Emotional Changes during Imagery Rescripting of Aversive Social Memories in Social Anxiety Disorder: A Randomized Controlled Trial.

INTRODUCTION: Imagery rescripting (ImRs) is a psychotherapeutic intervention targeting aversive memories. During the three-phase intervention, patients reexperience their aversive memory (phase 1), observe the scene from their adult perspective, and intervene to help their former selves (phase 2), and reexperience it again with the positive changes (phase 3). Previous studies have rarely investigated emotional and regulatory processes taking place during the intervention. OBJECTIVE: This randomized controlled trial investigated self-reported affective and physiological responses during ImRs. METHODS: Seventy-seven patients with social anxiety disorder (SAD) were randomly assigned to a single session of ImRs or a control intervention (recall and discussion of the memory) targeting an aversive social memory. Heart rate (HR) and heart rate variability (HRV) were assessed during and post hoc ratings of positive and negative feelings after baseline and the intervention phases. RESULTS: Relative to the control intervention, ImRs resulted in an initial increase in negative feelings from baseline to phase 1 and a following larger (phase 1 to phase 2) and more stable (phase 2 to phase 3) decrease in negative feelings/increase in positive feelings. On the physiological level, during ImRs compared to the control intervention, mean HR was significantly higher during phase 1 and HRV during phase 3, each compared to baseline. CONCLUSIONS: These results provide further information about the specific sequence of emotional responses on different response levels during ImRs, being consistent with known theories of emotional processing and supposed mechanisms of ImRs.

Neural correlates of context-dependent extinction recall in social anxiety disorder: relevance of intrusions in response to aversive social experiences.

BACKGROUND: There are phenomenological similarities between social anxiety disorder (SAD) and posttraumatic stress disorder, such as a provoking aversive event, posttraumatic stress symptoms (e.g. intrusions) in response to these events and deficient (context-dependent) fear conditioning processes. This study investigated the neural correlates of context-dependent extinction recall and fear renewal in SAD, specifically in patients with intrusions in response to an etiologically relevant aversive social event. METHODS: During functional magnetic resonance imaging a two-day context-dependent fear conditioning paradigm was conducted in 54 patients with SAD and 54 healthy controls (HC). This included fear acquisition (context A) and extinction learning (context B) on one day, and extinction recall (context B) as well as fear renewal (contexts C and A) one day later. The main outcome measures were blood oxygen level-dependent responses in regions of interest and skin conductance responses. RESULTS: Patients with SAD showed reduced differential conditioned amygdala activation during extinction recall in the safe extinction context and during fear renewal in the acquisition context compared to HC. Patients with clinically relevant intrusions moreover exhibited hypoactivation of the ventromedial prefrontal cortex (vmPFC) during extinction learning, extinction recall, and fear renewal in a novel context, while amygdala activation more strongly decreased during extinction learning and increased during fear renewal in the acquisition context compared with patients without intrusions. CONCLUSIONS: Our study provides first evidence that intrusions in SAD are associated with similar deficits in context-dependent regulation of conditioned fear via the vmPFC as previously demonstrated in posttraumatic stress disorder.

Decontextualized fear memories? Stronger conditioned fear responses during extinction learning and extinction recall in a safe context predict the development of long-term analog intrusions.

BACKGROUND: Difficulties in the context-dependent modulation of conditioned fear are known for posttraumatic stress disorder and may explain the occurrence of intrusive memories in safe contexts. The current study therefore investigated if reduced context-dependent modulation of conditioned fear and its underlying neural circuitry constitute risk factors for the development of analog intrusions in response to an experimental trauma. METHODS: Eighty-five healthy women participated in the trauma film paradigm to investigate the development of analog intrusions as well as explicit memory for an experimental trauma after one week and three months, respectively. Before, participants underwent a context-dependent fear conditioning paradigm during functional magnetic resonance imaging with fear acquisition in context A and extinction training in context B on a first day, as well as extinction recall in context B and fear renewal in a novel context C one day later. Skin conductance responses (SCRs) and blood oxygen level dependent responses were main outcome measures. RESULTS: In addition to stronger fear acquisition in context A, stronger conditioned fear responses in the safe context B, as indicated by stronger conditioned SCRs or stronger activation of fear expressing regions during extinction learning and recall, predicted the development of long-term analog intrusions. CONCLUSIONS: Stronger fear responses in safe and danger contexts were risk factors for the development of long-term analog intrusions and point to decontextualized fear memories and difficulties in the context-dependent modulation of conditioned fear. Altered fear conditioning processes and reduced storage of contextual information may cause the occurrence of fear independent of context.

