Conducting exposure and response prevention treatment for contamination fears during COVID-19: The behavioral immune system impact on clinician approaches to treatment
Open accessAbstract
The coronavirus disease 2019 (COVID-19) pandemic sparked significant anxiety regarding viral rates and means of transmission. Heightened concerns about contamination have prompted new hygienic strategies to vigilantly guard against infection, including hand washing immediately after touching foreign objects or suspected contaminants. This has presented a critical challenge for the delivery of exposure and response prevention (ERP) therapy to individuals with contamination fears due to Obsessive Compulsive Disorder (OCD), as providers must manage not only their clients’ attitudes and reactions but their own as well. In this investigation, self-identified anxiety and OCD treatment specialists (N = 139) provided demographic information, including their anxiety and OCD caseloads, and completed measures related to intolerance of uncertainty (IUS-SF; Carlton et al., 2007), beliefs about exposure therapy (TBES; Deacon et al., 2013), and emotional reactions to physical sensations (The Chills; Maruskin et al., 2012). We tested the hypothesis that intolerance of uncertainty and activation of the behavioral immune system (BIS; Schaller & Park, 2011), a mechanism theoretically activated by the prominent emergence of pathogens to protect against illness would predict attitudes toward exposure. The Chills Scale was used to assess BIS activation, a broad assessment of vasoconstriction responses associated with different emotional reactions, and includes a subscale (coldness) that evaluates vasoconstriction associated with defense against pathogens. Both coldness and OCD caseload, but not anxiety caseload or subscales of intolerance of uncertainty, emerged as significant predictors of clinicians’ beliefs about exposure; increases in OCD caseload were also related to decreases in negative beliefs about exposure. Findings are useful in determining methods for aiding clinicians in developing effective approaches to contamination fears during and post-pandemic that include addressing their own BIS-related concerns and mapping out means for social behavioral norms associated with engaging in exposure treatment. © 2020 Elsevier Ltd
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
5 of 17 cited sources checked · 4 supported · 0 flagged · accuracy not yet measured
- Premisecitation
The behavioral immune system is a useful theoretical framework for explaining potential hesitancies in clinicians delivering treatment for contamination fears.
“The behavioral immune system (BIS; Schaller & Park, 2011) is a useful theoretical framework to explain potential hesitancies in clinicians in delivering treatment for contamination fears.”
Quote in the paperNot a substantial claim1 of 1 sources checked- cites Schaller & Park, 2011 source
- Findingown data
The survey results indicate that the behavioral immune system plays a highly specific role in clinicians' concerns about delivering exposure for contamination OCD.
“Survey findings show a highly specific role for BIS in clinician’s concerns about exposure for contamination OCD.”
Quote in the paperSubstantial claim - Findingown data
The regression model including coldness, percentage of OCD caseload, and the Avoidance subscale of the IUS-SF significantly predicted TBES scores.
“Similarly, the model with coldness, percentage of OCD cases, and the Avoidance subscale of the IUS-SF was significant in predicting the TBES (F(5,127) = 21.24, p < .001, with Adjusted R2 change = 0.43).”
Quote in the paperNot a substantial claim - Findingown data
The primary regression model including coldness, percentage of OCD caseload, and the Anxiety subscale of the IUS-SF significantly predicted TBES scores.
“The primary model with the coldness subscale of the CHILLS, percentage of OCD cases, and the Anxiety subscale of the IUS-SF was significant in predicting the TBES (F(5,127) = 21.35, p < .001, with Adjusted R2 change = 0.43).”
Quote in the paperSubstantial claim - Findingown data
When the percentage of anxiety caseload was used instead of OCD caseload, only the coldness subscale remained a significant predictor of TBES.
“These same models were also run with the percentage of the anxiety caseload; in each case, only the coldness subscale was a significant predictor of TBES.”
- Also stated in: § Discussion · plain
“This was not found for overall anxiety disorder caseload.”
Quote in the paperNot a substantial claim - Also stated in: § Discussion · plain
- Findingown data
In the avoidance model, percentage of OCD caseload was a significant negative predictor of TBES (β=-.47, p<.001).
“Again, the percentage of OCD cases (β=-.−47, p < .001) and coldness (β = 0.18, p < .01) were significant predictors.”
Quote in the paperSubstantial claim - Findingown data
The other CHILLS subscales (goosebumps, tingling, shivers) were not significant predictors of TBES in the same models.
“The same models were run for each additional subscale of the CHILLS (goosebumps, tingling, and shivers) with no significant predictors.”
Quote in the paperNot a substantial claim - Findingown data
In the primary model, percentage of OCD caseload was a significant negative predictor of TBES (β=-.47, p<.001).
“In this model, only the percentage of OCD cases (β=-.47, p < .001) and coldness (β = 0.19, p < .01) were significant.”
- Also stated in: § Discussion · plain
“An encouraging note on the findings is that as the percentage of OCD caseload increased, the negative views on exposure decreased in the models tested.”
Quote in the paperSubstantial claim - Also stated in: § Discussion · plain
- Findingown data
In the primary model, coldness was a significant positive predictor of TBES (β=0.19, p<.01).
“In this model, only the percentage of OCD cases (β=-.47, p < .001) and coldness (β = 0.19, p < .01) were significant.”
- Also stated in: § Discussion · hedged
“Those clinicians with heightened physiological reactions were most likely to report negative attitudes towards exposure.”
Quote in the paperSubstantial claim - Also stated in: § Discussion · hedged
- Findingown data
In the avoidance model, coldness was a significant positive predictor of TBES (β=0.18, p<.01).
