THE RELATIONSHIP BETWEEN INTRUSIVE COGNITIONS AND DEFENSE MECHANISMS IN HEALTHY AND CLINICAL POPULATIONS

Purpose: to examine the relationship between defense mechanisms and intrusive cognitions in normal healthy individuals and psychiatric patients. Methodology: The study sample consists of a healthy group (n=60; 30 males & 30 females), whereas the clinical group (n=66; 34 males, 32 females) includes patients with major depressive disorder (12 patients, 5 males, 7 females), schizophrenia (31 patients; 14 males, 17 females), obsessive-compulsive disorder (23 patients; 15 males, 8 females). We used several scales to measure the following variables: intrusive cognitions, intrusive memories, and defense mechanisms. Finding: The results show that there is a positive correlation between defense mechanisms and intrusive cognitions in healthy and clinical groups. Intrusive cognitions were more common in the patient than in a healthy group. Furthermore, there was no significant difference between males and females in measures of intrusive thoughts and memories in both groups. Implications: These findings have implications for behavioral treatment. Treatments used for managing posttraumatic stress disorder can also be used for the treatment of a major depressive disorder, OCD, and schizophrenia. Originality: This investigation the relationship between intrusive cognitions and defense mechanisms in healthy and clinical populations and its implication on the cue exposure therapy that can be the treatment of intrusive cognitions and thoughts in with major depressive disorder, OCD, and schizophrenia.

The Appearance Intrusions Questionnaire

This study aims to examine whether Body Dysmorphic Disorder (BDD) related preoccupations might consist of unwanted intrusive cognitions, and if so, their degree of universality, its dimensionality from normality to BDD psychopathology, and their associations with symptom measures. The Appearance Intrusions Questionnaire (AIQ) was designed to assess intrusive thoughts related to appearance defects (AITs). A sample of 410 undergraduate university students completed a former 54-item version of the AIQ. Principal Components Analyses (PCA) and Parallel Analysis yielded a five-factor structure and a reduction to 27 items. The 27-items AIQ was examined in a new sample of 583 non-clinical community participants. Confirmatory Factor Analyses (CFAs) grouped the AITs in five factors: Defect-related, Others-related, Concealment, Bodily functions, and Urge to do something. Up to 90% of the participants experienced AITs. The AIQ scores were more associated with BDD, Obsessive-Compulsive Disorder (OCD), and body image measures than with worry, suggesting that AITs are closer to obsessional intrusions than to worries. The new AIQ might be a valid and reliable measure of AITs and would help to reliably detect individuals at risk for BDD in nonclinical populations using a brief self-report.

El carácter transdiagnóstico de las intrusiones mentales: una revisión y una propuesta basada en datos.

The transdiagnostic nature of mental intrusions: A review and data-based proposal. The objective of a transdiagnostic perspective in psychopathology is to better understand the commonalities among clinically different mental disorders on the basis of a set of shared etiopathogenic dimensions and processes. Unwanted intrusive cognitions (UI) and their functional consequences had been proposed as symptom dimensions in Obsessive-Compulsive Disorder (OCD), Body Dysmorphic Disorder (BDD), Hypochondriasis (HYP) and Eating Disorders (EDs). In this article, we review the empirical data about the putative transdiagnostic nature of UI and their functional consequences in the four mentioned disorders. Firstly, the results about the universality and dimensionality of UI with contents of each disorder are reviewed. Secondly, data about UI as common symptom dimensions in OCD and EDs are presented. Finally, we offer information about our current research about the hypothetical transdiagnostic nature of UI with obsessional, dysmorphic, hypochondriac, and eating-disorders contents. Keywords: Mental intrusions; transdiagnostic; obsessive-compulsive disorder; body dysmorphic disorder; hypochondriasis; eating disorders.Resumen: El propósito de adoptar un enfoque transdiagnóstico en psicopatología es comprender las comunalidades entre trastornos mentales clínicamente diferentes sobre la base de un rango de dimensiones y procesos etiopatogénicos compartidos. Las intrusiones mentales no deseadas (IM) y sus consecuencias funcionales se han propuesto como dimensiones de síntomas en el Trastorno Obsesivo-Compulsivo (TOC), el Trastorno Dismórfico Corporal (TDC), la Hipocondría (HIP) y los Trastornos Alimentarios (TA). Este artículo resume y actualiza los datos disponibles sobre el potencial valor transdiagnóstico de las intrusiones mentales y sus consecuencias funcionales en los cuatro trastornos mencionados. Se presentan, primero, los resultados sobre la universalidad y dimensionalidad de IM con contenidos característicos de cada trastorno; segundo, los datos sobre las IM como dimensiones de síntomas comunes en el TOC y los TA; por último, se aporta información sobre una investigación propia cuyo objetivo es poner a prueba la hipótesis del carácter transdiagnóstico de IM obsesivas, dismórficas, hipocondríacas y alimentarias.

CBT for OCD: habituation or cognitive shift?

Cognitive Behavioural Therapy (CBT) including Exposure and Response Prevention (ERP) is recommended by NICE as the psychological treatment of choice for obsessive compulsive disorder (OCD). Twenty-five percent of OCD patients refuse ERP, and many psychologists advocate formulation-driven cognitive therapy, including ERP, as opposed to ERP alone. However, a recent meta-analysis suggested there is insufficient evidence to suggest ERP is improved by cognitive methods. This paper proposes to contribute to this debate by providing a detailed description of the treatment of a patient with intrusive cognitions of a sexual nature, who was treated successfully using behavioural experiments designed to test cognitions, rather than ERP. This is, arguably, the way in which most cognitive behavioural therapists would work with someone with OCD. However, this approach is not reflected in the literature at present. The authors report the patient's feedback that therapeutic change was brought about through cognitive shift, as a result of the formulation-driven behavioural experiments.

Rumination in PTSD as well as in Traumatized and Non-Traumatized Depressed Patients: A Cross-Sectional Clinical Study

Background: Although rumination is a key process in the onset and maintenance of depressive symptoms and a powerful predictor of persistent posttraumatic stress disorder (PTSD), little is known about the differences and similarities of rumination in these conditions. Previous research has not always differentiated between rumination and intrusive images. Aims: We sought to systematically evaluate rumination and to gather more information about the content and associated emotions in three patient groups (PTSD, and depressed with and without trauma; n = 65). Furthermore, we examined the interaction between rumination and another predominant intrusive cognition, intrusive image. Method: A multi-method assessment for rumination, including a rumination questionnaire and a rumination log (kept for one week), was employed. Results: Rumination was found to be complex and composed of subcomponents that are similar across the diagnostic groups. Rumination rarely stopped intrusive images and it made the participants feel worse. There were, however, also important differences: in PTSD, rumination always or often triggered intrusive images and the traumatized individuals (PTSD and depressed with trauma) ruminated more than non-traumatized depressed patients. Conclusions: The results corroborate the assumption of rumination being a transdiagnostic process, with similarities but also with important differences across diagnostic groups. Moreover, the findings support recent research on the intricate relationship between different types of intrusive cognitions.