JOURNAL OF BEHAVIOR THERAPY AND EXPERIMENTAL PSYCHIATRY

Neurocognitive performance in obsessive-compulsive disorder before and after treatment with cognitive behavioral therapy
Wheaton MG, Kalanthroff E, Mandel M, Marsh R and Simpson HB
Cross-sectional studies have reported neurocognitive performance deficits in obsessive-compulsive disorder (OCD), particularly on tasks assessing response inhibition and proactive control over stimulus-driven behaviors (task control). However, it is not clear whether these deficits represent trait-like markers of OCD or are state-dependent.
Counterfactual thinking is associated with impoverished attentional control in women prone to self-critical rumination
Allaert J, De Raedt R, Sanchez-Lopez A and Vanderhasselt MA
Excessive engagement in counterfactual thinking (CFT), where individuals imagine alternative outcomes to past events, is associated with rumination, a process characterized by repetitive negative self-referential thoughts. Attentional control difficulties are closely linked with rumination, and negative thoughts can negatively impact attentional control among rumination-prone individuals. This study aimed to investigate the relationship between CFT and emotional and non-emotional attentional control among individuals with varying levels of self-critical rumination.
A decade on: Reflecting on the limitations of the first meta-analysis of the Implicit Relational Assessment Procedure's (IRAP) criterion validity in the clinical domain
Vahey N, Nicholson E and Barnes-Holmes D
Hussey (in press) recently conducted a detailed critical reanalysis of Vahey, Nicholson and Barnes-Holmes' (2015) meta-analysis. Its stated purpose was to (a) examine the extent to which Vahey et al.'s (2015) meta-analysis contains errors; and (b) to test how computationally reproducible it is by current standards of best practice. Hussey identified a small number of minor numerical errors, but crucially was unable to exactly replicate the original meta-effect of r‾ = .45. Six different variations of the meta-analysis reported by Vahey et al. were used and obtained meta-effects that deviated from the original by Δr‾ = .01-.02. Hussey also reported corresponding 95% credibility intervals that were all of zero width. These discrepancies prompted the present authors to conduct a detailed audit of the original meta-analysis. This revealed one minor transposing error in addition to three identified by Hussey. Once corrected this resulted in a marginally increased Hunter and Schmidt meta-analytic effect of r‾ = .46 without a credibility interval, and a Hedges-Vevea meta-effect of r‾ = .47 with 95% confidence interval (.40, .54). This correction was too small to have any bearing on Vahey et al.'s supplementary analyses regarding publication bias or statistical power. Vahey et al. contained a much lower proportion of transposing errors than is typical of meta-analyses even still (cf. Kadlec, Sainani, & Nimphius, 2023; Lakens et al., 2016; Lakens et al., 2017). Nonetheless, Hussey highlighted important ambiguities about the theoretical and practical meaning of the meta-effect reported by Vahey et al. We clarify our position on these matters in summary, and in so doing explain why we believe that the wider IRAP literature would undoubtedly benefit from increased adoption of contemporary open science standards.
Reappraising beliefs about losing control: An experimental investigation
Fridgen CPEA and Radomsky AS
Beliefs about losing control over one's thoughts, emotions, behaviours, and/or bodily functions have been shown to cause obsessive-compulsive symptoms. The cognitive model of obsessive-compulsive disorder (OCD) suggests that catastrophic misappraisals of intrusions will lessen if underlying maladaptive beliefs are effectively reduced. The primary aim of this study was to experimentally investigate whether preexisting negative appraisals about losing control could be reduced by reappraising a previous perceived loss of control.