“Again, the percentage of OCD cases (β=-.−47, p < .001) and coldness (β = 0.18, p < .01) were significant predictors.”
Quote in the paperSubstantial claim - Premisecitation
Exposure therapy is most effective when conducted in vivo with accompanying imagery.
“Research has consistently shown that exposure is most effective when practiced in vivo with accompanying imagery (McKay et al., 2015).”
Quote in the paperSubstantial claim0 of 1 sources checked- cites McKay et al., 2015 source
- Premisecitation
When clinicians deliver exposure with hesitation about its efficacy, clients receive reduced benefits.
“Specifically, as clinicians deliver exposure with hesitation regarding its efficacy, the benefits to clients are reduced (Farrell, Deacon, Kemp, Dixon, & Sy, 2013).”
Quote in the paperSubstantial claim0 of 1 sources checked- cites Farrell, Deacon, Kemp, Dixon, & Sy, 2013 source
- Study design and conductown data
None of the study variables were correlated with the number of individuals the clinician knew who contracted COVID-19.
“None of the study variables were correlated with the number of individuals the clinician knew who contracted COVID-19.”
Quote in the paperSubstantial claim - Interpretationown data
As practitioners engage in specific OCD-relevant treatment, their ability to continue viewing exposure favorably may not be influenced by individual characteristics such as behavioral immune system activation.
“This suggests that as practitioners engage in specific OCD-relevant treatment, the ability to continue to view exposure through a favorable lens may not be influenced by individual characteristics, such as activation of the BIS.”
Quote in the paperSubstantial claim - Interpretationown data
The findings suggest that behavioral immune system activation has implications for negative attitudes about implementing exposure among clinicians.
“The findings from this study suggest that BIS activation has implications for negative attitudes about implementing exposure among clinicians.”
Quote in the paperSubstantial claim - Premisecitation
Additional behaviors to manage the spread resemble those practiced by individuals with contamination fears associated with OCD.
“Additional behaviors to manage the spread resemble those practiced by sufferers from contamination fears associated with Obsessive-Compulsive Disorder (OCD), such as washing groceries (and their containers) with disinfectants and avoiding various surfaces and places (e.g., doorknobs, public restrooms) (Centers for Disease Control & Prevention, 2020b).”
- Also stated in: § Discussion · plain
“Many of these behaviors resemble those routinely conducted by individuals suffering from contamination-based OCD.”
Quote in the paperSubstantial claim0 of 1 sources checked- cites Centers for Disease Control & Prevention, 2020b
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
- Also stated in: § Discussion · plain
- May combine two claims. 9
- Classified as probably not a substantial claim. 14
May combine two claims.
PremisecitationSome clinicians are apprehensive about conducting exposure, reporting fears of harming clients, potential vicarious traumatization, and increased malpractice risk.
“Past research has shown that some clinicians are apprehensive about conducting exposure, endorsing fears of harming clients (Deacon, Lickel, Farrell, Kemp, & Hipol, 2013), potential for vicarious traumatization to the therapist as well as being unacceptably aversive to clients (Zoellner et al., 2011), and increased malpractice risk (Richard & Gloster, 2006).”
Quote in the paperSubstantial claim1 of 3 sources checkedProbably not a substantial claim: may not pass S3 (load-bearing).
PremisecitationDisgust has a specific moderating role in the relationship between anxious interoceptive awareness and fear of contracting COVID-19.
“Recent research has shown that there is a specific moderating role for disgust in the relationship between anxious interoceptive awareness and fear of contracting COVID-19 (McKay, Yang, Elhai, & Asmundson, 2020).”
Quote in the paperNot a substantial claim1 of 1 sources checked- cites McKay, Yang, Elhai, & Asmundson, 2020 source
Classified as probably not a substantial claim. May combine two claims.
PremisecitationThe behavioral immune system is an evolved protective response that increases interoceptive awareness of potential infections and also increases disgust sensitivity.
“Briefly, the BIS is an evolved protective response that activates increased interoceptive awareness for potential infections. In addition to increased anxiety, there is also increased disgust sensitivity, as a further means of protecting from contaminants.”
Quote in the paperSubstantial claim1 of 1 sources checked- cites Schaller & Park, 2011 source
The available passages from our copy contain bibliographic metadata, not the article’s discussion of the behavioral immune system. Searches for interoceptive awareness, infection, anxiety, and disgust returned no substantive passage, so this copy cannot verify the attributed claim. (LLM, conf=0.74)
Experimental — accuracy not yet measured
Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing).
PremisecitationConducting exposure in the COVID era, both during and after the pandemic, requires balancing symptom nature and severity with social-behavioral norms.
“As recently discussed (Storch et al., 2020), the conduct of exposure in the COVID era, both during and following the pandemic, requires balancing the nature and severity of the symptoms with the social-behavioral norms.”
Quote in the paperNot a substantial claim1 of 1 sources checked- cites Storch et al., 2020 source
May combine two claims.
Findingown dataThe IUS-SF subscales (Anxiety and Avoidance) were not significant predictors of TBES in the models.
“In this model, only the percentage of OCD cases (β=-.47, p < .001) and coldness (β = 0.19, p < .01) were significant.”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S3 (load-bearing).
PremisecitationThe chills refers to a range of reactions to stimuli and events, including feelings of awe or wonder.
“In the most general way, the chills refers to a range of reactions to stimuli and events, such as feelings of awe or wonder (Kupfer & Fessler, 2018; Maruskin, Thrash, & Elliot, 2012).”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites Kupfer & Fessler, 2018; Maruskin, Thrash, & Elliot, 2012
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
May combine two claims.
