Publications by authors named "Frederick Aardema"

36 Publications

The relationship between obsessions and the self: Feared and actual self-descriptions in a clinical obsessive-compulsive disorder sample.

Clin Psychol Psychother 2021 Aug 3. Epub 2021 Aug 3.

Departament de Personalitat, Avaluació i Tractaments Psicològics, Facultat de Psicologia, Universitat de València, Valencia, Spain.

Cognitive models of obsessive-compulsive disorder (OCD) posit the relevance of the self in OCD, although the nature of this association is still unclear. We aimed to explore actual and feared selves and its association with obsessions and intrusions in a group of OCD patients. A group of 58 patients with OCD identified their most upsetting obsession and intrusion (non-clinical obsession) experienced in the past 3 months. These cognitions were classified as either moral-based or autogenous (obsessions n = 32; intrusions n = 26) or non-moral-based or reactive, depending on their content. Next, patients described their actual self and their feared self, that is, the person they feared being or becoming, and whether they believed these descriptions were associated with their obsessions/intrusions. Results indicate that individuals with OCD described themselves as insecure, anxious and fearful, but also as good and nice. They particularly feared a selfish, aggressive, bad, liar, coward, insecure and arrogant self. Two-thirds of the patients believed that their obsessions said something about their actual self (65.52%) and that their obsessions brought them closer to the person they do not want to be (62.06%). A third of patients believed their intrusions said something about their actual self (actual self: 30.35%; feared self: 25%), which was a significantly lower percentage than for obsessions. These associations existed independent from the content of the obsession and/or intrusion, although patients with obsessions with moral-based contents more often tended to believe that their obsessions brought them closer to the person they do not want to be. Results suggest the relevance of the real and feared selves in the maintenance of obsessions.
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http://dx.doi.org/10.1002/cpp.2656DOI Listing
August 2021

Development and validation of the multidimensional version of the fear of self questionnaire: Corrupted, culpable and malformed feared possible selves in obsessive-compulsive and body-dysmorphic symptoms.

Clin Psychol Psychother 2021 Sep 23;28(5):1160-1180. Epub 2021 Feb 23.

Department of Psychology, Concordia University, Montreal, Quebec, Canada.

In recent years, cognitive-behavioural models of OCD have increasingly recognized the potential role of feared possible selves in the development and maintenance of OCD, while simultaneously re-examining factors that have historically been linked to self-perceptions in OCD. The current article describes the development and validation of a multidimensional version of the Fear of Self Questionnaire (FSQ-EV) in a non-clinical (N = 626) and clinical OCD sample (N = 79). Principal component analyses in the non-clinical sample revealed three conceptually and factorially distinct components revolving around a feared corrupted possible self, a feared culpable possible self and a feared malformed possible self. The questionnaire showed a strong internal inconsistency, and good divergent and convergent validity, including strong relationships to obsessional symptoms. In particular, the corrupted feared self predicted OCD symptoms independently from depression and other related self-constructs and obsessive beliefs, while also strongly interacting with importance and control of thoughts in the prediction of almost all specific symptoms of OCD. Results are consistent with the notion that self-constructs can be conceptually and empirically distinguished from obsessive beliefs and appraisals with significant potential to improve our understanding of OCD and related disorders.
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http://dx.doi.org/10.1002/cpp.2565DOI Listing
September 2021

The impact of the coronavirus pandemic on specific symptom dimensions and severity in OCD: A comparison before and during COVID-19 in the context of stress responses.

J Obsessive Compuls Relat Disord 2021 Apr 26;29:100626. Epub 2021 Jan 26.

Psychosocial Injuries Research Center, Ilam University of Medical Sciences, Ilam, Iran.

The present study aimed to compare a group of patients with obsessive-compulsive disorder (OCD; N = 270) before and during COVID-19 on specific obsessive-compulsive (OC) symptom dimensions and symptom severity. In addition, the study aimed to evaluate the associations of COVID-19-related stress responses with change in OC symptom dimensions and severity of symptoms as the result of the pandemic. Results showed that patients with OCD had higher scores on all OC symptom dimensions and symptom severity during the pandemic as compared to their scores from before the pandemic. Thus, the effect of COVID-19 is not limited to an increase in fears of contamination alone, but occurs across other symptom dimensions, including responsibility for harm, unacceptable thoughts, and symmetry. In addition, regression analyses indicated that COVID-19-related stress responses significantly predicted the observed increase in specific OC symptom dimensions and general severity, after controlling for pre-COVID-19 scores of symptoms and severity. The increase of symptoms as the result of COVID-19 might be best understood in the context of a non-specific stress-related response similar to the effects observed in non-clinical and other clinical populations.
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http://dx.doi.org/10.1016/j.jocrd.2021.100626DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7834974PMC
April 2021

Reality check: An experimental manipulation of inferential confusion in eating disorders.

J Behav Ther Exp Psychiatry 2021 03 6;70:101614. Epub 2020 Sep 6.

OCD Spectrum Study Center, Montreal Mental Health University Institute, 7331 Hochelaga Montreal, Quebec, H1N 3V2, Canada; Université de Montréal, Psychiatry Department, 2900, Boul. Édouard-Montpetit Montreal, Quebec, H3T 1J4, Canada.

Background And Objectives: Inferential confusion (IC) entails confusing an imagined possibility with a sensory-based possibility, and acting upon the imagined possibility as if it was real. Although IC was formulated in the context of obsessive-compulsive disorder (OCD), this reasoning bias has shown to be relevant to other obsessive-compulsive spectrum disorders, such as eating disorders (EDs). The goal of this study was to induce IC experimentally in individuals with EDs relative to healthy controls (HC).

