Cornelia Exner

A Taxometric Exploration of the Latent Structure of Hoarding.

Despite controversy regarding the classification and diagnostic status of hoarding disorder, there remains a paucity of research on the nosology of hoarding that is likely to inform the classification debate. The present investigation examined the latent structure of hoarding in three, large independent samples. Data for three well-validated measures of hoarding were subjected to taxometric procedures, including MAXimum EIGenvalue, Mean Above Minus Below A Cut, and Latent-Mode factor. Two symptom measures, one of which closely mirrors the proposed diagnostic criteria for hoarding disorder, and a measure of hoarding beliefs were analyzed. Sample 1 (n=2,501) was representative of the general German population, while Samples 2 (n=1,149) and 3 (n=500) consisted of unselected undergraduate students. Findings across all three samples and taxometric procedures provided converging evidence that hoarding is best conceptualized as a dimensional construct, present in varying degrees in all individuals. Results have implications across research and treatment domains, particularly with respect to assessment approaches, treatment response determination, and policy decisions. These findings underscore the need for further investigations on the nosology of hoarding, to help validate this construct as we move forward with respect to our research and treatment efforts, as well as the potential inclusion of hoarding disorder in the Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM-5; American Psychiatric Association, 2012).

Hoarding and the multi-faceted construct of impulsivity: A cross-cultural investigation

The proposed hoarding disorder represents a serious psychiatric condition and considerable public health burden. Although tremendous strides have been made in understanding the phenomenology and treatment of this condition, many features regarding the etiology and nosology remain unclear. In particular, the association between impulsivity and hoarding, as well as the differential role of impulsivity versus compulsivity has yet to be fully considered. The current investigation sought to fill this gap in the literature by examining the relationship between hoarding and impulsivity across two independent, cross-cultural investigations. Two separate conceptualizations of the impulsivity construct were considered, including the Barratt Impulsivity Scale and the UPPS Impulsive Behavior Scale. Across Study 1 (US young adult sample; N = 372) and Study 2 (German young adult sample; N = 160) results revealed that hoarding was associated with greater rates of impulsivity, despite controlling for theoretically relevant covariates. More fined-grained analyses revealed a differential relationship with respect to the various facets of impulsivity, such that hoarding was most strongly linked with attentional and motor impulsivity, as well as urgency (i.e., impulsive behaviors in response to negative affect) and lack of perseverance. When considered simultaneously, both impulsivity and non-hoarding OCD symptoms explained unique variance in hoarding. The implications of impulsivity for hoarding are discussed from a classification perspective, as well as from a vulnerability standpoint.

Quality of life in cancer rehabilitation: the role of life goal adjustment.

A cancer diagnosis affects patients quality of life (QOL) as well as their pursuit of life goals. However, numerous studies have shown surprisingly stable QOL measures in cancer patients over time. We propose that life goal adjustment can act as the missing link in explaining this response shift. Thus, the aim of this study was to examine associations between life goal adjustment and patients QOL at baseline and over the course of 20 months.

Decline in attainability of communion and agency life goals over 2 years following acquired brain injury and the impact on subjective well-being.

Acquired brain injury (ABI) confronts patients with sudden and possibly permanent functional impairments which disrupt or block the attainment of important life goals and reduce subjective well-being (SWB). This longitudinal study aimed at investigating changes in the importance and the attainability of communion and agency life goals and their impact on SWB. Self-report measures of life goals, functional status and SWB were assessed in 42 patients during acute rehabilitation two months following ABI (baseline) and reassessed 19 months following discharge (follow up). Results indicate a significant longitudinal decrease of the general attainability of life goals and of the present success in achieving communal and agentic life goals. Life goal importance remained stable. After controlling for baseline SWB and follow up functional status the attainability of communal life goals significantly predicted SWB at follow up whereas agentic life goals failed to predict SWB. The present findings show long-term deterioration of life goal attainability. They highlight that more emphasis should be given to realistic attainability attributions during rehabilitation processes. Moreover, the results stress the need for outpatient treatment to promote disengagement from unobtainable life goals and to offer means for the engagement in alternative life goals in order to maintain or regain SWB.

Imminent danger? Probabilistic classification learning of threat-related information in obsessive-compulsive disorder.

A tendency to overestimate threat has been shown in individuals with OCD. We tested the hypothesis that this bias in judgment is related to difficulties in learning probabilistic associations between events. Thirty participants with OCD and 30 matched healthy controls completed a learning experiment involving 2 variants of a probabilistic classification learning task. In the neutral weather-prediction task, rainy and sunny weather had to be predicted. In the emotional task danger of an epidemic from virus infection had to be predicted (epidemic-prediction task). Participants with OCD were as able as controls to improve their prediction of neutral events across learning trials but scored significantly below healthy controls on the epidemic-prediction task. Lower performance on the emotional task variant was significantly related to a heightened tendency to overestimate threat. Biased information processing in OCD might thus hamper corrective experiences regarding the probability of threatening events.

