Is OCD a deficiency in relying on internal signals?

Lazarov, A., Dar, R., Liberman, N., & Oded, Y. (2012). Obsessive-compulsive tendencies and undermined confidence are related to reliance on proxies for internal states in a false feedback paradigm. Journal of behavior therapy and experimental psychiatry, 43(1), 556–564.

There are several descriptions of OCD patients that not only doubt their cognitive functions but also other internal states such as the “feeling of knowing,”. Thus, one could describe OCD as an inability to generate this inner feeling, which in turn creates anxiety and doubt regarding safety, which leads to compensatory seeking of and reliance on external stimuli to achieve a “feeling of knowing”. A recent article by an Israelian research group has investigated this issue. The authors have in a previous study shown that participants with high obsessive-compulsive (OC) tendencies rely more on biofeedback in judging their state of relaxation, indicating that people with high OC symptoms are more susceptible to self perception effects.

In this study the authors first replicated their previous study and let two groups of participants with high OC tendencies vs. low OC tendencies to rate their own comfort when looking at a false pre-programmed biofeedback computer: One of a descending line graph signaling to participants decrease in muscle tension, and one of an ascending line graph signaling increase in muscle tension. The results showed that high OC, compared to low OC participants, relied more on the false biofeedback in judging their own muscle tension levels, indicating that they were more susceptible to self-perception effects.

In a second experiment, the authors wanted to investigate if undermined confidence are causally related to increased reliance on external stimuli. This was done using the same method as the first experiment but one group was told, “feelings of relaxation can be misleading. People often feel that they are relaxed only to discover later on that they were not, thus realizing that their confidence about their own feeling of relaxation had been false. Therefore, you should ask yourself whether you are really and genuinely relaxed, and whether you are confident about what you are feeling.”. Results showed that undermined confidence participants were more affected by the false biofeedback when judging their level of relaxation as compared to control participants, suggesting that undermined confidence on internal signals indeed are causally related to higher reliance on external stimuli.

What is new in this study?

The authors conclude “Whereas previous models emphasize the repetitive nature of compulsive acts, which are understood as repetitive and prolonged attempts to generate the missing internal feelings of knowing or subjective conviction, our model emphasizes the functional aspect of rituals, which are conceptualized as informative proxies that substitute and thereby compensate for lacking subjective conviction regarding internal states.”

How is this relevant to clinicians?

We managed to get a short interview with professor Dar who is one of the authors:

– I think what I find useful is to explain to patients the proxy mechanism and its flaws. I explain to them about the loss of conviction that many OCD patients experience in regard to many subjective states, like feelings (do I really love her?), understanding (have I really understood what you’ve just said), beliefs, attitudes etc. I explain my view that many of the rules and rituals they have developed over the years were proxies for these original internal states. So, if I can’t know for sure what I’m feeling toward my fiancée, I now have a proxy in the form of the number of phone calls I make to her every day or how much money I spend on presents etc. But these proxies have serious flaws – number of phone calls is not really a good approximation for love, and learning by heart for understanding. The solution? To tolerate better the feeling of uncertainty, to accept the partial control we all have over our lives and to live with the doubt.

Read the full text article here

Prof. Dar