Gilbert Pinard

Psychometric validation of the Obsessive Beliefs Questionnaire and the Interpretation of Intrusions Inventory: Part I

This article reports on the validation of the Obsessive Beliefs Questionnaire (OBQ) and Interpretations of Intrusions Inventory (III) developed by the Obsessive Compulsive Cognitions Working Group (OCCWG) to assess the primary beliefs and appraisals considered critical to the pathogenesis of obsessions. A battery of questionnaires that assessed symptoms of anxiety, depression, obsessive-compulsive symptoms and worry was administered to 248 outpatients with a DSM-IV diagnosis of Obsessive-Compulsive Disorder (OCD), 105 non-obsessional anxious patients, 87 non-clinical adults from the community, and 291 undergraduate students. Tests of internal consistency and test-retest reliability indicated that the OBQ and III assessed stable aspects of OC-related thinking. Between-group differences and correlations with existing measures of OC symptoms indicated that the OBQ and III assess core cognitive features of obsessionality. However, the various subscales of the OBQ and III are highly correlated, and both measures evidenced low discriminant validity. The findings are discussed in terms of the relevance and specificity of cognitive constructs like responsibility, control and importance of thoughts, overestimated threat, tolerance of uncertainty and perfectionism for OCD.

The effect of tryptophan on social interaction in everyday life: a placebo-controlled study.

In monkeys increasing serotonin function enhances affiliative interactions and promotes the acquisition of dominance. To examine whether similar effects occur in humans, we treated 98 subjects for 12 days with the serotonin precursor tryptophan (1g TID) and for 12 days with placebo in a double-blind, cross over study. Agreeableness/quarrelsomeness and dominance/submission were measured using an event-contingent method, in which subjects reported on various behaviors during important social interactions throughout their day. Tryptophan decreased quarrelsome behavior, but only when placebo was given first, suggesting that a decrease in quarrelsomeness when tryptophan was given first may have carried over into the subsequent placebo period. Tryptophan increased dominant behavior, an effect that was independent of the order of treatment, the broad social context, and the subjects and partners sex. Our results suggest that serotonin may enhance dominance in humans, as in monkeys, and illustrate the advantages of the event contingent methodology in studying the associations between biology and human social interaction.

Overestimation of Threat and Intolerance of Uncertainty in Obsessive Compulsive Disorder

Publisher Summary This chapter describes the overestimation of threat and intolerance of uncertainty in Obsessive Compulsive Disorder (OCD). The chapter reviews the literature of dysfunctional beliefs and information processing biases related to overestimation of threat and intolerance of uncertainty in OCD. Intolerance of uncertainty refers to the “beliefs about the necessity of being certain, about the capacity to cope with unpredictable change.” Intolerance of uncertainty may be one factor that influences estimation of threat in OCD. Studies carried out by the obsessive compulsive cognitions working group suggest that OCD patients endorse selected beliefs in the domain of intolerance of uncertainty more strongly than other anxiety disorders and normal subjects. These beliefs are significantly related to OCD symptoms even when the effect of anxiety and depression is controlled. The available evidence indicates that dysfunctional beliefs about threat and uncertainty are moderately to highly related to beliefs about importance of thoughts, control of thoughts, responsibility, and perfectionism, which also discriminate OCD from other groups. Over-estimation of threat from inner phenomena; such as thoughts is associated with exaggeration of their importance and attempts at overcontrol. Individuals who are intolerant of uncertainty may have a lower threshold for perceiving a variety of ambiguous situations as threatening. Difficulty with unpredictability, newness, and change could increase the range of situations in which “degree of danger” is overestimated and “capacity to cope” is underestimated. This chapter concludes that further research depends on the extent of overestimation of threat is a central aspect of OCD that it is a necessary condition to the development and maintenance of symptoms.

Vulnerability Schemas in Obsessive-Compulsive Disorder

This article elaborates on the construct of dysfunctional vulnerability schemas in Obsessive-Compulsive Disorder (OCD)(Sookman & Pinard, 1995,1999; Sookman, Pinard, & Beauchemin, 1994). These schemas are conceptualized as a central mechanism of excessive threat appraisals proposed to be the predominant cognitive problem in anxiety (Beck, 1996; Beck & Clark, 1997). Four domains of beliefs are hypothesized to comprise vulnerability in OCD: Perceived Vulnerability; View of/Response to Unpredictability, Newness, and Change; View of Strong Affect; and Need for Control. A study carried out with 111 subjects indicated that OCD patients more strongly endorsed these beliefs compared with patients with other anxiety disorders, mood disorders, and normal controls. The discriminant function derived from these four belief domains was effective in classifying OCD patients and other subjects into their respective groups. The results support the inclusion of dysfunctional vulnerability beliefs in cognitive assessment and treatment of OCD.

