Kristin E. Fitch

Excessive reassurance seeking and anxiety pathology: Tests of incremental associations and directionality

Excessive reassurance-seeking (ERS) is hypothesized to play a key role in emotional disorders but has been studied mostly in relation to depression. Study 1 reports a new measure of reassurance seeking that assessed ERS related to general and evaluative threats in a non-clinical student sample, and its factor structure was further examined in Study 2. In Study 3, the scale, along with other symptom-related measures and an existing measure of depressive ERS, was administered to an undergraduate sample at two different time points, one month apart. Greater ERS was associated with greater symptoms of social anxiety, generalized anxiety disorder, and obsessive-compulsive disorder (OCD), even after controlling for trait anxiety, depression, and intolerance of uncertainty. Among OCD symptoms, only thoughts of harm were uniquely related to ERS, a finding consistent with emerging literature. ERS involving general threats also predicted changes in social anxiety and GAD symptoms one month later. Overall, the findings implicate an important role for ERS across anxiety disorders.

The role of comorbidity in explaining the associations between anxiety disorders and smoking

INTRODUCTION Research has generally found strong associations between smoking and anxiety disorders. The present study sought to examine the role of comorbidity in explaining these relationships. METHODS Participants from the National Comorbidity Survey-Replication (N = 5,692) were included in the present study. Axis I disorders were assessed using the World Mental Health Survey Initiative version of the World Health Organization Composite International Diagnostic Interview. In addition, smoking and mental health treatment history were assessed. RESULTS Multivariate analyses covarying for demographic variables and psychiatric and substance use comorbidity found that posttraumatic stress disorder was uniquely associated with every smoking outcome of interest, including 12-month and lifetime daily and heavy smoking, nicotine dependence, and cessation failure. Generalized anxiety disorder and social anxiety disorder were associated with fewer smoking-related outcomes, and contrary to predictions, panic disorder was only independently associated with 12-month daily smoking. Panic attack history, however, was uniquely associated with 12-month daily and heavy smoking, nicotine dependence, and lifetime cessation failure. In addition, analyses indicated that greater number of anxiety disorders was associated with greater prevalence of each smoking outcome, and the presence of even one anxiety disorder was associated with elevated smoking prevalence. DISCUSSION Several specific anxiety disorders were found to be uniquely associated with smoking behavior. Findings suggest that comorbidity may only explain the associations with smoking difficulties for some anxiety disorders.

A Multifaceted Assessment of Emotional Tolerance and Intensity in Hoarding

Hoarding is characterized by emotionally reinforced saving behaviors, which often combine with excessive acquisition to give rise to clutter, distress, and impairment. Despite the central role emotional processes are thought to play in hoarding, very little research has directly examined this topic. There is suggestive evidence linking hoarding with several facets of emotional intolerance and avoidance, though one key limitation of this past research has been the exclusive reliance on self-report questionnaires. The aim of the current study was to conduct a multimethod investigation of the relationship between hoarding and perceptions of, and cognitions about, negative emotional states. A large unselected sample of nonclinical young adults (N=213) completed questionnaires, behavioral tasks, and a series of negative mood inductions to assess distress tolerance (DT), appraisals of negative emotions, and emotional intensity and tolerance. Hoarding symptoms were associated with lowered tolerance of negative emotions, as well as perceiving negative emotions as more threatening. Individuals high in hoarding symptoms also experienced more intense emotions during the mood inductions than individuals low in hoarding symptoms, though there was no association with poorer performance on a behavioral index of DT. Across measures, hoarding was consistently associated with experiencing negative emotions more intensely and reporting lower tolerance of them. This relationship was particularly pronounced for the difficulty discarding and acquiring facets of hoarding. Our results offer initial support for the important role of emotional processes in the cognitive-behavioral model of hoarding. A better understanding of emotional dysfunction may play a crucial role in developing more effective treatments for hoarding.

Comorbid panic attacks among individuals with posttraumatic stress disorder: Associations with traumatic event exposure history, symptoms, and impairment

Little is known about the prevalence of panic attacks in PTSD and their influence on symptom severity and disability. Utilizing the National Comorbidity Survey-Replication data, respondents meeting DSM-IV criteria for past year PTSD (n=203) with and without comorbid panic attacks were compared across various dimensions. Past year panic attacks were found among 35% of the sample and were associated with greater PTSD-related disability and less time spent at work. Panic attacks were also associated with greater prevalence of comorbid depression, substance abuse/dependence, medically unexplained chronic pain, number of anxiety disorders and lifetime traumatic events, PTSD reexperiencing and avoidance/numbing symptoms, and treatment-seeking related to traumatic stress reactions. Multivariate analyses revealed that panic attacks were one of the only unique predictors of severe PTSD-related disability. Overall, findings suggest that panic attacks are common among individuals with PTSD; therapeutic strategies targeting panic in this population may be of significant benefit.