Methods: Thirty-six women (ED group, n = 18; HC group, n = 18) were assigned to one of two experimental conditions: in the High IC condition, participants watched ED-themed videos with key sequences missing - provoking a distrust of the senses and lending more space for the imagination, thus triggering IC. In the Low IC condition, participants watched videos without sequences missing. Participants completed measures of IC, negative affect and compulsive behaviors after watching the videos.

Results: One-way ANOVA indicated that ED participants assigned to the High IC condition reported a greater urge to engage in compulsive behaviors. ED participants also neutralized more after watching the videos and endorsed higher trait IC.

Limitations: There was no clinical control group.

Conclusions: These findings suggest that individuals with EDs display a greater vulnerability to IC, as they are more prone to compulsive behaviors when IC is triggered. This investigation may foster our understanding of the relationship between EDs and OCD through the examination of cognitive factors that are implicated in both disorders.
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http://dx.doi.org/10.1016/j.jbtep.2020.101614DOI Listing
March 2021

Is context a crucial factor in distinguishing between intrusions and obsessions in patients with obsessive-compulsive disorder?

J Clin Psychol 2021 03 18;77(3):804-817. Epub 2020 Sep 18.

Departamento de Personalidad, Evaluación y Tratamientos Psicológicos, Facultad de Psicología, Universitat de València, Valencia, Spain.

Objective: Some cognitive models of obsessive-compulsive disorder (OCD) posit that intrusions exist on a continuum with obsessions; others consider that they may be unrelated phenomena that differ in the context where they occur. We aimed to examine and compare, at two different moments, the context of the occurrence of intrusions and obsessions.

Method: Sixty-eight patients with OCD completed an interview appraising their most upsetting obsession and intrusion.

Results: At their onset, the obsessions/intrusions were associated with experiencing negative emotional states and life events, and they were more likely to appear in "inappropriate" contexts. The context of the obsessions/intrusions differed the last time they were experienced. Autogenous obsessions/intrusions occurred more frequently in contexts with an indirect link.

Conclusions: The context distinguishes between intrusions and obsessions, not when they emerge, but when the obsession is already established. The results support that there is a continuum or progression from intrusions to obsessions.
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http://dx.doi.org/10.1002/jclp.23060DOI Listing
March 2021

COVID-19, obsessive-compulsive disorder and invisible life forms that threaten the self.

J Obsessive Compuls Relat Disord 2020 Jul 30;26:100558. Epub 2020 Jun 30.

Centre de Recherche de L'Institut Universitaire en Santé Mentale de Montréal, University of Montreal, Department of Psychiatry and Addictology, 7331 Hochelaga Street, Montreal, QC, H1N 3V2, Canada.

This communication explores unique characteristics of obsessive-compulsive disorder (OCD) in the context of the current coronavirus pandemic. When do irrational fears of contamination as seen in OCD start to diverge from rational fears and behaviors? The current paper argues that the personal meaning attributed to viruses and germs, including their personification as entities that possess human-like characteristics, allows them to threaten and violate an individual's identity. Specifically, it suggests that fears of contamination become obsessional when the threat of viruses and germs becomes personal, not solely in terms of its objective outcomes, but in how these life forms are able to threaten the self as the result of a fear of corruption characterizing those with OCD. The person with OCD may act as if, or believe that they are acting upon reality when they fear contagion, but are in effect only acting upon an underlying fear of inner corruption that is confused with reality itself. The current paper concludes with some clinical recommendations on how to treat obsessional fears of contamination in the context of the current pandemic.
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http://dx.doi.org/10.1016/j.jocrd.2020.100558DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7324330PMC
July 2020

Lateralized readiness potentials and sensorimotor activity in adults with obsessive-compulsive disorder.

Prog Neuropsychopharmacol Biol Psychiatry 2021 01 8;104:110061. Epub 2020 Aug 8.

Centre de recherche de l'Institut universitaire en santé mentale de Montréal, Montréal, QC, Canada; Département de neurosciences, Université de Montréal, Montréal, QC, Canada; Département de psychiatrie et d'addictologie, Université de Montréal, Montréal, QC, Canada. Electronic address:

Obsessive-compulsive disorder (OCD) patients are known to have various functional abnormalities in prefrontal and motor areas. Given the presence of compulsions in many OCD patients, impaired response preparation processes could be a core feature of OCD. Yet, these processes remain understudied from a neurophysiological standpoint. Nineteen OCD patients were matched on age and sex to 19 healthy controls. Continuous EEG was recorded in all participants during a stimulus-response compatibility task. EEG from electrodes C3 and C4 was then averaged into stimulus- and response-locked LRPs. We compared both groups on various LRP measures, such as the LRP onset, the Gratton dip, and the maximum LRP peak. OCD patients showed significantly larger LRP peak than healthy controls, as well as larger Gratton dip. However, there was no group difference regarding LRP onset. Among OCD patients, it seems that motor regions are overactive during response preparation. Such overactivity was found for both incorrect responses that are aborted before execution and responses that are truly executed. These results suggest that regulation of sensorimotor activity should be addressed in the treatment of OCD.
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http://dx.doi.org/10.1016/j.pnpbp.2020.110061DOI Listing
January 2021

Spanish version of the Inferential Confusion Questionnaire-Expanded Version: Further support for the role of inferential confusion in obsessive-compulsive symptoms.

Clin Psychol Psychother 2020 Jul 3;27(4):515-527. Epub 2020 Mar 3.

Department of Psychiatry and Addictology, University of Montreal, Montréal, Quebec, Canada.