Special Issue Registered Report: Intentional suppression as a method to boost fear extinction
Quaedflieg CWEM, Ashton SM, Beckers T and Timmers I
Fear is a universal experience and fuels our response to cope with threat. Persistent fear, after the threat is no longer present, is a central symptom seen in a number of clinical conditions. Exposure therapy, the most common treatment to target fear, aims to reduce fear responses through repeated, controlled exposures to feared situations in the absence of the negative consequence, thus promoting extinction. However, this treatment is by no means effective for all people. This may be due to impaired extinction and the underlying mechanism of inhibitory retrieval. Intentional memory suppression has been shown to be a promising strategy to enhance this underlying inhibitory mechanism. We employed a newly developed paradigm combining aspects of the Think/No-Think procedure with fear extinction. Sixty-eight healthy participants learned 36 strong naturalistic reminder objects for aversive scenes. After learning, half of the objects were paired with an aversive scream (unconditioned stimulus/US). During the extinction phase, while viewing the objects, participants were instructed to repeatedly retrieve (Think instruction) or suppress (No-Think instruction) the corresponding scenes, or passively view the objects (View instruction). We hypothesised that intentional suppression would boost fear extinction, as shown by a reduced US expectancy to threat-conditioned objects that had been subject to memory suppression during extinction training compared to threat-conditioned objects that were passively viewed. Both intentional memory suppression and passive viewing reduced negative valence for upsetting scenes over time. Contrary to our hypothesis, the results indicated that intentional suppression (No-Think instruction) was not more effective in reducing US expectancy and fear than standard extinction (View instruction). Future research should address the limitation of self-reports by using physiological measures and examine whether intentional suppression may impact fear recovery and generalization following a longer extinction delay. The current findings show that, although intentional suppression can support inhibition of memories and reduce their valence, it may not be as effective as standard extinction methods in diminishing fear responses.
Can an app designed to reduce repetitive negative thinking decrease depression and anxiety in young people? Results from a randomized controlled prevention trial
Funk J, Kopf-Beck J, Takano K, Watkins E and Ehring T
Rates of mental health disorders are rising among adolescents and young adults. Therefore, scalable methods for preventing psychopathology in these age groups are needed. As repetitive negative thinking (RNT) is a risk factor for depression and anxiety disorders, targeting RNT via smartphone app promises to be an effective, scalable strategy. The current three-arm, parallel group, randomized controlled trial tested whether a self-help app designed to reduce RNT decreased psychopathological symptoms and RNT in adolescents and young adults at risk for mental disorders.
An online group behavioral activation therapy for major depressive disorder: Adaptation, effectiveness, and trajectories of change in a lower-middle income country
Sardashti S, Farhadian M, Ghaleiha A, Renner F, Ahsani-Nasab S and Moradveisi L
Depressive disorders are common mental illnesses associated with high burden of disease. In this study, the effects of an online group behavioral activation on depressive symptoms and rumination were evaluated, and trajectories of change in patients with major depressive disorder adapted for a lower-middle income context investigated.
Impact of a brief self-compassion intervention on state emotion dysregulation in self-reported generalized anxiety disorder
De Herrera JM and Turk CL
The current study examined emotion dysregulation and self-compassion as an intervention in individuals with generalized anxiety disorder (GAD) symptoms.
Verification report: A critical reanalysis of Vahey et al. (2015) "A meta-analysis of criterion effects for the Implicit Relational Assessment Procedure (IRAP) in the clinical domain"
Hussey I
The meta-analysis reported in Vahey et al. (2015) concluded that the Implicit Relational Assessment Procedure (IRAP) has high clinical criterion validity (meta-analytic r‾ = .45) and therefore "the potential of the IRAP as a tool for clinical assessment" (p. 64). Vahey et al. (2015) also reported power analyses, and the article is frequently cited for sample size determination in IRAP studies, especially their heuristic of N > 37. This article attempts to verify those results. Results were found to have very poor reproducibility at almost every stage of the data extraction and analysis with errors generally biased towards inflating the effect size. The reported meta-analysis results were found to be mathematically implausible and could not be reproduced despite numerous attempts. Multiple internal discrepancies were found in the effect sizes such as between the forest plot and funnel plot, and between the forest plot and the supplementary data. 23 of the 56 (41.1%) individual effect sizes were not actually criterion effects and did not meet the original inclusion criteria. The original results were also undermined by combining effect sizes with different estimands. Reextraction of effect sizes from the original articles revealed 360 additional effect sizes that met inclusion criteria that should have been included in the original analysis. Examples of selection bias in the inclusion of larger effect sizes were observed. A new meta-analysis was calculated to understand the compound impact of these errors (i.e., without endorsing its results as a valid estimate of the IRAP's criterion validity). The effect size was half the size of the original (r‾ = .22), and the power analyses recommended sample sizes nearly 10 times larger than the original (N > 346), which no published original study using the IRAP has met. In aggregate, this seriously undermines the credibility and utility of the original article's conclusions and recommendations. Vahey et al. (2015) appears to need substantial correction at minimum. In particular, researchers should not rely on its results for sample size justification. A list of suggestions for error detection in meta-analyses is provided.
