Pregnancy-related claustrophobia

A 35-year-old primigravida presented with significant anxiety symptoms at 26 weeks’ gestation. Symptoms were preceded by a nightmare about her upcoming labour. She developed repetitive intrusive thoughts of being trapped emotionally and physically in her pregnancy. Her symptoms were suggestive of new-onset claustrophobia associated with pregnancy, which has not been previously reported on. Her symptoms ameliorated with a combination of cognitive–behavioural therapy and pharmacotherapy (sertraline and low dose quetiapine). The later stages of pregnancy were associated with minimal symptoms and the resolution of her subjective ‘entrapment’. A subsequent pregnancy resulted in similar although less severe symptomatology. No postpartum anxiety symptoms were demonstrated on both occasions. Anxiety symptoms can adversely impact both the mother and fetus, and thus correct identification and management of pregnancy-related claustrophobia improved symptomatology and functioning and allowed for earlier detection and reduced symptomatology in a subsequent pregnancy.

Obsessive-Compulsive Disorder and Mobile Technology

Obsessive-compulsive disorder (OCD) is characterized by the presence of persistent and unwanted obsessions, which take the form of intrusive thoughts. These lead to widespread anxiety and/or compulsions which take the form of repetitive acts to relieve anxiety. In 2020, for the author's master's degree final project, she decided to propose the creation of a mobile application for people with OCD, whose main purpose was to reduce the anxiety caused by it. Although mobile applications already exist for the treatment of OCD, it was necessary to fill some gaps and improve them. This chapter will examine the techniques that were applied on the investigation of the author's project—a competitor analysis and an exploratory qualitative research—and understand how they can help to retain some information that is beyond the literature review, and what needs to be retained from them to know which features and functionalities are most useful in an app that aims to support therapeutic intervention in individuals with OCD, as well as possible gaps that could be improved.

Cognitive Defusion as Strategy to Reduce the Intensity of Craving Episodes and Improve Eating Behavior

The elaborated intrusion theory of desire proposes that craving is a cognitive motivational process involving intrusive thoughts. Changing the way we react to them, cognitive defusion (CD), should limit thought elaboration and craving. We induced chocolate craving in female chocolate cravers before CD (Study 1). A decrease in craving measured by a single-item scale, Visual Analogical Scale (VAS; p < .001, ηp2 = .449) and as a state, State Food Craving Questionnaire (FCQ-S; p = .029, ηp2 = .106) were found in the experimental group, while similar results were also found in group control. The reduction in craving (VAS) in group CD correlated negatively with chocolate consumption on a bogus taste test (r = –.439, p = .036), while the correlation was positive in the case of group control (r = .429, p = .047). Food craving as a trait, measured by the Trait Food Craving Questionnaire (FCQ-T), showed negative correlations with measures of CD and mindfulness skills (lowest r = –.313, p = .018). In Study 2 participants made use of a smartphone application implementing the CD procedure in real contexts whenever they experienced food craving. A corresponding decline in self-reported craving was found, as well as in consumption of the craved food (indulgence) compared with the control condition. Our findings indicate that CD may be a promising intervention for tackling the elaboration of intrusive thoughts and eating behavior in young female food cravers, both in a controlled laboratory environment after a cue-food exposure craving induction procedure, as well as responding to naturally occurring food cravings in real-life settings.

The Effect of Mindfulness-Based Cognitive Therapy On Rumination and Intrusive Thoughts in Patients With Bipolar Disorder: Secondary Analyses From a Randomized Controlled Trial

