Third ROCD symposium at the WCBCT Berlin

Below are the abstracts of the talks presented:

Pathological narcissism and relationship obsessive compulsive disorder (ROCD) symptoms

Laura Caccico, Gabriele Melli, Francesco Bulli, Simona Gelli, Elena Micheli, Guy Doron

Introduction: One impairing symptom dimension of obsessive-compulsive disorder (OCD) that has been receiving increasing research and clinical interest is Relationship OCD (ROCD). This OCD dimension includes two main presentations. Relationship-centered ROCD symptoms focusing on the suitability of the relationship itself and partner-focused ROCD symptoms centering on the relational partner perceived suitability. Partner-focused ROCD symptoms include obsessive doubts and concerns about perceived partners’ flaws in a wide variety of domains, such as morality, sociability, appearance. Clinical experience suggests that clients presenting with partner-focused ROCD symptoms may also show increased levels of narcissistic traits. For instance, like increased narcissistic traits, partner-focused ROCD symptoms have been associated with over-reliance on partner’s perceived value for one’s self-esteem, increased attentiveness to alternative romantic partners, and infidelity. This study aimed to explore the association between partner-focused ROCD symptoms and pathological narcissism, particularly the vulnerable narcissism. More specifically, we evaluated a model whereby narcissistic traits increase vulnerability to partner-focused ROCD symptoms via partner value contingent self-worth.

Methods: 310 participants with a self-referred diagnosis of ROCD were recruited online. They were administered the Pathological Narcissism Inventory (PNI)the Partner-Related Obsessive-Compulsive Symptoms Inventory (PROCSI), the Partner Value Contingent Self-Worth (PVCSW), the Relationship Catastrophization Scale (RECATS), and the maladaptive relationship belief and the Obsessive Beliefs Questionnaire-20 (OBQ-20).

Results: As expected, the correlation between vulnerable narcissism and partner-focused ROCD symptoms was large (.51). Vulnerable narcissism was a significant predictor of partner-focused ROCD symptoms, together with maladaptive beliefs about the catastrophic consequences of remaining in a wrong relationship and partner value contingent self-worth. The latter was a partial mediator in the relationship between vulnerable narcissism and partner-focused ROCD symptoms.

Conclusion: As expected, vulnerable narcissism seems to have an important role in the development of partner-focused ROCD symptoms via partner value contingent self-worth.

Reducing Relationship Obsessive-Compulsive Disorder symptoms and related psychological features: preliminary evidence form a brief mobile-app intervention

Silvia Cerea¹, Gioia Bottesi¹, Guy Doron², Denise Broggio¹, & Marta Ghisi¹

¹Department of General Psychology, University of Padua, Italy; ²Baruch Ivcher School of Psychology, Interdisciplinary Center Herzliya, Herzliya, Israel

Introduction: Relationship Obsessive-Compulsive Disorder (ROCD) is characterized by obsessive and compulsive symptoms pertaining intimate relationships (Doron et al., 2014). ROCD have been associated with dyadic distress, depression, and anxiety (Doron et al., 2012; Doron et al., 2014). A recent study (Roncero et al., 2019) found a reduction in ROCD symptoms after 15 consecutive days of training with a mobile-app intervention called GGRO. GGRO was developed by Doron to challenge maladaptive beliefs that underline ROCD following Cognitive Behavioral Therapy principles. Based on previous evidence, the aim of the current study was to evaluate the efficacy of GGRO in reducing ROCD symptoms and its associated psychological features in the Italian context.

Method: Thirty-three participants (72.73% females) who scored above the cut-off on self-report questionnaires assessing ROCD beliefs and symptoms were randomized to groups undertaking immediate-use (iApp, n = 17) or delayed use (dApp, n = 16) of GGRO. All participants completed online self-report questionnaires assessing ROCD (Relationships Obsessive Compulsive Inventory, ROCI; Partner-Related Obsessive Compulsive Symptoms Inventory, PROCSI) and OCD (Obsessive Compulsive Inventory-Revised, OCI-R) symptoms, and related psychological features such as self-esteem (Rosenberg Self-Esteem Scale, RSES), social anxiety (Social Interaction Anxiety Scale, SIAS), general distress (Depression Anxiety Stress Scale-21, DASS-21), and intolerance of uncertainty (Intolerance of Uncertainty Scale-12, IUS-12). Questionnaires were completed at baseline (T0), 15 days from baseline (T1), and 30 days from baseline (T2). Participants in the iApp group started to use the app at baseline and continued for 15 days. Participants in the dApp group were requested to wait for 15 days before starting to use the app for 15 consecutive days (T1 to T2).