The purposes of this research were (1) to analyse the psychometric properties of the Inferential Confusion Questionnaire-Expanded Version (ICQ-EV) in a Spanish population; (2) to explore the role of inferential confusion in obsessive-compulsive disorder (OCD); and (3) to compare the inferential confusion construct in nonclinical and clinical samples. A sample of 342 nonclinical participants and 66 patients with OCD completed the ICQ-EV Spanish adaptation as well as a set of questionnaires. Results confirmed a good fit of the ICQ-EV Spanish version to the original unifactorial structure and excellent internal consistency and test-retest reliability. Moreover, results confirmed that the ICQ-EV predicts Obsessing, Checking, Washing, and Hoarding symptoms, independently of the contribution of dysfunctional beliefs. In addition, OCD patients scored significantly higher on the ICQ-EV than nonclinical participants. The Spanish version of the ICQ-EV is a reliable instrument to assess inferential confusion, and further support is provided for the relevance of the inferential confusion construct in OCD.
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http://dx.doi.org/10.1002/cpp.2435DOI Listing
July 2020

Inverse reasoning processes in obsessive-compulsive disorder: Replication in a clinical sample.

J Anxiety Disord 2019 04 29;63:1-8. Epub 2019 Jan 29.

School of Psychology, UNSW Sydney, NSW, Australia.

The inference-based approach (IBA) is one cognitive model that aims to explain the aetiology and maintenance of obsessive-compulsive disorder (OCD). IBA theory suggests that certain reasoning processes lead an individual with OCD to confuse imagined possibilities with actual probabilities, a process termed inferential confusion. One such reasoning process is inverse reasoning, where hypothetical causes form the basis of conclusions about reality. Recently, we developed a task-based measure of inverse reasoning. In an online sample, we reported significant and positive associations between endorsement of inverse reasoning on this task and OCD symptomatology. We concluded that there was some support for the role of inverse reasoning in OCD but these results required extension using a between-groups design in a clinical sample. Therefore, the present study compared endorsement in inverse reasoning on this task between individuals diagnosed with OCD, anxiety and/or mood disorder (clinical controls), and healthy individuals (healthy controls). Relative to both control groups, the OCD group demonstrated significantly greater endorsement in inverse reasoning on scenarios where OCD relevant concerns were prompted. When non-OCD relevant concerns were involved, the OCD group only evidenced greater endorsement in inverse reasoning relative to the healthy control group. Implications for IBA theory are discussed.
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http://dx.doi.org/10.1016/j.janxdis.2019.01.005DOI Listing
April 2019

Reduced fear-of-self is associated with improvement in concerns related to repugnant obsessions in obsessive-compulsive disorder.

Br J Clin Psychol 2019 Sep 12;58(3):327-341. Epub 2018 Dec 12.

Centre de recherche de l'Institut universitaire en santé mentale de Montréal, Quebec, Canada.

Objective: The potential causal and maintaining role of vulnerable self-themes and beliefs about the self in obsessive-compulsive disorder (OCD) have received increasing attention from cognitive-behavioural theorists. This interest was translated into the development of a self-report measurement of the feared self (the fear of who one might be or become), a construct theoretically and empirically pertinent to unwanted thoughts and impulses in OCD (i.e., repugnant obsessions).

Method: The current study aimed to provide converging evidence on the relevance of the feared self in OCD, by examining whether improvements in symptoms associated with repugnant obsessions (measured on the Vancouver Obsessional Compulsive Inventory [VOCI] obsessions subscale) would be predicted by reduced feared self-perceptions (measured on the Fear-of-Self Questionnaire [FSQ]) in a sample of 93 patients receiving psychotherapy for OCD.

Results: Using a series of hierarchical linear regression models, we found that treatment-related reductions on the FSQ significantly and uniquely predicted reductions on the VOCI obsessions subscale and the contamination subscale.

Conclusions: The current study thus replicated previous research suggesting the relevance of the feared possible self in psychological disorders such as OCD, where negative self-perception is a dominant theme.

Practitioner Points: Current results suggest that changes in feared self-perceptions may be the mechanism through which OCD symptoms improve via therapy. Interventions specifically aimed at changing feared self-perceptions may prove effective in improving cognitive-behavioural treatments for OCD. One limitation of the current study is the lack of behavioural measures of OCD to supplement self-report measures of OCD. Another limitation is that the small number of patients receiving some of the treatments precludes investigations into which treatments may be more effective in altering feared self-perceptions.
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http://dx.doi.org/10.1111/bjc.12214DOI Listing
September 2019

What do I look like? Perceptual confidence in bulimia nervosa.

Eat Weight Disord 2020 Feb 17;25(1):177-183. Epub 2018 Jul 17.

Research Center, Montréal Mental Health University Institute, 7331 Hochelaga, Montreal, QC, H1N 3V2, Canada.

Cognitive confidence, a type of metacognition referring to confidence in one's cognitive abilities (e.g., memory, perception, etc.), has been identified as relevant to eating disorders (EDs) using self-report measures. Repeated checking has been found to elicit decreases in perceptual confidence in obsessive compulsive disorder (OCD). The purpose of the present study was to experimentally investigate perceptual confidence, a type of cognitive confidence, in EDs. Specifically, this construct was investigated in the context of body checking, a behaviour with similarities to compulsive checking as observed in OCD. Women with bulimia nervosa (BN; n = 21) and healthy controls (HC; n = 24) participated in the study. There were no group differences with regards to perceptual confidence at baseline F(1, 43) = 0.5, p = 0.48, η = 0.01, but a significant difference was observed post-checking F(1, 43) = 7.79, p = 0.008, η = 0.15, which was accounted for by significant decreases in perceptual confidence in the BN group F(1, 43) = 13.31, p < 0.001, η = 0.24. Similar to compulsive checking in OCD, body checking may paradoxically decrease confidence regarding one's appearance. LEVEL OF EVIDENCE: Level I, experimental study.
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http://dx.doi.org/10.1007/s40519-018-0542-xDOI Listing
February 2020

Doubt and fear of self in bulimia nervosa.