Weathering the storm of emotions: immediate and lasting effects of reinterpretation and distancing on event-related potentials and their association with habitual use of cognitive reappraisal.

Reinterpretation and distancing, two cognitive reappraisal tactics, are known to effectively reduce negative feelings and event-related potentials (ERPs), such as the P300 and the late positive potential (LPP), in the short-term. Less is known about differential and lasting effects on ERPs as well as their association with habitual reappraisal. Fifty-seven participants were instructed to passively view or reappraise (reinterpretation, distancing) pictures that were repeatedly presented with the same instruction (active regulation phase). Thirty minutes later, these pictures were shown again without instruction for the assessment of lasting effects (re-exposure phase). ERPs were recorded and participants rated the intensity of negative feelings following picture presentation. Reappraisal led to an attenuation of the LPP, and both tactics decreased negative feelings during active regulation, whereby reinterpretation had a stronger impact on the subjective level. Passive re-exposure resulted in reduced negative feelings for previously reappraised pictures but had no lasting effects on ERPs. Higher habitual reappraisal was associated with higher P300 and early LPP amplitudes for emotional reactivity during the active regulation phase. During the re-exposure phase, higher habitual reappraisal was not related to ERPs. The current findings emphasize the effectiveness of both tactics in the short-term and lasting effects on the subjective experience of negative feelings. Enhanced emotional reactivity on the electrocortical level in individuals with a more frequent habitual use of reappraisal might indicate a higher preparedness to regulate.

Behavioral pattern separation is associated with neural and electrodermal correlates of context-dependent fear conditioning.

Hippocampus-dependent pattern separation is considered as a relevant factor for context discrimination and might therefore impact the contextual modulation of conditioned fear. However, the association between pattern separation and context-dependent fear conditioning has not been investigated so far. In the current study, 72 healthy female students completed the Mnemonic Similarity Task, a measure of behavioral pattern separation, in addition to a context-dependent fear conditioning paradigm during functional magnetic resonance imaging. The paradigm included fear acquisition in context A and extinction training in context B on a first day, as well as retrieval testing of the fear and extinction memories in the safe context B (extinction recall) and a novel context C (fear renewal) one day later. Main outcome measures comprised skin conductance responses (SCRs) and blood oxygen level-dependent responses in brain regions of the fear and extinction circuit. Regarding retrieval testing, pattern separation did not correlate with extinction recall, but with stronger dorsal anterior cingulate cortex activation and conditioned SCRs (trend) during fear renewal, indicating a stronger retrieval of the fear memory trace. Our findings suggest that behavioral pattern separation ability seems to be important for context-dependent fear modulation, which is impaired in patients with posttraumatic stress disorder.

Memory representation of aversive social experiences in Social Anxiety Disorder.