Results: Concerning the iApp group, 1×3 (Time; T0 vs. T1 vs. T2) Repeated Measure ANOVAs were performed and a significant reduction from T0 to T1 and from T0 to T2 (but not from T1 to T2) emerged in the ROCI (p <.001), PROCSI (p <.001), OCI-R (p =.03), and IUS-12 (p <.001); the same pattern emerged with an increasing of the RSES (p <.001). Regarding the SIAS and the DASS-21, a significant reduction only from T0 to T1 (respectively, p =.02 and p =.03) was observed. Moreover, a series of 2 (Group) x2 (Time; T0 vs. T1) Repeated Measure ANOVAs were conducted to compare the iApp and the dApp groups across time. Analyses revealed significant Group x Time interactions in RSES (p =.01), SIAS (p =.01), ROCI (p =.01), PROCSI (p <.001), and IUS-12 (p =.03); specifically, the iApp group showed decreased scores (increased with respect to RSES) than the dApp group at T1.

Discussion and Conclusion: Present results show that 15 consecutive days of GGRO may lead to significant reduction in ROCD symptoms and in its associated psychological features. To note, most of those reductions were maintained after 2 weeks (follow-up). These findings, in accordance with previous studies (Roncero et al., 2018; Roncero et al., 2019), provide further evidence for the efficacy of GGRO in reducing ROCD beliefs and symptoms and its associated psychological features also in an Italian non-clinical sample.

Differential Cognitive Predictors of Relationship, Sexual-Orientation and general Obsessive Compulsive Symptoms

Richard Moulding, Stephanie Fernandez. Deakin University, Geelong, Australia.

Background and Objectives: Two previously understudied symptom themes of Obsessive Compulsive Disorder (OCD) have recently received greater consideration in the literature: Relationship-related OCD (ROCD) and Sexual-Orientation OCD (SO-OCD). Cognitive appraisal models of OCD suggest that symptoms are maintained by maladaptive beliefs that drive unhelpful interpretations of normal intrusive thoughts. The present study aimed to examine the contribution of general, specific, and self-related beliefs to obsessive-compulsive (OC) symptoms of both ROCD and SO-OCD.

Method: The sample comprised 264 non-clinical participants (135 males) with a mean age of 34.65 years (SD = 12.01). Participants completed an online questionnaire, which comprised a battery of self-report items.

Results: Using Structural Equation Modeling (SEM), the study found that different cognitions related to different OCD symptoms dimensions. It was found that general maladaptive beliefs were predictive of most forms of general OCD symptoms. Specific sexual-orientation beliefs were predictive of SO-OCD, over-and-above the more general beliefs noted in the cognitive appraisal model of OCD, but specific relationship-related beliefs did not strongly predict ROCD symptoms. Self-themes, particularly the “feared self”, were found to contribute significantly to OC symptoms in ROCD and SO-OCD, as well as to general OCD (particularly symptoms involving repugnant thoughts).

Conclusions: Self-themes and their contribution to specific OCD symptoms suggest that beliefs centred on feared self-perceptions and inner-self concerns may also be important in understanding symptom presentations. These findings, if replicated in clinical samples, may provide a basis for the development of specific cognitive-behavioural interventions that target such beliefs relevant to OCD, and potentially other related disorders.

“My Partner is Unreliable”: Exploring Obsessive Distrust as an Additional Dimension of Partner-Focused ROCD Symptoms

Guy Doron, Or Brandes & Avital Stern

Baruch Ivcher School of Psychology, Interdisciplinary Center Herzliya, Herzliya, Israel