PremisecitationA specific disgust-relevant behavioral immune system reaction is associated with contamination fears and arises from concerns about pathogens penetrating the skin.
“Further, recent research shows a specific disgust-relevant BIS-based reaction associated with contamination fears that is a result of concerns with pathogens penetrating the skin (Mancusi & McKay, 2020).”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites Mancusi & McKay, 2020
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
Probably not a substantial claim: may not pass S3 (load-bearing).
PremisecitationEvidence suggests that components of the chills may signal a warning of potential pathogens penetrating the skin.
“However, there is also evidence that components of the chills may signal a warning of potential pathogens penetrating the skin (discussed in Blake, Yih, Zhao, Sung, & Harmon-Jones, 2016).”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites Blake, Yih, Zhao, Sung, & Harmon-Jones, 2016 source
Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.
PremisecitationColdness and shivers are more associated with negative affectivity; coldness is particularly linked to thermoregulation and tactile sensations of disgust.
“Two of these, coldness and shivers, are more associated with negative affectivity; coldness is particularly associated with efforts at thermoregulation (Maruskin et al., 2012) and tactile sensations of disgust (Saluja & Stevenson, 2019).”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites Maruskin et al., 2012; Saluja & Stevenson, 2019
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
Classified as probably not a substantial claim.
InterpretationreasoningClinician-specific reactions to the COVID-19 pandemic are expected to affect their concerns about delivering exposure treatment.
“Given that clinicians are embedded in the cultures in which they practice, and that wider social events significantly influence methods of practice, it can be anticipated that clinician-specific reactions to the COVID-19 pandemic would have consequences for their concerns around delivering exposure treatment.”
Quote in the paperSubstantial claim- Rests on an assumption: Clinicians are embedded in the cultures in which they practice, and wider social events significantly influence methods of practice.
Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.
Study design and conductcitationThe TBES is a psychometrically sound 21-item single-factor measure with excellent internal consistency (α = 0.95).
“The TBES is a psychometrically sound 21-item measure designed to assess negative attitudes regarding exposure therapy in practitioners.”
- Also stated in: § Measures · plain
“It is a single factor scale.”
- Also stated in: § Measures · plain
“The measure has excellent internal consistency (α = 0.95).”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites Deacon et al., 2013 source
- Also stated in: § Measures · plain
Probably not a substantial claim: may not pass S3 (load-bearing).
Study design and conductcitationNo variables were significantly skewed or kurtotic.
“Using prior benchmarks, no variables were significantly skewed or kurtotic.”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S3 (load-bearing).
Study design and conductown dataAge and gender were controlled in the regression analyses.
“Age and gender were controlled in regression analyses.”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.
Study design and conductcitationThe CHILLS is a psychometrically sound 12-item measure with four subscales (goosebumps, tingling, coldness, shivers) established through cluster, principal components, and confirmatory factor analyses.
“The CHILLS is a psychometrically sound 12-item measure that assesses physical sensations associated with variations of interoceptive disgust-related experiences.”
- Also stated in: § Measures · plain
“These disgust experiences are assessed based on tactile manifestations, and is comprised of four subscales: goosebumps, tingling, coldness, and shivers.”
- Also stated in: § Measures · plain
“The subscales were established through cluster, principal components, and confirmatory factor analyses.”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites Maruskin et al., 2012 source
- Also stated in: § Measures · plain
Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.
Study design and conductcitationThe IUS-SF has satisfactory convergent validity with anxiety, worry, and depression, high internal consistency (α > 0.9), and a factor structure replicated in an OCD sample.
“In the original scale development research, it was found to have satisfactory convergent validity with assessments of anxiety and worry, as well as depression.”
- Also stated in: § Measures · plain
“The two subscales were identified in confirmatory factor analysis and high internal consistency reliability (α > 0.9).”
- Also stated in: § Measures · plain
“The factor structure and internal consistency has been replicated in a sample of individuals with OCD (Jacoby, Fabricant, Leonard, Riemann, & Abramowitz, 2013).”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites Jacoby, Fabricant, Leonard, Riemann, & Abramowitz, 2013 source
- Also stated in: § Measures · plain
Probably not a substantial claim: may not pass S3 (load-bearing).
Study design and conductown dataTests of multivariate normality using Cook's and Mahalanobis distances indicated that the assumption was met.
“Tests of multivariate normality using Cook’s and Mahalanobis distances showed that the assumption was met.”
Quote in the paperNot a substantial claimMay combine two claims.
Study design and conductown dataNo significant differences were found between groups on COVID-19 specific demographic variables except for whether the clinician knew someone with COVID-19 for the coldness subscale.
“No significant differences were found except for whether the clinician knew someone with COVID-19 for the coldness subscale of the CHILLS scale.”
Quote in the paperNot a substantial claimClassified as probably not a substantial claim.
Study design and conductnone givenThere was no multicollinearity.
“There was no multicollinearity.”
Quote in the paperSubstantial claim
The paper relies on this without support.
Clinicians are embedded in the cultures in which they practice, and wider social events significantly influence methods of practice.
“Given that clinicians are embedded in the cultures in which they practice, and that wider social events significantly influence methods of practice, it can be anticipated that clinician-specific reactions to the COVID-19 pandemic would have consequences for their concerns around delivering exposure treatment.”
The paper relies on this without support.
Clinicians' own hesitancy around contamination due to COVID-19 would limit their ability to deliver exposure therapy for contamination fears.
