Inductive reasoning and doubt in obsessive compulsive disorder.

BACKGROUND AND OBJECTIVES: Previous studies show that individuals with obsessive compulsive disorder (OCD) accord more importance than healthy controls (HC) to alternative conclusions, resulting in increased doubt regarding an initial conclusion. The goal of the present study was to replicate and extend this finding. METHODS: Eighteen participants diagnosed with OCD and 16 HC completed the Reasoning with Inductive Arguments Task (RIAT), which operationalizes doubt as change in confidence towards a conclusion after alternative conclusions are presented. To examine conditions that facilitate doubt, the impact of alternative conclusions that both supported and contradicted the initial conclusion was compared, as well as the effect of neutral and OCD-relevant item content. RESULTS: Both the OCD and HC groups decreased confidence after contradicting conclusions, but only the HC group increased confidence when presented with supporting conclusions. Furthermore, decrease in confidence in the OCD group correlated with OCD symptom severity. LIMITS: The RIAT could be adapted to better take into account of OCD subtypes. CONCLUSION: Doubt generation may contribute to obsessional doubting.

Inference-based therapy for body dysmorphic disorder.

Body dysmorphic disorder (BDD) is a debilitating disorder characterized by an excessive pre-occupation with an imagined or very slight defect in one's physical appearance. Despite the overall success of cognitive behavioural therapy (CBT) in treating BDD, some people do not seem to benefit as much from this approach. Those with high overvalued ideation (OVI), for instance, have been shown to not respond well with CBT. The purpose of this study was to evaluate the efficacy of an inference-based therapy (IBT) in treating BDD. IBT is a cognitive intervention that was first developed for obsessive-compulsive disorder with high OVI, but whose focus on beliefs can also apply to a BDD population. IBT conceptualizes BDD obsessions (e.g., 'I feel like my head is deformed') as idiosyncratic inferences arrived at through inductive reasoning processes. Such primary inferences represent the starting point of obsessional doubt and the treatment focuses on addressing the faulty inferences that maintain the doubt. Thirteen BDD participants, of whom 10 completed, underwent a 20-week IBT for BDD. The participants improved significantly over the course of therapy, with large diminutions in BDD and depressive symptoms. OVI also decreased throughout therapy and was not found to be related to reduction in BDD symptoms. Although a controlled-trial comparing CBT with IBT is needed, it is proposed that IBT constitutes a promising treatment alternative for BDD especially in cases where OVI is high.

Virtual reality induces dissociation and lowers sense of presence in objective reality.

This study utilizes an innovative experimental paradigm to investigate the effects of virtual reality (VR) on dissociative experience and the sense of presence. A nonclinical sample of 30 people were administered measures of dissociation, sense of presence, and immersion before and after an immersion in a virtual environment. Results indicate an increase in dissociative experience (depersonalization and derealization), including a lessened sense of presence in objective reality as the result of exposure to VR. Higher preexisting levels of dissociation and a tendency to become more easily absorbed or immersed were associated with higher increases in dissociative symptoms resulting from VR immersion. Results are discussed in terms of imaginative processes underlying the dissociative experience and potential implications to the treatment of anxiety disorders with VR.

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.