Relationship Obsessive–compulsive disorder (ROCD) is a dimension of Obsessive–compulsive disorder (OCD) focusing on close and intimate relationships. ROCD may focus on the relationship itself (i.e., relationship-centered) or the perceived flaws of the relationship partner (i.e., partner-focused). Obsessive preoccupations with the perceived flaws of the relationship partner has been shown to center on domains such as intelligence, appearance, sociality, emotional regulation, competence and morality. Clinical experience suggests, however, that obsessive doubts and preoccupation with the perceived untrustworthiness or unreliability of the partner (i.e., obsessive distrust) may be an additional domain of partner-focused ROCD symptoms. The present investigation reports on the development and evaluation of the Obsessive Distrust Inventory (ODIS), an 11-item measure assessing the severity of obsessive distrust phenomena. Factor analysis supported a one internally consistent factor. The ODIS also showed the expected associations with OCD symptoms, ROCD symptoms and other mental health and relationship measures. Moreover, the ODIS signiﬁcantly predicted depression, anxiety and relationship violence, over-and-above common mental health and relationship measures. Theoretical and clinical implications of these results will be discussed.

Randomized Control Trial (RCT) shows our app GGRO is usefull in reducing ROCD symptoms

See this paper for further details. Roncero M, Belloch A, Doron G (in press). Can brief, daily training using a mobile applications help change maladaptive beliefs? A cross-over randomized-control study evaluating the efficacy of GGRO in reducing maladaptive beliefs and obsessive-compulsive symptoms. JMIR mHealth and uHealth. DOI: 10.2196/11443

A new paper published on ROCD!

The paper is entitled:” Maladaptive beliefs in relationship obsessive compulsive disorder (ROCD): Replication and extension in a clinical sample”. Press here to see the paper.

A paper published using our GGRO mobile application for ROCD

The paper is entitled: A novel approach to challenging OCD related beliefs using a mobile-app: An exploratory study .

To see a pre-printed version of the paper see this link

A post explaining ROCD on Mental Health on The Mighty

Click here! or read below.

What We’re Learning About Relationship Obsessive-Compulsive Disorder (ROCD)

Serious young couple, woman with head in hands

“During the holidays my obsessions are the worst. Doctor, I must know whether I’m in the right relationship! I cannot go on like this. Every little thing triggers my relationship doubts. When I see couples buying each other holiday gifts or families going shopping with their kids, I think ‘Do I love my partner that much? Is he the one I want to have kids with?’ Even everyday experiences such as seeing other interesting-looking men in the street or someone posting an interesting post on Facebook trigger thoughts such as, ‘This person may be a better fit for me than my current partner.’ These thoughts and doubts have a real negative impact on my life. I do not know what to do! I check and recheck how I feel towards my partner, whether I’m really in love with him and whether I am passionate about him. The problem is my feelings change all the time. At times, I am not sure whether I love him and I obsess about his incompetence and slowness. I fear he will embarrass me in front of my family or friends. Other times, I miss him, want to be with him and I think I love him. Not only that… I get obsessively jealous about him. I check his Facebook page (I have his password) and his phone all the time. I interrogate him about his day, who he spoke with and why. Please tell me, should I stay with my current partner?”

Intense preoccupation with whether one is in the right relationship is the hallmark symptom of relationship obsessive compulsive disorder (relationship OCD or ROCD). Our clients describe hours a day doubting the strength or quality of their feelings towards their romantic partner and the “rightness” of the relationship and their partner’s feelings towards them. Other clients describe being obsessively preoccupied with the perceived flaws or deficiencies of their partners. They spend several hours a day thinking about flaws in their partner’s appearance (e.g., body proportion, hair, facial features etc.), character (e.g., intelligence, morality, social skills) or both. They often describe being extremely distressed by these doubts and preoccupations.

I always ask my clients, “Do you make any attempts to get rid of these thoughts or to reduce your anxiety?” More often than not, they describe a long list of strategies and behaviors they use to reduce their distress. They describe asking others for reassurance regarding their relationship, they monitor their body for feelings of love or passion and compare the qualities of their current partner with the qualities of other potential partners. They also try “not to think” about their partners’ flaws and the relationships and avoid situations where their doubts and preoccupations are triggered. In addition, many clients use self-criticism (e.g., “I’m so stupid for having such thoughts.”), self-reassurance (e.g., ”He is smart – he said something intelligent the other day.”) and many other strategies to reduce their doubts and distress.

Of course, from time to time, we all have doubts regarding our partner or our relationship. Psychological intervention is warranted in cases where such doubts and preoccupations are distressing, time-consuming, and lead to problems in functioning in areas of life such as work, school, or social interactions.

