ArticleJournal of affective disorders2026
Why compulsions persist: An ecological momentary assessment study of the reinforcement of compulsions.
Article in Journal of affective disorders, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 4 papers.
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Who cites it
4 citing papers in PubMed.
- Impaired midfrontal‑motor theta phase synchronization characterizes maladaptive motivational behavior in people with obsessive‑compulsive disorder.PLoS biology · 2026Article
- A network analysis of obsessive-compulsive patients in intensive outpatient treatment.European psychiatry : the journal of the Association of European Psychiatrists · 2026Article
- Development and validation of the eight item contrast avoidance questionnaire-general emotion scale (CAQ-GE-8): An item-response theory analysis.Journal of anxiety disorders · 2026Article
- Thought suppression worsens mood and obsessions but improves them subsequently: First evidence of a contrast avoidance effect for the maintenance of thought suppression.Behaviour research and therapy · 2026Article
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2 authors.
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Abstract
backgroundThe cognitive-behavioral model (CBM) for obsessive-compulsive disorder (OCD) posits that compulsions are negatively reinforced by providing temporary relief from distress, removal of unwanted thoughts, and reinforcement of obsessive beliefs. However, research has yet to test these assumptions using longitudinal and ecological methods.
methodWe examined the CBM using an intensive-repeated measures ecological-momentary assessment design. Participants with OCD (n = 45) completed items assessing momentary compulsion severity, anxiety, unwanted thoughts, and perceived threat 7×/day for 7 days.
resultsGreater anxiety, unwanted thoughts, and perceived threat immediately before compulsions were associated with greater compulsion severity. Greater compulsion severity was also associated with greater reduction from before to after compulsions of anxiety and was nonlinearly associated with unwanted thoughts, such that both large increases and decreases in unwanted thoughts were associated with greater compulsion severity. All levels of anxiety reduction and no change or smaller (relative to larger) increases in anxiety from before to after a compulsion were associated with a greater likelihood of compulsions at the next timepoint.
conclusionsThis is the first study to provide ecological validity to several aspects of the CBM for OCD. Anxiety reduction and avoidance of a negative emotional contrast (no change or small increase in anxiety from before to after the compulsion) were significant predictors of future compulsions, and were the only longitudinal reinforcers of compulsions. Findings underscore the importance of addressing anxiety tolerance in treatment and show the first evidence for a novel contrast avoidance effect in the reinforcement of compulsions.
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