Aversive social experiences are proposed to be a risk factor for developing Social Anxiety Disorder (SAD). Many patients with SAD report associated daily life symptoms, such as intrusive re-experiencing (e.g., negatively distorted images of oneself), avoidance, alterations in cognitions and mood, as well as hyperarousal, resembling symptom dimensions of Posttraumatic Stress Disorder (PTSD). These PTSD-like symptoms may result from maladaptive processing and representation of the aversive social experiences in memory. Emotional hyperreactivity during memory retrieval of aversive social experiences is another feature of SAD which was found in previous studies. This study aimed to further investigate PTSD-like symptoms and emotional reactivity associated with etiologically relevant aversive social experiences and shed more light on a potential relationship between both. Eighty-five patients with SAD and 85 healthy controls (HC) participated in this cross-sectional study. It comprised an imagination task with self-report and physiological measures to assess emotional reactivity during the cued recall of the aversive social experience and clinical interviews to assess PTSD-like symptoms. We expected increased emotional reactivity and more severe PTSD-like symptoms in response to the aversive social experience in patients with SAD compared to HC, as well as a positive correlation between emotional reactivity and PTSD-like symptoms in patients with SAD. Indeed, patients with SAD showed emotional hyperreactivity (self-report, physiology) during the cued recall of the aversive social experiences, also when compared to two control memory conditions (neutral, negative non-social) and HC. Patients with SAD furthermore reported more severe PTSD-like symptoms compared to HC and intrusive re-experiencing symptoms were positively correlated with distress during imagery of the social aversive event in patients with SAD. These results might point toward a maladaptive representation of aversive social experiences in memory. Similar to PTSD, this maladaptive memory representation might promote the development of PTSD-like symptoms such as intrusive re-experiencing (e.g., in the form of intrusive self-images in patients with SAD), which might finally lead to and maintain symptoms of SAD.

Social phobic beliefs mediate the relationship between post-event processing regarding the worst socially aversive experience and fear of negative evaluation.

The experience of socially aversive events is proposed to be a critical etiological factor in the development of social anxiety symptoms even though the experience itself is also common among healthy individuals. Rather than the event itself, accompanying factors such as maladaptive processing might be associated with higher levels of social anxiety symptoms. One-hundred-seventy-four individuals participated in this online-survey comprising questionnaires regarding social anxiety symptoms and retrospective reports concerning maladaptive processing of the worst socially aversive event. Structural equation modelling was used to analyze the hypothesized mediation of maladaptive processing and fear of negative evaluation by intrusive re-experiencing and social phobic beliefs. The positive association between retrospectively evaluated maladaptive processing after the worst socially aversive event and fear of negative evaluation was mediated by social phobic beliefs but not by intrusive re-experiencing. These results point towards the relevance of further investigating processing strategies after socially aversive events as a potential influencing factor for SAD development. Trial registration. The trial was registered at the German Clinical Trial Register (DRKS00021502) on June 3rd, 2020. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s12144-022-02805-9.

Lasting effects of cognitive emotion regulation: neural correlates of reinterpretation and distancing.

Reinterpretation and distancing are two cognitive reappraisal tactics, used to regulate one's emotions in response to emotion-eliciting stimuli or situations. Relatively less is known about their (differential) lasting effects on emotional responding and related neural correlates. This functional magnetic resonance imaging study investigated 85 healthy females, participating in a 2-day cognitive emotion regulation experiment. On the first day, participants were instructed to passively look at, reinterpret or distance from repeatedly presented aversive pictures. One week later, they were re-exposed to the same stimuli without regulation instruction, in order to assess lasting effects. The main outcome measures comprised ratings of negative feelings and blood-oxygen-level-dependent responses. Lasting effects for reinterpretation compared with looking at aversive pictures during passive re-exposure 1 week later were reflected in stronger activation of the left amygdala, the ventromedial prefrontal cortex (vmPFC) and reduced negative feelings. Neither distancing compared with looking at aversive pictures nor reinterpretation compared with distancing did result in significant effects during re-exposure. These findings indicate that reinterpretation leads to reduced negative feelings 1 week later, which might be mediated by inhibitory vmPFC activation or stronger positive emotions during re-exposure. However, the missing difference compared with distancing questions the specificity of the results and the mechanisms underlying these two cognitive reappraisal tactics.

Psychometric properties of the Posttraumatic Diagnostic Scale (PDS) in alcohol-dependent patients.

