Anxiety Disorders: Rachman S

Rachman S. · Department of Psychology, University of British Columbia, Vancouver, Canada V6 T 1Z4. · J Behav Ther Exp Psychiatry. · Pubmed #18054779 No free full text.

Abstract: The nature and content of intrusive images in obsessional compulsive disorders (OCD) are described. They are primarily visual, usually vivid, effortless, fully formed, of brief duration, and remarkably stable. The persistence and changes of the images are described and some therapeutic possibilities considered.

Rachman S. · Department of Psychology, University of British Columbia, Vancouver, Canada, V6T 1Z4. · Behav Res Ther. · Pubmed #15381436 No free full text.

Abstract: Compulsive cleaning is an attempt to remove feelings of contamination that threaten one's physical health, mental health or ability to function socially. The fear of becoming contaminated can be complex, powerful, persistent and easily spread. Contamination is defined, the main types of contaminants set out and the characteristics of the fear are described. The distinction between normal and abnormal feelings of contamination is considered, and abnormal beliefs about contamination are analysed. Attention is drawn to the fact that contamination can occur without any physical contact, and the concept of mental pollution is used to elucidate this process. The causes and consequences of contamination fears are described, and some connections between fear and disgust are considered. The concept of cognitive co-morbidity is applied to an analysis of associations between the fear of contamination and obsessions, social fears and phobias. It is suggested that applying cognitive analyses and tactics may improve our ability to treat these powerful and tenacious fears.

Shafran R, Rachman S. · Department of Psychiatry, Oxford University, Warneford Hospital, Oxford, OX3 7JX, UK. · J Behav Ther Exp Psychiatry. · Pubmed #15210372 No free full text.

Abstract: The cognitive bias of "Thought Action Fusion" (TAF) has received significant research attention in the past decade. The review addresses the assessment of TAF, its place in cognitive theories of obsessional difficulties, and the evidence demonstrating that TAF is relevant to disorders beyond Obsessive Compulsive Disorder (OCD). Data on the components of TAF, its extension to positive outcomes and its role in the aetiology, maintenance and treatment of OCD are reviewed. It is concluded that the moral form of TAF is less robust than the likelihood form and that scales may be best used as a starting point in identifying beliefs and conducting experimental investigations. It is also suggested that the scales be amended to include harm avoidance, which would also increase their clinical utility.

Newth S, Rachman S. · Psychology Department, University of British Columbia, Vancouver, Canada. · Behav Res Ther. · Pubmed #11280343 No free full text.

Abstract: Patients' deliberate concealment from others of the content and frequency of their obsessions is a common and important aspect of obsessive-compulsive disorder (OCD). It is an overlooked manifestation of the safety behaviour that is believed to sustain OCD (e.g., neutralizing, thought suppression, avoidance behaviour, concealment). The phenomenon of concealment is understandable in terms of the cognitive theory of obsessions which states that obsessions are caused when the person attaches catastrophic personal significance to their unwanted intrusive thoughts. It is suggested that the selected, planned, suitable disclosure of obsessions can be therapeutic--presumably because it exposes the patient to alternative interpretations of the significance of the unwanted thoughts.

Salkovskis P, Shafran R, Rachman S, Freeston MH. · University of Oxford Department of Psychiatry, Warneford Hospital, UK. · Behav Res Ther. · Pubmed #10500320 No free full text.

Abstract: The purpose of this paper is to consider the possible origins of an inflated sense of responsibility which occupies an important place in the cognitive theory of obsessive compulsive disorder (Rachman, S. (1993). Obsessions, responsibility, and guilt. Behaviour Research and Therapy, 31, 149-154. Salkovskis, P. M. (1985). Obsessional-compulsive Problems: A cognitive-behavioural analysis. Behaviour Research and Therapy, 23 (5), 571-583). Clinical experience and consideration of current cognitive conceptualisations of obsessions and obsessive compulsive disorder suggest a number of possibilities, each of which is described after a brief introduction to the concept itself. While there are reasons to believe that some general patterns can be identified, the origins of obsessional problems are best understood in terms of complex interactions specific to each individual.

