Compulsive perseveration: Empirical criticism on the mood-as-input model

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Abstract

It has been proposed that the “Mood as Input” model provides an explanation of the perseverative nature of Obsessive Compulsive (OC) behaviour (MacDonald, B. C., & Davey, G. C. L. (2005). A mood-as-input account of perseverative checking: The relationship between stop rules, mood and confidence in having checked successfully. Behaviour Research and Therapy, 43, 69–91). The model implies that task perseveration occurs when individuals (a) experience a bad mood and (b) ask themselves “did I do as much as I can?” In two earlier experiments with healthy participants (MacDonald, B. C., & Davey, G. C. L. (2005). A mood-as-input account of perseverative checking: The relationship between stop rules, mood and confidence in having checked successfully. Behaviour Research and Therapy, 43, 69–91) it was found that when the allegedly critical conditions were met (negative mood and “did I as much as I can?” stop rule) perseveration occurred on a complex text-correction task. This finding was held to support a “mood as input” explanation of compulsive perseveration. It is important to note, however, that perseveration in clinical samples occurs for very simple “tasks” (e.g. closing a door or washing ones hands) and perseveration does not increase efficacy of performance.

In the present study we compared the effects of the original task to effects of text correction tasks that were simpler and more OCD-like. The original effects were replicated: the combination of negative mood and the “did I do as much as I can” stop rule provoked perseveration. Meanwhile, “perseveration” was highly functional: the more “perseveration” the more text-errors were detected. Secondly, to the degree that tasks became simpler and more OCD-like, less checking occurred and the effects of the “did I do as much as I can?” stop rule on detection of errors became smaller. The findings raise questions about the validity of the paradigm as a model of OC perseveration.

Introduction

Compulsive behaviours like washing and checking have been explained by referring to beliefs held by these patients (Frost & Steketee, 2002). For instance, inflated beliefs about personal responsibility and threat may motivate checking and the belief that one may spread contamination may motivate cleaning. Compulsive behaviour, however, is perseverative. Belief-accounts of obsessive compulsive disorder (OCD) have served to explain why people check or wash in situations in which others do not, but less attention has been paid to the perseverative nature of checking and washing. Why is washing one's hands, for e.g., half a minute not sufficient and why is a single check not enough to satisfy the OC patient?

A fresh perspective on this issue is offered by recent work on perseveration (Davey, Startup, Zara, MacDonald, & Field, 2003; MacDonald & Davey, 2005). Based on earlier work by Martin & Davies (1998), it is suggested that when deciding whether or not to stop an intentional action, people may ask themselves one of two questions: either, do I “Feel like Continuing?” (FLC) or did I do “As Much As I Can?” Second, it is proposed that the answer to these questions is largely determined by the current mood of the individual. That is, when someone poses the FLC question, a negative mood is held to be taken as indication that, apparently, one does not FLC and the activity will be terminated. When mood is positive, the FLC question is answered affirmatively and the activity will be continued. Conversely, when the As Much As Can (AMAC) question is posed, a negative mood is taken to imply that one did not do as much as one could and the person will continue, while a positive mood will motivate to stop when the AMAC question is asked. Thus, perseveration is held to result from the interaction between stop rule and mood. Tasks will be continued when mood is positive/the FLC is asked or when mood is negative and the AMAC question is asked. Tasks will be stopped when a positive mood is combined with the AMAC stop rule or when negative mood is combined with the FLC rule. The “mood as input” model was earlier applied to catastrophic worrying (Startup & Davey (2001), Startup & Davey (2003)) and depressive rumination (Watkins & Mason, 2002). Of the two applications to compulsive perseveration (Davey et al., 2003; MacDonald & Davey, 2005) the 2005 paper was argued to be most relevant to understanding OCD (MacDonald & Davey, 2005, p. 71).

In the latter publication two experiments were reported (MacDonald & Davey, 2005). In both studies, healthy participants were asked to correct errors in a 41-line text containing some 100 errors in spelling, punctuation and grammar. In each experiment four groups participated: AMAC/negative mood, AMAC/positive mood, FLC/negative mood and FLC/positive mood. The experimenter instructed the participants what stop rule to use while mood was manipulated with a musical mood-induction procedure. The checking task was open-ended and considered to be analogous to compulsive checking (but see below). Results from both experiments showed that relative to the negative mood/FLC condition, participants in the negative mood/AMAC condition continued checking for approximately twice as long, the overall number of checks was more than twice as large while the same held for the total numbers of lines checked. The opposite was true for the positive mood conditions: here participants persisted more in the FLC condition as opposed to the AMAC condition. The mood X stop-rule interactions were highly significant. As to the relevance for OCD, such patients are known for their inflated sense of responsibility (Salkovskis, 1985). Responsibility in doing a task boils down to “doing one's best” which seems semantically equivalent to using the AMAC stop rule. Compulsions are carried out in response to obsessions that are typically experienced as distressing rendering it unlikely that patients are in a positive mood during ritualising. In fact, OCD patients tend to experience negative mood both generally (Frost, Sher, & Geen, 1986) and seminal work by Rachman and co-workers documented that the early phase of checking is attended by subjective distress (Rachman & Hodgson, 1980). Thus, it seems that the combination of negative mood/the AMAC stop rule mimics the position that OC patients find themselves in. Indeed, the data from this condition were interpreted as providing “support for a mood-as-input explanation of perseverative psychopathologies such as compulsive checking” (MacDonald & Davey, 2005, p. 69).