BACKGROUND: A high prevalence of comorbid posttraumatic stress disorder (PTSD) is found in patients with substance use disorders (SUDs). In the few existing studies, mixed results regarding the psychometric properties of common screening instruments for PTSD have been reported for patients with SUDs. No results are available for the Posttraumatic Diagnostic Scale (PDS), an established self-report measure for PTSD. METHODS: The authors assessed 105 patients with alcohol dependence according to DSM-IV (Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition) (70% male) 2 weeks after their admission to an inpatient detoxification unit. Participants were administered the PDS, the PTSD module of the Structured Clinical Interview for DSM-IV (SCID), as well as measures of depression and anxiety. Patients with other substance use disorders were excluded as were patients reporting no traumatic event. RESULTS: Internal consistencies were good to very good for the total scale (.93) and the subscales of the PDS (.82-.91). In our sample, the PDS had a high specificity (.89) but only moderate sensitivity (.57). Diagnostic agreement with the SCID was 83% (.46). The results of a receiver operating characteristic (ROC) analysis suggested that a PDS score of 8 was the optimal cutoff to screen for PTSD. The highest diagnostic agreement between PDS and SCID (89%; .60) was achieved using a cutoff score of 24. CONCLUSIONS: These findings confirm previous results suggesting that the psychometric properties of self-report measures of PTSD in patients with SUDs might differ from those in the general population. When the PDS is used in recently detoxified patients with alcohol dependence, it seems advisable to modify the cutoff score of this instrument to improve its sensitivity and diagnostic accuracy.

Effects of behavioral therapy or pharmacotherapy on brain glucose metabolism in subjects with obsessive-compulsive disorder as assessed by brain FDG PET.

This prospective study investigated the effect of pharmacotherapy (PT) and cognitive behavioral therapy (CBT) on cerebral glucose metabolism in adults with obsessive-compulsive disorder (OCD). Dynamic positron emission tomography (PET) of the brain with F-18-fluorodeoxyglucose (FDG) was performed before and after treatment in 16 subjects diagnosed for OCD for at least 2 years (PT: n=7). Pre-to-post-treatment change of scaled local metabolic rate of glucose (SLMRGlc) was assessed separately in therapy responders and non-responders. Correlation was tested between SLMRGlc change and change of OCD, depression, or anxiety symptoms. SLMRGlc increased in the right caudate after successful therapy. The increase tended to correlate with the improvement of OCD symptom severity. The finding of increased local caudate activity after successful therapy is in contrast to most previous studies. Possible explanations include effects of therapy on concomitant depression symptoms and/or the large proportion of early-onset OCD in the present sample.

Evidence for an attentional bias for washing- and checking-relevant stimuli in obsessive-compulsive disorder.

There is equivocal evidence whether or not patients with obsessive-compulsive disorder (OCD) share an attentional bias for concern-related material and if so, whether this reflects hypervigilance towards or problems to disengage from disorder-related material. In a recent study, we failed to detect an attentional bias in OCD patients using an emotional variant of the inhibition of return (IOR) paradigm containing OCD-relevant and neutral words. We reinvestigated the research question with a more stringent design that addressed potential moderators. A new IOR paradigm was set up using visual stimuli. Forty-two OCD patients and 31 healthy controls were presented with neutral (e.g., cup), anxiety-relevant (e.g., shark), checking-relevant (e.g., broken door), and washing-relevant (e.g., dirty toilet) cue pictures at one of two possible locations. Following a short or long interval sensitive to automatic versus controlled processes, a simple target stimulus appeared at either the cued or the uncued location. OCD patients responded significantly slower to targets that were preceded by an OCD-relevant cue. Results lend support to the claim that OCD patients share a processing abnormality for concern-related visual material.

Words may not be enough! No increased emotional Stroop effect in obsessive-compulsive disorder.