“One of the factors that would be expected to limit the ability of clinicians to deliver exposure therapy for contamination fears would be their own hesitancy around contamination due to COVID-19.”
The paper relies on this without support.
Practitioners are themselves likely engaged in recommended hygienic behaviors and may recommend ERP for OCD sufferers.
“There are also consequences for practitioners, who themselves are likely both engaged in these same recommended hygienic behaviors and simultaneously may recommend exposure with response prevention (ERP) strategies for OCD sufferers as a means to stem their symptoms.”
The paper relies on this without support.
The sample of self-identified practitioners specializing in anxiety disorders and OCD is highly suitable for addressing the research question.
“This study addressed this question in a highly suitable sample, namely a self-identified group of practitioners who specialize in anxiety disorders and OCD.”
The paper relies on this without support.
COVID-19 has resulted in significant changes in treatment delivery for contamination OCD.
“COVID-19 has resulted in significant changes in treatment delivery for contamination OCD.”
The paper relies on this without support.
This study is the first investigation into the relationship between behavioral immune system activation and delivery of exposure during the COVID-19 pandemic.
“Although previous studies have also explored clinicians’ attitudes to exposure, this constitutes the first investigation (to the authors’ knowledge) into the relationship between BIS activation and delivery of exposure during the COVID-19 pandemic.”
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
Intolerance of uncertainty biases information processing, leading to faulty appraisals of threat, and reduces coping abilities.
“It is a cognitive, emotional, and behavioral tendency to react negatively to uncertain or ambiguous situations and unpredictable future events [57,58], which biases information processing, leading to faulty appraisals of threat, and reduces coping abilities [59].”
Statistics recomputed
Every reported test result, recomputed from its test statistic and degrees of freedom. A result shows as not adding up only once an independent check has confirmed it.
- ConsistentF(5, 127) = 21.35reported p < .001 · recomputed p < .001
“F(5,127) = 21.35, p < .001”
- ConsistentF(5, 127) = 21.24reported p < .001 · recomputed p < .001
“F(5,127) = 21.24, p < .001”
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
African-American percentage does not match counts
MajorThe stated percentage for African-American respondents is inconsistent with the count and total sample size. One out of 139 participants is 0.72%, not 0.1%.
Reported 0.1 · recomputed 0.719424
“with the remainder Latinx (N = 4; 2.8 %), Asian (N = 4; 2.8 %), African-American (N = 1; 0.1 %) and N = 5 (3.5 %) did not indicate.”
African-American participant percentage is understated
MinorOne participant out of 139 is approximately 0.7% of the sample, not the reported 0.1%.
Reported 0.1 · recomputed 0.719424
“African-American (N = 1; 0.1 %)”
Cites
Fearing the unknown: A short version of the Intolerance of Uncertainty Scale
Carleton, R. N., Norton, M. A. P. J., & Asmundson, G. J. G. (2007) · Journal of Anxiety Disorders · doi:10.1016/j.janxdis.2006.03.014 · Cited by 2,288 · see citing works
Coronavirus Disease 2019–COVID-19
Dhama, K., Sharun, K., Tiwari, R., Sircar, S., Bhat, S., Malik, Y. S., Singh, K. P., Chaicumpa, W., Bonilla‐Aldana, D. K., & Rodriguez-Morales, A. J. (2020) · Clinical Microbiology Reviews · doi:10.1128/cmr.00028-20 · Cited by 1,917 · see citing works
The behavioral immune system (and why it matters)
Schaller, M., & Park, J. H. (2011) · Current Directions in Psychological Science · doi:10.1177/0963721411402596 · Cited by 1,119 · cited 3× · see citing works
“We tested the hypothesis that intolerance of uncertainty and activation of the behavioral immune system (BIS; Schaller & Park, 2011), a mechanism theoretically activated by the prominent emergence of pathogens to protect against illness would predict attitudes toward exposure.”
BackgroundMethodInfluentialCoronavirus Disease 2019 (COVID‐19)
(2020) · Journal of Midwifery & Women s Health · doi:10.1111/jmwh.13196 · Cited by 391 · see citing works
Efficacy of cognitive-behavioral therapy for obsessive-compulsive disorder
McKay, D., Sookman, D., Neziroglu, F., Wilhelm, S., Stein, D. J., Kyrios, M., Matthews, K., & Veale, D. (2015) · Psychiatry Research · doi:10.1016/j.psychres.2014.11.058 · Cited by 283 · cited 1× · see citing works
“practiced in vivo with accompanying imagery (McKay et al., 2015).”
Self-citationMcKay, D., Yang, H., Elhai, J., & Asmundson, G. J. G. (2020) · Journal of Anxiety Disorders · doi:10.1016/j.janxdis.2020.102233 · Cited by 152 · cited 1× · see citing works
“Further, recent research shows a specific disgustrelevant BIS-based reaction associated with contamination fears that is a result of concerns with pathogens penetrating the skin (Mancusi & McKay, 2020).”
Self-citationFarrell, N. R., Deacon, B. J., Kemp, J. J., Dixon, L. J., & Sy, J. T. (2013) · Journal of Anxiety Disorders · doi:10.1016/j.janxdis.2013.03.007 · Cited by 133 · cited 1× · see citing works
“Prior research has shown that as negative attitudes about exposure increase, treatment is delivered with greater caution, leading to sub-optimal intervention (Farrell et al., 2013).”
Maruskin, L. A., Thrash, T. M., & Elliot, A. J. (2012) · Journal of Personality and Social Psychology · doi:10.1037/a0028117 · Cited by 121 · cited 1× · see citing works
“T practiced in vivo with accompanying imagery (McKay et al., 2015).”
