Advertisement

Cognitive Therapy and Research

, Volume 42, Issue 5, pp 686–698 | Cite as

Attentional Bias and Its Modification in Contamination OCD Symptomatology

  • Melissa Rouel
  • Evelyn Smith
Original Article

Abstract

Attentional biases, particularly difficulty disengaging, have been found in contamination obsessive–compulsive disorder (OCD) and may be a maintaining factor. Attentional bias modification (ABM) may reduce this bias and avoidance behavior. This study examined attentional biases in 54 individuals with contamination OCD symptomatology and whether ABM reduces biases and symptoms. Participants completed one 30 min session of either ABM training or a control task and a spatial cueing task before and after to assess attentional bias. Questionnaires and behavioral tasks were also completed. Participants returned for a follow up 1 month later. As expected, there was evidence of difficulty disengaging from threats directly and indirectly associated with disease. Attention training led to a reduction in this bias, which was maintained for 1 month. However, there was no improvement in avoidance or contamination fear on a behavioral task, contamination OCD symptoms, safety behaviors and anxiety. Implications for treatment of OCD are discussed.

Keywords

Obsessive–compulsive disorder Contamination fear Attentional bias Difficulty disengaging Attentional bias modification 

Notes

Compliance with Ethical Standards

Conflict of Interest

Ms Rouel and Dr Smith declare that they have no conflict of interest.

Animal Rights

This article does not contain any studies with animals performed by any of the authors.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed Consent

Informed consent was obtained from all individual participants included in the study.