Fairbrother N, Newth SJ, Rachman S. · Anxiety Disorders Unit, Department of Psychiatry, University of British Columbia Hospital, Purdy Pavilion, M42, 2221 Westbrook Mall, Vancouver, BC, Canada V6T 2B5. · Behav Res Ther. · Pubmed #15531357 No free full text.

Abstract: An experiment was carried out in order to test the hypothesis that feelings of mental pollution can be induced without physical contact. A sample of 121 female university undergraduates were asked to imagine experiencing a non-consensual kiss at a party, as described on an audiotape, or a consensual kiss described on a comparable audiotape. The manipulation succeeded and participants in the non-consensual kiss condition reported significant feelings of mental pollution, negative emotions and cognitions, as well as the urge to wash. Further, eight participants in the non-consensual kiss condition engaged in washing/rinsing behaviour to counteract feelings of mental pollution. The results are consistent with the hypothesis and with reports from an earlier study of victims of sexual assault, a majority of whom described feelings of mental pollution post-assault. The results are also compatible with case descriptions of the onset of mental pollution and OCD subsequent to sexual trauma. Some possible implications of the results, clinical and theoretical are adumbrated.

Radomsky AS, Rachman S. · Department of Psychology, Concordia University, 7141 Sherbrooke St West, Montreal, QC, Canada H4B 1R6. · J Behav Ther Exp Psychiatry. · Pubmed #15210375 No free full text.

Abstract: Investigations of memory and associated phenomena in obsessive-compulsive disorder (OCD) can advance our understanding of this often debilitating problem. Theoretical models predict both the presence and absence of memory biases in favour of threat-relevant information in association with anxiety disorders generally, and with OCD specifically. Two previous experiments (one involving compulsive washing and another involving compulsive checking) that demonstrated such a memory bias are reviewed in the context of the existing literature. Additionally, a new experiment failing to demonstrate such a bias (in association with compulsive ordering and arranging) is presented. The results are discussed in terms of cognitive-behavioural and information processing approaches to understanding OCD. It is argued that experiments which utilize stimuli that are low in ecological validity are unlikely to detect explicit memory biases in OCD. As such, experimental paradigms that are perceived as particularly significant, relevant and important to participants with OCD are encouraged.

Radomsky AS, Rachman S, Hammond D. · University of British Columbia, Psychology Department, Vancouver, Canada. · Behav Res Ther. · Pubmed #11419612 No free full text.

Abstract: Recent research suggests that there is a positive memory bias for threatening information in compulsive cleaners. However, the relationship between OCD and memory is likely to be more complex when the compulsive behaviour is checking. Hence, we decided to explore this relationship in a clinical sample of people who check compulsively. Participants completed a diagnostic interview and were then asked to complete a standard 'baseline' check which normally causes distress/discomfort. Two additional checks were then completed--one under conditions of high responsibility and one under low responsibility. The order of responsibility manipulation was randomized across participants. After each check, participants completed a Memory and Confidence Interview which assessed memory for threat-relevant and threat-irrelevant aspects of the check, and also confidence in memory for the check. One week later, participants came into the laboratory to complete additional Memory and Confidence Interviews after watching a videotape of the checks completed earlier in their own homes. These videotaped checks were taken as conditions of 'no responsibility'. Results show a positive memory bias for threat-relevant information. As responsibility was inflated, this positive memory bias was amplified. Under conditions of no responsibility, no memory bias was detectable. Also, responsibility appears to have had a greater impact on confidence in memory than on memory itself in OCD. The results are discussed in terms of the mnestic deficit theory of OCD and in terms of cognitive-behavioural approaches to understanding the disorder.

Radomsky AS, Rachman S. · Department of Psychology, University of British Columbia, Vancouver, Canada. · Behav Res Ther. · Pubmed #10402686 No free full text.

