Advertisement

Choice Blindness, Confabulatory Introspection, and Obsessive–Compulsive Symptoms: Investigation in a Clinical Sample

  • Shiu F. WongEmail author
  • Frederick Aardema
  • Martha Giraldo-O’Meara
  • Lars Hall
  • Petter Johansson
Original Article

Abstract

The content of obsessions in obsessive–compulsive disorder (OCD) often run contrary to the actual self of the individual experiencing them. The ego-dystonic nature of obsessions has led some researchers to propose that individuals with OCD form these false beliefs about themselves due to limited introspective access. The current study therefore aimed to extend on recent findings from non-clinical samples, which suggest the relevance of confabulatory introspection on OCD symptoms, in a clinical population. Participants were community participants diagnosed with OCD (n = 54) or another anxiety or mood disorder (n = 28), as well as healthy individuals (n = 110). Groups completed the Choice Blindness Paradigm, an experimental task designed to have participants confabulate outside of their awareness. Contrary to predictions, the OCD group did not have a greater proportion of individuals who confabulated on this task. Furthermore, only within healthy participants was the occurrence of confabulation associated with elevated OCD symptoms. We speculate that confabulatory introspection may be an important precursor to the development of clinical obsessions and its early detection could inform the prevention of obsessive–compulsive and related disorders.

Keywords

Choice blindness Obsessive–compulsive disorder 

Notes

Funding

The study was supported by a grant (no. 111261) awarded to the second author from the Canadian Institutes for Health Research (CIHR). The first author is also a recipient of a senior research scholar award from the Quebec Health Research Fund (Fonds de la recherche en santé du Québec). The fourth and fifth authors were supported by the Swedish Research Council (2014-1371).

Compliance with Ethical Standards

Conflict of interest

The authors declare that they have no conflicts of interest.

