Hill Tower

General Mental Health

Betty Liao, Metaxia Toumbelekis, Enrique Mergelsberg, Asher Strauss, Güliz Şenormanci / Arnoud Arntz (Chair) Speaker

Chair: Arnoud Arntz, University of Amsterdam

14:00 The Effects of Attention Allocation on Fear Extinction
           Betty Liao, University of California San Francisco-Fresno
           Michelle Craske,University of California Los Angeles

14:15 Thinking of your loved one can reduce fear learning.
           Metaxia Toumbelekis, Belinda J. Liddell, Richard A. Bryant, UNSW Sydney

14:30 An Investigation into Factors that Influence Successful Attention Bias Modification
           Enrique Mergelsberg, Patrick Clarke, Ottmar Lipp, Curtin University

14:45 Does Uncertainty Induce Checking Behavior in the Lab? A Meta-Analysis of OCD and
           Asher Strauss,Issac Fradkin,Jonathan D. Huppert, The Hebrew University of Jerusalem
           Omer Linkovski, Stanford University
           Gideon Anholt, Ben-Gurion University of the Negev

15:00 Comparison of Metacognitions in Obsessive Compulsive Disorder, Generalized Anxiety
             Disorder, Panic Disorder and Healthy Controls
           Güliz Şenormanci, University of Health Sciences Bursa
           Ramazan Konkan, University of Health Sciences Bakirkoy
           Oya Güçlü, Ömer Şenormanci,University of Health Sciences Bagcilar

15:15 Discussion


1) The Effects of Attention Allocation on Fear Extinction

Betty Liao, Center for Medical Education and Research, University of California San Francisco-Fresno;Michelle Craske, Department of Psychology, University of California Los Angeles.

Although the literature on fear conditioning and the literature on selective attention to threat have received wide support and have consequently implicated the treatment of anxiety disorders in their own right, there is very little integration and reconciliation of the two into a more parsimonious, yet comprehensive, theory of anxiety development, maintenance, and treatment. This study attempted to integrate both bodies of work by examining the effect of attention bias modification training upon Pavlovian fear extinction.  This study tested the prediction that training attention towards the threat cue (CS+) would facilitate fear extinction; whereas training attention towards the safety cue (CS-) would impair fear extinction.  High trait-anxious participants were trained to attend towards the threat cue, towards the safety cue, or equally to both cues in a modified dot probe task.  Next, transfer of attention processing tendencies was examined in a differential conditioning paradigm across 2 visits.   Results indicated participants trained to attend towards the safety cue demonstrated temporary enhancement of extinction performance, but it did not persist through Visit 2.  Participants trained to attend towards the threat cue demonstrated reduced fear responding on an expectancy measure of conditioning that did not become apparent until Visit 2.  These results suggest that attention training towards the threat cue may benefit extinction learning in the long-term and that attention training towards the safety cue may provide short-term relief from fear.  Other clinical implications will be discussed.


2) Thinking of your loved one can reduce fear learning.

Metaxia Toumbelekis; Belinda J. Liddell; Richard A. Bryant, School of Psychology, UNSW Sydney, Australia

We have evolved to seek proximity to our attachment figures especially during times of distress or threat.  Attachment theory has been studied extensively in infants for decades. More recently, the literature has begun to elucidate the benefits of this proximity-seeking behaviour to attachment figures even in adulthood.  There is evidence that even thinking of an attachment figure elicits a range of psychological benefits and enhances emotion regulation.  However, the extent to which activating attachment representations impact acquisition and extinction of fear memories has not yet been thoroughly studied. This research question would have important implications for our understanding of how fear develops and how it can be better treated.  In this study, 50 participants underwent a standard fear conditioning and extinction paradigm. Half the participants thought about a supportive attachment figure and half thought about a non-attachment positive experience prior to the fear conditioning. All participants then underwent a differential fear conditioning and fear extinction paradigm, and returned two days later for an extinction recall task. Fear-potentiated startle and subjective expectancy of shock ratings were measured as the primary indicators of fear learning across trials.The attachment prime significantly reduced the acquisition of fear-potentiated startle (p = 0.028), and this lower level of fear was maintained at the extinction recall task (p = 0.028).These results demonstrate that attachment primes can modulate the acquisition of conditioned fear. These findings provide preliminary evidence for the protective nature of attachment relationships at times that are characterized by fear learning.  Future studies will examine the impact of attachment primes on fear extinction to identify if this protective mechanism can boost the learning process occurring during exposure-based therapies such as in Cognitive-Behavioral Therapy (CBT).