Int J Eat Disord 2017 12 16;50(12):1437-1441. Epub 2017 Oct 16.

Research Center, Montreal Mental Health University Institute, Montreal, Quebec, H1N 3V2, Canada.

Objective: Several overlapping cognitive processes have been identified in eating disorders (EDs) and obsessive compulsive disorder (OCD). Drawing from the OCD literature, the present study examined whether bulimia nervosa (BN) is associated with a maladaptive inductive reasoning style characterized by the over-investment in possibility-based (as opposed to reality-based) information.

Method: Women with BN (n = 25) and healthy controls (HC; n = 24) completed the Inference Processes Task (IPT), an ecological inductive reasoning task previously validated in OCD samples. Participants also completed the Fear of Self Questionnaire (FSQ) that evaluates investment in a feared possible identity.

Results: Significant differences on the IPT indicate that the BN group was more influenced by possibility-based information throughout the task than the HC group (F[5.44, 255.78] = 6.94, p > .001). It was also found that the BN group scored significantly higher on the FSQ than the HC group (t[29.98] = 8.4, p > .001), replicating previous findings. Finally, scores on the IPT were significantly correlated with measures of symptom severity.

Discussion: These findings suggest that BN may be associated with maladaptive inductive reasoning processes characterized by over-investment in possibility-based feared outcomes and identities.
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http://dx.doi.org/10.1002/eat.22789DOI Listing
December 2017

The role of feared possible selves in obsessive-compulsive and related disorders: A comparative analysis of a core cognitive self-construct in clinical samples.

Clin Psychol Psychother 2018 Jan 9;25(1):e19-e29. Epub 2017 Aug 9.

Department of Psychiatry, University of Montreal, Montreal, Quebec, Canada.

Increasingly, cognitive-behavioural models have been considering the role of beliefs about the self in the development and maintenance of obsessive-compulsive disorder (OCD), including sensitive domains of self-concept and feared self-perceptions. This has led to the development of the Fear of Self Questionnaire (FSQ; Aardema et al., ), which has shown strong internal consistency, divergent and convergent validity, and found to be a major predictor of unwanted thoughts and impulses (i.e., repugnant obsessions). The current study aimed to investigate fear of self-perceptions using the FSQ in an OCD sample (n = 144) and related psychological disorders (eating disorders, n = 57; body dysmorphic disorder, n = 33) in comparison to a non-clinical (n = 141) and clinical comparison group (anxiety/depressive disorders, n = 27). Following an exploratory factor analysis of the scale in the OCD sample, the results showed that participants with OCD in general did not score significantly higher on fear of self-perceptions than did the clinical comparison participants. However, consistent with previous findings, fear of self was highly characteristic among OCD patients with unwanted repugnant thoughts and impulses. In addition, fear of self-perceptions were significantly more elevated in those with eating or body dysmorphic disorders relative to the other non-clinical and clinical groups. The construct of a "feared possible self" may be particularly relevant in disorders where negative self-perception is a dominant theme, either involving concerns about one's inner self or concerns related to perceived bodily faults.
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http://dx.doi.org/10.1002/cpp.2121DOI Listing
January 2018

Augmentation of Psychotherapy through Alternative Preconscious Priming: A Case Series Exploring Effects on Residual Symptoms.

Front Psychiatry 2017 31;8. Epub 2017 Jan 31.

Research Center of the Montreal University Institute of Mental Health, Montreal, Canada; University of Geneva, Geneva, Switzerland; Geneva University Hospitals, Geneva, Switzerland.

The current paper describes a case series using a new strategy for facilitating change based on Augmentation of Psychotherapy through Alternative Preconscious Priming (APAP) (1) in the treatment of eight treatment-resistant patients suffering from social phobia or generalized anxiety disorder. The patients had previously only shown a partial response to cognitive behavioral therapy (CBT) despite good treatment adherence. The patients completed APAP using a computerized program, which consisted of three steps during which alternative, more functional thoughts and beliefs relevant to the idiosyncratic difficulties experienced by the patients were formulated. Subsequently, these formulations were recorded and mixed with masking relaxing music, which the patient listened to in a passive state twice daily for 20 min for a period of 8 weeks. This case series aimed to assess the effect and acceptability of APAP using quantitative and qualitative measures administered before, after, and 16 weeks' posttreatment. Results showed a reduction in dysfunctional idiosyncratic thoughts reported by most patients, as well as mild improvements in anxiety and important improvements in quality of life. APAP could be a valuable addition to CBT by facilitating or enhancing cognitive and symptom change. Further studies are needed to confirm these promising results.
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http://dx.doi.org/10.3389/fpsyt.2017.00008DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5281544PMC
January 2017

The Inference-Based Approach (IBA) to the Treatment of Obsessive-Compulsive Disorder: An Open Trial Across Symptom Subtypes and Treatment-Resistant Cases.

Clin Psychol Psychother 2017 Mar 9;24(2):289-301. Epub 2016 Jun 9.

Department of Psychiatry, University of Montreal, Montréal, Canada.

