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Kvale G, Hansen B, Hagen K, Abramowitz JS, Børtveit T, Craske MG, Franklin ME, Haseth S, Himle JA, Hystad S, Kristensen UB, Launes G, Lund A, Solem S, Öst LG. Effect of D-Cycloserine on the Effect of Concentrated Exposure and Response Prevention in Difficult-to-Treat Obsessive-Compulsive Disorder: A Randomized Clinical Trial. JAMA Netw Open 2020; 3:e2013249. [PMID: 32789516 PMCID: PMC7426745 DOI: 10.1001/jamanetworkopen.2020.13249] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
IMPORTANCE Evidence is lacking for viable treatment options for patients with difficult-to-treat obsessive-compulsive disorder (OCD). It has been suggested that D-cycloserine (DCS) could potentiate the effect of exposure and response prevention (ERP) treatment, but the hypothesis has not been tested among patients with difficult-to-treat OCD. OBJECTIVE To evaluate whether DCS potentiates the effect of concentrated ERP among patients with difficult-to-treat OCD. DESIGN, SETTING, AND PARTICIPANTS The study was a randomized placebo-controlled triple-masked study with a 12-month follow-up. Participants were adult outpatients with difficult-to-treat OCD. A total of 220 potential participants were referred, of whom 36 did not meet inclusion criteria and 21 declined to participate. Patients had either relapsed after (n = 100) or not responded to (n = 63) previous ERP treatment. A total of 9 specialized OCD teams within the public health care system in Norway participated, giving national coverage. An expert team of therapists from the coordinating site delivered treatment. Inclusion of patients started in January 2016 and ended in August 2017. Data analysis was conducted February to September 2019. INTERVENTIONS All patients received individual, concentrated ERP treatment delivered during 4 consecutive days in a group setting (the Bergen 4-day treatment format) combined with 100 mg DCS, 250 mg DCS, or placebo. MAIN OUTCOMES AND MEASURES Change in symptoms of OCD and change in diagnostic status. Secondary outcomes measures included self-reported symptoms of OCD, anxiety, depression, and quality of life. RESULTS The total sample of 163 patients had a mean (SD) age of 34.5 (10.9) years, and most were women (117 [71.8%]). They had experienced OCD for a mean (SD) of 16.2 (10.2) years. A total of 65 patients (39.9%) were randomized to receive 100 mg DCS, 67 (41.1%) to 250 mg of DCS, and 31 (19.0%) to placebo. Overall, 91 (56.5%) achieved remission at posttreatment, while 70 (47.9%) did so at the 12-month follow-up. There was no significant difference in remission rates among groups. There was a significant reduction in symptoms at 12 months, and within-group effect sizes ranged from 3.01 (95% CI, 2.38-3.63) for the group receiving 250 mg DCS to 3.49 (95% CI, 2.78-4.18) for the group receiving 100 mg DCS (all P < .001). However, there was no significant effect of treatment group compared with placebo in obsessive-compulsive symptoms (250 mg group at posttreatment: d = 0.33; 95% CI, -0.10 to 0.76; 100 mg group at posttreatment: d = 0.36; 95% CI, -0.08 to 0.79), symptoms of depression and anxiety (eg, Patient Health Questionnaire-9 score among 250 mg group at 12-month follow-up: d = 0.30; 95% CI, -0.17 to 0.76; Generalized Anxiety Disorder-7 score among 100 mg group at 12-month follow-up: d = 0.27; 95% CI, -0.19 to 0.73), and well-being (250 mg group: d = 0.10; 95% CI, -0.42 to 0.63; 100 mg group: d = 0.34; 95% CI, -0.19 to 0.86). No serious adverse effects were reported. CONCLUSIONS AND RELEVANCE In this study, DCS did not potentiate ERP treatment effect, but concentrated ERP treatment was associated with improvement. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT02656342.
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van der Veld WM, Duppen L, Hendriks GJ, Abramowitz JS, Kampman M. Psychometric Properties of the Dutch Dimensional Obsessive-Compulsive Scale (DOCS). EUROPEAN JOURNAL OF PSYCHOLOGICAL ASSESSMENT 2020. [DOI: 10.1027/1015-5759/a000600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Abstract. The Dimensional Obsessive-Compulsive Scale (DOCS) is a self-report questionnaire aimed to measure the severity of obsessive-compulsive symptoms on four thematically different symptom dimensions (contamination, responsibility for harm, unacceptable thoughts, and symmetry and completeness). The DOCS was developed in the US in response to the insufficiency of existing OCD measures. The 20-item scale is used in research and clinical settings. We translated the DOCS into Dutch and examined the psychometric properties in a clinical sample. In addition, we further examined the US version of DOCS with respect to measurement invariance between patient and non-patients and also between the US and the Dutch version of the DOCS. The analyses showed that the Dutch version is a valid and reliable version of the DOCS. Measurement invariance tests indicated that patient scores can be validly compared with non-patient scores. Therefore, the DOCS is a good instrument to monitor the development of OCD, for example, during treatment. The same result was found for the US DOCS and the Dutch DOCS, hence US scores and Dutch scores can be validly compared. With these two studies we have extended our knowledge of the DOCS, beyond the common psychometric properties.