While the text-correction-checking task used by MacDonald and Davey yielded strong statistical effects, it is not self-evident that the task provides a valid analogue of clinical OC perseveration. First, perseveration by OCD patients tends to occur in “tasks” that at least in healthy people require no or hardly any cognitive resources and that are carried out effortlessly, like washing ones hands, closing the door, see if the gas is off etc. The task used by MacDonald and Davey (2005), however, requires sharp concentration and mental effort. Second, the authors do not report whether repetition of checking was associated with the detection of errors. The task was complex and, just like many complex cognitive tasks, a “repetition-accuracy trade off” may be anticipated: the more checking, the more accurate the individual may become. Inherent in clinical checking, however, is its dysfunctionality: checking, e.g., the door three or more times does not increase accuracy (Coles, Radomsky, & Horng, 2006; Radomsky, Gilchrist, & Dussault, 2006; van den Hout & Kindt, 2003). The authors acknowledge this and state that checking in their paradigm may be “conceived” as functional rather than dysfunctional (MacDonald & Davey, 2005, p. 90). Whether or not checking in this paradigm is functional can be learned from the data that the paradigm generates. If it is functional and non OCD-like, a repetition-accuracy trade off should be present. If it is non-functional and OCD-like, no such trade off should be present.

In sum, then, there is sound evidence that the combination of stop rule and mood breeds perseveration. This does not necessarily imply that the experimental results can be applied to OC perseveration. As to the text-correction task, one cannot rule out that the continuation of checking occurred because the task makes repetition productive, thus motivating individuals to persist in checking. If perseveration was “functional”, it would differ in a crucial respect from OC perseveration. Thus, the first issue to be addressed is whether in the task used by MacDonald and Davey, a repetition-accuracy trade off occurs. Texts checked by OC patients are typically simple, secretaries may check addresses on letters that are to be sent, nurses may check dosages on prescriptions, police officers may check the copying of a number plate etc. A second aim of the present study was to test if repetition under AMAC/negative mood conditions would also occur with text-correction tasks that are made more OCD-relevant by rendering them simpler, less demanding and less likely to make perseveration functional. It was predicted (1) that in line with the findings by MacDonald and Davey (2005) individuals in a negative mood and using the AMAC stop rule would check more and longer relative to individuals in a negative mood who use the FLC stop rule. Positive findings were seen to count as a successful replication of the MacDonald and Davey (2005) findings. Second (2a), it was predicted that this increased checking is functional: under negative mood/AMAC conditions more error detections were expected than in case of a negative mood/FLC stop rule. The “repetition/accuracy trade off” was predicted to become evident too from correlational analysis: the more the checking, the more errors detected (2b). By making tasks simpler and more OCD relevant it was predicted (3) that there would be less perseveration and the AMAC vs. FLC between-group difference would become smaller. Fourth (4a) we expected the AMAC vs. FLC difference in accuracy to become smaller with simpler tasks while (4b) in the simpler tasks, we predicted that the correlation between “perseveration” and accuracy would wane.

In the MacDonald and Davey experiments, four groups were compared: negative vs. positive mood and FLC vs. AMAC stop rule. However, the authors convincingly argue that the positive mood conditions are of less theoretical interest to OCD (MacDonald & Davey, 2005, p.72). To avoid the design becoming unnecessary complex, no positive mood was induced in the present study. All participants underwent a negative mood induction. The study had a 2×3 between-subject design: there were 3 levels of task complexity while half of the participants received the AMAC instruction and the other half the FLC instruction.

Section snippets

Participants

Participants were all students of Utrecht University. There were 16 males and 74 females, the mean age was 21.5 years (sd=2.7) and all participated in exchange for money or course credits. Six participants were left out because Dutch proved not to be their native language or they were distracted by loud noises from outside. Participants were randomly assigned to each of the 6 conditions, leaving n=15 participants per condition.

Checking: tasks and measures

The tasks consisted of checking texts that contained 100 random

Mood manipulation measures

The VAS's on sadness, happiness and tension were administered before the mood induction, directly afterwards and after the task instruction (see procedure). A one-way repeated measures ANOVA was carried out to test the efficacy of the mood induction. Data are given in Table 1.

There were significant effects on both sadness [F(1,89)=24.7, p<0.01], happiness [F(1,89)=6.6, p<0.01] and tension [F(1,89)=5.5, p<0.05]. Pair wise comparisons between the first and second measurements revealed an increase

Discussion

After the mood induction procedure, participants reported deteriorations of mood. There was neither a positive mood induction group nor a no-induction control group so that, strictly speaking, the causal relation between mood induction and mood change was not established. Note, however, that the focus of the study was not on mood/stop rule interactions per se, but on the validity of the checking task as a model of OC perseveration. The mood induction was used exclusively to create experimental

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