References

  1. Adams, T. G., Cisler, J. M., Brady, R. E., Lohr, J. M., & Olatunji, B. O. (2013). Preliminary psychometric evidence for distinct affective and cognitive mechanisms mediating contamination aversion. Journal of Psychopathology and Behavioral Assessment, 35(3), 375–388.  https://doi.org/10.1007/s10862-013-9343-8.CrossRefGoogle Scholar
  2. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: American Psychiatric Association.CrossRefGoogle Scholar
  3. Amir, N., Beard, C., Burns, M., & Bomyea, J. (2009a). Attention modification program in individuals with generalized anxiety disorder. Journal of Abnormal Psychology, 118, 28–33.  https://doi.org/10.1037/a0012589.CrossRefPubMedPubMedCentralGoogle Scholar
  4. Amir, N., Beard, C., Taylor, C. T., Klumpp, H., Elias, J., Burns, M., et al. (2009b). Attention training in individuals with generalised social phobia: A randomized controlled trial. Journal of Consulting and Clinical Psychology, 77(5), 961–973.  https://doi.org/10.1037/a0016685.CrossRefPubMedPubMedCentralGoogle Scholar
  5. Amir, N., Weber, G., Beard, C., Bomyea, J., & Taylor, C. T. (2009c). The effect of a single session attention modification program on response to a public speaking challenge in socially anxious individuals. Journal of Abnormal Psychology, 117, 860–868.  https://doi.org/10.1037/a0013445.CrossRefGoogle Scholar
  6. Bar-Haim, Y. (2010). Research review: Attention bias modification (ABM): A novel treatment for anxiety disorders. Journal of Child Psychology and Psychiatry and Allied Disciplines, 51(8), 859–870.  https://doi.org/10.1111/j.1469-7610.2010.02251.x.CrossRefGoogle Scholar
  7. Bar-Haim, Y., Lamy, D., Pergamin, L., Bakermans-Kranenburg, M. J., & van Ijzendoorn, M. H. (2007). Threat-related attentional bias in anxious and nonanxious individuals: A meta-analytic study. Psychological Bulletin, 133(1), 1–24.  https://doi.org/10.1037/0033-2909.133.1.1.CrossRefPubMedGoogle Scholar
  8. Burns, G. L., Keortge, S. G., Formea, G. M., & Sternberger, L. G. (1996). Revision of the Padua Inventory of obsessive compulsive disorder symptoms: Distinctions between worry, obsessions, and compulsions. Behaviour Research and Therapy, 34(2), 163–173.  https://doi.org/10.1016/0005-7967(95)00035-6.CrossRefPubMedGoogle Scholar
  9. Carretié, L., Ruiz-Padial, E., López-Martín, S., & Albert, J. (2011). Decomposing unpleasantness: Differential exogenous attention to disgusting and fearful stimuli. Biological Psychology, 86(3), 247–253.  https://doi.org/10.1016/j.biopsycho.2010.12.005.CrossRefPubMedGoogle Scholar
  10. Cisler, J. M., Bacon, A. K., & Williams, N. L. (2009). Phenomenological characteristics of attentional biases towards threat: A critical review. Cognitive Therapy and Research, 33(2), 221–234.  https://doi.org/10.1007/s10608-007-9161-y.CrossRefPubMedPubMedCentralGoogle Scholar
  11. Cisler, J. M., Brady, R. E., Olatunji, B. O., & Lohr, J. M. (2010). Disgust and obsessive beliefs in contamination-related OCD. Cognitive Therapy and Research, 34, 439–448.  https://doi.org/10.1007/s10608-009-9253-y.CrossRefPubMedPubMedCentralGoogle Scholar
  12. Cisler, J. M., & Koster, E. H. W. (2010). Mechanisms of attentional biases towards threat in anxiety disorders: An integrative review. Clinical Psychology Review, 30(2), 203–216.  https://doi.org/10.1016/j.cpr.2009.11.003.CrossRefPubMedGoogle Scholar
  13. Cisler, J. M., & Olatunji, B. O. (2010). Components of attentional biases in contamination fear: Evidence for difficulty in disengagement. Behaviour Research and Therapy, 48(1), 74–78.  https://doi.org/10.1016/j.brat.2009.09.003.CrossRefPubMedGoogle Scholar
  14. Cohen, Y., Lachenmeyer, J. R., & Springer, C. (2003). Anxiety and selective attention in obsessive–compulsive disorder. Behaviour Research and Therapy, 41(11), 1311–1323.  https://doi.org/10.1016/S0005-7967(03)00037-8.CrossRefPubMedGoogle Scholar
  15. Cougle, J. R., Wolitzky-Taylor, K. B., Lee, H. J., & Telch, M. J. (2007). Mechanisms of change in ERP treatment of compulsive hand washing: Does primary threat make a difference? Behaviour Research and Therapy, 45(7), 1449–1459.  https://doi.org/10.1016/j.brat.2006.12.001.CrossRefPubMedGoogle Scholar
  16. Curtis, V., Aunger, R., & Rabie, T. (2004). Evidence that disgust evolved to protect from risk of disease. Proceedings of the Royal Society Biological Sciences Series B, 271(Suppl. 4), S131–S133.  https://doi.org/10.1098/rsbl.2003.0144.CrossRefGoogle Scholar