Abstract: There is a memory bias associated with depression, and good reason to expect a memory bias associated with anxiety. However, the results of studies reported to date have been ambiguous. Accordingly, an experiment was conducted to assess memory for contamination in people with different types of anxiety. Memory for contaminated stimuli among participants who met DSM-IV criteria for obsessive-compulsive disorder (OCD) and indicated a fear of contamination (n = 10) was compared to memory in a group of anxious controls (n = 10), and in undergraduate students (n = 20). Participants were shown 50 objects, 25 of which were contaminated by the experimenter and 25 which were touched but not contaminated. They then completed a neuropsychological memory assessment, after which the participants were asked to recall all of the objects touched by the experimenter. They were then asked to approach each object and to rate their anxiety about touching it. Finally, participants were asked about their perceptions of the cleanliness of each object. The OCD group had better memory for contaminated objects than for clean ones. Neither control group showed such a bias. Neuropsychological test scores indicated that this bias is not the result of differences in general memory ability. The results are discussed in terms of the memory-deficit theory of OCD and of behavioural and cognitive approaches to understanding the role of information processing in fear and anxiety.

Rachman S, Radomsky AS, Shafran R. · Department of Psychology, University of British Columbia, 2136 West Mall, Vancouver, BC, V6T 1Z4, Canada. · Behav Res Ther. · Pubmed #18199423 No free full text.

Abstract: There is ample evidence that the use of safety behaviour can interfere with the progress of therapy, particularly if exposure is involved. As a result, it is widely asserted that safety behaviour is anti-therapeutic. However, an unqualified rejection of safety behaviour should be reconsidered because we now have theoretical justification, experimental evidence and clinical observations showing that the judicious use of safety behaviour, especially in the early stages of treatment, can be facilitative. Experiments in which escape behaviour facilitated fear reduction, and others in which the use of safety gear facilitated fear reduction, are reviewed. It also appears that safety behaviour does not necessarily prevent disconfirmatory experiences. We propose that additional investigations of the judicious use of safety behaviour will help to elucidate therapeutic uses of safety behaviour in the treatment of anxious and related types of psychopathology.

Herba JK, Rachman S. · Department of Psychology, University of British Columbia, 2136 West Mall, Vancouver, BC, Canada V6T 1Z4. · Behav Res Ther. · Pubmed #17765866 No free full text.

Abstract: Mental contamination refers to feelings of contamination that arise without physical contact with a contaminant. Mental contamination has been documented among sexual assault victims, some of whom report feeling dirty and wanting to wash in response to memories of the assault. This study examined variables associated with increased vulnerability to mental contamination. Female undergraduates (n=100) filled out a series of questionnaires and listened to an audiotape that instructed them to imagine experiencing a forced kiss by an undesirable male. Controls (n=20) imagined a consensual kiss by a desirable male. Women in the non-consensual condition reported stronger feelings of dirtiness and urge to wash than those in the consensual condition. Twenty-seven women in the non-consensual condition spontaneously rinsed in order to alleviate physical sensations evoked by the tape. Regression analyses revealed that significant predictors of dirtiness included contact contamination fear and disgust sensitivity, and there was a trend for anxiety sensitivity to predict dirtiness. Contact contamination fear was also a significant predictor of urge to wash. Prior experience with unwanted sexual contact was a significant predictor of rinsing, and there was a trend for fear of negative evaluation to predict rinsing. Discussion focuses on the implications of these findings for our understanding of mental contamination.

Fairbrother N, Rachman S. · Interdisciplinary Women's Reproductive Health Research Training Program, BCRICWH Department of Health Care and Epidemiology Faculty of Medicine, University of British Colombia, 5804 Fairview Avenue, Vancouver, BC, Canada V6T 1Z3. · J Behav Ther Exp Psychiatry. · Pubmed #16563306 No free full text.

Abstract: We investigated a major component of the Ehlers-Clark theory of post-traumatic stress disorder (PTSD) in a sample of 50 female victims of sexual assault. In particular, we tested the hypothesis that the victims' appraisals of the trauma and its consequences contribute significantly to the persistence of PTSD symptoms. The results indicated that the victims' appraisals of the sexual assault and its sequelae are strongly and positively related to PTSD symptoms. This finding remained significant after statistically controlling for the perceived severity of the assault. Most of the results are consistent with the Ehlers-Clark theory.