A multi-method examination of the role of incompleteness in compulsive checking

Emerging evidence implicates an important relationship between feelings of incompleteness and compulsive checking. To date, this work has relied mostly on self-report measures and correlational research designs. We explored the relationship in three different studies using in vivo tasks. In Study 1, we found checking symptoms to be uniquely associated with negative affective response to a pile of clutter (an incompleteness induction). In Study 2, two different measures of incompleteness were predictive of urge to check following a stove checking task. In Study 3, following a stove checking task, participants were randomized to incompleteness induction or control conditions, and urge to check was assessed afterwards. Among those with elevated checking symptoms and dispositional incompleteness, the incompleteness induction led to greater urge to check than the control condition. No effect of condition was found among those low in checking symptoms and dispositional incompleteness. Together, these studies provide novel data in support of an important role for incompleteness in checking compulsions.

A multi-modal investigation of the roles of distress tolerance and emotional reactivity in obsessive-compulsive symptoms

Emerging evidence implicates important roles of poor distress tolerance and heightened emotional reactivity in obsessive-compulsive disorder. To date, investigations have relied mostly on self-report measures, and we sought to extend the literature by examining the relationship between OC symptoms and distress tolerance, as well as emotional reactivity, using three laboratory assessments. Nonclinical participants (N=167) viewed emotional films associated with four different negative emotions and also completed mirror tracing and handgrip persistence tasks. Greater obsessions scores were predictive of poorer emotional tolerance for a sad film and shorter persistence on the mirror tracing task. Among men only, obsessions were negatively correlated with persistence on the handgrip task. Associations between increased emotional reactivity and washing symptoms also emerged. These findings provide further evidence for the role of poor distress tolerance in obsessions and suggest heightened emotional reactivity may play a role in compulsive washing.

Clarifying Relations Between Thought-Action Fusion, Religiosity, and Obsessive–Compulsive Symptoms Through Consideration of Intent

Conflicting findings regarding the relations between thought-action fusion (TAF), religiosity, and obsessive compulsive disorder (OCD) may be due to a lack of clarity regarding the intent associated with the negative thoughts under consideration. In Study 1, we examined the perceptions of the immorality of intentional and unwanted morally-relevant thoughts (Moral TAF) and their relations with OCD symptoms, religiosity, and obsessive beliefs in a non-clinical sample. In Study 2, we randomly assigned participants to complete one of two versions of a previously used sentence neutralization task that was varied in terms of intent. Perception of the immorality of intentional negative thoughts but not unwanted negative thoughts was associated with Protestant/Catholic affiliation and greater prayer frequency, and perception of the immorality of unwanted thoughts was consistently associated with obsessive beliefs. Neither form of Moral TAF was associated with OCD symptoms. Further, reaction to the modified non-intentional neutralization task was associated with OCD symptoms, thought-action fusion, and scrupulosity, while reaction to the original intentional task was only associated with Moral TAF. Overall, the findings suggest that individuals differ in their perceptions of intentional versus unintentional thoughts. Perceptions of intentional morally-relevant thoughts appear related to religiosity, while perceptions of unintentional thoughts are likely to be of greater relevance to our understanding of OCD.

Guilt and Compulsive Washing: Experimental Tests of Interrelationships

Recent evidence suggests a potentially important relationship between guilt and compulsive washing. The present studies sought to clarify this relationship. In Study 1, we examined whether washing reduced guilt. Following guilt induction, 132 non-clinical participants were randomized to one of three conditions: hand-wiping, straightening of clutter, or a control task. Contrary to predictions, analyses indicated no differences between conditions in post-task guilt. Moderator analyses indicated that among those in the straightening task, higher ordering symptoms were associated with greater increases in guilt. Study 2 examined whether guilt increased washing behavior. Sixty-one non-clinical participants were randomized to either a guilt induction or neutral condition. Afterwards, participants were timed as they cleansed their hands. Individuals in the guilt induction condition washed significantly longer than those in the neutral condition. These findings suggest that hand-washing does not lead to unique reductions in guilt, but guilt may prolong hand-washing behavior. Theoretical and clinical implications are discussed.

Six In Vivo Assessments of Compulsive Behavior A Validation Study Using the Obsessive–Compulsive Inventory–Revised

Due to the complex and heterogeneous nature of obsessive–compulsive disorder (OCD), movement toward multimodal assessment has become necessary to more precisely understand the nature of the disorder and interrelations between symptom clusters. Thus, the present study utilized large undergraduate samples (total N = 800) to test the validity of six in vivo assessments of OC symptoms (i.e., one ordering/arranging task, two contamination fear/washing tasks, and three checking tasks). Associations between task-specific variables and self-reported symptom scores (as measured by the Obsessive–Compulsive Inventory–Revised [OCI-R]) were examined. The majority of the in vivo task variables (those presented in Studies 1-4) exhibited significant relationships with the corresponding OCI-R symptom subscale (i.e., ordering, washing, checking). However, many of the task variables demonstrated relationships with other OCI-R symptom subscales, as well. Some evidence for discriminant validity was found, as task variables were generally unrelated to past-week symptoms of depression or anxiety. While continued research is necessary to further establish the validity and utility of the tasks discussed in the current article, findings have implications for improving future empirical examination of OC symptoms.