Recently, aspects of self concept and insecure attachment orientations have
been theoretically and empirically linked with obsessive compulsive disorder(OCD).
According to this view, many individuals experience events or thoughts challenging
their sense of safety, cleanliness, or moral standards, but are not flooded by negative
self-evaluations, dysfunctional beliefs, and pathological preoccupation. In fact, for
most people, such experiences result in the activation of distress-regulation strategies
that can dissipate these unwanted thoughts, reaffirm the challenged self, and restore
emotional equanimity. However, dysfunctional functioning of the attachment system,
as manifested in heightened attachment anxiety or avoidance, can disrupt the distressregulation process and lead to OCD-related phenomena. In the current project, 4
studies were undertaken to examine the influence of experimental manipulations of
the attachment system on implicit self esteem (ISE) and urge to act in response to
scenarios previously shown to be OCD-relevant.
Study 1(n=59) and Study 2 (n=60) examined the influence of the priming of
the attachment system on implicit self esteem (ISE) using 2 student cohorts. In study
1, participants were randomly assigned to one of two conditions. In the first condition,
participants were instructed to recall a painful relationship break-up with, or
separation from, a romantic partner (attachment-anxiety condition). In the second
condition, participants were asked to recall a negative event not related to self or
separation, such as the events of 9/11 (negative control condition). In study 2,
participants were also randomly divided into two conditions. In the first condition,
participants were instructed to visualize a specific situation where an attachment
figure (previously identified) actually comforted and helped them when they were
feeling distressed or worried, and to write a brief description of the recalled situation
and the way they felt during it (priming of attachment security condition). In the
second condition participants were asked to visualize a specific situation with an
acquaintance with whom they had enjoyed, studied or worked, but who is not an
attachment figure (acquaintance-priming control condition). In both studies
participants' level of implicit self esteem was measured following the attachment
manipulation. However, these studies did not yield any statistically significant
findings. Dr Doron therefore examined the direct effects of attachment security
priming on obsessive-compulsive related phenomena using two different priming
methods. In study 3 (n=87), we examined whether being subliminally exposed (for 22
milliseconds) to names of people they nominated as a source of security (experimental
group) or to names of acquaintances (control group) on a computer task reduced OC
tendencies as measured on OC relevant scenarios. In study 4 (n=90), participants'
attachment security was supraliminally primed by asking participants to recall a
security-enhancing experience (experimental group) or a shopping experience (control
group). All participants then completed a questionnaire assessing their responses to
OCD-relevant scenarios of washing and checking concerns.
Examination of the results from study 3 and study 4 indicate that individuals
with high attachment anxiety reacted to the subliminal priming (Study 3) of
attachment security by reduced distress and urge to act in response to OCD-related
scenarios compared to neutral priming. Supraliminal priming (Study 4), however, did
not lead to any change in urge to act in response to OCD-related situations. Dr Doron
has suggested that because deliberate, controlled processes may not take place during
subliminal priming, such methods can automatically assuage distress and
dysfunctional beliefs by bypassing OC relevant deliberate processing biases (e.g., OC
related beliefs).
OCD is a significantly-disabling personal, social and health service problem
with high degrees of comorbidity, and relatively poor long-term prognosis. Despite
recent advances in the understanding and treatment of the disorder, outcomes remain
poor relative to some other anxiety disorders. Furthermore, reliable predictors of
treatment response and relapse remain elusive, and there has been some debate about
factors that need to be targeted in treatment. There have been recent calls for
clarification of the nature and contribution of attachment and self related variables to
OCD vulnerability, particularly in terms of developing therapeutic and preventative
interventions. These studies is the first step towards improving our understanding of
self and attachment processes in OCD, in order to then develop enhanced assessments
and treatments.