Sensitivity and response bias in non-clinical social anxiety to detect changes in facial expressions
Yuan J, Chen X, Wang Z, Zhao X, Wang Y and Liu Z
Previous research has not established a consensus on the ability of higher socially anxious individuals to detect facial expressions. The purpose of this study was to examine this issue using Signal Detection Theory (SDT) as a framework.
A feasibility study of an add-on psychomotor body-image protocol during CBT-E in female patients with an eating disorder
Mares SHW, Voskamp M, Wezenberg E and van Elburg AA
Disturbed body image is a potential precursor and maintaining factor when it comes to eating disorders. One of the dominant treatment approaches for eating disorders, enhanced cognitive-behaviour therapy (CBT-E), includes the cognitive-affective body image dimension as a core treatment target. Adding a component that focuses on the lived body dimension, could improve body image. In the current study, the feasibility of a psychomotor body image treatment as an add-on to CBT-E was examined.
Fighting OCD together: An experimental study of the effectiveness and acceptability of seeking and receiving emotional support for OCD
Causier C and Salkovskis P
Excessive reassurance-seeking in OCD has been linked to the maintenance of OCD, functioning as a type of checking ritual. Current treatments recommend the imposition of the extinction of seeking and providing reassurance; however, this is not well tolerated. Although it has been suggested that the provision of support may provide a more helpful alternative, there is no empirical evidence for this. In the present study, 36 participants with OCD engaged with two personalised semi-idiographic scenarios in which they imagined seeking and receiving reassurance and seeking and receiving emotional support in counterbalanced order. The primary outcome measure was anticipated urge to seek reassurance, which was found to significantly decrease in the imagined support condition relative to the imagined reassurance condition regardless of order of presentation. Emotional support was perceived as significantly more acceptable when compared to imagining reassurance in terms of higher ratings of perceived helpfulness in managing emotions, feelings of calmness and closeness, and the sense that they were fighting OCD together. These findings provide preliminary evidence for the value of encouraging the seeking and giving of emotional support as an alternative to reassurance. Implications for clinical work and further research are discussed.
Examining the causal effects of social exclusion on shame and dissociative detachment
Catton AKH, Yogeeswaran K and Dorahy MJ
Dissociative detachment experiences (e.g., derealization, absorption) underpin much psychopathology and are often researched in relation to co-occurring affective states such as shame, the latter being known to occur in situations involving actual or perceived negative social evaluation. The association between shame and dissociative detachment may also be moderated by individual differences in people's need to belong. The goal of the present study was to experimentally investigate the effects of social exclusion on shame and dissociative detachment depending on perceivers' need to belong.
The effect of feedback in attention training on Attention Bias to Threat in individuals with Sluggish Cognitive Tempo
Kim K and Lee JH
This study was conducted to identify the characteristics of attentional bias of individuals with Sluggish Cognitive Tempo (SCT) and how Attention Bias to Threat (ABT) changes when feedback was provided in attention training.
Joint attention effect on irrelevant stimuli resistance in high functional autism and neurotypical adults
Marcella B, Riccardo A, Franca C, Antea D', Mauro P, Giovanni M and Rosalia DM
Clinical practice reveals that individuals with autism characterized by the absence of cognitive impairment (High Functioning Autism-HFA) show difficulty in sharing attention with unfamiliar people. We hypothesized that this difficulty could affect cognitive control by selectively impairing stimulus-encoding or response-selection.
Predictors of polyregulation and its effectiveness following exposure to One's most personally distressing intrusive thought
Daniel KE, Wilhelm S and Jacoby RJ
Using multiple emotion regulation strategies in response to a single stressor-known as polyregulation-is an understudied but common event. The role of polyregulation in psychological disorders characterized by repetitive negative thinking (RNT) is unexplored, despite well-documented difficulties in emotion regulation and strong urges to avoid and escape one's intrusive thoughts in RNT.