The current open trial evaluated an inference-based approach (IBA) to the treatment of obsessive-compulsive disorder (OCD) across symptom subtypes and treatment-resistant cases. Following formal diagnosis through semi-structured interview by an independent evaluator, a total of 125 OCD participants across five major symptom subtypes entered a program of 24 sessions of treatment based on the IBA. An additional group of 22 participants acted as a natural wait-list control group. Participants were administered the Yale-Brown Obsessive-Compulsive Scale before and after treatment as the principal outcome measure, as well as measures of negative mood states, inferential confusion and obsessive beliefs. Level of overvalued ideation was assessed clinically at pre-treatment using the Overvalued Ideation Scale. After 24 weeks of treatment, 102 treatment completers across all major subtypes of OCD showed significant reductions on the Yale-Brown Obsessive-Compulsive Scale with effect sizes ranging from 1.49 to 2.53 with a clinically significant improvement in 59.8% of participants. No improvement was observed in a natural wait-list comparison group. In addition, IBA was effective for those with high levels of overvalued ideation. Change in inferential confusion and beliefs about threat and responsibility were uniquely associated with treatment outcome. The study is the first large-scale open trial showing IBA to be effective across symptom subtypes and treatment-resistant cases. The treatment may be particularly valuable for those who have previously shown an attenuated response to other treatments. Copyright © 2016 John Wiley & Sons, Ltd.

Key Practitioner Message: Psychological treatment based on the inference-based approach is an effective treatment for all major subtypes of obsessive-compulsive disorder. The treatment is equally effective for those with high and low levels of overvalued ideation. Treatment based on the inference-based approach may be particularly valuable for those who have shown an attenuated response to cognitive-behaviour therapy as usual.
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http://dx.doi.org/10.1002/cpp.2024DOI Listing
March 2017

The inference-based approach to obsessive-compulsive disorder: A comprehensive review of its etiological model, treatment efficacy, and model of change.

J Affect Disord 2016 Sep 26;202:187-96. Epub 2016 May 26.

Centre de Recherche de l'Institut Universitaire en Santé Mentale de Montréal, Université de Montréal, Canada; Département de Psychiatrie, Université de Montréal, Canada.

Background: The inference-based approach (IBA) postulates that individuals with obsessive-compulsive disorder (OCD) confuse a possibility with reality (inferential confusion) according to specific inductive reasoning devices and act as if this possibility were true. A new treatment modality, the inference-based therapy (IBT), was developed. The aim of this study was to critically review empirical evidence regarding the etiological model, treatment efficacy, and model of change of IBA.

Methods: A search of the literature was conducted using PsycINFO and Medline.

Results: Thirty-four articles were included in the review. The review reveals that intrusive thoughts of non-clinical and OCD individuals may occur in different contexts. There is support for a specific inductive reasoning style in OCD. Inferential confusion is associated with OCD symptoms. There is good evidence that IBT is an efficacious treatment for OCD, including two randomized controlled trials showing that IBT was as efficacious as cognitive-behavior therapy. There is some but limited evidence that the process of change during treatment is coherent with IBA's assumptions.

Limitations: Key premises were investigated in only a few studies. Some of these studies were conducted in non-clinical samples or did not include an anxious control group.

Conclusions: IBA's etiological model, treatment modality, and model of change make a significant contribution to OCD.
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http://dx.doi.org/10.1016/j.jad.2016.05.060DOI Listing
September 2016

Schizotypal, Dissociative, and Imaginative Processes in a Clinical OCD Sample.

J Clin Psychol 2015 Jun 7;71(6):606-24. Epub 2015 Apr 7.

Department of Psychology, Northern Illinois University.

Objective: Previous research in a nonclinical sample has suggested that schizotypal, dissociative, and imaginative processes may play a role in obsessive-compulsive disorder (OCD) symptoms (Aardema & Wu, ). The present study aims to extend these findings in a clinical sample.

Method: N = 75 adults (mean age = 37.99; 61.3% female), meeting the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision, diagnostic criteria for OCD completed a battery of self-report questionnaires measuring schizotypal, dissociative, and imaginative processes.

Results: Hierarchical regression analyses revealed inferential confusion and dissociation to be the strongest predictors of OCD symptoms, replicating and extending the findings by Aardema and Wu ().

Conclusion: Results support the notion that inferential confusion and dissociation are important variables to consider in understanding symptoms of OCD independently from obsessive beliefs and negative mood states.
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http://dx.doi.org/10.1002/jclp.22173DOI Listing
June 2015

Fear of Self and Unacceptable Thoughts in Obsessive-Compulsive Disorder.

Clin Psychol Psychother 2016 May 16;23(3):226-35. Epub 2015 Mar 16.

Centre for Mental Health and Wellbeing Research, Deakin University, Melbourne, Australia.

Unlabelled: Cognitive-behavioural models have linked unacceptable or repugnant thoughts in obsessive-compulsive disorder (OCD) with vulnerable self-themes and fear-of-self concerns. To investigate this notion, Aardema and coworkers recently developed and validated the Fear of Self-Questionnaire (FSQ) in non-clinical samples, finding it had strong internal inconsistency, and good divergent and convergent validity, including strong relationships to obsessional symptoms and with other processes implicated in cognitive models of OCD (e.g., obsessive beliefs and inferential confusion). The current article describes two studies that aim to replicate and extend these findings in clinical OCD and non-clinical samples. Study 1 investigated the psychometric properties of an Italian translation of the FSQ in a non-clinical sample (n = 405). Results of confirmatory factor analysis supported the unidimensionality of the scale; the FSQ also showed very good internal consistency and temporal stability. Study 2 investigated the role of fear of self in OCD symptoms, and unacceptable thoughts and repugnant obsessions in particular, using a clinical OCD sample (n = 76). As expected, fear of self was a unique, major predictor of unacceptable thoughts independent of negative mood states and obsessive beliefs. Moreover, even when considered with obsessive beliefs, anxiety and depression, the feared self was the only unique predictor of obsessionality, providing support for the notion that self-themes could explain why some intrusions convert into obsessions, whereas others do not. Implications for current cognitive-behavioural models are discussed. Copyright © 2015 John Wiley & Sons, Ltd.