Selective attention deficits in obsessive–compulsive disorder: The role of metacognitive processes

While initial studies supported the hypothesis that cognitive characteristics that capture cognitive resources act as underlying mechanisms in memory deficits in obsessive-compulsive disorder (OCD), the influence of those characteristics on selective attention has not been studied, yet. In this study, we examined the influence of cognitive self-consciousness (CSC), rumination and worrying on performance in selective attention in OCD and compared the results to a depressive and a healthy control group. We found that 36 OCD and 36 depressive participants were impaired in selective attention in comparison to 36 healthy controls. In all groups, hierarchical regression analyses demonstrated that age, intelligence and years in school significantly predicted performance in selective attention. But only in OCD, the predictive power of the regression model was improved when CSC, rumination and worrying were implemented as predictor variables. In contrast, in none of the three groups the predictive power improved when indicators of severity of obsessive-compulsive (OC) and depressive symptoms and trait anxiety were introduced as predictor variables. Thus, our results support the assumption that mental characteristics that bind cognitive resources play an important role in the understanding of selective attention deficits in OCD and that this mechanism is especially relevant for OCD.

Metacognitive Beliefs and Rumination: A Longitudinal Study

High prevalence and costs of depression underline the importance of understanding and treating vulnerability factors of depression such as rumination. Given the role of rumination in predicting the onset of new depressive episodes, it is important to learn why previously healthy people start to ruminate. One explanation is provided by the metacognitive model of depression, which assumes that positive beliefs about rumination initiate rumination. However previous research has been predominantly cross-sectional in nature. We investigated the effect of positive beliefs about rumination on engagement in rumination in a longitudinal design and tested the indirect effect of positive beliefs about rumination on depressive symptoms in 60 healthy university students. A hierarchical regression revealed a significant effect of Time 1 (T1) positive beliefs about rumination on Time 2 rumination, even after controlling for T1 rumination. Additionally, an indirect effect of positive beliefs about rumination on depressive symptoms via rumination was confirmed using a multiple regression and a Sobel test.

(Re-)defining the self – Enhanced posttraumatic growth and event centrality in stroke survivors: A mixed-method approach and control comparison study

Growing evidences highlight the co-existence of negative and positive (e.g. posttraumatic growth) identity changes following stroke. Identity changes were assessed by comparing 42 survivors 21 months after stroke and healthy controls. A total of 26 stroke survivors participated in a semi-structured interview. Stroke survivors showed significantly higher posttraumatic growth (F(1, 75) = 9.79, p = .003) and integrated the critical life event to a higher extent into their identity (event centrality) (F(1, 74) = 37.54, p < .001). Qualitative analysis revealed increased appreciation of life and more intense/selective relationships as the most common positive changes. Considering positive changes might provide additional perspectives for rehabilitation.

Does "thinking about thinking" interfere with memory? An experimental memory study in obsessive-compulsive disorder.

Neuropsychological assessments of participants with obsessive-compulsive disorder (OCD) indicate impaired verbal memory if to be remembered material has to be organized. People with OCD also tend to focus their attention on their thoughts (heightened cognitive self-consciousness). We tested the hypothesis that cognitive self-consciousness causes verbal memory deficits by provoking a division of attention between study task and thoughts. Thirty-six participants with OCD, 36 matched healthy controls and 36 participants with major depressive disorder (MDD) learned under proactive interference in three study conditions: single-task condition, condition with heightened cognitive self-consciousness and condition with an external secondary task. Memory was impaired in the cognitive self-consciousness condition compared to both other conditions. Independent of condition, participants with OCD showed a reduced memory performance compared to healthy controls, but did not differ from participants with MDD. Our results are in line with the hypothesis that cognitive self-consciousness causes memory impairment.

Thinking about thinking: Neural mechanisms and effects on memory

It is a well-established finding that memory encoding is impaired if an external secondary task (e.g. tone discrimination) is performed simultaneously. Yet, while studying we are also often engaged in internal secondary tasks such as planning, ruminating, or daydreaming. It remains unclear whether such a secondary internal task has similar effects on memory and what the neural mechanisms underlying such an influence are. We therefore measured participants blood oxygenation level dependent responses while they learned word-pairs and simultaneously performed different types of secondary tasks (i.e., internal, external, and control). Memory performance decreased in both internal and external secondary tasks compared to the easy control condition. However, while the external task reduced activity in memory-encoding related regions (hippocampus), the internal task increased neural activity in brain regions associated with self-reflection (anterior medial prefrontal cortex), as well as in regions associated with performance monitoring and the perception of salience (anterior insula, dorsal anterior cingulate cortex). Resting-state functional connectivity analyses confirmed that anterior medial prefrontal cortex and anterior insula/dorsal anterior cingulate cortex are part of the default mode network and salience network, respectively. In sum, a secondary internal task impairs memory performance just as a secondary external task, but operates through different neural mechanisms.