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Attachment anxiety, Self Structures and Obsessive Compulsive Disorder (OCD)

Final Report Summary - ATTACHMENT AND OCD (Attachment anxiety, self-structures and obsessive compulsive disorder (OCD))

Recently, aspects of self-concept and insecure attachment orientations have been theoretically and empirically linked with obsessive compulsive disorder (OCD). In the current project, 4 studies were undertaken to examine the influence of experimental manipulations of the attachment system on implicit self-esteem (ISE) and urge to act in response to scenarios previously shown to be OCD-relevant. Study 1 (n = 59) and Study 2 (n = 60) examined the influence of the priming of the attachment system on ISE using 2 student cohorts. In Study 1, participants were randomly assigned to one of two conditions. In the first condition, participants were instructed to recall a painful relationship break-up with, or separation from, a romantic partner (attachment-anxiety condition). In the second condition, participants were asked to recall a negative event not related to self or separation, such as the events of 9 / 11 (negative control condition). In Study 2, the participants were also randomly divided into two conditions. In the first condition, the participants were instructed to visualise a specific situation where an attachment figure (previously identified) actually comforted and helped them when they were feeling distressed or worried, and to write a brief description of the recalled situation and the way they felt during it (priming of attachment security condition). In the second condition participants were asked to visualise a specific situation with an acquaintance with whom they had enjoyed, studied or worked, but who is not an attachment figure (acquaintance-priming control condition). In both studies, the participants' level ISE was measured following the attachment manipulation. However, these studies did not yield any statistically significant findings. Dr Doron, therefore, examined the direct effects of attachment security priming on obsessive-compulsive related phenomena using two different priming methods. In Study 3 (n = 87), we examined whether being subliminally exposed (for 22 milliseconds) to names of people they nominated as a source of security (experimental group) or to names of acquaintances (control group) on a computer task reduced OC tendencies as measured on OC relevant scenarios. In Study 4 (n = 90), participants' attachment security was supraliminally primed by asking participants to recall a security-enhancing experience (experimental group) or a shopping experience (control group). All participants then completed a questionnaire assessing their responses to OCD-relevant scenarios of washing and checking concerns. Examination of the results from Study 3 and Study 4 indicate that individuals with high-attachment anxiety reacted to the subliminal priming (Study 3) of attachment security by reduced distress and urge to act in response to OCD-related scenarios compared to neutral priming. Supraliminal priming (Study 4), however, did not lead to any change in urge to act in response to OCD-related situations. Dr Doron has suggested that because deliberate, controlled processes may not take place during subliminal priming, such methods can automatically assuage distress and dysfunctional beliefs by bypassing OC relevant deliberate processing biases (e.g. OC-related beliefs).OCD is a significantly-disabling personal, social and health service problem with high degrees of comorbidity, and relatively poor long-term prognosis. Despite the recent advances in the understanding and treatment of the disorder, the outcomes remain poor relative to some other anxiety disorders. Furthermore, reliable predictors of treatment response and relapse remain elusive, and there has been some debate about factors that need to be targeted in treatment. There have been recent calls for clarification of the nature and contribution of attachment and self-related variables to OCD vulnerability, particularly in terms of developing therapeutic and preventative interventions. These studies is the first step towards improving our understanding of self and attachment processes in OCD, in order to then develop enhanced assessments and treatments.