Thordarson DS, Radomsky AS, Rachman S, Shafran R, Sawchuk CN, Ralph Hakstian A. · Department of Psychology, University of British Columbia, 2136 West Mall, Vancouver, BC, V6T 1Z4, Canada. · Behav Res Ther. · Pubmed #15381439 No free full text.

Abstract: The original Maudsley Obsessional Compulsive Inventory (MOCI) has been widely used and is considered to be one of the best available self-report instruments for measuring observable obsessive-compulsive problems such as washing and checking. However, it has several limitations and requires updating. Our revision of the MOCI, the Vancouver Obsessional Compulsive Inventory (VOCI), was designed to provide assessment of a range of obsessions, compulsions, avoidance behaviour, and personality characteristics of known or theoretical importance in obsessive-compulsive disorder (OCD). The development of the VOCI is described, and we provide evidence of its reliability and validity. Our findings in samples of people with OCD, people with other anxiety disorders or depression, community adults, and undergraduate students suggest that the VOCI is a promising new measure. We anticipate that, like its predecessor, the VOCI will have widespread use in both research and clinical settings.

Rachman S. · Department of Psychology, University of British Columbia, 2136 West Mall, Vancouver, BC, Canada V6T 1Z4. · J Behav Ther Exp Psychiatry. · Pubmed #15210380 No free full text.

This publication has no abstract.

Radomsky AS, Rachman S. · Department of Psychology, Concordia University, Montreal, Quebec, Canada. · Behav Res Ther. · Pubmed #15178465 No free full text.

Abstract: Compulsive ordering and arranging, and a preoccupation with symmetry are features of obsessive-compulsive disorder (OCD) that have not been examined experimentally. Three connected studies were conducted to examine this phenomenon: a self-report measure of this behaviour was developed and validated, participants were asked to engage in tasks designed to assess preferences for order, and to assess the interference of disorderly surroundings in the completion of a stressful activity. The self-report measure has sound psychometric properties and validity. Participants with a strong preference for order were made more anxious by having to complete a difficult task in a disorganized environment. Participants without this preference did not show this effect. The results are discussed in terms of the phenomenology of compulsive ordering and arranging, and its relationships with both OCD and normal human behaviour. It is suggested that compulsive ordering and a drive for symmetry are extreme manifestations of the common preference for order and symmetry.

Fairbrother N, Rachman S. · Anxiety Disorders Unit, Department of Psychiatry, UBC Hospital, A Site of Vancouver Hospital and Health Sciences Centre, Detwiller Pavillion, 2211 Westbrook Mall, Vancouver, BC V6T 2B5, Canada. · Behav Res Ther. · Pubmed #14975779 No free full text.

Abstract: This paper describes an investigation of the phenomenon of mental pollution in a sample of 50 female victims of sexual assault. Feelings of mental pollution were assessed using an interview and a questionnaire. An experimental procedure was employed to determine if feelings of dirtiness and the urge to wash could be provoked by deliberate attention to the assault memory. Thirty (60%) of the 50 participants reported some feelings of mental pollution subsequent to the assault, and feelings of mental pollution were related to post-assault washing behaviour. Deliberate recall of the assault resulted in stronger feelings of dirtiness and the urge to wash than did deliberate attention to a pleasant memory or scene. Nine women reported washing their hands in response to deliberate recall of the assault. These findings suggest that feelings of mental pollution may be prominent in victims of sexual assault.

Shafran R, Frampton I, Heyman I, Reynolds M, Teachman B, Rachman S. · Oxford University Department of Pschiatry, Warnefond Hospital, Oxford OX3 7JX, UK. · J Adolesc. · Pubmed #12550826 No free full text.

Abstract: The aim of this study was to develop a reliable self-report instrument to assess obsessive-compulsive disorder (OCD) in young people. The children's Obsessional Compulsive Inventory (CHOCI) had good internal consistency, criterion validity and was significantly correlated with the Children's Yale-Brown Obsessive Compulsive Scale (CY-BOCS). This preliminary new measure could serve to provide a more efficient and accessible way of assessing OCD in young people.

Radomsky AS, Rachman S, Hammond D. · University of British Columbia, Vancouver, Canada. · J Anxiety Disord. · Pubmed #12171216 No free full text.

