Mechanisms and Effectiveness of Imagery Strategies in Reducing Disgust in Contamination-Related Obsessive–Compulsive Disorder: Comparing Imagery Rescripting, Imagery Self-compassion and Mood-Focused Imagery

Abstract

Background Strong feelings of disgust and anxiety are maintaining factors in contamination-related obsessive–compulsive disorder (C-OCD). To this day there are not many studies that investigated strategies for changing pathological disgust. In a previous study, it was shown that imagery rescripting could successfully change disgust. However, whether imagery rescripting or more general imagery processing, helps to reduce pathological disgust, remains unclear. Therefore, the aim of the present study was to investigate how successful imagery rescripting is in comparison to imagery self-compassion and a passive positive imagery condition in reducing disgust. Methods For this, the three strategies were compared to each other on 2 days (within-subject) in a laboratory experiment. The study included 24 subjects with diagnosed C-OCD, and 24 matched, healthy controls (between-subject). Results The results show that all three strategies changed disgust, they do not differ from each other and that different traits appear to influence the strategies’ success or failure. The theoretically derived underlying mechanisms of the strategies were found in an elaborate content analysis. Conclusions The present study provides first indications that imagery in general can help to change pathological disgust experience.

A systematic review of the effectiveness of compassion focused imagery in improving psychological outcomes in clinical and non‐clinical adult populations

“…The effectiveness of CFI was examined in two separate groups, depending on whether a study included a control imagery condition or not. Eleven studies included a control imagery condition (Ascone et al, 2017; Bibbey, 2019; Campbell et al, 2019; Duarte et al, 2015; Fink‐Lamotte et al, 2021; Lincoln et al, 2013; Maratos & Sheffield, 2020; O'Neil & MacMillan, 2012, Tsivos, 2015; Wright, 2019), and nine did not (Baldwin et al, 2020; Forkert et al, 2022; Gilbert & Irons, 2004; Kamboj et al, 2015, 2018; McEwan & Gilbert, 2016; Naismith et al, 2018; Rockliff et al, 2011).…”

“…Bibbey (2019) also observed reductions in paranoia and negative affect in both conditions. Fink‐Lamotte et al (2021) found all imagery conditions were equally successful in reducing feelings of disgust. Wright (2019) also reported that all imagery conditions, including control, had been successful in improving relaxed affect and safe/content positive affect.…”

“…Studies that did implement a control condition and that reported improvements in psychological outcomes were methodologically stronger (Ascone et al, 2017; Fink‐Lamotte et al, 2021; Lincoln et al, 2013; Tsivos, 2015; Wright, 2019). These studies indicate that CFI intervention led to a more positive self‐to‐self relationship for the participants.…”

“…A summary of the risk of bias assessment is presented in Table 3, which displays the breakdown of scores across six assessment criteria and the final global rating. Five studies scored a 'Strong' global rating (Ascone et al, 2017;Fink-Lamotte et al, 2021;O'Neill, 2011;Tsivos, 2015;Wright, 2019). Ten scored a 'Moderate' global rating (Baldwin et al, 2020;Bibbey, 2019;Brown et al, 2020;Campbell et al, 2019;Kamboj et al, 2015Kamboj et al, , 2018Lincoln et al, 2013;Maratos & Sheffield, 2020;Naismith et al, 2019;Rockliff et al, 2011).…”

Ewww–Investigating the neural basis of disgust in response to naturalistic and pictorial nauseating stimuli

“…However, this may run into a sort of ceiling effect, as the maximal disgust strength induced by pictures is still likely lower than the disgust induced by disgusting naturalistic stimuli. Nevertheless, using pictures for emotion induction is still useful, especially when investigating sensitive populations like strongly-affected patients or children since outcomes like emotion regulation can also be investigated with pictures ( 59 ).…”