3) An Investigation into Factors that Influence Successful Attention Bias Modification Training
Enrique L.P. Mergelsberg, Patrick J.F. Clarke, Ottmar V. Lipp, School of Psychology, Curtin University, Perth, Australia

Attention is at default a biased mechanism that guides our perception. It is believed that the tendency to selectively attend to negative information can lead to the development and maintenance of emotional and non-emotional disorders. A substantial body of literature has sought to examine the potential therapeutic benefits of modifying biased attention in an attention bias modification (ABM) paradigm. ABM typically employs the dot-probe task (DPT) to assess and train selective attention. Previous studies have shown that if selective attention training is successful, it leads to a decrease in attention bias and, subsequently, disorder-related symptoms. However, the conditions under which selective attention can be reliably and successfully modified with a DPT is still unclear. The two experiments conducted investigated how malleable attention bias is and what role contingency awareness plays in ABM using the DPT. In an attempt to establish a baseline for the training and transfer of ABM with DPT, Experiment 1 used only neutral stimuli (shapes). First, participants (n = 46) were trained in 160 trials towards one of the two shapes in a 95/5% contingency, within training, the 95% congruent was compared with the 5% incongruent trials to assess if training was successful. Then possible transfer was assessed in a 50/50% contingency in a post-training assessment (80 trails). Secondly, the contingency was reversed in the second training, attention bias was assessed and in the end contingency awareness was reported. It was found that only in the second training, selective attention was successfully modified, however, only when participants were aware of the stimulus-target contingency (n = 23). This effect was not transferred to the post-training assessment. Overall, it was concluded that selective attention towards neutral stimuli is malleable when aware of the stimulus-target contingency, and that 160 training trials may not be enough to achieve initial training. The second experiment included emotional stimuli and investigated if attention control mediates contingency awareness and training of selective attention. Participants (n = 120) completed anxiety questionnaires and a baseline assessment of selective attention of 80 trials. Then a training of 240 trials, either towards angry or neutral faces or no training (control), was followed by a post-assessment. Finally, contingency awareness was reported, and attention control and state anxiety were assessed. Firstly, the findings showed that participants in the trained towards neutral condition did not become aware of the contingency (compared to 50% in the trained towards angry condition). This could possibly explain why the effect of awareness was only marginally significant this time. Secondly, individual measures of anxiety and attention control did not explain any variance. Finally, it was replicated that there was no transfer evident from training to assessment. The lack of transfer to assessment could suggest that the assessment is influencing the pattern of bias rather than simply capturing what happens in training. These results give insight in important factors that influence successful training of selective attention in ABM. This insight could help improve ABM and deliver better methods that also may transfer to the clinic.    

4) Does Uncertainty Induce Checking Behavior in the Lab? A Meta-Analysis of OCD and Checking

Asher Strauss,Issac Fradkin, Department of Psychology, The Hebrew University of Jerusalem;Linkovski Omer,Department of Psychiatryand Behavioral Sciences, Stanford University;Gideon Anholt, Department of Psychology, Ben-Gurion University of the Negev; Jonathan D. Huppert, Department of Psychology, The Hebrew University of Jerusalem.