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Storch EA, Peris TS, De Nadai A, Piacentini J, Bloch M, Cervin M, McGuire J, Farrell LJ, McCracken JT, McKay D, Riemann BC, Wagner AP, Franklin M, Schneider SC, Walkup JT, Williams L, Abramowitz JS, Stewart SE, Fitzgerald KD, Goodman WK. Little Doubt That CBT Works for Pediatric OCD. J Am Acad Child Adolesc Psychiatry 2020; 59:785-787. [PMID: 32618273 DOI: 10.1016/j.jaac.2020.01.026] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Revised: 12/27/2019] [Accepted: 04/24/2020] [Indexed: 12/19/2022]
Abstract
We write with great concern in response to the recent systematic review and meta-analysis of cognitive-behavioral therapy (CBT) in pediatric obsessive-compulsive disorder (OCD) by Uhre et al.1 Although the authors' results consistently support the clinical efficacy of CBT for pediatric OCD, we expect that, much like ourselves, readers will be confused by the discordant and inappropriate conclusions that they put forward. These conclusions stem from the authors' application and interpretation of their particular qualitative methods, which could lead important stakeholders (eg, parents, patients, clinicians, and payers) to wrongly discount clear evidence for what is known to be the best evidence-based therapy for pediatric OCD.
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Fontenelle LF, Oldenhof E, Eduarda Moreira-de-Oliveira M, Abramowitz JS, Antony MM, Cath D, Carter A, Dougherty D, Ferrão YA, Figee M, Harrison BJ, Hoexter M, Soo Kwon J, Küelz A, Lazaro L, Lochner C, Marazziti D, Mataix-Cols D, McKay D, Miguel EC, Morein-Zamir S, Moritz S, Nestadt G, O'Connor K, Pallanti S, Purdon C, Rauch S, Richter P, Rotge JY, Shavitt RG, Soriano-Mas C, Starcevic V, Stein DJ, Steketee G, Storch EA, Taylor S, van den Heuvel OA, Veale D, Woods DW, Verdejo-Garcia A, Yücel M. A transdiagnostic perspective of constructs underlying obsessive-compulsive and related disorders: An international Delphi consensus study. Aust N Z J Psychiatry 2020; 54:719-731. [PMID: 32364439 DOI: 10.1177/0004867420912327] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
BACKGROUND The Research Domain Criteria seeks to bridge knowledge from neuroscience with clinical practice by promoting research into valid neurocognitive phenotypes and dimensions, irrespective of symptoms and diagnoses as currently conceptualized. While the Research Domain Criteria offers a vision of future research and practice, its 39 functional constructs need refinement to better target new phenotyping efforts. This study aimed to determine which Research Domain Criteria constructs are most relevant to understanding obsessive-compulsive and related disorders, based on a consensus between experts in the field of obsessive-compulsive and related disorders. METHODS Based on a modified Delphi method, 46 experts were recruited from Australia, Africa, Asia, Europe and the Americas. Over three rounds, experts had the opportunity to review their opinion in light of feedback from the previous round, which included how their response compared to other experts and a summary of comments given. RESULTS Thirty-four experts completed round one, of whom 28 (82%) completed round two and 24 (71%) completed round three. At the final round, four constructs were endorsed by ⩾75% of experts as 'primary constructs' and therefore central to understanding obsessive-compulsive and related disorders. Of these constructs, one came from the Positive Valence System (Habit), two from the Cognitive Control System (Response Selection/Inhibition and Performance Monitoring) and the final construct was an additional item suggested by experts (Compulsivity). CONCLUSION This study identified four Research Domain Criteria constructs that, according to experts, cut across different obsessive-compulsive and related disorders. These constructs represent key areas for future investigation, and may have potential implications for clinical practice in terms of diagnostic processes and therapeutic management of obsessive-compulsive and related disorders.