The role of desired positive affect in depression in daily life
Yoon S, Kim H, Kim S, Kim Y and Kang E
Emotion goals (desired affect) have been theorized to play an essential role in a person's emotional experiences, guiding emotion regulation processes toward experiencing desired states. Hence, understanding whether and which emotion goals are associated with reduced negative states is crucial for individuals struggling to regulate these states, such as persons with depression. Using ecological momentary assessment (EMA), we examined the relationship between momentary desired positive affect and subsequent depressive affect in daily life, as well as future depressive symptoms, among individuals with depressive disorders.
Further analyses of appraisals of losing control and other OCD-related cognitions: A quasi-experimental investigation
Sandstrom A and Radomsky AS
Cognitive models of OCD posit that dysfunctional beliefs contribute to the maintenance of symptoms. In addition to well-established belief domains, beliefs about losing control has been identified as a novel cognitive domain which may influence OCD phenomena, including other dysfunctional beliefs. However, the exact nature of these relationships and whether such relationships are influenced by OCD symptoms is unclear. The aim of this study was to examine the relationships between appraisals of losing control and other OCD-relevant appraisals in individuals scoring high and low on OCD symptoms.
Ecological momentary assessment models trajectories of expectancy following exposure: A proof-of-concept pilot study
Losiewicz OM, McGlade AL, Treanor M and Craske MG
The Inhibitory Retrieval Approach to exposure therapy for fears and anxiety emphasizes prediction error as one of several strategies for improving outcomes. Prediction error depends on disconfirmation of expectancies for the feared outcome, and thus exposure strategies that derive from inhibitory retrieval approaches emphasize expectancy violation during exposure. However, research studies examining expectancy violation in exposure therapy have treated expectancy as a stable characteristic, assuming that expectancy following an exposure exercise remains constant over time. This brief report outlines two different uses of a methodology for using ecological momentary assessment (EMA) to assess between-session expectancy following exposure during treatment for anxiety, and reports on pilot trial results.
Inducing dissociative states: A (re)view from the laboratory
Sleight FG, McDonald CW, Mattson R and Lynn SJ
Laboratory-based inductions of dissociative states promise to facilitate understanding of the etiology, maintenance, and treatment of dissociation and dissociative disorders. In the present scoping review, we identified articles via a systematic search of PsycINFO, PsycARTICLES, PubMed, and Google Scholar, resulting in 59 articles that met a priori inclusion criteria. Of the 19 techniques described, numerous elicited changes in dissociative symptoms. However, studies were highly heterogeneous regarding their definition and measurement of dissociation. We call attention to relevant validity concerns presented by laboratory-based inductions and offer directions and recommendations for future research.
A multilevel examination of an inhibitory retrieval approach to exposure: Differentiating the unique and combined effects of multiple-context and multiple-stimulus cues
Jessup SC, Armstrong T, Hord CM, Dalmaijer ES and Olatunji BO
A proposed strategy for attenuating the return of fear is conducting exposure therapy in multiple contexts (e.g., different locations), which is believed to enhance the generalizability of safety learning. Although conducting exposure in multiple contexts can be differentiated from conducting exposure with multiple stimuli, the two strategies are often conflated. Furthermore, researchers have not yet determined whether one of these strategies, or a combination thereof, is most effective in attenuating fear renewal.
To be aware or not aware: Do intrusions with and without meta-awareness differ?
Keeping CA, Nixon RDV, Bridgland VME and Takarangi MKT
People sometimes re-experience traumatic events via intrusive memories that spontaneously and unintentionally intrude into consciousness (i.e., intrusions). Such intrusions can be experienced without explicit awareness (i.e., meta-awareness). However, we do not know whether intrusions with and without meta-awareness differ in how people experience them (i.e., characteristics) or react to them via maladaptive responses (i.e., suppression, negative interpretations), and therefore whether they are important to differentiate. To investigate this issue, we asked participants to watch a trauma analogue film and-during a subsequent unrelated reading task-intermittently probed them to capture and assess one film-related intrusion. Intrusion meta-awareness positively correlated with intrusion negativity, re-experiencing, and suppression, but not with how people interpreted the meaning of their intrusion. Our findings suggest intrusions with and without meta-awareness can differ in how they are experienced and associated with thought suppression-highlighting the importance of considering both types of intrusions in theory and practice.
