Short communicationExposure to emotionally arousing, contamination-relevant pictorial stimuli interferes with response inhibition: Implication for obsessive–compulsive disorder
Introduction
Theoretical and empirical literatures suggest failures of cognitive control may partially underlie the pathogenesis and acute exacerbation of obsessions and compulsions (Schultz, Evans, & Wolff, 1999). Multiple studies have reported that individuals diagnosed with Obsessive–Compulsive Disorder (OCD) evince impaired performance on tests designed to measure response inhibition when compared to both healthy and anxious controls (Chamberlain et al., 2005, Rosenberg and Keshavan, 1998). For example, meta-analyses suggest that individuals diagnosed with OCD perform much worse (g=.77) on the stop-signal task – a measure of action cancellation – relative to healthy controls (Lipszyc & Schachar, 2010). Similarly, several studies have shown that individuals diagnosed with OCD commit more errors of commission during go/no-go tasks – a measure of action restraint – when compared to healthy and anxious controls (Aycicegi et al., 2003, Bannon et al., 2002, Penades et al., 2007, Watkins et al., 2005). Importantly, response inhibition findings are notoriously mixed across studies, samples, and methods (Greisberg & McKay, 2003) and multiple studies have failed to detect significant deficits in response inhibition among subjects diagnosed with OCD (Bohne et al., 2008, Page et al., 2009, Watkins et al., 2005).
Evidence suggests that visual exposure to emotionally provocative stimuli interferes with response inhibition (De Houwer and Tibboel, 2010, Verbruggen and De Houwer, 2007). For example, De Houwer and Tibboel (2010) demonstrated that exposure to pictures that were high in emotional arousal interfered with action restraint – as measured by an emotional go/no-go task – and that pictures that were high in emotional arousal and negatively valenced interfered more than neutral pictures. De Houwer and Tibboel provided an attentional account of their findings. They proposed that the effortful act of stopping a prepotent responses is dependent on attention being directed at said task. Processing of emotional stimuli can draw attention away from a variety of effortful tasks (Schimmack & Derryberry, 2005). Emotional stimuli can, therefore, interfere with inhibitory processes when said stimuli are sufficiently arousing to draw attention from the task of stopping. Indeed, this was what was reported by in both studies by De Houwer׳s group; the presentation of emotionally arousing stimuli immediately prior to stopping tasks increased errors of commission (De Houwer & Tibboel, 2010) and increased stop-signal reaction time (Verbruggen & De Houwer, 2007). If the attentional account of emotional interference of response inhibition is correct, then interfering effects of emotionally arousing stimuli on response inhibition should be greater among populations with attentional biases toward emotionally arousing information.
OCD patients and analog samples of obsessive–compulsive participants, especially those reporting contamination/washing symptoms, have reliably shown attentional biases toward disorder relevant information (Summerfeldt & Endler, 1998). An effect that is likely due to prolonged maintanence on or difficulty disengaging attention from disorder-relevant stimuli (Armstrong et al., 2010, Armstrong et al., 2012, Cisler and Olatunji, 2010, Olatunji et al., 2011). Accordingly, the interfering effects of emotionally arousing, disorder relevant stimuli on response inhibition should be intensified among participants diagnosed with OCD and those reporting elevated obsessions and compulsions. Meaning, once attention is drawn to the arousing stimuli performance on tasks that require substantial attentional allocation – such as most response inhibition tasks – should be handicapped. No research has directly tested how affective factors might contribute to difficulties with response inhibition among obsessive–compulsive samples (Krikorian, Zimmerman, & Fleck, 2004). This is particularly noteworthy given that clinical examples of failed response inhibition among OCD patients occur in emotionally arousing situations that typically contain multiple emotionally arousing stimuli. Take, for example, compulsive hand washing, which can be explained by a strong motivation to wash and a failure to resist or stop washing (i.e., failures of inhibition). The internal and contextual features that motivate washing are emotionally salient, capture and hold patient׳s attention, and may interfere with inhibition of washing behaviors.
The present study addresses gaps in the extant literature by testing how presentation of emotionally arousing, contamination-relevant stimuli interference with action restraint. The study utilized two quasi-experimental participant groups: 1) an obsessive–compulsive group who endorsed elevated contamination/washing symptoms [high-contamination obsessive–compulsive (OC)], and 2) a low-contamination-OC group control who endorsed minimal obsessions and compulsions (including minimal contamination/washing symptoms). Participants completed a symptom-specific version of the emotional go/no-go task, which was designed to experimentally test the interfering effects of contamination-threat stimuli on action restraint. The present study utilized a 2 (Group: high-contamination-OC vs. low-contamination-OC)×2 (Threat: contamination-threat vs. neutral] mixed factorial design. It was predicted that: 1) visual exposure to contamination-threat stimuli prior to task performance would interfere with action restraint; 2) high-contamination-OC participants would evidence poorer action restraint than low-contamination-OC participants; and 3) the interfering effects of contamination-threat would be greater among high-contamination-OC participants relative to low-contamination-OC participants. Additional variables were also analyzed for exploratory purposes, including: errors of omission (not going on go trials), no-go RT (latency of key press on no-go trials), and go RT (latency of key press on go trials).
Section snippets
Materials
Emotional Go/No-Go (Fig. 1). Go/no-go tasks require participants to go (e.g., press a spacebar) following the presentation of one stimulus (i.e., go symbol) and to restrain from going following the presentation of a second stimulus (i.e., no-go symbol). The proportion of trials that a participant fails to restrain (error of commission) relative to the proportion of successfully restrained trials provides a measure of the participant׳s ability to inhibit prepotent actions. As such, more
Results
Multilevel modeling (MLM) was utilized to test hypotheses. MLM has fewer and less strict assumptions than ANOVA (including mixed ANOVA). The present study utilized a between-within design with markedly unequal sample sizes on the between-subjects factor. Equal sample sizes and homogeneity of variance on the between subject׳s factor is not required for MLM (Raudenbush & Bryk, 2002). Moreover, MLM provides a powerful method for analyzing experimental psychopathology data, particularly data that
Discussion
The present study was focused on how visual exposure to emotionally arousing, contamination-relevant pictorial stimuli interfered with action restraint among an analog sample of obsessive–compulsive participants. This sample was particularly relevant to the questions at hand given the large body of research suggesting that failures of response inhibition, various emotional factors, and attentional biases are implicated in the pathogenesis of obsessions and compulsions. Consistent with the
Role of funding sources
Portions of this research was supported by the Marie Howell׳s Fund (HB001342). This funding organization and its staff has no involvement in the study design, collection, analysis, or interpretation of data, writing the manuscript, or the decision to submit the manuscript for publication.
Contributors
The first author was responsible for the design of the study, data collection and analysis, and preparation of the manuscript.
Conflicts of interest
The authors have no conflicts of interest to declare.
Acknowledgments
The author would like to thank Dr. Jan De Houwer and Thomas Armstrong for their willingness to share research materials.
The author would also like to thank Dr. Jefferey Lohr for his mentorship through all phases of this project and Alex Fessler, Chelsea Golden, and Ashlyn Testut for their assistance with data collection.
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