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INTRODUCTION: Checking behaviour (CB) occurs in various mental health problems. Cognitive-behavioural models for these mental disorders share similar theoretical assumptions. Thus, they postulate a negative reinforcing effect of CB by reducing negative affect (ie, anxiety) and a maintenance of the pathology due to a lack of reality testing of concerns. This paper details methods for a systematic review that will be conducted to synthesise empirical evidence testing these theoretical assumptions across obsessive-compulsive, generalised anxiety, eating, body dysmorphic and illness anxiety disorder. The results are expected to foster our understanding of the mechanisms of action underlying CB, which is of high clinical relevance. Depending on whether or not the findings confirm the model assumptions regarding CB, the focus of treatments would need to be intensified or modified. METHODS AND ANALYSIS: We will search PsycINFO, PubMed, PSYNDEX and Scopus for studies investigating the emotional state in which CB is being used as well as the immediate and longer-term effects of CB on cognitive and emotional measures in clinical and analogue samples. The selection process, data extraction and quality assessment of included studies will be performed by two independent reviewers. In the case of inconsistencies, a third reviewer will be involved. Study results will be reported in a narrative synthesis. ETHICS AND DISSEMINATION: Ethics approval will not be required as this is a protocol for systematic review. The results are mainly disseminated through peer-reviewed publications. PROSPERO REGISTRATION NUMBER: CRD42021238835.

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Body checking (BC) is not only inherent to the maintenance of eating disorders but is also widespread among healthy females. According to etiological models, while BC serves as an affect-regulating behavior in the short term, in the longer term it is assumed to be disorder-maintaining and also produces more negative affect. The present study therefore aimed to empirically examine the proposed longer-term consequences of increased BC. In an online study, N = 167 women tracked their daily amount of BC over a total of 7 days: Following a 1-day baseline assessment of typical BC, participants were asked to check their bodies in an typical manner for 3 days and with a 3-fold increased frequency for 3-days. Before and after each BC episode, the impact of BC on affect, eating disorder symptoms, general pathology and endorsement of different functions of BC was assessed. Participants showed longer-term consequences of increased BC in terms of increased negative affect and general pathology, while eating disorder symptoms remained unaffected. In the case of typical BC, participants showed decreased general pathology and anxiety. Furthermore, the endorsement of a higher number of BC functions led to increased negative affect and an increased amount of typical BC. The findings support the theoretically assumed role of maladaptive BC in maintaining negative emotion in the longer term. However, though requiring replication, our finding of positive effects of typical BC calls into question the overall dysfunctionality of BC among non-clinical women who are not at risk of developing an eating disorder.

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OBJECTIVES: Recent research has shown that placebos can be effective even if they are openly prescribed to participants. Yet, it is unclear how such "open-label placebos" (OLPs) compare to deceptive placebo (DP) and what the mechanisms of actions are. In this study, we therefore compared 2 versions of OLP to DP and no treatment (NT). MATERIALS AND METHODS: Using a standard heat pain paradigm, 117 healthy volunteers underwent a baseline and a posttreatment pain assessment. With the exception of NT, all groups received an inert placebo cream after the first assessment. OLP was administered by either evoking positive expectancies or by raising hope for placebo analgesia, thus distinguishing for the first time conceptually between expectancy and hope in experimental pain research. The primary outcome was pre-post change in pain tolerance. RESULTS: Increase in pain tolerance was larger in the 3 treatment groups compared with NT, whereas the treatment groups did not differ from each other. Further results showed that participants receiving DP reported a large reduction of subjective pain intensity and unpleasantness, whereas no such reduction was found for the 2 OLP groups. The 2 OLP versions did not differ in terms of their analgesic effects. DISCUSSION: The study provided evidence for traditional placebo analgesia on the basis of deception. For OLP, we found that OLP indeed increased pain tolerance; however, participants receiving OLP were reluctant to report any subjective analgesic effects. Combined with previous studies, the present findings suggest that the effects of OLP are weaker in healthy volunteers than in clinical samples.

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