Key Practitioner Message: Unacceptable thoughts in OCD have been linked with vulnerable self-themes and a fear of self. Aardema and coworkers recently developed and validated the Fear of Self-Questionnaire (FSQ). Study 1 investigated the Psychometric properties of an Italian translation of the FSQ in a non-clinical sample. Study 2 investigated the role of fear of self in unacceptable thoughts, using a clinical OCD sample. Fear of self was a unique, major predictor of unacceptable thoughts in OCD over and beyond obsessive beliefs.
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http://dx.doi.org/10.1002/cpp.1950DOI Listing
May 2016

Fear of self, doubt and obsessive compulsive symptoms.

J Behav Ther Exp Psychiatry 2015 Dec 21;49(Pt B):164-172. Epub 2015 Feb 21.

Brain and Psychological Sciences Research Centre (BPsyC), Swinburne University of Technology, Hawthorn, Australia.

Background And Objectives: Following observations in the literature that obsessions often contain or imply negative evaluative information about the self, Aardema et al. (2013) recently developed a measure of feared-self relevant to OCD. The current study aimed to provide further examination of the relevance of such feared self-beliefs to obsessive compulsive processes - in particular whether they partially underlie doubt in OCD-relevant situations.

Method: Nonclinical participants (N = 463; 291 females; Mage = 25.17, SD = 7.47), were presented with three vignettes, related to washing, checking and non-OCD relevant themes, which assessed doubt through providing alternating sensory and possibility-based information.

Results: Higher levels of OCD symptoms and feared-self beliefs both significantly predicted both higher baseline levels of doubt and greater fluctuation in levels of doubt in both the contamination and checking scenarios, and to a much lesser extent in the control scenario. Feared-self beliefs did not predict fluctuation in doubt over-and-above OCD symptoms, consistent with a mediation model.

Limitations: The main limitation was the use of a non-clinical sample, although this allowed sufficient participant numbers to test hypotheses.

Conclusions: The findings provided further experimental support for reasoning processes in OCD, and suggested that feared self-beliefs may make individuals vulnerable to experiencing doubt. Additionally, these results suggested that individuals with high OCD symptoms and those with high feared self-beliefs are unable to recognise the improbable nature of possibility-based statements. Implications for treatment and theory are discussed.
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http://dx.doi.org/10.1016/j.jbtep.2015.02.005DOI Listing
December 2015

Food for thought: ego-dystonicity and fear of self in eating disorders.

Eur Eat Disord Rev 2015 May 1;23(3):179-84. Epub 2015 Mar 1.

Research Center, OCD Spectrum Study Center, Montreal Mental Health University Institute, Canada; University of Montreal, Canada.

Degree of ego-dystonicity in obsessions is clinically relevant to the conceptualization and treatment of eating disorders (EDs). Obsessive-compulsive disorder research has suggested that the transformation of intrusive thoughts into obsessions is linked to the degree to which intrusive thoughts threaten core perceptions of the self. This study aims to explore the relationship between the ego-dystonic nature of obsessions in ED patients and a fear of self, the link between ED symptom severity and ego-dystonicity in obsessions, and differences between non-clinical and individuals with EDs in the presence of ego-dystonic thoughts and a fear of self. Ego-dystonicity (Ego-dystonicity Questionnaire (EDQ)) and feared self (Fear of Self Questionnaire (FSQ)) degrees were measured in a clinical sample (n = 57 with EDs) and a non-clinical sample (n = 45). EDQ and FSQ scores were highly correlated in both samples. EDQ scores were not significantly correlated to ED symptom severity with the exception of the EDQ Irrationality subscale, which was strongly related to compulsion severity. Participants with an ED had significantly higher EDQ and FSQ scores compared with controls.
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http://dx.doi.org/10.1002/erv.2349DOI Listing
May 2015

Evaluation of Inference-Based Therapy (Doubt Therapy) as a Self-Help Tool for Obsessive-Compulsive Disorder.

J Cogn Psychother 2015 1;29(4):315-330. Epub 2015 Jan 1.

Mental Health University Institute of Montreal, University of Montreal, Québec, Canada.

Introduction: Inference-based therapy (IBT) is a novel therapeutic approach aimed at reducing obsessive-compulsive symptoms. For this study, the original therapist-guided protocol was adapted for self-help administration.

Method: Fifty patients with obsessive-compulsive disorder who had been recruited via specialized online fora were randomly allocated to either IBT or a wait-list control condition. At baseline and 4 weeks later, questionnaires tapping into psychopathology, quality of life, and faulty reasoning were administered.

Results: The completion rate was acceptable (74%) and not significantly different across groups. Relative to controls, patients in the IBT group showed modest but significant symptom decline on obsessions (Yale-Brown Obsessive-Compulsive Scale [Y-BOCS] self-report and Obsessive-Compulsive Inventory-Revised [OCI-R]) and washing compulsions (OCI-R) across time. No significant differences emerged for depression, quality of life, and inferential confusion. Ratings at the post-assessment suggest that the training was well accepted among patients. Test-retest reliability was high indicating good quality of the data.