Obsessive compulsive disorder (OCD) is characterized by repetitive ritual behaviors that the person feels compelled to perform. A common reported compulsion in OCD is checking. Recently, an important model for the onset and maintenance of compulsive checking has been proposed: feelings of uncertainty prompt the checking behavior, and the checking behavior itself perpetuates feelings of uncertainty, resulting in a vicious cycle. While this proposed model is congruent with several recent findings and appeals to clinical intuition, the context and means in which individuals suffering from OCD react with checking behavior is not fully understood. In fact, past reports have been mixed. More importantly, given that uncertainty is suggested by the model to both promote checking and result from checking, the mere observation that OCD is associated with tendency to check does not imply that uncertainty causes checking, nor that checking causes uncertainty. To support the model, both directions need to be empirically substantiated in the lab. The purpose of the current meta-analysis is to examine the causal role of uncertainty as promoting checking. Four databases (PsycNet, Pubmed, Web of Science, and Proquest) were searched for experimental tasks in which uncertainty was manipulated and a behavioral measure of checking was obtained. Eligible studies were required to include: 1) A task in which participants were forced to decide between two or more options 2) Exploration of options and exploitation of options were separate phases. 3) The amount of checking behavior was measured via a behavioral measure (checking could refer to requesting the same information again or new information) 5) Direct comparison between adult with a primary diagnosis of OCD and healthy controls. 6) Treatment studies will be included only if pre-treatment test scores were reported. 7) Only studies written in English or translated to English will be included. Our search, after removing duplicates, yielded 1927 studies. We are currently engaged in abstract screening and study coding. So far 19 studies have met inclusion criteria. Various tasks were identified including: the bead task, card task, information sampling task, delayed matching to sample task, virtual reality checking task and eye tracking checking task. Possible moderators which are being coded and examined include but are not limited to: stimulus type (anxiety provoking / OCD threat provoking / neutral), consequence of decision (reward / punishment / none) and checking type (new / same information). Analysis will be conducted using a multilevel random-effect model to account for the nested nature of the data (e.g. multiple dependent variables within tasks). Detailed results will be presented and discussed within the context of the onset and maintenance model for checking behavior.


5) Comparison of Metacognitions in Obsessive Compulsive Disorder, Generalized Anxiety Disorder, Panic Disorder and Healthy Controls

Güliz Şenormanci,Ramazan Konkan,Oya Güçlü, Ömer Şenormanci,University of Health Sciences Bursa Yuksek Ihtisas Training and Research Hospital, University of Health Sciences Bakirkoy Training and Research Hospital, University of Health Sciences Bagcilar Training and Research Hospital

Although there are studies evaluating dysfunctional metacognitive functions in anxiety disorder and depression, as far as we know, there is no study investigating metacognitive functions in obsessive compulsive disorder  (OCD), generalized anxiety disorder (GAD), panic disorder (PD) and healty control (HC) groups. The aim of the present study was to compare metacognitions in OCD, GAD, PD and HC groups.
The present study included 106 OCD, 100 GAD and 104 PD patients who referred to Bakırköy Training and Research Hospital met study criteria and 105 HC. In the present study,  Metacognition Questionnaire-30 (MCQ-30), Beck Depression Inventory (BDI), Generalized Anxiety Disorder-7 (GAD-7), Panic and Agoraphobia Scale (PAS), Yale-Brown Obsessive Compulsive Scale (Y-BOCS) were used to evaluate patients. Groups were compared in terms of metacognition with and without controlling confounding effects of depression level.
MCQ-30 cognitive confidence (CC) score in OCD group was significantly higher than that in HC. When depression levels were controlled for, significant difference between HC and OCD groups with regard to MCQ-30 CC scores disappeared. MCQ-30 negative beliefs about uncontrollability of thoughts and danger (NBUD) score was significantly higher in GAD group than HC group, but when the confounding effect of depression was controlled for, this significance disappeared.
OCD, GAD and PD have some characteristics in terms of dysfunctional metacognitions. No clear unique profile exists among the groups. This indicates that it could represent a transdiagnostic phenomenon.
Metacognition, obsessive compulsive disorder, generalized anxiety disorder, panic disorder, depression