Publications by authors named "Marieke B J Toffolo"

7 Publications

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Patients With Obsessive-Compulsive Disorder Check Excessively in Response to Mild Uncertainty.

Behav Ther 2016 07 20;47(4):550-9. Epub 2016 Apr 20.

Utrecht University; Altrecht Academic Anxiety Center.

Patients with obsessive-compulsive disorder (OCD) not only respond to obsessions with perseverative checking, but also engage in more general checking, irrespective of their obsessive concerns. This study investigated whether general checking is specific to OCD and exacerbated when only mild uncertainty is induced. Thirty-one patients with OCD, 26 anxiety- and 31 healthy controls performed a visual search task with eye-tracking and indicated in 50 search displays whether a target was "present" or "absent". Target-present trials were unambiguous, whereas target-absent trials induced mild uncertainty, because participants had to rely on not overlooking the target. Checking behavior was measured by assessing search time and the number of fixations, measured with an eye-tracker. Results showed that in both target-present and target-absent trials patients with OCD searched longer and made more fixations than healthy and anxiety controls. However, the difference in checking behavior between patients with OCD and the control groups was larger in target-absent trials (where mild uncertainty was induced). Anxiety and healthy controls did not differ in checking behavior. Thus, mild uncertainty appears to specifically promote checking in patients with OCD, which has implications for treatment.
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http://dx.doi.org/10.1016/j.beth.2016.04.002DOI Listing
July 2016

Perseveration induces dissociative uncertainty in obsessive-compulsive disorder.

J Behav Ther Exp Psychiatry 2016 09 10;52:1-10. Epub 2016 Feb 10.

Department of Clinical and Health Psychology, Utrecht University, Utrecht, The Netherlands; Altrecht Academic Anxiety Centre, Utrecht, The Netherlands.

Background And Objectives: Obsessive compulsive (OC)-like perseveration paradoxically increases feelings of uncertainty. We studied whether the underlying mechanism between perseveration and uncertainty is a reduced accessibility of meaning ('semantic satiation').

Methods: OCD patients (n = 24) and matched non-clinical controls (n = 24) repeated words 2 (non-perseveration) or 20 times (perseveration). They decided whether this word was related to another target word. Speed of relatedness judgments and feelings of dissociative uncertainty were measured. The effects of real-life perseveration on dissociative uncertainty were tested in a smaller subsample of the OCD group (n = 9).

Results: Speed of relatedness judgments was not affected by perseveration. However, both groups reported more dissociative uncertainty after perseveration compared to non-perseveration, which was higher in OCD patients. Patients reported more dissociative uncertainty after 'clinical' perseveration compared to non-perseveration..

Limitations: Both parts of this study are limited by some methodological issues and a small sample size.

Conclusions: Although the mechanism behind 'perseveration → uncertainty' is still unclear, results suggest that the effects of perseveration are counterproductive.
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http://dx.doi.org/10.1016/j.jbtep.2016.02.001DOI Listing
September 2016

Check, check, double check: Investigating memory deterioration within multiple sessions of repeated checking.

J Behav Ther Exp Psychiatry 2016 12 10;53:59-67. Epub 2015 Sep 10.

Department of Clinical and Health Psychology, Utrecht University, Utrecht, The Netherlands.

Background And Objectives: Extensive research has shown that repeated checking causes memory distrust. Therefore, it has been suggested that people may subsequently get into a vicious cycle of decreased memory confidence and increased checking behavior, which may play a role in the maintenance and development of OCD. This study investigated in two experiments how repeated checking influences memory distrust over multiple checking episodes.

Methods: In experiment 1, 70 healthy undergraduates performed two sessions of a virtual checking task with a 30 min break in between. In experiment 2, 41 healthy undergraduates performed two sessions of the checking task on a real kitchen stove and sink.

Results: Results of experiment 1 showed that memory confidence for checking the stove decreased after repeated checking in session 1, and remained low in session 2, but memory vividness and detail decreased in both sessions and recovered in between. In experiment 2, all three meta-memory ratings for checking the stove decreased after repeated checking in both sessions, but recovered in between.

Limitations: Future research may include patients with OCD. To further investigate the development of memory distrust over time, more checking episodes may be included and the time between sessions may be increased. Although replication is needed, the findings of experiment 2 seem more informative.

Conclusions: Repeated checking may decrease memory vividness and detail (and, in turn, presumably also decrease memory confidence) each time this counterproductive strategy is used, which may have implications for using this paradigm as a behavioral experiment in cognitive-behavioral therapy.
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http://dx.doi.org/10.1016/j.jbtep.2015.09.001DOI Listing
December 2016

Safety Behavior Increases Obsession-Related Cognitions About the Severity of Threat.

Behav Ther 2015 Jul 30;46(4):521-31. Epub 2015 Apr 30.

Utrecht University.