Handbook of Exposure Therapies
Richard, D. C. S., & Lauterbach, D. (2007) · Elsevier eBooks · doi:10.1016/b978-0-12-587421-2.x5000-5 · Cited by 118 · see citing works
Jacoby, R. J., Fabricant, L. E., Leonard, R. C., Riemann, B. C., & Abramowitz, J. S. (2013) · Journal of Anxiety Disorders · doi:10.1016/j.janxdis.2013.07.008 · Cited by 102 · see citing works
Therapist perceptions and delivery of interoceptive exposure for panic disorder
Deacon, B. J., Lickel, J. J., Farrell, N. R., Kemp, J. J., & Hipol, L. J. (2013) · Journal of Anxiety Disorders · doi:10.1016/j.janxdis.2013.02.004 · Cited by 101 · cited 2× · see citing works
“beliefs about exposure therapy (TBES; Deacon et al., 2013), and emotional reactions to physical sensations (The”
Ectoparasite defence in humans: Relationships to pathogen avoidance and clinical implications
Kupfer, T. R., & Fessler, D. M. T. (2018) · Philosophical Transactions of the Royal Society B: Biological Sciences · doi:10.1098/rstb.2017.0207 · Cited by 85 · see citing works
Exposure therapy has a public relations problem
Richard, D. C. S., & Gloster, A. T. (2007) · Handbook of Exposure Therapies · doi:10.1016/b978-012587421-2/50019-3 · Cited by 77 · see citing works
Zoellner, L. A., Feeny, N. C., Bittinger, J. N., Bedard-Gilligan, M. A., Slagle, D. M., Post, L. M., & Chen, J. A. (2011) · Psychological Trauma: Theory, Research, Practice, and Policy · doi:10.1037/a0024642 · Cited by 52 · cited 1× · see citing works
“Past research has shown that some clinicians are apprehensive about conducting exposure, endorsing fears of harming clients (Deacon, Lickel, Farrell, Kemp, & Hipol, 2013), potential for vicarious traumatization to the therapist as well as being unacceptably aversive to clients (Zoellner et al., 2011), and increased ma…”
Perceptual and cognitive determinants of tactile disgust
Saluja, S., & Stevenson, R. J. (2019) · Quarterly Journal of Experimental Psychology · doi:10.1177/1747021819862500 · Cited by 28 · see citing works
Blake, K. R., Yih, J., Zhao, K., Sung, B., & Harmon-Jones, C. (2017) · Cognition and Emotion · doi:10.1080/02699931.2016.1202199 · Cited by 27 · see citing works
Storch, E. A., Schneider, S. C., Guzick, A., McKay, D., & Goodman, W. K. (2020) · Psychiatry Research · doi:10.1016/j.psychres.2020.113310 · Cited by 26 · see citing works
Self-citationMancusi, L., & McKay, D. (2021) · Journal of Anxiety Disorders · doi:10.1016/j.janxdis.2021.102366 · Cited by 8 · cited 1× · see citing works
“Further, recent research shows a specific disgustrelevant BIS-based reaction associated with contamination fears that is a result of concerns with pathogens penetrating the skin (Mancusi & McKay, 2020).”
BackgroundSelf-citation
Flagged first, then by citations
1 of the 19 references couldn’t be matched to a known paper.
Cited by
Sorted by citations
Do we experience pandemic fatigue? current state, predictors, and prevention
Haktanir, A., Can, N., Seki, T., Kurnaz, M., & Dilmac, B. (2021) · Current Psychology · doi:10.1007/s12144-021-02397-w · Cited by 143 · see citing works
“, 2020), anxiety, depression levels (Glowacz & Schmits, 2020; Rettie & Daniels, 2020), obsessive and physical tendencies (McKay et al., 2020), insomnia symptoms (Voitsidis et al.”
BackgroundKhosravani, V., Aardema, F., Ardestani, S. M. S., & Bastan, F. S. (2021) · Journal of Obsessive-Compulsive and Related Disorders · doi:10.1016/j.jocrd.2021.100626 · Cited by 112 · see citing works
Obsessive–Compulsive Disorder During the COVID-19 Pandemic: a Systematic Review
Guzick, A. G., Candelari, A. E., Wiese, A. D., Schneider, S. C., Goodman, W. K., & Storch, E. A. (2021) · Current Psychiatry Reports · doi:10.1007/s11920-021-01284-2 · Cited by 109 · see citing works
Self-citationCOVID-19 stress and substance use: Current issues and future preparations
McKay, D., & Asmundson, G. J. G. (2020) · Journal of Anxiety Disorders · doi:10.1016/j.janxdis.2020.102274 · Cited by 68 · see citing works
“As illustrated in various papers included in this volume, fears specific to the coronavirus and contamination (Lee et al., 2020; McKay et al., 2020; Mertens et al., 2020) as well as factors that exacerbate negative psychological outcomes, including viewing stressful media content (Chao et al.,…”
BackgroundSelf-citationStorch, E. A., Sheu, J. C., Guzick, A. G., Schneider, S. C., Cepeda, S. L., Rombado, B. R., Gupta, R., Hoch, C. T., & Goodman, W. K. (2020) · Psychiatry Research · doi:10.1016/j.psychres.2020.113597 · Cited by 57 · see citing works
Self-citationKorte, C., Friedberg, R. D., Wilgenbusch, T., Paternostro, J. K., Brown, K., Kakolu, A., Tiller-Ormord, J., Baweja, R., Cassar, M., Barnowski, A., et al. (2022) · Journal of Clinical Psychology in Medical Settings · doi:10.1007/s10880-021-09816-x · Cited by 54 · see citing works