Conflicting evidence has been obtained whether or not patients diagnosed with obsessive-compulsive disorder (OCD) share an attentional bias towards disorder-related stimuli. Some of these inconsistencies can be accounted for by suboptimal stimuli selection. In consideration of the heterogeneity of OCD, we investigated Stroop interference effects for two classes of OCD items (i.e., washing and checking) in 23 OCD patients and 23 healthy controls. In order to cover prevalent OCD concerns, item compilation was based on experts' appraisals. Patients neither displayed greater immediate as well as delayed Stroop interference nor any bias for OCD and subtype-congruent stimuli. On the contrary, for washing-related items, OCD patients, and here especially washers, displayed facilitation relative to healthy controls. Although the present study at first sight refutes the notion of an attentional bias in OCD in contrast to other anxiety disorders, several potential moderators need to be considered before this account is ultimately dismissed. In particular, an attentional bias may only be elicited using visual material that is more attention-grabbing than verbal stimuli. Finally, blockwise instead of random item administration and greater consideration of individual relevance may be crucial prerequisites for the effect to emerge.

A prospective long-term follow-up study of alexithymia in obsessive-compulsive disorder.

BACKGROUND: Studies evaluating the stability of alexithymia over long follow-up periods are rare. We examined the temporal stability of alexithymia in patients with obsessive-compulsive disorder (OCD) over 6 years and the association of alexithymia with the long-term outcome of OCD. SAMPLING AND METHODS: Of 42 patients with OCD, 34 (81%) could be reassessed 6 years after inpatient treatment. The 20-item Toronto Alexithymia Scale, Yale-Brown Obsessive-Compulsive Scale, and Hamilton Depression Rating Scale were used at pretreatment, posttreatment, and follow-up. RESULTS: The 20-item Toronto Alexithymia Scale total scores and its factors 1 and 2 decreased significantly during follow-up, whereas factor 3 remained stable. High correlations of the 20-item Toronto Alexithymia Scale total scores (r = 0.84, P < .001) and its 3 factors emerged between posttreatment and follow-up, suggesting relative stability over several years. Regression analyses (with and without controlling for depressive symptoms) showed that higher alexithymia scores did not predict a worse long-term outcome of OCD. CONCLUSIONS: Relative stability over such a very long follow-up period strongly supports the view that alexithymia is a stable psychologic characteristic in patients with OCD. The result that higher alexithymia scores were not associated with poorer long-term outcome of OCD might be explained with the decrease of alexithymia during treatment and follow-up. However, our sample size was small, and further research is clearly required to evaluate the impact of changes in alexithymia and its association with the course of OCD.

Severity of subjective cognitive impairment in patients with obsessive-compulsive disorder and depression.

Previous research on obsessive-compulsive disorder (OCD) has consistently found cognitive impairments in the domains of executive and nonverbal (memory) functioning, particularly in patients with comorbid depressive symptoms. In contrast, little is known about the degree to which such deficits are cognizant to patients or the degree to which these impairments interfere with daily activities. The aim of the present study was to assess prevalence and specificity of subjective cognitive dysfunction in OCD patients. A self-rating scale, the Subjective Neurocognition Inventory (SNI), was administered to 67 OCD patients upon admission to hospital. Forty healthy and 30 depressed participants served as controls. Relative to healthy participants, OCD patients reported greater impairment on SNI subscales measuring psychomotor speed, selective and divided attention. Impairments in the OCD group were particularly pronounced in patients with severe OCD or depressive psychopathology. OCD patients were no more disturbed than depressed participants on any of the domains tested. Memory problems were only reported by a minority of OCD patients-even in patients with checking compulsions. In conjunction with prior studies showing few memory difficulties in non-depressed OCD patients, present findings further challenge the memory deficit hypothesis which claims that checking compulsions are a dysfunctional compensation for real or imagined forgetfulness.

Do personality disorders predict negative treatment outcome in obsessive-compulsive disorders? A prospective 6-month follow-up study.