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Ojalehto HJ, Abramowitz JS, Hellberg SN, Buchholz JL, Twohig MP. Adherence to exposure and response prevention as a predictor of improvement in obsessive-compulsive symptom dimensions. J Anxiety Disord 2020; 72:102210. [PMID: 32208231 DOI: 10.1016/j.janxdis.2020.102210] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Accepted: 03/05/2020] [Indexed: 11/18/2022]
Abstract
Exposure and response prevention (ERP) is an effective treatment for obsessive compulsive disorder (OCD); yet, improvement rates vary and it is therefore important to examine potential predictors of outcome. The present study examined adherence with ERP homework as a predictor of (a) treatment response across OCD symptom dimensions and (b) reductions in psychological factors implicated in the maintenance of OCD. Fifty adults with OCD received manualized twice-weekly ERP as part of a treatment trial. Results indicated that treatment was effective for all OCD symptom dimensions and that greater adherence with ERP homework predicted post-treatment (but not follow-up) improvements in OCD symptoms pertaining to responsibility for harm, unacceptable obsessional thoughts, and symmetry. Adherence did not predict outcomes for contamination symptoms, however. Adherence also predicted improvement in psychological maintenance factors such as obsessive beliefs and experiential avoidance. Implications of the findings include the importance of emphasizing adherence to homework instructions, as well as the importance of considering OCD symptoms dimensionally as opposed to globally in examining predictors of treatment response.
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Buchholz JL, Abramowitz JS. The therapeutic alliance in exposure therapy for anxiety-related disorders: A critical review. J Anxiety Disord 2020; 70:102194. [PMID: 32007734 DOI: 10.1016/j.janxdis.2020.102194] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Revised: 01/15/2020] [Accepted: 01/16/2020] [Indexed: 11/29/2022]
Abstract
The therapeutic alliance has been the subject of a great deal of psychotherapy research, and evidence from numerous empirical studies suggests that a strong patient-therapist relationship predicts favorable treatment outcomes. Despite the consistency of the alliance outcome relationship across treatment modalities and diagnoses, little attention has been given to this potential prognostic indicator in exposure therapy for anxiety-related disorders. Given that exposure therapy requires patients to engage in challenging and distressing activities (e.g., confrontation with feared stimuli), a strong alliance between patient and therapist is conceptually relevant to treatment. Relatively few published exposure therapy trials have included the therapeutic alliance as a process variable, and no single review summarizes findings from this body of literature. Accordingly, the purpose of this review is to provide an overview and synthesis of existing research on the alliance-outcome relationship in exposure therapy. Methodological and conceptual considerations will be discussed, and future research priorities will be identified.
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Hellberg SN, Buchholz JL, Twohig MP, Abramowitz JS. Not just thinking, but believing: Obsessive beliefs and domains of cognitive fusion in the prediction of OCD symptom dimensions. Clin Psychol Psychother 2019; 27:69-78. [PMID: 31657499 DOI: 10.1002/cpp.2409] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Revised: 09/17/2019] [Accepted: 10/17/2019] [Indexed: 11/08/2022]
Abstract
Cognitive fusion (CF) involves the tendency to "buy in" to thoughts and feelings and consists of three empirically established domains: somatic concerns, emotion regulation, and negative evaluation. CF is hypothesized to play a role in obsessive-compulsive disorder (OCD). The present study examined how well the CF domains, relative to traditional cognitive-behavioural constructs (i.e., obsessive beliefs such as inflated responsibility), predict OCD symptoms. Fifty-two treatment-seeking adults with OCD completed self-report measures of CF, obsessive beliefs, OCD symptoms, and general distress. Domains of CF were differentially associated with the responsibility for harm, symmetry, and unacceptable thoughts of OCD dimensions; yet after accounting for obsessive beliefs, only the negative evaluation domain of CF significantly predicted symmetry OCD symptoms. Obsessive beliefs significantly predicted all OCD dimensions except for contamination. These findings provide additional support for existing cognitive-behavioural models of OCD across symptom dimensions, with the exception of contamination symptoms, and suggest that the believability of thoughts and feelings about negative evaluation adds to the explanation of symmetry symptoms. Conceptual and treatment implications, study limitations, and future directions are discussed.