Background: Preliminary evidence suggests that Mindfulness-Based Cognitive Therapy (MBCT) is a promising treatment for bipolar disorder (BD). One of the proposed working mechanisms of MBCT in attenuating depressive symptoms is through the reduction of depressive rumination. In BD the effect of MBCT on rumination is less well studied. The primary aim of this study was to investigate the effect of MBCT on self-reported trait depressive rumination and an experimental state measure of negative intrusive thoughts. On an exploratory note, we investigated the effect of MBCT on positive rumination and positive intrusive thoughts.Methods: The study population consisted of a subsample of bipolar type I or II patients participating in a multicenter randomized controlled trial comparing MBCT + treatment as usual (TAU) (N = 25) to TAU alone (N = 24). Trait depressive rumination (RRS brooding subscale) and negative intrusive thoughts (breathing focus task (BFT)) were assessed at baseline and post-treatment. During the BFT, participants were asked to report negative, positive and neutral intrusive thoughts while focusing on their breathing. Results: Compared to TAU alone, MBCT + TAU resulted in a significant pre- to post-treatment reduction of trait depressive rumination (R2 = 0.16, F(1, 28) = 5.30, p = .029; medium effect size (f2 = 0.19)) and negative intrusive thoughts on the BFT (R2 = .15, F(1, 28) = 4.88, p = .036; medium effect size (f2 = 0.17)). MBCT did not significantly change positive rumination or positive intrusive thoughts on the BFT.Conclusions: MBCT might be a helpful additional intervention to reduce depressive rumination in BD which might reduce risk of depressive relapse or recurrence. Future research is required to replicate our findings and to explore whether this reduction in rumination following MBCT indeed mediates a reduction in depressive symptoms and leads to relapse prevention in BD.

Perceived need of psychological support for taboo obsessions in new parents: A cross-sectional survey

Previous research has shown that many new parents experience intrusive thoughts about intentionally harming their child, also known as “taboo obsessions”. These thoughts can for some parents lead to increased anxiety, depression and have a negative impact on parental function and quality of life. Taboo obsessions can be stigmatizing and many parents who could benefit from psychological support do not seek help. One way to increase access to psychological interventions for new parents could be to deliver the treatment online. Our research group has developed and evaluated an internet-delivered intervention targeting taboo obsessions in individuals with a diagnosis obsessive-compulsive disorder (OCD), with promising results. It is conceivable that the intervention could be helpful to a large proportion of parents from the general population who struggle with taboo obsessions (i.e. not only individuals with OCD). In the current study, 594 new parents filled out an online survey about taboo obsessions and the perceived need for psychological support. Fifty six percent reported currently experiencing or had previously experienced taboo obsessions. About half (54%) responded that the taboo obsessions had a negative impact on their self-image. Additionally, 18-19% reported that the intrusive thoughts were difficult to control and/or had a negative impact on the relationship to the child. Importantly, 51% responded that they would absolutely or probably like to try online treatments for these intrusive thoughts. Keeping the limitations of an online survey in mind, the results suggest that an online intervention targeting taboo obsessions in new parents could be well received.

The Role of Eye-Movements in Eye-Movement Desensitization and Reprocessing: Eye-Movements Lower the Number of Intrusive Thoughts of Negative Memories

<p>Eye-Movement Desensitization and Reprocessing (EMDR) was developed as a treatment for Post-Traumatic Stress Disorder (PTSD), and involves the patient thinking about a traumatic event while simultaneously moving their eyes from side to side. Despite substantial support for the efficacy of EMDR questions remain regarding how eye-movements contribute to therapy. One explanation is that eye-movements tax a part of working memory known as the central executive; however, the exact mechanism involved is still unclear. Previous eye-movement research has focussed on self-ratings of vividness and emotionality of negative memories as the primary outcome measures. The focus of the current research was to examine the effect of eye-movements on the suppression of negative autobiographical memories in addition to vividness and emotionality. Non-clinical participants were asked to recall negative autobiographical memories and then verbally reported ratings of vividness and emotionality. In the eye-movement conditions, which varied by speed and direction of movement, eye-movements were stimulated using dots on a computer screen. Participants were then asked to avoid thinking of their memories, and intrusive thoughts were measured by pressing a computer key. Six experiments found that, overall, the effect of eye-movements on self-ratings was inconsistent, but that eye-movements reliably improved suppression of negative autobiographical memories. The findings also support the central executive explanation for the effectiveness of eye-movements in EMDR.</p>

