1 - (SYM 41) The Naturalistic Reinforcement of Obsessions and Compulsions: An Ecological Momentary Assessment Study

Several theoretical models have been posited to explain the rise and maintenance of obsessive-compulsive (OC) symptoms. Among the most widely accepted is the cognitive-behavioral model (CBT model), which suggests that OC symptoms are maintained through (a) the reinforcement of obsessions via maladaptive appraisals (e.g., overestimation of threat) of intrusive thoughts and (b) the reinforcement of compulsions through the experience of temporary relief, removal of unwanted thoughts, and reduction in one’s perceived responsibility for preventing harm following compulsive episodes. The CBT model hypothesizes temporal relationships among cognitive constructs and OC symptoms, however, these hypotheses have relied almost exclusively on retrospective reports and cross-sectional data. Moreover, studies have suggested that not all tenets of the model may have been supported—A daily diary study found that some types of compulsions were more likely to be followed by relief than others; In other studies, OCD patients have not consistently exhibit elevated obsessive beliefs. As the relationship between cognitive constructs and OC symptoms is likely reciprocal and dynamic, it is important to examine these constructs as they evolve in real-time. Therefore, the present study used ecological momentary assessment to examine naturalistic reinforcers of obsessions and compulsions temporally and longitudinally. Individuals with OCD (N = 25) received 7 prompts per day for 7 days and rated items on OC symptoms, appraisals, thought suppression, emotion, and experiences following compulsions (e.g., relief, removal of thoughts). Using two-level multilevel models, we predict momentary levels of appraisals and thought suppression to drive changes in obsessions concurrently (time t) and subsequently (time t+1). We also predict that momentary levels of overestimation of threat will drive changes in compulsions concurrently (time t) and subsequently (time t+1). As little research has investigated other predictors of compulsions, it is exploratory whether momentary changes in relief, removal of unwanted thoughts, and beliefs of responsibility for harm following compulsive episodes will drive changes in compulsions concurrently (at time t) or subsequently (at time t + 1). All data will be analyzed by the time of the symposium. Findings will elucidate temporal dynamics between OC symptoms and cognitive constructs outlined in the CBT model, offering potential insight into treatment targets.