Integrative cognitive therapy for obsessive-compulsive disorder: A focus on multiple schemas

This paper describes integrative cognitive therapy for obsessive-compulsive disorder (OCD), which focuses on schemas. This treatment was developed by Sookman, Pinard, and Beauchemin (1994) for patients resistant to existing approaches. Multiple cognitive domains and levels of cognition, ranging from appraisals to core beliefs, are targeted. In addition to targeting domains such as inflated responsibility, perfectionism, and overimportance of thoughts (Obsessive Compulsive Cognitions Working Group, 1997), this approach also targets domains that the authors ( Sookman & Pinard, 1995 ) have proposed to be relevant to OCD: vulnerability; response to unpredictability, newness, and change; and view of response to strong affect. Developmental theory, role of attachment experiences, notion of schemas, emotional-interpersonal foci, and the structural dimension are integrated in the conceptualization and treatment of each case. Change in OCD symptoms, secondary depression, and dysfunctional cognitions are reported for seven treatment-resistant cases. On average, symptoms improved from a moderately severe to subclinical level. In some cases the strength of dysfunctional beliefs across multiple domains was reduced to the normal range. Preliminary results support the use of this integrative approach for patients resistant to existing approaches.

Multidimensional Schematic Restructuring Treatment for Obsessions: Theory and Practice

This paper describes a multidimensional schematic restructuring treatment approach for obsessions, developed to provide more substantial and enduring clinical improvement as compared with existing treatment approaches. The aim of treatment is to ameliorate symptoms by restructuring dysfunctional, core cognitive and affective schemas relevant to the etiology and/or maintenance of O.C.D. (Obsessive Compulsive Disorder) symptoms. Aspects of cognitive theory and developmental psychology not previously reported to be applied to O.C.D. are integrated theoretically and technically. Treatment targets preexisting dimensions as well as those in response to the obsession. Explicit as well as tacit structural levels are addressed. These include automatic thoughts and core beliefs, emotional responses and schemas, and behavioral coping deficits. Significant attachment and developmental experiences are identified and utilized. Strategies to identify, access, and restructure core obsession-related schemas; to reframe and decenter the obsession; and to address respondent automatic thoughts and dysphoric mood are described and illustrated. Restructuring strategies are combined with existing skills acquisition and exposure-based techniques. A multifaceted schematic constellation is proposed to underlie O.C.D. symptoms. Eleven O.C.D. specific schematic dimensions are under investigation in a new 160-item scale (Obsessive Compulsive Cognitive Schematic Scale, Sookman & Pinard, 1991). Indications for research are discussed.

Anxiety, emotional security and the interpersonal behavior of individuals with social anxiety disorder

BACKGROUND Interpersonal functioning is central to social anxiety disorder (SAD). Empirical examinations of interpersonal behaviors in individuals with SAD have frequently relied on analogue samples, global retrospective reports and laboratory observation. Moreover, research has focused on avoidance and safety behaviors, neglecting potential links between SAD and affiliative behaviors. METHOD The influence of situational anxiety and emotional security on interpersonal behaviors was examined for individuals with SAD (n=40) and matched normal controls (n=40). Participants monitored their behavior and affect in naturally occurring social interactions using an event-contingent recording procedure. RESULTS Individuals with SAD reported higher levels of submissive behavior and lower levels of dominant behavior relative to controls. Consistent with cognitive-behavioral and evolutionary theories, elevated anxiety in specific events predicted increased submissiveness among individuals with SAD. Consistent with attachment theory, elevations in event-level emotional security were associated with increased affiliative behaviors (increased agreeable behavior and decreased quarrelsome behavior) among members of the SAD group. Results were not accounted for by concurrent elevations in sadness or between-group differences in the distribution of social partners. CONCLUSIONS These findings are consistent with predictions based on several theoretical perspectives. Further, the present research documents naturally occurring interpersonal patterns of individuals with SAD and identifies conditions under which these individuals may view social interactions as opportunities for interpersonal connectedness.

