for avoidance of threat-relevant stimuli. We hypothesized that exposure to phobia-relevant stimuli would lead to visual avoidance in specific phobics. Spider phobic, blood-injection-injury phobic, and nonphobic participants were asked to view spider, injection, and neutral photographs through a three-channel tachistoscope that measured viewing time for each picture. Despite experimenter instructions to study the pictures carefully for a subsequent recognition test, phobic subjects showed decreased viewing times for threat-relevant pictures as compared to neutral pictures. Results are discussed in terms of cognitive models of anxiety disorders and implications for exposure-based therapies.

Disgust and disgust sensitivity in blood-injection-injury and spider phobia.

Blood-injection-injury (BII) phobics and spider phobics show markedly different cognitive, psychophysiological, and motoric reactions to activating stimuli. These observations have led theorists to question whether the emotion of fear mediates both phobias. The present study examined the role of disgust and disgust sensitivity in these subtypes of specific phobia. BII phobics, spider phobics, and nonphobics completed questionnaires and rated pictures of specific objects on fear and disgust scales. Questionnaire data indicated that phobic participants were higher than nonphobics on fear, and also on disgust sensitivity. The reaction of BII phobics to pictures of medical stimuli was one of disgust, rather than fear. The reaction of spider phobics to pictures of spiders was a combination of fear and disgust, though fear appeared to predominate. Results are discussed in view of current theories of emotional factors in specific phobia.

An empirical classification of motivations for domestic violence.

PIP: This study evaluates gender differences in self-reported motivations for use of violence. It was hypothesized that men would report motivations related to themes of domination and control, while women would report motivations related to self-defense or retaliation. Overall, the findings suggest more differences than similarities in the type of stated motivations of violence given by male and female perpetrators. Moreover, the hypothesis was generally supported. Female perpetrators were more likely than male perpetrators to report using violence to defend them from direct physical attack, escape from direct attack, or retaliate for prior physical and emotional abuse. In contrast, male perpetrators reported violence motivations related primarily to domination and control. These include domination and control, physical control, punishment for unwanted behavior, and imposing of coercive emotional control.^ieng

A large sample empirical typology of male spouse abusers and its relationship to dimensions of abuse.

A number of studies have described typologies of domestically violent men. Holtzworth-Munroe and Stuart (1994) recently proposed a theoretical model for predicting violence severity and generality from personality "type." The present study, using data from 833 identified abusive men, tested the model. Personality types were determined from cluster analysis of data from the Millon Clinical Multiaxial Inventory, and resulted in a three-cluster solution consistent with the Holtzworth-Munroe and Stuart model. The three main clusters included nonpathological, antisocial, and passive aggressive-dependent groups. Three other, smaller types were also identified. Multivariate and chi-square analyses comparing the main clusters on other variables generally supported the Holtzworth-Munroe and Stuart model. Nonpathological men had the lowest maximum violence and frequency. They restricted their violence primarily to intimate relationships and had the fewest police contacts. Antisocial and passive aggressive-dependent men did not differ in maximum violence, but antisocial men were the most generally violent and had the most police contacts. Passive aggressive-dependent men had the highest frequency of violence. Clinical, theoretical and methodological implications are discussed.

The empirical status of the clinical application of eye movement desensitization and reprocessing.

The published reports of the clinical application of eye movement desensitization and reprocessing (EMDR) are reviewed in terms of empirical validity. Case studies, single-subject experiments and group design experiments on clinical problems are evaluated for the effectiveness of the protocol, component effects, comparative effects and treatment fidelity. Classification of disorders and measurement issues are addressed. The protocol frequently reduces verbal report and independent observer ratings of distress--strikingly in some instances. Psychophysiologic measures show little effect of treatment. There is little empirical evidence to indicate the effect of treatment on motoric or behavioral indices. Eye movements do not appear to be an essential component of treatment, and there have been no substantial comparisons with other treatments. No studies have adequately controlled for nonspecific (placebo) effects of treatment. Suggestions are made for applying improved methodological controls for future applications of EMDR to clinical disorders.

Eye movement desensitization of medical phobias: two case studies.

We treated two medical phobic subjects with eye movement desensitization (EMD). Using detailed images of fear-related events, the treatment design conformed to an additive, within-series phase change to examine enduring effects. Results indicated that both subjects' verbal reports of fear decreased substantially using the EMD procedure. There were no consistent changes in heart rate. Similarly, self-reported fear toward a simulated blood draw decreased, but heart rate and blood pressure did not. Data for a number of standardized measures of medical fear indicated posttreatment reduction for both subjects. Anecdotal reports of medical procedures revealed limited generalization of treatment effects.