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. Aardema, F., Johansson, P., Hall, L., Paradisis, S. M., Zidani, M., & Roberts, R. (2014). Choice blindness, confabulatory introspection, and obsessive-compulsive symptoms: A new area of investigation. International Journal of Cognitive Therapy,7, 83–102.  https://doi.org/10.1521/ijct.2014.7.1.83.CrossRefGoogle Scholar
  2. Aardema, F., & O’Connor, K. P. (2007). The menace within: Obsessions and the self. Journal of Cognitive Psychotherapy: An International Quarterly,21, 182–197.  https://doi.org/10.1891/088983907781494573.CrossRefGoogle Scholar
  3. Aardema, F., O’Connor, K. P., & Emmelkamp, P. M. G. (2006). Inferential confusion and obsessive beliefs in obsessive-compulsive disorder. Cognitive Behaviour Therapy,35, 138–147.  https://doi.org/10.1080/16506070600621922.CrossRefPubMedGoogle Scholar
  4. Aardema, F., O’Connor, K. P., Pelissier, M., & Lavoie, M. E. (2009). The quantification of doubt in obsessive-compulsive disorder. International Journal of Cognitive Therapy,2, 118–205.  https://doi.org/10.1521/ijct.2009.2.2.188.CrossRefGoogle Scholar
  5. Beck, A., Epstein, N., Brown, G., & Steer, R. A. (1988). An inventory for measuring clinical anxiety: Psychometric properties. Journal of Consulting and Clinical Psychology,56, 893–897.  https://doi.org/10.1037/0022-006X.56.6.893.CrossRefPubMedGoogle Scholar
  6. Beck, A., Steer, R. A., & Brown, G. K. (1996). Beck depression inventory—Second edition manual. San Antonio: The Psychological Corporation.Google Scholar
  7. Berman, N. C., Wheaton, M. G., Fabricant, L. E., Jacobson, S. R., & Abramowitz, J. S. (2011). The effects of familiarity on thought-action fusion. Behaviour Research and Therapy,49, 695–699.  https://doi.org/10.1016/j.brat.2011.07.010.CrossRefPubMedGoogle Scholar
  8. Clark, D. A. (2015). Innovation in obsessive-compulsive disorder: A commentary. Journal of Behavior Therapy and Experimental Psychiatry,49, 129–132.  https://doi.org/10.1016/j.jbtep.2015.10.006.CrossRefPubMedGoogle Scholar
  9. Clark, D. A., & O’Connor, K. P. (2005). Thinking is believing: Ego-dystonic intrusive thoughts in obsessive-compulsive disorder. In D. A. Clark (Ed.), Intrusive thoughts in clinical disorders: Theory, research, and treatment (pp. 145–174). New York: The Guildford Press.Google Scholar
  10. Dar, R. (2004). Elucidating the mechanism of uncertainty and doubt in obsessive-compulsive checkers. Journal of Behavior Therapy and Experimental Psychiatry,35, 153–163.  https://doi.org/10.1016/j.jbtep.2004.04.006.CrossRefPubMedGoogle Scholar
  11. Doron, G., Kyrios, M., & Moulding, R. (2007). Sensitive domains of self-concept in obsessive-compulsive disorder (OCD): Further evidence for a multidimensional model of OCD. Journal of Anxiety Disorders,21, 433–444.  https://doi.org/10.1016/j.janxdis.2006.05.008.CrossRefPubMedGoogle Scholar
  12. First, M. B., Spitzer, R. L., Gibbon, M., & Williams, J. B. W. (2002). Structured clinical interview for DSM-IV-TR axis I disorders, research version, patient edition (SCID-I/P). New York: Biometrics Research, New York State Psychiatric Institute.Google Scholar
  13. Hall, L., Johansson, P., & Strandberg, T. (2012). Lifting the veil of morality: Choice blindness and attitude reversals on a self-transforming survey. PLoS ONE.  https://doi.org/10.1371/journal.pone.0045457.CrossRefPubMedPubMedCentralGoogle Scholar
  14. Janet, P. (1903). Les obsessions et la psychasthenie. Paris: Alcan.Google Scholar
  15. Johansson, P., Hall, L., Sikstrom, S., & Olsson, A. (2005). Failure to detect mismatches between intention and outcome in a simple decision task. Science,310, 116–119.  https://doi.org/10.1126/science.1111709.CrossRefPubMedGoogle Scholar
  16. Johansson, P., Hall, L., Sikstrom, S., Tarning, B., & Lind, A. (2006). How something can be said about telling more than we can know: On choice blindness and introspection. Consciousness and Cognition,15, 673–699.  https://doi.org/10.1016/j.concog.2006.09.004.CrossRefPubMedGoogle Scholar
  17. Kirouac, C., Denis, I., Fontaine, A., & Cote, S. (2006). Questionnaire sur la Santé: Fernand-Seguin Research Center, Louis-H Lafontaine Hospital.Google Scholar
  18. Lazarov, A., Cohen, T., Liberman, N., & Dar, R. (2015). Can doubt attenuate access to internal states? Implications for obsessive-compulsive disorder. Journal of Behavior Therapy and Experimental Psychiatry,49, 150–156.  https://doi.org/10.1016/j.jbtep.2014.11.003.CrossRefPubMedGoogle Scholar