This study investigated whether checking behavior, the most common safety behavior in obsessive-compulsive disorder (OCD), contributes to the development of OCD symptoms. Ninety healthy undergraduates spent a week between a pre- and posttest either actively engaging in clinically representative checking behavior on a daily basis (experimental group, n=30), monitoring their normal checking behavior (monitor group, n=30), or received no instructions on checking behavior (control group, n=30). Cognitions about the severity of threat increased from pre- to posttest in the experimental group, but not in the monitor and control groups. Cognitions about the importance of checking decreased in the monitor group. The results indicate that checking behavior contributes directly to the exacerbation of OCD symptoms. Together with the findings of previous studies, this suggests that safety behavior may be involved in the development of anxiety disorders and OCD. Potential mechanisms of how engaging in safety behavior increases threat perception are discussed.
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http://dx.doi.org/10.1016/j.beth.2015.04.001DOI Listing
July 2015

Proust revisited: odours as triggers of aversive memories.

Cogn Emot 2012 1;26(1):83-92. Epub 2011 Jun 1.

Clinical and Health Psychology, Utrecht University, Utrecht, The Netherlands.

According to the Proust phenomenon, olfactory memory triggers are more evocative than other-modality triggers resulting in more emotional and detailed memories. An experimental paradigm was used to investigate this in aversive memories, similar to those experienced by patients with posttraumatic stress disorder. Seventy healthy participants watched an aversive film, while simultaneously being exposed to olfactory, auditory and visual triggers, which were matched on intensity, valence, arousal and salience. During a second session one week later, participants were randomly exposed to one of the three triggers, and asked to think back about the film and to rate the resulting memory. Results revealed that odour-evoked memories of aversive events were more detailed, unpleasant and arousing than memories evoked by auditory, but not visual, triggers.
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http://dx.doi.org/10.1080/02699931.2011.555475DOI Listing
April 2012

Exposure plus response prevention versus exposure plus safety behaviours in reducing feelings of contamination, fear, danger and disgust. An extended replication of Rachman, Shafran, Radomsky & Zysk (2011).

J Behav Ther Exp Psychiatry 2011 Sep 24;42(3):364-70. Epub 2011 Feb 24.

Utrecht University, The Netherlands.

Background And Objectives: Safety behaviours are widely held to impede the beneficial effects of exposure, certainly in OCD. Recently, Rachman, Radomsky, Shafran, and Zysk (2011) challenged this view. Healthy volunteers repeatedly touched a contaminant in two sessions. Half of the participants did not engage in safety behaviours after touching (exposure + response prevention), while the other half did (exposure + safety behaviours, i.e., cleaning hands with a hygienic wipe). Scores of contamination, fear, danger, and disgust decreased in both sessions and the effects were not impeded by safety behaviours. Three potential artefacts were identified in the Rachman et al. study: a no-treatment control group was lacking, the stop rules for ending exposure differed between conditions, and positive expectations may have been induced in the safety behaviours group. We tried to critically replicate the main findings.

Method: The Rachman et al. (2011) study was replicated, with 44 volunteers but stop rules and expectations were similar between treatments, and effects were also assessed in a no-intervention control group.

Results: Relative to the control condition, both exposure interventions induced reliable decreases in feelings of contamination, fear, danger, and disgust. The decline followed an exponential curve with the largest gains at the first trials of each session.

Limitations: Findings were obtained from a non-clinical sample.

Conclusion: The findings attest to the robustness of the Rachman et al. findings, and challenge the notion that safety behaviours should be dismissed categorically in exposure treatments.
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http://dx.doi.org/10.1016/j.jbtep.2011.02.009DOI Listing
September 2011

EMDR: eye movements superior to beeps in taxing working memory and reducing vividness of recollections.

Behav Res Ther 2011 Feb 22;49(2):92-8. Epub 2010 Nov 22.

Clinical and Health Psychology, Utrecht University, Utrecht, The Netherlands.

Posttraumatic stress disorder (PTSD) is effectively treated with eye movement desensitization and reprocessing (EMDR) with patients making eye movements during recall of traumatic memories. Many therapists have replaced eye movements with bilateral beeps, but there are no data on the effects of beeps. Experimental studies suggest that eye movements may be beneficial because they tax working memory, especially the central executive component, but the presence/degree of taxation has not been assessed directly. Using discrimination Reaction Time (RT) tasks, we found that eye movements slow down RTs to auditive cues (experiment I), but binaural beeps do not slow down RTs to visual cues (experiment II). In an arguably more sensitive "Random Interval Repetition" task using tactile stimulation, working memory taxation of beeps and eye movements were directly compared. RTs slowed down during beeps, but the effects were much stronger for eye movements (experiment III). The same pattern was observed in a memory experiment with healthy volunteers (experiment IV): vividness of negative memories was reduced after both beeps and eye movements, but effects were larger for eye movements. Findings support a working memory account of EMDR and suggest that effects of beeps on negative memories are inferior to those of eye movements.
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http://dx.doi.org/10.1016/j.brat.2010.11.003DOI Listing
February 2011
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