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DOCTOR OF PHILOSOPHY Investigation of Attentional Bias in Obsessive-Compulsive Disorder Johnston, Rachel Award date: 2020 Awarding institution: Queen's University Belfast Link to publication Terms of use All those accessing thesis content in Queen’s University Belfast Research Portal are subject to the following terms and conditions of use • Copyright is subject to the Copyright, Designs and Patent Act 1988, or as modified by any successor legislation • Copyright and moral rights for thesis content are retained by the author and/or other copyright owners • A copy of a thesis may be downloaded for personal non-commercial research/study without the need for permission or charge • Distribution or reproduction of thesis content in any format is not permitted without the permission of the copyright holder • When citing this work, full bibliographic details should be supplied, including the author, title, awarding institution and date of thesis Take down policy A thesis can be removed from the Research Portal if there has been a breach of copyright, or a similarly robust reason. If you believe this document breaches copyright, or there is sufficient cause to take down, please contact us, citing details. Email: [email protected] Supplementary materials Where possible, we endeavour to provide supplementary materials to theses. This may include video, audio and other types of files. We endeavour to capture all content and upload as part of the Pure record for each thesis. Note, it may not be possible in all instances to convert analogue formats to usable digital formats for some supplementary materials. We exercise best efforts on our behalf and, in such instances, encourage the individual to consult the physical thesis for further information. Download date: 07. Oct. 2021 Investigation of Attentional Bias in Obsessive-Compulsive Disorder A thesis submitted to the School of Psychology, Queen’s University, Belfast, in fulfilment of the requirements for the degrees of Doctor of Philosophy (PhD) July 2019 By Rachel Ellen Johnston, BSc (Hons) Supervisors: Dr Kevin Dyer, Dr Donncha Hanna and Dr Eugene O’Hare Acknowledgments I would firstly like to convey my heartfelt gratitude towards my two supervisors, Dr Kevin Dyer and Dr Donncha Hanna for their unwavering support, patience and guidance throughout this PhD journey. I am so grateful to you both for this opportunity to carry out this research and for the invaluable experience I have gained. To all the staff at the School of Psychology, thank you for your incredible support and help. A special mention to Paul Coulter, Fred Maddalena and Kamil Kansas for their technical expertise, time and efforts. I would like to extend my gratitude to all those who participated in this research, without whom this PhD would not have been possible. One of the greatest gifts that has come from this PhD has been the friendships I have gained along the way. Rebecca, Jayne, Nicola, Emma and Paddy I will always be grateful to you all for your incredible friendships and support. To my mum, thank you for teaching me not to give up even when I feel like it’s impossible to keep going. To my life compasses, my Grannies (aka G-Harps and Hawk-Eye), thank you for your endless love, sacrifice, dedication and for showing me that there is always a silver lining. To my siblings, Adam and Leigh, thank you for everything and for always being there. To my best friend and lifejacket Cat, thank you for your support and love throughout this process. To my friends Alex, Colleen and Rebecca, thank you for all your support. To my husband, Ross, I can’t describe how lucky I feel to have you. Thank you for your incredible love, support and for believing in me and for teaching me to I believe in myself. Thank you to you and Forrest for never failing to make me smile on days it felt impossible to do so. II Abstract Obsessive-compulsive disorder (OCD) is a prevalent mental health difficulty that has a substantive negative impact on quality of life. The leading psychological treatment, Exposure and Response Prevention (ERP), is highly effective but has high rates of treatment refusal and dropout resulting in a need for innovative, acceptable and effective interventions for OCD to be created. A potential avenue for therapeutic intervention is the reduction of an attentional bias for anxiogenic stimuli. Salkovskis’ (1999) model of OCD suggests that an attentional bias for symptom specific to OCD symptoms plays a role in the creation and maintenance of symptoms. However, the previous literature exploring attentional bias in OCD has produced inconsistent findings and as a result the attentional processes involved in OCD are unclear. An intervention that targets attention bias and has significant therapeutic potential is Attentional Bias Modification Training (ABMT). ABMT has demonstrated efficacy in treating symptoms of psychopathology, but little research has been carried out on the application of ABMT to OCD. The aims of this PhD project was to explore an attentional bias in OCD in order to: 1. discern if ABMT paradigms are acceptable, efficacious interventions for OCD; 2. improve the stimuli and paradigms used in the measurement of attentional bias; and 3. further explore the mechanisms of attentional bias using this improved measurement understanding. Chapter 4 aimed to explore the perceived acceptability of ABMT by 66 individuals with a self-reported diagnosis of OCD and compared this with acceptability of ERP in order to ascertain if ABMT would be a preferable treatment option. The results indicated that ERP was rated higher than ABMT in terms of level of anxiety-provocation and how challenging it would be as a treatment modality. Despite this, ERP was also rated higher by participants for its effectiveness and ability to reduce OCD symptoms. III Chapter 5 aimed to compare the effects of ABMT with those of ERP on attentional bias, OCD symptoms and performance in a behavioural approach task (BAT) towards contamination related objects. A total of 77 participants without a diagnosis of OCD but with clinical levels of OCD symptoms took part. In contrast to what was hypothesised, the results of Chapter 5 found that ABMT had a negative influence on attentional bias. Inspection of BAT performance revealed that both ERP groups displayed significantly greater reduction of avoidance in the BAT task in comparison to the ABMT group. No differences were detected between acceptability of the ERP group and ABMT. Chapter 6 sought to create and validate visual stimuli related to OCD symptoms of symmetry, checking and contamination as there are few visual resources available for OCD research which is problematic when investigating attentional biases and designing appropriate interventions. It also included a neutral category that could be employed as control images. The images were validated by three groups: individuals with OCD (N=25), clinical psychologists (N=5) and a control group (N=40). A high test-retest reliability and Cronbach’s alpha was found for the stimuli set. The previous research exploring attentional bias in OCD has been filled with inconsistent and conflicting findings. Chapter 7 aimed to investigate the conditions in which an attentional bias in OCD can be observed by comparing different types of stimuli and methods of measuring attention. Participants were individuals with moderate obsessive-compulsive symptoms with contamination concerns (N=21) and control participants (N=21). The results found that the traditional approach for measuring attentional bias, reaction time, did not reveal any significant findings. However, the eye tracking data found that all participants displayed attentional biases IV for aversive words, aversive images and contamination images. No attentional bias was detected for neutral stimuli or contamination related words. The results suggest that reaction time is not sensitive enough to detect an attentional bias. They also support the argument that verbal stimuli may not be enough to provoke anxiety in individuals with contamination concerns as neither reaction time nor eye tracking data found evidence of an attentional bias. Finally, Chapter 8 provides a discussion of the clinical implications of the empirical findings of the current thesis. V Table of Contents Acknowledgments ............................................................................................ I Abstract .......................................................................................................... III Chapter 1 Attentional bias in Obsessive-Compulsive Disorder ....................... 1 1.1. Abstract .................................................................................................. 1 1.2. Introduction ............................................................................................... 1 1.2.1. Symptoms ........................................................................................... 3 1.2.2. Quality of life impact ...................................................................... 6 1.2.3. Prevalence ....................................................................................... 7 1.3. Theoretical Models................................................................................. 8 1.3.1. Treatment ......................................................................................... 17 1.3.2 Treatment resistance.......................................................................... 19 1.4. Conclusion ..........................................................................................
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