BACKGROUND: Comorbid personality disorders (PDs) are discussed as risk factors for a negative treatment outcome in obsessive-compulsive disorder (OCD). However, studies published so far have produced conflicting results. The present study examined whether PDs affect treatment outcome in patients with OCD. METHOD: The treatment sample consisted of 55 patients with OCD who were consecutively referred to a Behaviour Therapy Unit for an in-patient or day-clinic treatment. Treatment consisted of an individualised and multimodal cognitive behaviour therapy (CBT, with or without antidepressive medication). Measurements were taken prior and after treatment and 6-month after admission. RESULTS: A large percentage of patients benefited from treatment irrespective of the presence of a PD and were able to maintain their improvement at follow-up. Duration of treatment was not prolonged in OCD patients with concomitant Axis II disorders. However, some specific personality traits (schizotypal, passive-aggressive) were baseline determinants for later treatment failure at trend level. CONCLUSIONS: Results are encouraging for therapists working with patients co-diagnosed with Axis II disorders since these patients are not necessarily non-responders. The results stress the importance of a specifically tailored treatment approach based on an individual case formulation in OCD patients with complex symptomatology and comorbid Axis II disorders.

Dissociation as a predictor of cognitive behavior therapy outcome in patients with obsessive-compulsive disorder.

BACKGROUND: Previous studies have found a strong association between dissociation and obsessive-compulsive disorder (OCD). The purpose of the present study was to evaluate whether dissociation is a predictor of cognitive behavior therapy (CBT) outcome in patients with OCD. METHODS: Fifty-two patients with OCD were assessed using the Dissociative Experience Scale (DES), the Yale-Brown Obsessive-Compulsive Scale and the Beck Depression Inventory. CBT lasted on average 9.5 weeks and included exposure therapy. RESULTS: Patients who dropped out due to noncompliance had higher baseline DES scores and depression scores compared to the 43 patients (83%) who completed the study. Significant OCD symptom reduction at posttreatment was observed in study completers with a large effect size (d = 1.7). More severe OCD symptoms at posttreatment were associated with higher DES scores at baseline, and treatment nonresponders had significantly higher baseline DES scores compared to responders. These associations with outcome were mainly due to the DES subfactor absorption-imaginative involvement. In regression analyses, higher absorption-imaginative involvement scores at baseline predicted poorer CBT outcome, even after controlling for depressive symptoms, comorbid axis I disorders and concomitant psychotropic drugs. CONCLUSIONS: Results from this preliminary study suggest that higher levels of dissociation (particularly absorption-imaginative involvement) in patients with OCD might predict poorer CBT outcome. If our results can be replicated, treatment outcome might be improved by additional interventions for those patients with OCD who indicate high levels of dissociation, for example by using interventions aimed at improving coping with emotionally stressful situations.

Dissociation and symptom dimensions of obsessive-compulsive disorder. A replication study.

BACKGROUND: Obsessive-compulsive disorder (OCD) is a phenotypically very heterogeneous disease with high rates of comorbid psychiatric pathology. Previous studies have indicated that OCD is associated with higher levels of dissociation. The aims of the present study were to replicate and extend previous findings of a significant link between certain OCD symptom dimensions and dissociation. METHODS: The study sample comprised 50 patients with OCD, as confirmed by the Mini International Neuropsychiatric Interview,who had a score of at least 16 on the Yale-Brown Obsessive-Compulsive Scale. All patients were assessed with the short version of the Hamburg Obsessive-Compulsive Inventory and the Dissociative Experience Scale (DES). Correlation analyses and multiple regression analyses were performed to evaluate the relationship between OCD symptom dimensions and dissociation. RESULTS: The checking dimension was most strongly related to dissociation, followed by the symmetry/ordering and obsessive thoughts dimensions. In contrast, no significant relationship was found between dissociation and the washing/cleaning, counting/touching, and aggressive impulses/fantasies dimensions. Multiple regression analyses revealed that: (1) only the checking dimension showed an independent positive correlation with dissociation, and (2) only higher scores on the DES subscale "amnestic dissociation" were associated with higher scores for checking compulsions. CONCLUSIONS: Our results suggest that there might be a specific link between checking behavior and dissociation in OCD. Moreover, checking compulsions seem to be particularly associated with amnestic dissociation. Further studies focusing on amnestic dissociation as a potentially important determinant of checking compulsions are warranted.