Fontenelle, L. F., Albertella, L., Brierley, M., Thompson, E. M., Destrée, L., Chamberlain, S. R., & Yücel, M. (2021) · Journal of Psychiatric Research · doi:10.1016/j.jpsychires.2021.03.046 · Cited by 56 · see citing works
“…concerns as predicting symptom aggravation during the pandemic [and how best to manage these symptoms clinically (Fineberg et al., 2020; McKay et al., 2020; Sheu et al., 2020)], our data suggest that other symptom dimensions (fear of harm and symmetry) are important determinants of OCD…”
Bongelli, R., Canestrari, C., Fermani, A., Muzi, M., Riccioni, I., Bertolazzi, A., & Burro, R. (2021) · Healthcare · doi:10.3390/healthcare9081086 · Cited by 38 · see citing works
“It is a cognitive, emotional, and behavioral tendency to react negatively to uncertain or ambiguous situations and unpredictable future events [57,58],”
BackgroundKhosravani, V., Ardestani, S. M. S., Bastan, F. S., McKay, D., & Asmundson, G. J. G. (2021) · Clinical Psychology & Psychotherapy · doi:10.1002/cpp.2602 · Cited by 28 · see citing works
Self-citationMorbid Polarization: Exposure to COVID-19 and Partisan Disagreement about Pandemic ResponsePreprint
Rodriguez, C. G., Gadarian, S. K., Goodman, S. W., et al. (2020) · doi:10.31234/osf.io/wvyr7 · Cited by 21 · see citing works
Variation in Obsessive-Compulsive Disorder Symptoms and Treatments: A Side Effect of COVID-19
Liu, W., Zhang, H., & He, Y. (2021) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph18147420 · Cited by 16 · see citing works
Li, I., Millard, M., Haskelberg, H., Hobbs, M. J., Luu, J., & Mahoney, A. (2021) · Behavioural and Cognitive Psychotherapy · doi:10.1017/s1352465821000448 · Cited by 17 · see citing works
“The considerable uptake of online mental health services seen in this study is also highly consistent with numerous expert concerns about the impacts of the pandemic on the wellbeing of people with OCD (e.g. Banerjee, 2020; Kumar and Somani, 2020; McKay et al., 2020; Silva et al., 2020).”
BackgroundResultInfluentialJelinek, L., Voderholzer, U., Moritz, S., Carsten, H. P., Riesel, A., & Miegel, F. S. (2021) · Journal of Anxiety Disorders · doi:10.1016/j.janxdis.2021.102493 · Cited by 13 · see citing works
“According to norm values of the English version of the OCI-R (Abramovitch, Abramowitz, Riemann, & McKay, 2020) and the mean total score of 25 for the German version of the OCI-R in the current study, severity of OCD could still be considered “moderate” (total score Note.”
MethodSanfilippo, F., Tigano, S., Rosa, V. L., Morgana, A., Murabito, P., Oliveri, F., Longhini, F., & Astuto, M. (2021) · Brazilian Journal of Anesthesiology (English Edition) · doi:10.1016/j.bjane.2021.08.017 · Cited by 12 · see citing works
shabani, M. J., Mohsenabadi, H., Gharraee, B., Shayanfar, F., Corcoran, V. P., & McKay, D. (2022) · International Journal of Cognitive Therapy · doi:10.1007/s41811-022-00152-y · Cited by 13 · see citing works
“Anxiety sensitivity and body vigilance are two processes that are hypothesized to develop and sustain health anxiety (Abramowitz et al., 2007; McKay et al., 2020a, b).”
BackgroundSelf-citationFear of COVID-19 and secondary trauma: Moderating role of self-efficacy
Li, Y., Abbas, Q., Manthar, S., Hameed, A., & Asad, Z. (2022) · Frontiers in Psychology · doi:10.3389/fpsyg.2022.838451 · Cited by 9 · see citing works
“Even though social distancing and other safety measures provide safety (McKay et al., 2020), mental health is likely to be affected by living in isolation (Mukhtar, 2020).”
BackgroundKaragöz, A., Keskin, B., Kültürsay, B., Çeneli, D., Akbal, Ö. Y., Tokgöz, H. C., Tanyeri, S., Efe, S. Ç., Doğan, C., Bayram, Z., et al. (2021) · The American Journal of Emergency Medicine · doi:10.1016/j.ajem.2021.01.083 · Cited by 9 · see citing works
Jelinek, L., Balzar, A., Moritz, S., Liebherz, S., & Yassari, A. H. (2024) · Journal of Obsessive-Compulsive and Related Disorders · doi:10.1016/j.jocrd.2024.100860 · Cited by 7 · see citing works
Sutradhar, J., & Sarkar, B. R. (2021) · Journal of pharmacopuncture · doi:10.3831/kpi.2021.24.4.165 · Cited by 7 · see citing works
“[35] have investigated BIS activation during this pandemic and the attitude which was related to fear leading to OCD.”
BackgroundDampak Covid-19 pada Kesehatan Mental: Kajian Literature Review Menggunakan Nvivo Plus 12
Sulistyorini, A., Kusumawaty, I., Yunike, Y., & Gani, A. (2022) · JSHP ( Jurnal Sosial Humaniora dan Pendidikan) · doi:10.32487/jshp.v6i2.1521 · Cited by 7 · see citing works
Leveraging AI-based digital systems in psychological interventions: a research opinion
Panduwiyasa, H. (2025) · Frontiers in Digital Health · doi:10.3389/fdgth.2025.1693504 · Cited by 4 · see citing works
Digital students go to campus: did stress and anxiety affect the intention for organization?