My colleagues and I started investigating ROCD in 2012. We noticed some clients diagnosed with OCD did not respond well to treatment. These clients seemed to have obsessions and compulsions in a very specific domain: romantic relationships. Most of these clients initially sought couple or family counseling, but these interventions did not seem to address their difficulties. Their relationship had problems, but mainly as a side effect of one partners’ doubts and preoccupations. The core of the problem did not seem to be the couple or family dynamics.

Applying cognitive behavioral therapy (CBT) for OCD helped many of our ROCD clients. However, they did not respond as well as we expected. Both ourselves and our clients felt there is something missing in the therapeutic process. We have decided to look for more ROCD-specific targets for CBT. We looked at the professional literature but did not find much research focusing on this presentation of OCD. Therefore, during the last few years, we have started researching ROCD to get a better understanding of ROCD symptoms, what maintains ROCD, and ultimately how to better help our clients. We interviewed clients, developed questionnaires and assessed the impact of ROCD symptoms on peoples’ lives. We found that ROCD symptoms may cause difficulties in sexual functioning and reduce relationship satisfaction. We found that ROCD symptoms are associated with other OCD symptoms but also with depression, anxiety, and symptoms of body dysmorphic disorder (BDD, being obsessed about one’s own perceived physical flaws). In some cases, a person’s ROCD symptoms may lead their partner to obsess more about the relationship as well as their own flaws. Finally, we found that ROCD symptoms may also be associated with obsessive jealousy.

Importantly, our research and clinical work further informed us about the problematic strategies people use to deal with ROCD symptoms and the maladaptive beliefs and self-vulnerabilities that may maintain ROCD symptoms. For instance, we found that people with ROCD often compulsively monitor their own feelings towards their partner. Such increased monitoring reduces their ability to truly experience emotions which further increases their doubts and preoccupations. Clients with ROCD also report extreme beliefs about romantic relationships (e.g., “Being in a wrong relationship will destroy me and I will never be able to get out.”), love (e.g., “If you have any negative feelings towards your partner, it’s not real love.”) and regret (e.g., “I will never be able to cope with feelings of regret.”). Holding such beliefs increases relationship-related anxiety and negative interpretations of daily events. For example, believing one should never have negative thoughts or feelings towards a partner may lead people to interpret everyday fluctuation in mood and naturally occurring critical thoughts as indicating something is wrong with their relationship. Our experience suggests that using CBT techniques to address extreme beliefs regarding romantic relationships and self-vulnerabilities may improve therapy outcome.

Unfortunately our understanding of ROCD is not complete and requires more research. At the relationship OCD research unit (ROCD-RU), we are doing our best to learn more about ROCD and disseminate our knowledge. On our website, we provide full access to papers/book chapters on ROCD. We have developed mobile applications to help with the treatment of ROCD (for iPhone and Android) and other OCD symptoms (for iPhone; for Android), and we are working on an ROCD treatment manual. Our goal is to enhance and disseminate knowledge of the causes and consequences of ROCD symptoms to reduce misdiagnosis and improve existing evidence-based treatments.

Added to ROCD net: A one year follow up study investigating the reciprocal relationship between partner-focused and relationship-centered ROCD symptoms over time.

Letting It Linger: : Exploring the Longitudinal Effects of Relationship-Related Obsessive-Compulsive Phenomena [Szepsenwol, Shahar, & Doron, in press]

A pilot study conducted on GGRO showed encouraging results!

We thank all those participating in our pilot study of GGRO! below are the results of the study.

Background: Previous research has linked relationship-related anxieties, doubts and preoccupations (i.e., relationship obsessive compulsive disorder symptoms; ROCD) with reduced functioning, decreased relational and sexual functioning and lower mood. As knowledge of ROCD is emerging, individuals with such symptoms may be frequently misdiagnosed leading to reduced accessibility to adequate treatment. A growing body of literature has supported the usefulness of mobile technology in increasing accessibility to mental health knowledge and in fostering mental health or behavior change. In the present study, we examined associations between relationship related anxieties, doubts and preoccupations (i.e., ROCD symptoms) and the pattern of use of a mobile application named GGRO. This mobile application was designed to challenge maladaptive beliefs related to relationship difficulties. GGRO encourages two minutes of daily training (3 levels a day) over a period of at least 15 days.