Abstract: A comprehensive theory of panic must explain not only the cause(s) of episodes of panic but also why and when panic episodes terminate. Accordingly, we conducted a set of three studies on participants with panic disorder in order to investigate these aspects of panic episodes. In Study 1, we asked participants to monitor their panics prospectively, paying particular attention to the episodes' conclusions and the time period which followed. Results from Study 1 were consistent with earlier retrospective studies, showing that people engage in safety and other behaviors in an attempt to end their panics. We also collected information from the participants on beliefs about panic termination and the post-panic period. Study 2 was designed to determine if a post-panic refractory period occurs. Participants were asked to complete a hyperventilation exercise, and then to repeat the exercise a second time. Results from this study provide scant evidence of a post-panic refractory period. Study 3 was a more ecologically valid version of Study 2, in which participants were asked to re-trigger panics that occurred in their natural surroundings. Again, there was little support for a post-panic refractory period. Results are discussed in terms of cognitive-behavioral and biological theories of panic disorder.

Rachman S. · Department of Psychology, University of British Columbia, Vancouver, Canada. · Behav Res Ther. · Pubmed #12051482 No free full text.

Abstract: It is proposed that compulsive checking occurs when people who believe that they have a special, elevated responsibility for preventing harm, mainly to others, are unsure that the perceived threat has been reduced or removed. The intensity and duration of this checking is determined by three "multipliers": increased responsibility, probability of harm and anticipated seriousness of harm. The recurrency of the checking is promoted by a self-perpetuating mechanism, comprising four elements: paradoxical increases in responsibility and in perceived probability of harm, reduced confidence in memory and the absence of a certain end to the threat. The relation between compulsive checking and other anxiety disorders is examined and the successes and failures of past or present treatments re-considered. Experimental predictions are set out and the therapeutic implications of the construal are discussed.

Rachman S. · University of British Columbia, Department of Psychology, Vancouver, Canada. · Behav Res Ther. · Pubmed #11814177 No free full text.

This publication has no abstract.

Radomsky AS, Rachman S, Thordarson DS, McIsaac HK, Teachman BA. · Department of Psychology, Concordia University, Montreal, Quebec, Canada. · J Anxiety Disord. · Pubmed #11474815 No free full text.

Abstract: The content and psychometric properties of the Claustrophobia Questionnaire (CLQ) are described. An earlier version of the CLQ was developed to test the hypothesis that claustrophobia is comprised of two distinct but related fears--the fear of suffocation and the fear of restriction [J. Anxiety Disord. 7 (1993) 281.]. The scale was used to assess patients undergoing the magnetic resonance imaging (MRI) procedure [J. Behav. Med. 21 (1998) 255.] and in participants with panic disorder [J. Abnorm. Psychol. 105 (1996) 146; Taylor, S., Rachman, S., & Radomsky, A. S. (1996). The prediction of panic: a comparison of suffocation false alarm and cognitive theories. Unpublished data.]. On the basis of these studies, we decided to revise and shorten the CLQ, collect normative data, and provide information on the scale's predictive and discriminant validity as well as its internal consistency and test-retest reliability. This was done through a set of four interconnected studies that included psychometric analyses of undergraduate and community adult questionnaire responses and behavioural testing. Results indicate that the CLQ has good predictive and discriminant validity as well as good internal consistency and test-retest reliability. The CLQ appears to be a reliable and sensitive measure of claustrophobia and its component fears. We encourage the use of the CLQ in a variety of clinical and research applications. The scale is provided in this paper for public use.

Rachman S, Grüter-Andrew J, Shafran R. · Department of Psychology, University of British Columbia, Vancouver, Canada. · Behav Res Ther. · Pubmed #10846809 No free full text.

Abstract: A psychometric study was conducted in order to collect basic information about post-event processing in social anxiety. It was found that such processing occurs commonly after an anxiety-evoking or embarrassing social event and post-event processing scores were significantly correlated (r = 0.40) with social anxiety. The recollections of the social event tended to be recurrent and intrusive, interfering with concentration. Post-event processing was associated with the avoidance of similar social situations. The results are discussed in terms of the Clark and Wells model of social phobia.