  17. Deacon, B., & Maack, D. J. (2008). The effects of safety behaviors on the fear of contamination: An experimental investigation. Behaviour Research and Therapy, 46(4), 537–547.  https://doi.org/10.1016/j.brat.2008.01.010.CrossRefPubMedGoogle Scholar
  18. Fox, E., Russo, R., Bowles, R., & Dutton, K. (2001). Do threatening stimuli draw or hold visual attention in subclinical anxiety? Journal of Experimental Psychology: General, 130(4), 681–700.  https://doi.org/10.1037/0096-3445.130.4.681.CrossRefGoogle Scholar
  19. Fox, E., Russo, R., & Dutton, K. (2002). Attentional bias for threat: Evidence for delayed disengagement from emotional faces. Cognition and Emotion, 16(3), 355–379.  https://doi.org/10.1080/02699930143000527.CrossRefPubMedGoogle Scholar
  20. Grafton, B., Mackintosh, B., Vujic, T., & MacLeod, C. (2014). When ignorance is bliss: Explicit instruction and the efficacy of CBM-A for anxiety. Cognitive Therapy and Research, 38(2), 172–188.  https://doi.org/10.1007/s10608-013-9579-3.CrossRefGoogle Scholar
  21. Hoc, J. M. (2001). Towards ecological validity of research in cognitive ergonomics. Theoretical Issues in Ergonomics Science, 2(3), 278–288.  https://doi.org/10.1080/14639220110104970.CrossRefGoogle Scholar
  22. Koster, E. H. W., Crombez, G., Verschuere, B., & De Houwer, J. (2004). Selective attention to threat in the dot probe paradigm: Differentiating vigilance and difficulty to disengage. Behaviour Research and Therapy, 42(10), 1183–1192.  https://doi.org/10.1016/j.brat.2003.08.001.CrossRefPubMedGoogle Scholar
  23. Koster, E. H. W., Crombez, G., Verschuere, B., Van Damme, S., & Wiersema, J. R. (2006). Components of attentional bias to threat in high trait anxiety: Facilitated engagement, impaired disengagement, and attentional avoidance. Behaviour Research and Therapy, 44(12), 1757–1771.  https://doi.org/10.1016/j.brat.2005.12.011.CrossRefPubMedGoogle Scholar
  24. Koster, E. H. W., Fox, E., & MacLeod, C. (2009). Introduction to the special section on cognitive bias modification in emotional disorders. Journal of Abnormal Psychology, 118(1), 1–4.  https://doi.org/10.1037/a0014379.CrossRefPubMedGoogle Scholar
  25. Krebs, G., Hirsch, C. R., & Mathews, A. (2010). The effect of attention modification with explicit vs. minimal instructions on worry. Behaviour Research and Therapy, 48(3), 251–256.  https://doi.org/10.1016/j.brat.2009.10.009.CrossRefPubMedGoogle Scholar
  26. Lang, P. J., Bradley, M. M., & Cuthbert, B. N. (2005). International affective picture system (IAPS): Affective ratings of pictures and instruction manual. Gainseville, FL: University of Florida.Google Scholar
  27. Lazarov, A., Abend, R., Seidner, S., Pine, D. S., & Bar-Haim, Y. (2017). The effects of training contingency awareness during attention bias modification on learning and stress reactivity. Behavior Therapy, 48(5), 638–650.  https://doi.org/10.1016/j.beth.2017.03.002.CrossRefPubMedGoogle Scholar
  28. Liao, H. I., Yeh, S. L., & Shimojo, S. (2011). Novelty vs. familiarity principles in preference decisions: Task-context of past experience matters. Frontiers in Psychology, 2, 1–8.  https://doi.org/10.3389/fpsyg.2011.00043.CrossRefGoogle Scholar
  29. Mikels, J. A., Fredrickson, B. L., Larkin, G. R., Lindberg, C. M., Maglio, S. J., & Reuter-Lorenz, P. A. (2005). Emotional category data on images from the international affective picture system. Behavior Research Methods, 37(4), 626–630.  https://doi.org/10.3758/BF03192732.CrossRefPubMedPubMedCentralGoogle Scholar
  30. Mogg, K., & Bradley, B. P. (1998). A cognitive motivational analysis of anxiety. Behaviour Research and Therapy, 36, 809–848.  https://doi.org/10.1016/S0005-7967(98)00063-1.CrossRefPubMedGoogle Scholar
  31. Mogg, K., & Bradley, B. P. (2016). Anxiety and attention to threat: Cognitive mechanisms and treatment with attention bias modification. Behaviour Research and Therapy, 87, 76–108.  https://doi.org/10.1016/j.brat.2016.08.001.CrossRefPubMedGoogle Scholar
  32. Mogg, K., Holmes, A., Garner, M., & Bradley, B. P. (2008). Effects of threat cues on attentional shifting, disengagement and response slowing in anxious individuals. Behaviour Research and Therapy, 46(5), 656–667.  https://doi.org/10.1016/j.brat.2008.02.011.CrossRefPubMedPubMedCentralGoogle Scholar
  33. Mogoaşe, C., David, D., & Koster, E. H. W. (2014). Clinical efficacy of attentional bias modification procedures: An updated meta-analysis. Journal of Clinical Psychology, 70(12), 1133–1157.  https://doi.org/10.1002/jclp.22081.CrossRefPubMedGoogle Scholar
