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Klinik für Psychiatrie und Psychotherapie

Research group Külz

"Impact of thought control strategies and mindfulness on insight in obsessive compulsive disorder"

Insight into the unreasonableness or excessiveness of obsessive symptoms has for a long time been regarded as an essential characteristic of obsessive-compulsive disorder (OCD). However, a growing body of research indicates that OCD is characterized by a spectrum of insight with a remarkable proportion of patients exhibiting poor or even absent insight. Since poor insight is associated with greater impairment, this phenomenon deserves more attention in clinical research. Based on clinical observations showing that level of insight varies among different obsessions as well as over time, several authors reject a stable trait-like insight concept, recommending repeated assessments of insight instead of a global, retrospective assessment conducted in a clinical interview setting. Despite this recommendation, the temporal variation of the level of insight has never been empirically studied. Furthermore, it is still unknown which processes are associated with a consecutive increase or decrease of insight level. Several studies indicate that besides engaging in avoidance behavior and compulsions, people suffering from OCD also tend to use maladaptive thought control strategies such as worry and self-punishment in order to deal with unwanted/intrusive thoughts. Since both strategies are presumed to increase the frequency of intrusions, maintain a state of enhanced threat expectation, perceived uncontrollability and heightened distress, it is likely that the use of these maladaptive thought control strategies decreases consecutive level of insight. On the other hand, the use of mindfulness and acceptance-based strategies (characterized by a willingness to experience thoughts and feelings as temporary mental events rather than accurate reflections of reality) are assumed to improve consecutive degree of insight.

In order to investigate these temporal relationships, Ecological Momentary Assessment Method (EMA) provides a powerful research tool. The repeated collection of real-time data on participants’ momentary experiences in their natural environments guarantees the realization of ecological validity. Furthermore, unlike retrospective measures, EMA is less prone to memory distortions like recall biases, because participants are asked to record their current or very recent experiences.

We hypothesize that both antecedent worry and self-punishment predict lower levels of insight in the proximal period as well as time-lagged, whereas a mindful approach in dealing with intrusive thoughts is expected to have the reverse effect. Furthermore, besides corroborating the findings of previous studies suggesting that OCD patients tend to use rather maladaptive than adaptive thought control strategies, this study aims at exploring the relevance of thought control strategies in dealing with unwanted/intrusive thoughts as compared to overt and mental compulsions usually adopted to neutralize obsessions and associated distress. Moreover, it should be examined whether obsessive beliefs surrounding the importance of and the need to control thoughts predict the use of thought control strategies in daily life.

A total of 60 subjects with a primary diagnosis of OCD according to DSM will record current level of insight, OC-symptoms and antecedent use of thought control strategies as well as overt and mental compulsions 10 times a day on 6 consecutive days on a smartphone equipped with the web-based experience-sampling application movisensXS. Data will be analyzed using multilevel modelling to account for the hierarchical structure of real-time data. Besides improving insight conceptualization, the current study could help develop effective intervention strategies to directly target the processes that lead to a decline of insight in OCD e.g. by fostering those strategies that promote a detachment from obsessive fears.

Project Members

  • Dipl.-Psych. Sarah Landmann
  • Dr. Anne Katrin Külz
  • Natalie Peschl
  • Magdalena Schmidt-Ott

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