Brain Regional α-[11C]Methyl-L-Tryptophan Trapping in Medication-Free Patients With Obsessive-Compulsive Disorder

CONTEXT The hypothesis of a serotonin (5-hydroxytryptamine [5-HT]) dysfunction in obsessive-compulsive disorder (OCD) stems largely from the clinical efficacy of 5-HT reuptake inhibitors. Serotonergic abnormalities in the unmedicated symptomatic state, however, remain to be fully characterized. OBJECTIVE To investigate brain regional 5-HT synthesis, as indexed by positron emission tomography and the α-[(11)C]methyl-L-tryptophan trapping constant (K*), in treatment-free adults meeting criteria for OCD. DESIGN Between-group comparison. SETTING Department of Psychiatry and Montreal Neurological Institute, McGill University, and Department of Psychology, McGill University Health Centre, Quebec, Canada. PARTICIPANTS Twenty-one medication-free patients with OCD (15 men with a mean [SD] age of 33.2 [9.3] years and 6 women with a mean [SD] age of 35.8 [7.1] years) and 21 healthy controls matched for age and sex (15 men with a mean [SD] age of 32.9 [10.1] years and 6 women with a mean [SD] age of 36.5.5 [8.6] years). Main Outcome Measure The α-[(11)C]methyl-L-tryptophan brain trapping constant K*, which was analyzed with Statistical Parametric Mapping (SPM8) and with proportional normalization (extent threshold of 100 voxels with a peak threshold of P ≤ .005). RESULTS Compared with healthy controls, the patients with OCD exhibited significantly greater α-[(11)C]methyl-L-tryptophan trapping in the right hippocampus and left temporal gyrus (Brodmann area 20). In the larger subsample of all men, these same differences were also evident, as well as higher K* values in the caudate nucleus. Individual differences in symptom severity correlated positively with K* values sampled from the caudate and temporal lobe of the patients with OCD, respectively. There were no regions where the patients exhibited abnormally low K* values. Volumetric analyses found no morphometric alterations that would account for the group differences. CONCLUSION The results support previous reports of greater striatal and temporal lobe activity in patients with OCD than in healthy controls and suggest that these disturbances include a serotonergic component. Previously reported glucose metabolic disturbances in OCD involving the orbitofrontal and cingulate cortices, in comparison, might reflect postsynaptic changes in the serotonergic system.

Tryptophan, Serotonin and Human Social Behavior

Animals research suggests that increasing serotonin can decrease aggression, increase affiliative behaviors and increase dominant behaviors. We tested the relevance of these data to humans by giving 100 healthy people tryptophan (1 g after each meal) and placebo, each for 12 days in a double-blind cross-over study. Social behaviors were studied using an event sampling method in which subjects filled in a one page questionnaire about their behaviors after each social interaction lasting at least 5 minutes. Tryptophan caused a significant decrease in quarrelsome behaviors and a significant increase in dominant behaviors.

Brain serotonin synthesis capacity in obsessive-compulsive disorder: effects of cognitive behavioral therapy and sertraline

Cognitive behavioral therapy (CBT) and selective serotonin reuptake inhibitors (SSRIs) are both effective treatments for some patients with obsessive-compulsive disorder (OCD), yet little is known about the neurochemical changes related to these treatment modalities. Here, we used positron emission tomography and the α-[11C]methyl-l-tryptophan tracer to examine the changes in brain regional serotonin synthesis capacity in OCD patients following treatment with CBT or SSRI treatment. Sixteen medication-free OCD patients were randomly assigned to 12 weeks of either CBT or sertraline treatment. Pre-to-post treatment changes in the α-[11C]methyl-l-tryptophan brain trapping constant, K* (ml/g/min), were assessed as a function of symptom response, and correlations with symptom improvement were examined. Responders/partial responders to treatment did not show significant changes in relative regional tracer uptake; rather, in responders/partial responders, 12 weeks of treatment led to serotonin synthesis capacity increases that were brain-wide. Irrespective of treatment modality, baseline serotonin synthesis capacity in the raphe nuclei correlated positively with clinical improvement. These observations suggest that, for some patients, successful remediation of OCD symptoms might be associated with greater serotonergic tone.