Discussion: This study confirms prior research suggesting that IBT is effective as a stand-alone technique. Follow-up studies are needed to elucidate the long-term effects of the training and whether positive effects are maintained if IBT is introduced as an add-on to standard treatment (i.e., cognitive behavioral therapy/medication).
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http://dx.doi.org/10.1891/0889-8391.29.4.315DOI Listing
January 2015

The impact of emotions on body-Focused repetitive behaviors: evidence from a non-treatment-seeking sample.

J Behav Ther Exp Psychiatry 2015 Mar;46:189-97

Unlabelled: Body-focused repetitive behaviors (BFRBs) are repetitive, injurious, and non-functional habits that cause significant distress or impairment, including hair-pulling, skin-picking, and nail-biting. The emotion regulation (ER) model suggests that BFRBs are triggered by negative emotions and reinforced by alleviation of unpleasant affect. The frustrated action (FA) model suggests that BFRBs are triggered by and alleviate impatience, boredom, frustration, and dissatisfaction. Individuals with BFRBs are hypothesized to be particularly susceptible to these emotions because they demonstrate maladaptive planning styles characterized by high standards and unwillingness to relax.

Objectives: The objective of this study was to test these two models.

Methods: This study compared urge to engage in BFRBs in a BFRB group (n = 24) and a control group (n = 23) in experimental conditions designed to elicit boredom/frustration, stress, and relaxation, respectively.

Results: The BFRB group reported a significantly greater urge to engage in BFRBs than did the control group across conditions. Participants in the BFRB group reported a stronger urge to engage in BFRBs in the boredom/frustration condition than in the relaxation condition but not in the stress condition. Finally, the BFRB group presented significantly higher scores on maladaptive planning style, and maladaptive planning style was significantly correlated with difficulties with ER.

Limitations: Future studies may wish to exclusively use validated mood induction techniques and more stringent inclusion criteria.

Conclusions: The results highlight the role of boredom, frustration, and impatience in triggering BFRBs, and support the FA model.
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http://dx.doi.org/10.1016/j.jbtep.2014.10.007DOI Listing
March 2015

Dissolving the tenacity of obsessional doubt: implications for treatment outcome.

J Behav Ther Exp Psychiatry 2012 Jun 20;43(2):855-61. Epub 2011 Dec 20.

University of Montreal, Fernand-Seguin Research Center, 7331 Hochelaga, Montréal, Québec H1N 3V2, Canada.

Background And Objectives: Previous research has found that a high impact of possibility based information during reasoning prevents the resolution of doubt among those with Obsessive-Compulsive Disorder (OCD). It was expected that the ability of those with OCD to resolve obsessional doubt would improve following Inference Based Treatment (IBT).

Methods: The ability to resolve doubt, including the relative impact of reality and possibility based information, was measured before and after treatment with the Inference Processes Task in a group of 35 participants diagnosed with OCD.

Results: Results confirmed that IBT improved the participants' ability to resolve obsessional doubt. Those who improved their ability to resolve doubt showed a significantly better treatment outcome. Improvements appeared mostly due to a lowered impact of possibility based information following treatment.

Limitations: The study did not include a control condition although results clearly indicate that the ability to resolve obsessional is closely linked to the most relevant quantifiers of treatment outcome. In addition, relatively small sample sizes prevented more powerful multiple comparisons between groups.

Conclusions: Results suggest treatment implications and the relevance of dissolving the tenacity of obsessional doubt in OCD.
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http://dx.doi.org/10.1016/j.jbtep.2011.12.006DOI Listing
June 2012

Imaginative, dissociative, and schizotypal processes in obsessive-compulsive symptoms.

J Clin Psychol 2011 Jan 11;67(1):74-81. Epub 2010 Oct 11.

University of Montreal, Fernand-Seguin Research Center, Montréal, Québec, Canada.

This study investigates imaginative, dissociative, and schizotypal processes that are potentially relevant to obsessive-compulsive (OC) symptoms. Students (n = 377) completed questionnaires that assessed inferential confusion, absorption, schizotypal personality, and other domains. Hierarchical regression revealed that inferential confusion and absorption were the most consistent predictors of OC symptoms; other content predicted variance for specific OC symptoms. For example, schizotypal personality predicted checking and hoarding symptoms, but not cleanliness or ordering rituals. Immersive tendencies predicted cleanliness and hoarding but not checking or ordering rituals. Results are consistent with an inference-based model of OC, in which an overreliance on imagination during reasoning gives rise to experiences that are inconsistent with reality. This study suggests additional domains that may help explain why intrusive thoughts become obsessions.
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http://dx.doi.org/10.1002/jclp.20729DOI Listing
January 2011

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

Cyberpsychol Behav Soc Netw 2010 Aug;13(4):429-35

Fernand-Seguin Research Center, 7331 Hochelaga, Montréal, Québec, Canada.

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.
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http://dx.doi.org/10.1089/cyber.2009.0164DOI Listing
August 2010

Intrusions related to obsessive-compulsive disorder: a question of content or context?

J Clin Psychol 2009 Jul;65(7):709-22

Centre de Recherche Fernand-Sequin, Université de Montréal, Quebec, Canada.

The aim of the current study was to investigate whether intrusions of individuals with obsessive-compulsive disorder (OCD) and nonclinical individuals differed in content and in context of occurrence. The results suggest that although the intrusions of OCD and nonclinical individuals are similar in content, they differ in their context of occurrence. Chi square analyses revealed that the intrusions of nonclinical participants were more likely to be directly linked than indirectly linked to observations in the here and now, whereas the intrusions of participants with OCD were more prone to be indirectly linked than directly linked to triggers in the environment at the time they occurred. The implications of the results for cognitive models of OCD are discussed.
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http://dx.doi.org/10.1002/jclp.20578DOI Listing
July 2009

Inferential confusion, obsessive beliefs, and obsessive-compulsive symptoms: a replication and extension.