The Role of Eye-Movements in Eye-Movement Desensitization and Reprocessing: Eye-Movements Lower the Number of Intrusive Thoughts of Negative Memories

<p>Eye-Movement Desensitization and Reprocessing (EMDR) was developed as a treatment for Post-Traumatic Stress Disorder (PTSD), and involves the patient thinking about a traumatic event while simultaneously moving their eyes from side to side. Despite substantial support for the efficacy of EMDR questions remain regarding how eye-movements contribute to therapy. One explanation is that eye-movements tax a part of working memory known as the central executive; however, the exact mechanism involved is still unclear. Previous eye-movement research has focussed on self-ratings of vividness and emotionality of negative memories as the primary outcome measures. The focus of the current research was to examine the effect of eye-movements on the suppression of negative autobiographical memories in addition to vividness and emotionality. Non-clinical participants were asked to recall negative autobiographical memories and then verbally reported ratings of vividness and emotionality. In the eye-movement conditions, which varied by speed and direction of movement, eye-movements were stimulated using dots on a computer screen. Participants were then asked to avoid thinking of their memories, and intrusive thoughts were measured by pressing a computer key. Six experiments found that, overall, the effect of eye-movements on self-ratings was inconsistent, but that eye-movements reliably improved suppression of negative autobiographical memories. The findings also support the central executive explanation for the effectiveness of eye-movements in EMDR.</p>

Severe Anxiety Post-COVID-19 Infection

COVID-19 infection is linked to increased risk of neuropsychiatric symptoms such as psychosis and suicidal ideation/behavior. After further review of the literature, there is not a large body of data on anxiety following COVID-19 infection. Most literature found is related to fear/anxiety of contracting and dying from COVID-19. We illustrate a case of a 27-year-old male with no previous psychiatric treatment history or symptomology, who developed severe anxiety with intrusive thoughts of self-harm via firearm after COVID-19 infection. Given the severe nature of the anxiety and intrusive thoughts, the patient feared for his safety and sought acute inpatient admission. The patient was effectively treated with group therapy and psychotropic medications and was able to be discharged in a timely manner with outpatient psychiatric follow-up. Much is still unknown of COVID-19. With this case report, we discuss a potential relationship between anxiety and COVID-19 infection.

Eye-Movement does not reduce ratings of vividness and emotionality or the number of intrusive thoughts of unpleasant memories: Implications for Eye-Movement Desensitisation and Reprocessing (EMDR)

<p>Eye-Movement Desensitisation and Reprocessing (EMDR) is a psychotherapy that incorporates the use of saccadic Eye-Movements (EM) to alleviate distress caused by traumatic memories. Although EMDR is recognised as a front-line treatment for individuals suffering from Posttraumatic Stress Disorder (PTSD), the mechanisms underlying the efficacy of the EM component remain a point of contention. The aim of the current research was to investigate first, whether EM reduced ratings of memory vividness and emotionality by taxing Working Memory (WM) capacity, and second, to examine whether EM lowered the number of intrusive thoughts under two opposing suppression conditions. In two experiments, 244 non-clinical participants were asked to recall an unpleasant memory while simultaneously engaging in fast-EM, slow-EM or a no-EM control. Participants then received an instruction to intentionally avoid thinking about the memory, or to think about whatever came to mind. Relative to no-EM, fast-EM and slow-EM had no significant effect on vividness and emotionality ratings, nor did they influence the number of intrusive thoughts. In addition, the level of suppression intent had no impact on memory outcomes. Overall, the results from these two experiments oppose earlier findings in support of WM theory, and a significant body of research that has demonstrated the efficacy of the EM component. Implications for the EM component in EMDR are discussed, and an alternative explanation for EM is offered.</p>