Panduwiyasa, H., & Wibowo, F. S. (2024) · Journal of Education and Learning (EduLearn) · doi:10.11591/edulearn.v18i3.21744 · Cited by 4 · see citing works
“The challenges associated with adapting to new hybrid learning models, coupled with concerns about health and safety, further exacerbate anxiety levels [37].”
BackgroundCOVID-19 Pandemisi ve Obsesif Kompulsif Bozukluk
Okray, Z. (2021) · Psikiyatride Guncel Yaklasimlar - Current Approaches in Psychiatry · doi:10.18863/pgy.829348 · Cited by 4 · see citing works
Gamified Digital Intervention to Ameliorate the Aptitude of Exposure Therapy for OCD
Eishita, F. Z., Tasnim, R. A., Pongratz, R., & Beard, D. J. (2023) · IEEE Gaming, Entertainment, and Media Conference (GEM) · doi:10.1109/gem59776.2023.10390472 · Cited by 2 · see citing works
“A timely workaround to this can be the frequent communication between the clinicians and patients [18] utilizing the modern technology such that smartphone interventions [20].”
BackgroundDisgust and Obsessive-Compulsive Disorder
Moran, E., & McKay, D. (2025) · Journal of Health Service Psychology · doi:10.1007/s42843-025-00126-6 · Cited by 2 · see citing works
“…clearly expressed when faced with the prospect of a contaminant penetrating the skin and is called the chills (i.e., in fears of contracting COVID; McKay et al., 2020) or the heebie-jeebies (Mancusi & McKay, 2021), it may also pre-sent itself with other subtypes of OCD, including paraphilia OCD…”
Self-citation石, 建. (2024) · Advances in Psychology · doi:10.12677/ap.2024.142096 · Cited by 1 · see citing works
Powell, P. A., & Consedine, N. S. (2021) · Springer eBooks · doi:10.1007/978-3-030-84486-8_16 · Cited by 1 · see citing works
Storch, E. A., & Sheu, J. C. (2021) · Journal of Cognitive Psychotherapy · doi:10.1891/jcpsy-d-20-00040
Self-citationDIFICULDADES NA ASSISTÊNCIA DE ENFERMAGEM DURANTE A PANDEMIA DE COVID-19
Silva, A. A., Leandro, A. M., Ramiro, B. F., Homem, D. S., Silva, K. M. B. D. N., & Kusano, L. A. E. (2021) · Editora Creative eBooks · doi:10.53924/epcjrs.11
ADOECIMENTO CARDIOVASCULAR E COVID 19: UMA REVISÃO NARRATIVA
Brilhante, R. R. D. C., Sampaio, T. E. S., de Oliveira, I. M. M., Cestari, V. R. F., da Silva, J. N. G., & Pessoa, V. L. M. D. P. (2021) · Editora Creative eBooks · doi:10.53924/epcjrs.37
Kind, D. C., Silva, A. D. A., Franco, D. F., Passos, L. D. A. G., Dias, N. D. S., Santos, T. L., & de Oliveira, C. S. (2021) · Editora Creative eBooks · doi:10.53924/epcjrs.14
dos Santos, B. C. F., Barbosa, A. A. X., Barbieri, B., Lazarino, V. L., Cavalcante, V. F., Gomes, J. R. D. C., & Guedes, C. D. C. F. V. (2021) · Editora Creative eBooks · doi:10.53924/epcjrs.04
Vasconcelos, A. R. C., Ramos, E. S. P., Krause, J. C., Pereira, M. M. T., Fiori, R. F., & Passos, M. P. D. S. (2021) · Editora Creative eBooks · doi:10.53924/epcjrs.35
TEMPESTADE DE CITOCINAS NA COVID-19 E SEUS PRINCIPAIS TRATAMENTOS
Viana, A. R., & de Brito, A. F. (2021) · Editora Creative eBooks · doi:10.53924/epcjrs.13
PREVALÊNCIA DE SINTOMAS OBSESSIVO-COMPULSIVOS DURANTE A PANDEMIA DE COVID-19
Santana, A. R., Soeiro, A. C. C., de Negreiros, A. B. G., Cunha, E. S., do Nascimento, V. B., Pedrosa, V. M. F., & Rocha, A. S. (2021) · Editora Creative eBooks · doi:10.53924/epcjrs.18
DIABETES MELLITUS COMO FATOR DE RISCO A COMPLICAÇÕES DA COVID- 19: UMA REVISÃO INTEGRATIVA
Sousa, Z. D. S., Filho, M., Silva, A. A. L., Sabóia, S. K. R., Castro, A. M. A., Nogueira, J. E. S., & Filho, A. M. A. C. (2021) · Editora Creative eBooks · doi:10.53924/epcjrs.28
IMPACTO DA COVID-19 EM PACIENTES HIPERTENSOS
Brandet, D. R., Caldas, B. R., & Silva, M. B. (2021) · Editora Creative eBooks · doi:10.53924/epcjrs.05
COVID-19: GASTROENTEROPATIAS E PROGNÓSTICO
Nascimento, C. A. B., Silva, A. L. G., Costa, E. F., Alves, I. H. F., Cintra, T. V. P., Batista, T. W. R., & Melo, D. F. (2021) · Editora Creative eBooks · doi:10.53924/epcjrs.01
O MANEJO DA COVID-19 NA ATENÇÃO PRIMÁRIA À SAÚDE POR MEIO DA TELESSAÚDE
Rodrigues, C. S. S., Souza, A. R. S., Rodrigues, D. L., Silva, V. H., Martiniano, C. S., & Silva, C. R. D. V. (2021) · Editora Creative eBooks · doi:10.53924/epcjrs.31
COVID-19 NO CEARÁ: UM ESTUDO SOBRE DADOS SECUNDÁRIOS