A check on the memory deficit hypothesis of obsessive-compulsive checking.

A number of recent studies have challenged the hypothesis that patients with obsessive-compulsive disorder (OCD) display global memory deficits. An alleviated form of the memory deficit hypothesis posits that OCD patients share deficits to vividly recall memory episodes. According to the latter view, checking rituals can be understood as counter-productive coping strategies to "enrich" memory episodes in order to make them more distinctive. A source memory task was administered to 27 OCD (17 checkers) and 51 healthy participants. Along with confidence judgments, a remember-know procedure was employed to assess whether OCD patients display problems with conscious/vivid recollection. Patients with or without checking compulsions did not exhibit differences to controls on source memory accuracy and meta-memory. Patients forgot more self-generated items, which, however, was related to comorbid depressive but not OCD symptoms. Findings challenge the ubiquity of memory deficits in OCD. To account for the inconclusive pattern of results in the literature, it is suggested that patients mistrust their memories and adopt checking rituals only when perceived responsibility is inflated.

Quality of life in obsessive-compulsive disorder before and after treatment.

BACKGROUND: The assessment of Quality of Life (QoL) is an important tool for elucidating target symptoms that are particularly bothersome to patients. The present study was designed to explore predictors of decreased QoL in obsessive-compulsive disorder (OCD) patients and to explore which aspects of QoL are most affected in OCD. Furthermore, the study investigated changes in QoL after treatment and the association between QoL change scores with symptomatic outcome. In line with prior research, it was expected that low QoL in OCD patients would be most pronounced for the emotional and social aspects of the construct. METHODS: Seventy-nine OCD patients were initially recruited. Patients were assessed with the SF-36 both before and after treatment. Norm values were derived from the general population to characterize status of impairment. OCD patients were contrasted with published SF-36 scores from 2 OCD samples as well as a newly recruited psychiatric and healthy control sample. RESULTS: Correlations with QoL were most pronounced for depression severity and number of OCD symptoms. Apart from low social and emotional QoL in the majority of patients, a large subgroup also reported lower physical well-being. Decreased scores on this subscale were mainly associated with length of illness, depression, and number of compulsions. Overall, QoL was significantly improved in therapy responders relative to nonresponders. CONCLUSIONS: The results largely correspond to previous findings showing that OCD patients share severely compromised well-being. Somewhat unexpected from previous research, QoL deficits were not restricted to emotional and social aspects of QoL but extended to somatic domains. The present results suggest that clinicians should thoroughly explore for depression as well as physical impairments in OCD patients, which, when present, may be additionally targeted to achieve comprehensive treatment success.

Extent, profile and specificity of visuospatial impairment in obsessive-compulsive disorder (OCD).

Recent reviews on the neurocognitive profile of patients diagnosed with obsessive-compulsive disorder (OCD) have converged on the assumption that both visuospatial and especially nonverbal memory performance are impaired in OCD. However, as most prior studies have contrasted performance of OCD patients with healthy controls only, no inferences can yet be drawn about the specificity of these deficits to OCD. Further, the administration of complex and multifunctional tasks limit conclusions about clearly defined cognitive deficits. The present study compared 71 OCD patients to 30 healthy and 33 psychiatric control participants on a large battery of visuospatial and nonverbal memory tasks at two time-points. In addition, a visuospatial battery (VS battery), which assesses a wide range of elementary visuospatial functions, was administered. While OCD patients performed worse than healthy controls on some complex tasks (e.g., Block Design), no visuospatial component proved to be impaired specifically in OCD. OCD patients and controls performed similarly on parameters of nonverbal memory. Regarding organizational strategy, OCD patients performed worse than healthy (but not psychiatric) control participants on two out of three Rey-figure trials (copy and immediate). It is suggested that prior research overestimated the severity and significance of visuospatial and nonverbal memory impairment in OCD.