Method. Fifty-one users of GGRO responded to a short survey pertaining to application use, satisfaction and relationship-related anxieties and preoccupations.

Results. The number of sessions ranged from 1 to 100 with forty-five participants reporting using GGRO five times or more. Medium-size statistically significant correlations were found between reported number of sessions of GGRO users (i.e., in participants that used GGRO more than 5 times) and relationship-related anxieties and preoccupations (Spearman’s rho r=-.35) suggesting greater number of sessions was related to less such relationship difficulties reported. Similarly, the higher the level participants reported reaching on GGRO (maximum being 45), the less relationship-related anxieties and preoccupations they described (Spearman’s rho r=-.30). Finally, as expected, satisfaction from GGRO was also related to less reported relationship anxieties and preoccupations (Spearman’s rho r=-.45).

Conclusions. Daily use of mobile technology aimed at challenging underlying relationship-related maladaptive beliefs may be associated with reduced relationship-related anxieties and preoccupations.

ROCD paper presented at the research meeting entitled: “Advancing Psychological Treatments for OCD: A blueprint for research”, Melbourne, 2016.

In a research meeting dedicated to advancing OCD treatment with Profs Paul Salkovskis, Randy Frost, Gail Steketee, David Veale, David Clark, Associate Prof. Guy Doron presented a paper about ROCD in a section

dedicated to the homogeneity and heterogeneity of obsessive-compulsive phenomena (Chaired by Prof. Randy Frost).

Associate Prof. Guy Doron and Gur Ilany explain about the new App for ROCD named ‘GG Relationship’

According to Professor Guy Doron and his colleague Gur Ilany, the application developed (named ‘GG Relationship’) was especially designed for dealing with relationship doubts and fears. The application is based on the principles of Cognitive Behavioral Therapy (CBT) – one of the most research-supported psychological therapies.

According to CBT models, negative self-talk – individuals’ ongoing interpretations of the self, others and the world – maintain psychological difficulties such as obsessive preoccupation, low mood, and maladaptive behaviors. In ROCD, for instance, individuals negative self-talk often relates to fear of being in the wrong relationships or/and missing the ‘right’ relationship. Individuals with such fears will continuously say to themselves (in their heads) phrases such as ‘Maybe my partner is not the ONE’, ‘He is not smart enough for me’ or ‘I will regret my decision to stay/leave with my partner forever‘. Such negative self-talk, of course, ultimately increases relationship doubts/fears, intensifies negative mood and often provokes relationship conflict.

Professor Guy Doron says ‘GG Relationship was developed in order to provide an accessible CBT training platform that would allow individuals with relationship fears and doubts to better deal with negative self-talk’. According to Gur Ilany, the application is designed to ‘(1) increase individuals’ awareness of negative self-talk, (2) train individuals’ to better identify and challenge negative self-talk, (3) increase individuals’ access to neutral and positive self-talk, and (4) increase the automaticity of the above processes’.

The core gameplay of the training is simple: individuals are presented with ‘blocks’ featuring self-talk statements such as “I am proactive”, “I am reliable” or “I am a loser”- and have to respond by pulling the supportive ‘blocks’ towards themselves (i.e., downwards) and throwing away from themselves the negative ‘blocks’ (i.e., rejecting them upwards). A/Prof Doron says ‘to further strengthen learning of supportive self-talk, each level the player completes is followed by a small memory game in which one has to identify a supportive statements that appeared in the previous level’. As the game progresses, the individual passes through thematically relevant issues such as self-esteem, beliefs in change, dealing with relationship doubts, facing uncertainty, overcoming perfectionism, coping with embarrassment, commitment anxiety, etc.,.

Training using this application, Gur says ‘will hopefully allow for gradual, steady learning of more positive self-talk thereby helping to break the vicious thought cycle maintaining relationship doubts and preoccupations’.

New App to help in the treatment of ROCD symptoms: coming soon !

A/Prof. Doron and his colleague Guy Ilany are working on an innovative training application (App) to help with the treatment of ROCD symptoms. The app is planned to include over 30 levels addressing ROCD related difficulties such as relationship doubts, intolerance for uncertainty, perfectionism, commitment anxiety and embarrassment. They said it is going to be ready to download from the App store and Google Play by June. We will keep you posted !