J Anxiety Disord 2009 Aug 11;23(6):746-52. Epub 2009 Mar 11.

Northern Illinois University, 311 Psychology-Computer Science Bldg, Department of Psychology, DeKalb, IL 60115, United States.

This study replicated and extended previous research regarding utility of an inference-based approach (IBA) to the study of Obsessive-Compulsive Disorder (OCD). The IBA is a model for the development of OCD symptoms through false reasoning. One of its key features is inferential confusion-a form of processing information in which an individual accepts a remote possibility based only on subjective evidence. In a nonclinical sample, this study examined the specificity of relations between the expanded Inferential Confusion Questionnaire (ICQ-EV) and OC symptoms. Results were that the ICQ-EV significantly predicted OC symptoms after controlling for general distress, anxiety, and depression. This finding supports the unique association between inferential confusion and OCD. Further, the ICQ-EV was a stronger predictor of certain OC symptoms than scales from the Obsessive Beliefs Questionnaire, which itself has shown strong relations with OC symptoms. Thus, both inference-based and cognitive appraisal models appear useful for understanding OCD.
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http://dx.doi.org/10.1016/j.janxdis.2009.02.017DOI Listing
August 2009

Inferential confusion, obsessive beliefs and obsessive-compulsive symptoms: a multidimensional investigation of cognitive domains.

Clin Psychol Psychother 2008 Jul-Aug;15(4):227-38

Fernand-Seguin Research Center, Montreal, Quebec, Canada.

Generally, research into the relationship between cognitive domains and obsessive-compulsive symptoms involves the use of scales that are highly intercorrelated with each other. The current study investigates the relationship between cognitive constructs and obsessive-compulsive symptoms using the item set of the Obsessive Beliefs Questionnaire and the Inferential Confusion Questionnaire. In order to create constructs that would not be excessively correlated with each other, factor scores were used to investigate the relationship between cognitive domains and obsessive-compulsive symptoms. Factor analysis followed by oblique rotation resulted in four moderately correlated cognitive constructs (importance/control of thoughts, inferential confusion/threat estimation, perfectionism/certainty and responsibility for preventing harm). With the exception of responsibility for preventing harm, the cognitive constructs under investigation were quite strongly related to obsessive-compulsive symptoms. In particular, hierarchical regression revealed the construct inferential confusion/threat estimation to be a global and strong predictor of obsessive-compulsive symptoms, followed by the constructs of perfectionism/certainty and the construct importance/control. Responsibility for preventing harm acted to be a negative predictor of obsessive-compulsive symptoms. It is concluded that the construct of inferential confusion acts as a more powerful predictor of obsessive-compulsive symptoms than any specific obsessive belief
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http://dx.doi.org/10.1002/cpp.581DOI Listing
April 2009

Cognitive-behavioural, pharmacological and psychosocial predictors of outcome during tapered discontinuation of benzodiazepine.

Clin Psychol Psychother 2008 Jan-Feb;15(1):1-14

Fernand-Seguin Research Centre, Louis-H. Lafontaine Hospital, University of Montreal.

Eighty-six participants wishing to stop benzodiazepine and who met DSM-IV (Diagnostic and Statistical Manual of Mental Disorders, 4th ed. American Psychological Association, 1994) criteria for anxiety disorder or insomnia were assessed pre- and post-taper on clinical, pharmacological and psychosocial measures. An initial cohort of 41 participants received treatment as usual (taper only) plus physician counselling in the same clinic setting. A second cohort of 45 participants were randomly allocated to group cognitive-behavioural therapy (CBT) plus taper, or group support (GS) plus taper. At 3 months follow-up, the outcomes in both the CBT and the GS subgroups were equivalent. Intention to treat analysis revealed a slight advantage to the CBT over the GS group and the CBT group showed higher self-efficacy post-taper.Over all 86 participants, a high-baseline level of psychological distress, anxiety and dosage predicted a poor outcome, but increase in self-efficacy contributed to a successful outcome particularly in those with initially poor baseline predictors. Although there was a decrease in positive affect during preliminary stages of tapered discontinuation compared to baseline, there was no significant overall increase in negative affect.
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http://dx.doi.org/10.1002/cpp.556DOI Listing
May 2009

Treating delusional disorder: a comparison of cognitive-behavioural therapy and attention placebo control.

Can J Psychiatry 2007 Mar;52(3):182-90

Fernand-Seguin Research Centre, Montreal, Quebec.

Objective: Cognitive-behavioural therapy (CBT) has proved effective in treating delusions, both in schizophrenia and delusional disorder (DD). Clinical trials of DD have mostly compared CBT with either treatment as usual, no treatment, or a wait-list control. This current study aimed to assess patients with DD who received CBT, compared with an attention placebo control (APC) group.

Method: Twenty-four individuals with DD were randomly allocated into either CBT or APC groups for a 24-week treatment period. Patients were diagnosed on the basis of structured clinical interviews for mental disorders and the Maudsley Assessment of Delusion Schedule (MADS).

Results: Completers in both groups (n = 11 for CBT; n = 6 for APC) showed clinical improvement on the MADS dimensions of Strength of Conviction, Insight, Preoccupation, Systematization, Affect Relating to Belief, Belief Maintenance Factors, and Idiosyncrasy of Belief.

Conclusion: When compared with APC, CBT produced more impact on the MADS dimensions for Affect Relating to Belief, Strength of Conviction, and Positive Actions on Beliefs.
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http://dx.doi.org/10.1177/070674370705200310DOI Listing
March 2007
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