Examining Attentional Bias in Scrupulosity: Null Findings From the Dot Probe Paradigm.

Research consistently demonstrates that individuals with anxiety symptoms exhibit attentional biases toward threatening stimuli using various computer-based tasks. However, the presence of attentional biases across obsessive-compulsive symptom presentations has been mixed and requires clarification. This study was the first to use the dot probe paradigm to investigate the association between scrupulosity symptoms (obsessions and compulsions having to do with religion and morality) and selective attention to scrupulosity-relevant lexical stimuli. Contrary to hypotheses, individuals with higher levels of scrupulosity did not selectively attend (i.e., have faster reaction times) to scrupulosity-specific threat words (e.g., hell) more so than to general threat or neutral words. Various potential explanations for these null findings, as well as directions for future research, are discussed.Keywords: attention bias; religiosity; obsessive-compulsive disorderScrupulosity is a presentation of obsessive-compulsive disorder (OCD) involving obsessions and compulsions having to do with religion and morality (Abramowitz, 2001, 2008; Abramowitz & Jacoby, 2014; Huppert & Siev, 2010). Specifically, individuals with scrupulosity experience unwanted intrusive thoughts (i.e., obsessions) associated with the possibility that they have committed a moral or religious transgression (e.g., "Did I commit a sin without realizing it?"); intrusive blasphemous thoughts or images (e.g., images of the devil); doubts that one may not be faithful, moral, or pious enough (e.g., "Am I truly a Christian?"); concerns that one didn't perform a religious prayer or ceremony correctly (e.g., "Did I really confess all of my sins at confession?"); and fears of eternal damnation (e.g., "Am I going to hell?"). These intrusions are experienced as highly distressing and are accompanied by the drive to perform compulsive rituals-such as excessive prayer, re-reading Bible verses until they are read "perfectly," and repeatedly seeking reassurance from religious figures or loved ones about religious topics-that function to reduce anxiety. Individuals with scrupulosity also often avoid situations and stimuli that trigger obsessional thoughts and distress.Cognitive behavioral models of scrupulosity propose that one maintaining factor of this problem is attentional biases for threat (Abramowitz & Jacoby, 2014), which refers to the preferential processing of danger-related stimuli over neutral stimuli when both types of stimuli are competing for processing priority (MacLeod, Mathews, & Tata, 1986). For example, consider the case of Rebecca, a Catholic woman with scrupulosity whose obsessional doubts include uncertainty over whether she has fully confessed all of her sins at confession. Hypervigilant for cues related to confession, sin, and hell, Rebecca has become exquisitely sensitive to these words and notices every time they appear or whenever someone uses them (and even words that sound similar; e.g., being greeted by someone saying "Hello"). She also has difficulty disengaging her attention from these intrusive words and starts to ruminate about whether she has committed a sin that she has not confessed and if God is going to punish her by damning her to hell. Her anxiety steadily increases until she feels she can no longer tolerate the discomfort. To make herself feel better, she often makes excuses to leave these situations and return to church, confess any possible perceived sins, and reduce her anxiety.Research on anxiety, more generally consistently demonstrates-using various experimental paradigms-that individuals with anxiety symptoms exhibit attentional biases toward threatening stimuli (for a meta-analytic review, see Bar-Haim, Lamy, Pergamin, Bakermans-Kranenburg, & van IJzendoorn, 2007). The dot probe task (MacLeod et al., 1986) is one such paradigm, in which participants are asked to indicate as quickly as possible which letter (i. …