Attend to the positive while feeling anxious: The effect of state anxiety on the effectiveness of Attentional Bias Modification
Nuijs MD, Larsen H, Grafton B, MacLeod C, Bögels SM, Wiers RW and Salemink E
Elevating state anxiety during Attentional Bias Modification (ABM) may improve its effectiveness by matching the emotional state experienced during the training with the emotional state under which it is intended that the learned pattern of attentional bias will subsequently operate. This study examined whether inducing elevated levels of state anxiety during ABM enhanced the effectiveness in modifying an attentional bias to socially threatening information.
Can attentional biases predict outcome of CBT in children with social anxiety disorder?
Schmidtendorf S, Asbrand J, Tuschen-Caffier B and Heinrichs N
Many studies have investigated differences in attention allocation to threat between socially anxious individuals and healthy controls in adult and child samples. The extent to which differences exist within the group of socially anxious individuals and whether these have a predictive value for the extent of symptom reduction after cognitive-behavioral therapy (CBT) has been studied less until to date and yielded inconsistent findings, particularly in child samples.
A psycholinguistic investigation of biased semantic networks in contamination-related obsessive-compulsive disorder
Gesche S, Steffen M, Birgit H, Franziska M, Jakob S and Lena J
Increasing evidence confirms the significant involvement of disgust in contamination-related obsessive-compulsive disorder (C-OCD). More insights into the role of disgust within cognitive biases in OCD may illuminate the psychopathology and corresponding subdimensions or subtypes. The present study introduces a new approach adopted from psycholinguistic research to investigate biases in word association networks in C-OCD versus other OCD symptom dimensions (nC-OCD).
Examining two of the ingredients of Cognitive therapy for adolescent social anxiety disorder: Back-translation from a treatment trial
Leigh E, Clark D and Chiu K
Cognitive Therapy for Social Anxiety Disorder (CT-SAD) based on the Clark & Wells model is a complex intervention comprised of a series of therapeutic elements. Two of the key ingredients are the self-focused attention and safety behaviour experiment and video feedback. The present study examined the effects of these two therapeutic procedures in adolescents with SAD, as well as common themes of the young people's social fears and negative self-images.
Exploration of stress reactivity and fear conditioning on intrusive memory frequency in a conditioned-intrusion paradigm
Lam GN, Cooper J, Lipp OV, Mayo LM and Ney L
The conditioned-intrusion paradigm was designed to provide insight into the relationship between fear conditioning and intrusive memory formation, which is relevant to understanding posttraumatic stress disorder symptoms and treatment. However, boundary conditions of this new paradigm have not been explored and it is currently not known whether findings from this work are valid in a clinical context.
Neurophysiological effects of cognitive behavioral therapy in social anxiety: An ERP study using a dot-probe task
Jiang T, Song S, Zhao S, Tian X, Zhang M, Feng J and Ge R
Social anxious individuals show attention bias towards emotional stimuli, this phenomenon is considered to be an important cause of anxiety generation and maintenance. Cognitive-behavioral therapy (CBT) is a standard psychotherapy for social anxiety disorder. CBT decreases attention biases by correcting the maladaptive beliefs of socially anxious individuals, but it is not clear whether CBT alters neurophysiological features of socially anxious individuals at early automatic and/or late cognitive strategy stage of attentional processing.
Distress variability during exposure therapy and its relationship with PTSD symptom decline
Kooistra MJ, Hoeboer CM, Oprel DAC, Schoorl M, van der Does W, van Minnen A and de Kleine RA
Inhibitory Learning Theory (ILT) framework implies that in-session distress variability may promote extinction learning and thereby enhance exposure therapy efficacy. Thus far, research has mainly focused on in-session distress reduction. The aim of the current study was to assess whether in-session distress variability predicts next session PTSD symptom decline in PTSD patients receiving prolonged exposure (PE).
Two universal school-based prevention programs for depression and anxiety: 24-Month follow-up of an RCT
Rice KJ, Chen J, Kemps E, Roberts RM, Edwards S and Johnstone K
Transdiagnostic approaches have been promoted as a means of maximising preventative effects across multiple problems with depression and anxiety suitable targets as they appear to have highly interconnected systems in pathology development and maintenance. This study investigated long-term effects of two universal school-based programs, Emotion Regulation (ER) and Behavioral Activation (BA), that sought to prevent depression and anxiety by targeting worry (a transdiagnostic feature) to promote resilience.