  19. Myers, S. G., Fisher, P. L., & Wells, A. (2008). Belief domains of the Obsessive Beliefs Questionnaire-44 (OBQ-44) and their specific relationship with obsessive-compulsive symptoms. Journal of Abnormal Psychology,22, 475–484.  https://doi.org/10.1016/j.janxdis.2007.03.012.CrossRefGoogle Scholar
  20. Nedeljkovic, M., & Kyrios, M. (2007). Confidence in memory and other cognitive processes in obsessive-compulsive disorder. Behaviour Research and Therapy,45, 2899–2914.  https://doi.org/10.1016/j.brat.2007.08.001.CrossRefPubMedGoogle Scholar
  21. Nedeljkovic, M., Moulding, R., Kyrios, M., & Doron, G. (2009). The relationship of cognitive confidence to OCD symptoms. Journal of Anxiety Disorders,23, 463–468.  https://doi.org/10.1016/j.janxdis.2008.10.001.CrossRefPubMedGoogle Scholar
  22. Nisbett, R. E., & Wilson, T. D. (1977). Telling more than we can know: Verbal reports on mental processes. Psychological Review,9, 38–46.  https://doi.org/10.1037/0033-295X.84.3.231.CrossRefGoogle Scholar
  23. Obsessive Compulsive Cognitions Working Group. (2005). Psychometric validation of the Obsessive Belief Questionnaire and Interpretation of Intrusions Inventory—Part 2: Factor analyses and testing of a brief version. Behaviour Research and Therapy,43, 1527–1542.  https://doi.org/10.1016/j.brat.2004.07.010.CrossRefGoogle Scholar
  24. O’Connor, K. P. (2002). Intrusions and inferences in obsessive-compulsive disorder. Clinical Psychology and Psychotherapy,9, 38–46.  https://doi.org/10.1002/cpp.303.CrossRefGoogle Scholar
  25. Pennebaker, J. W., Boyd, R. L., Jordan, K., & Blackburn, K. (2015). The development and psychometric properties of LIWC2015. TX: Austin.Google Scholar
  26. Phillips, K. A. (2004). Psychosis in body dysmorphic disorder. Journal of Psychiatric Research,38, 63–72.  https://doi.org/10.1016/S0022-3956(03)00098-0.CrossRefPubMedGoogle Scholar
  27. Phillips, K. A., Didie, E. R., Menard, W., Pagano, M. E., Fay, C., & Weisberg, R. B. (2006). Clinical features of body dysmorphic disorder in adolescents and adults. Psychiatry Research,141, 305–314.  https://doi.org/10.1016/j.psychres.2005.09.014.CrossRefPubMedPubMedCentralGoogle Scholar
  28. Rachman, S. (2003). The treatment of obsessions. Oxford: Oxford University Press.CrossRefGoogle Scholar
  29. Rachman, S., & de Silva, P. (1978). Abnormal and normal obsessions. Behaviour Research and Therapy,16, 233–248.  https://doi.org/10.1016/0005-7967(78)90022-0.CrossRefPubMedGoogle Scholar
  30. Rachman, S., & Hodgson, R. J. (1980). Obsessions and compulsions. Englewood Cliffs: Prentice-Hall.Google Scholar
  31. Radomsky, A. S., Alcolado, G. M., Abramowitz, J. S., Alonso, P., Belloch, A., Bouvard, M., et al. (2014). Part 1. You can run but you can’t hide: Intrusive thoughts on 6 continents. Journal of Obsessive-Compulsive and Related Disorders,3, 269–279.  https://doi.org/10.1016/j.jocrd.2013.09.002.CrossRefGoogle Scholar
  32. Raine, A. (1991). The SPQ: A scale for the assessment of schizotypal personality based on DSM-III-R criteria. Schizophrenia Bulletin,17, 556–564.  https://doi.org/10.1093/schbul/17.4.555.CrossRefGoogle Scholar
  33. Shafran, R., & Rachman, S. (2004). Thought-action fusion: A review. Journal of Behavior Therapy and Experimental Psychiatry,35, 87–107.  https://doi.org/10.1016/j.jbtep.2004.04.002.CrossRefPubMedGoogle Scholar
  34. Thordarson, D. S., Radomsky, A. S., Rachman, S., Shafran, R., Sawchuk, C. N., & Hakstian, A. R. (2004). The vancouver obsessional compulsive inventory (VOCI). Behaviour Research and Therapy,42, 1289–1314.  https://doi.org/10.1016/j.brat.2003.08.007.CrossRefPubMedGoogle Scholar
  35. Tolin, D. F., Abramowitz, J. S., Brigidi, B. D., Amir, N., Street, G. P., & Foa, E. B. (2001). Memory and memory confidence in obsessive-compulsive disorder. Behaviour Research and Therapy,39, 913–927.CrossRefGoogle Scholar
  36. van den Hout, M., Engelhard, I. M., Smeets, M., Dek, E. C., Turksma, K., & Saric, R. (2009). Uncertainty about perception and dissociation after compulsive-like staring: Time course of effects. Behaviour Research and Therapy,47, 535–539.  https://doi.org/10.1016/j.brat.2009.03.001.CrossRefPubMedGoogle Scholar
  37. Wong, S. F., & Grisham, J. R. (2018). Factors leading to immersion in obsessions. Journal of Experimental Psychopathology.  https://doi.org/10.1177/2043808718778981.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of PsychologyConcordia UniversityMontréalCanada
  2. 2.Centre de Recherche de l’Institut Universitaire en Santé Mentale de MontréalMontréalCanada
  3. 3.Department of Psychiatry and AddictologyUniversity of MontréalMontréalCanada
  4. 4.Lund University Cognitive Science, Lund UniversityLundSweden

Personalised recommendations