Pereira, M. É. R., & da Silva, G. G. (2021) · Editora Creative eBooks · doi:10.53924/epcjrs.24
ATIVIDADES DE ENFRENTAMENTO DOS EFEITOS DA COVID-19 PARA INTERNOS DE UMA INSTITUIÇÃO DE ACOLHIMENTO
Nakamatsu, M. H. G., Oliveira, C. M., Koday, É. D. D. P., Simionatto, M., & Maciel, M. A. S. (2021) · Editora Creative eBooks · doi:10.53924/epcjrs.29
Melo, G., Vilela, A. F. R., Neves, F. C. S., Silva, J. L. R., Almeida, R. L. D. R., Sobrinho, W. D., & Ansaloni, L. V. S. (2021) · Editora Creative eBooks · doi:10.53924/epcjrs.33
DIABETES NO CONTEXTO DA PANDEMIA DA COVID-19: CONHECIMENTO SOBRE SINTOMAS E MEDIDAS PREVENTIVAS
Brilhante, R. R. D. C., de Oliveira, S. K. P., Sampaio, T. E. S., & da Silva, J. N. G. (2021) · Editora Creative eBooks · doi:10.53924/epcjrs.38
ENSINO REMOTO EMERGENCIAL: RELATO DE EXPERIÊNCIA DE DOCÊNCIA DURANTE A COVID-19
Santos, P. C., Santos, D. P., de Alencar, B. T., Silva, L. N. L., Borges, J. S., dos Santos, T. M., & Lima, N. R. D. O. (2021) · Editora Creative eBooks · doi:10.53924/epcjrs.36
Affective and Motivational Accounts of Moralizing COVID-19-Preventive Behaviors
Takamatsu, R., Min, M. C., & Takai, J. (2023) · Journal of Cognition and Culture · doi:10.1163/15685373-12340156
Analisis Adopsi Sistem ERP dalam Mengoptimasi Industri Pangan Menggunakan SEM dan Model UTAUT2
Panduwiyasa, H., & Yahya, R. H. (2023) · JURNAL SISTEM INFORMASI BISNIS · doi:10.21456/vol13iss1pp10-19
Think positive! Resolving human motion ambiguity in the presence of disease threat
Magalhães, A. C., Silva, F., Lameirinha, I., Rodrigues, M., & Soares, S. C. (2023) · Cognition & Emotion · doi:10.1080/02699931.2023.2269831
“Indeed, COVID-19 represents an unprecedented worldwide infectious disease threat (Shook et al., 2020) that resulted in signi fi cant changes in social-behavioural norms in the hopes of slowing down the spread of the virus (McKay et al., 2020).”
BackgroundRandazza, M. P., Ham, L. S., & McKay, D. (2024) · Substance Use & Misuse · doi:10.1080/10826084.2024.2392558
“…work has acknowledged the similarities between compulsive cleaning and Centers for Disease Control recommendations for the con-trol and prevention of COVID-19 as well as the role health anxiety plays in individual responses to pandemics (discussed in Dennis et al., 2021; McKay et al., 2020).”
Self-citationCognitive Behavioral Therapy With Exposure and Response Prevention for Obsessive-Compulsive Disorder
Ward, H. E., Moran-Meder, E., & McKay, D. (2026) · Elsevier eBooks · doi:10.1016/b978-0-443-29009-1.00140-2
Self-citationWahl-Kordon, A. (2024) · Elsevier eBooks · doi:10.1016/b978-3-437-22541-3.00007-5
- Authors
- McKay, D., Minaya, C., & Storch, E. A.
- Affiliations
- Fordham University (US)
- Baylor College of Medicine (US)
- Corresponding author
- McKay, Dean
- Venue
- Journal of Anxiety Disorders
- Publisher
- Elsevier BV
- Published
- 2020-08
- Volume
- 74
- Pages
- 102270
- ISSN
- 0887-6185 (ISSN-L)
- PMC
- PMC7328595
- OpenAlex
- W3039010221
- Cited by
- 50
- References
- 19
- Citations by year
- 2026: 1 · 2025: 2 · 2024: 5 · 2023: 4 · 2022: 4 · 2021: 32 · 2020: 2
- FWCI
- 4.19
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Journal of Anxiety Disorders (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Fordham Research Commons (Fordham University) (submittedVersion, cc-by-nc-nd)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Obsessive-Compulsive Spectrum Disorders
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Social Sciences › Psychology › Clinical Psychology › COVID-19 and Mental Health
- Keywords
- behavioral immune system, exposure and response prevention, fear of contamination, obsessive-compulsive disorder, COVID-19 pandemic, intolerance of uncertainty, hand washing, vasoconstriction, clinician anxiety
- MeSH terms
- COVID-19, Adult, Aged, Anxiety, Fear, Female, Humans, Implosive Therapy, Male, Middle Aged, Obsessive-Compulsive Disorder, Pneumonia, Viral, Coronavirus Infections, Uncertainty, Pandemics
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Claims read under definition version 3 (extract-v3) on 2026-09-28.
Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-09-28.
Cited sources are checked by gpt-6-sol.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