  34. Moritz, S., Von Mühlenen, A., Randjbar, S., Fricke, S., & Jelinek, L. (2009). Evidence for an attentional bias for washing- and checking-relevant stimuli in obsessive-compulsive disorder. Journal of the International Neuropsychological Society, 15(3), 365–371.  https://doi.org/10.1017/S1355617709090511.CrossRefPubMedGoogle Scholar
  35. Najmi, S., & Amir, N. (2010). The effect of attention training on a behavioral test of contamination fears in individuals with subclinical obsessive-compulsive symptoms. Journal of Abnormal Psychology, 119(1), 136–142.  https://doi.org/10.1037/a0017549.CrossRefPubMedPubMedCentralGoogle Scholar
  36. Ólafsson, R. P., Smári, J., Guðmundsdóttir, F., Ólafsdóttir, G., Harðardóttir, H. L., & Einarsson, S. M. (2011). Self reported attentional control with the attentional control scale: Factor structure and relationship with symptoms of anxiety and depression. Journal of Anxiety Disorders, 25(6), 777–782.  https://doi.org/10.1016/j.janxdis.2011.03.013.CrossRefPubMedGoogle Scholar
  37. Olatunji, B. O., Connolly, K., Lohr, J. M., & Elwood, L. S. (2008). Access to information about harm and safety in contamination-related obsessive-compulsive disorder. Journal of Cognitive Psychotherapy, 22(1), 57–67.  https://doi.org/10.1891/0889.8391.22.1.57.CrossRefGoogle Scholar
  38. Park, J., Shimojo, E., & Shimojo, S. (2010). Roles of familiarity and novelty in visual preference judgments are segregated across object categories. Proceedings of the National Academy of Sciences, 107(33), 14552–14555.  https://doi.org/10.1073/pnas.1004374107.CrossRefGoogle Scholar
  39. Peirce, J. W. (2007). PsychoPy—Psychophysics software in Python. Journal of Neuroscience Methods, 165(1–2), 8–13.  https://doi.org/10.1016/j.jneumeth.2006.11.017.CrossRefGoogle Scholar
  40. Posner, M. A. I. (1980). Orienting of attention. Quarterly of Journal of Experimental Psychology, 32A(1), 3–25.  https://doi.org/10.1080/00335558008248231.CrossRefGoogle Scholar
  41. Rachman, S. (2004). Fear of contamination. Behaviour Research and Therapy, 42(11), 1227–1255.  https://doi.org/10.1016/j.brat.2003.10.009.CrossRefPubMedGoogle Scholar
  42. Rouel, M., Stevenson, R. J., & Smith, E. (2018). Examination of responses involved in contamination aversion based on threat type. Journal of Social and Clinical Psychology, 37(2), 83–106.  https://doi.org/10.1521/jscp.2018.37.2.83.CrossRefGoogle Scholar
  43. Sagliano, L., Trojano, L., Amoriello, K., Migliozzi, M., & D’Olimpio, F. (2014). Attentional biases toward threat: The concomitant presence of difficulty of disengagement and attentional avoidance in low trait anxious individuals. Frontiers in Psychology, 5, 1–7.  https://doi.org/10.3389/fpsyg.2014.00685.CrossRefGoogle Scholar
  44. Sheehan, D. V., Lecrubier, Y., Sheehan, K. H., Amorim, P., Janavas, J., Weiller, E., et al. (1998). The Mini-International Neuropsychiatric Interview (MINI): The development and validation of a structured diagnostic psychiatric interview for DSM-IV and ICD-10. Journal of Clinical Psychiatry, 59(Suppl 20), 22–33.PubMedGoogle Scholar
  45. Smith, E., & Rieger, E. (2009). The effect of attentional training on body dissatisfaction and dietary restriction. European Eating Disorders Review, 17(3), 169–176.  https://doi.org/10.1002/erv.921.CrossRefPubMedGoogle Scholar
  46. Summerfeldt, L. J., & Endler, N. S. (1998). Examining the evidence for anxiety-related cognitive biases in obsessive-compulsive disorder. Journal of Anxiety Disorders, 12(6), 579–598.  https://doi.org/10.1016/S0887-6185(98)00035-8.CrossRefPubMedGoogle Scholar
  47. Tata, P. R., Leibowitz, J. A., Prunty, M. J., Cameron, M., & Pickering, A. D. (1996). Attentional bias in obsessional compulsive disorder. Behaviour Research and Therapy, 34(1), 53–60.  https://doi.org/10.1016/0005-7967(95)00041-U.CrossRefPubMedGoogle Scholar
  48. Weierich, M. R., Treat, T. A., & Hollingworth, A. (2008). Theories and measurement of visual attentional processing in anxiety. Cognition and Emotion, 22, 985–1018.  https://doi.org/10.1080/02699930701597601.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  1. 1.School of Social Sciences and PsychologyWestern Sydney UniversityPenrith South DCAustralia
  2. 2.Clinical and Health Psychology Research Initiative (CaHPRI)Western Sydney UniversityPenrith South DCAustralia

Personalised recommendations