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Jacoby RJ, Abramowitz JS, Blakey SM, Reuman L. Is the hierarchy necessary? Gradual versus variable exposure intensity in the treatment of unacceptable obsessional thoughts. J Behav Ther Exp Psychiatry 2019; 64:54-63. [PMID: 30851653 DOI: 10.1016/j.jbtep.2019.02.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Revised: 01/24/2019] [Accepted: 02/20/2019] [Indexed: 11/29/2022]
Abstract
Although research suggests that introducing varying levels of fear during exposure enhances outcomes for some anxiety-related problems, this has not been examined in the context of obsessions. The current preliminary study tested the hypothesis that introducing variability in exposure intensity would improve long-term outcomes relative to traditional gradual (hierarchical) exposure METHODS: Adults (N = 40) with a moderately distressing unacceptable obsessional thought were randomly assigned in parallel to four twice-weekly sessions of: (a) gradual exposure (EXP-G; n = 19) emphasizing hierarchical exposure completion, or (b) variable exposure (EXP-V; n = 21) emphasizing variability in exposure intensity RESULTS: There were no significant differences in pre to post changes between groups using self-report, interview, or behavioral outcomes (as evaluated by an independent assessor blind to treatment condition). Group comparisons at 3-month follow-up did not reach statistical significance but were moderate in magnitude. Specifically, as measured by clinical interview (the Yale-Brown Obsessive-Compulsive Scale; primary outcome) and self-report, individuals in the EXP-G group maintained gains at 3-month follow-up, while the EXP-V group continued to improve. Treatment expectancies and satisfaction were comparable for both groups. Five participants withdrew from the EXP-G condition, and none withdrew from the EXP-V condition. In contrast to previous studies, variability in subjective and physiological fear during exposure did not predict outcomes LIMITATIONS: The study employed an analogue sample with moderate unacceptable obsessions, and results should be replicated in clinical samples CONCLUSIONS: Variable exposure warrants future study to understand the mechanisms, moderators, and implications of this novel approach.
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Buchholz JL, Blakey SM, Abramowitz JS, Leonard RC, Riemann BC. Predictors of concurrent depressive symptoms in patients with obsessive-compulsive disorder. Psychiatry Res 2019; 279:267-271. [PMID: 30955863 DOI: 10.1016/j.psychres.2019.03.052] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2018] [Revised: 03/29/2019] [Accepted: 03/30/2019] [Indexed: 01/22/2023]
Abstract
Many patients with obsessive-compulsive disorder (OCD) exhibit concurrent depressive symptoms, which are associated with negative psychological outcomes. Yet little research has focused on identifying factors that predict depressive symptoms in OCD. The current study examined three transdiagnostic constructs-anxiety sensitivity (AS), intolerance of uncertainty (IU), and worry-as predictors of depressive symptom severity in a sample of treatment-seeking adults with a primary diagnosis of OCD (N = 93). Strong, positive associations between depressive symptoms and measures of AS, IU, and worry were detected, and AS and worry (but not IU) remained significant unique predictors of depression after controlling for the severity of OCD symptoms. The conceptual and clinical implications of these findings, as well as study limitations and future directions, are discussed.
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Buchholz JL, Abramowitz JS, Blakey SM, Reuman L, Twohig MP. Sudden Gains: How Important Are They During Exposure and Response Prevention for Obsessive-Compulsive Disorder? Behav Ther 2019; 50:672-681. [PMID: 31030882 DOI: 10.1016/j.beth.2018.10.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Revised: 10/09/2018] [Accepted: 10/09/2018] [Indexed: 01/27/2023]
Abstract
Symptom reduction over the course of cognitive-behavioral therapy is not always distributed evenly across sessions. Some individuals experience a sudden gain, defined as a large, rapid, and stable decrease in symptoms during treatment. Although research documents a link between sudden gains and treatment for depression and anxiety, findings in the context of obsessive-compulsive disorder (OCD) treatment are mixed. The present study investigated the relationship between sudden gains and treatment outcome in 44 adults with OCD and addressed limitations of previous studies by measuring OCD symptoms dimensionally and comparing individuals who experience sudden gains to those who experience gradual gains of similar magnitude. Sudden gains were observed among 27% of participants, with highest rates among individuals with primary contamination symptoms. Participants who experienced a sudden gain had greater OCD symptom reductions at posttreatment (but not at follow-up), and this difference did not persist after controlling for gain magnitude. Thus, the importance of sudden gains during OCD treatment may be limited. Findings are discussed in light of inhibitory learning models of cognitive-behavioral therapy.
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Blakey SM, Abramowitz JS. Dropping Safety Aids and Maximizing Retrieval Cues: Two Keys to Optimizing Inhibitory Learning During Exposure Therapy. COGNITIVE AND BEHAVIORAL PRACTICE 2019. [DOI: 10.1016/j.cbpra.2018.03.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Blakey SM, Abramowitz JS, Buchholz JL, Jessup SC, Jacoby RJ, Reuman L, Pentel KZ. A randomized controlled trial of the judicious use of safety behaviors during exposure therapy. Behav Res Ther 2019; 112:28-35. [DOI: 10.1016/j.brat.2018.11.010] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Revised: 10/30/2018] [Accepted: 11/19/2018] [Indexed: 10/27/2022]
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Ong ML, Reuman L, Youngstrom EA, Abramowitz JS. Discriminative Validity of the Dimensional Obsessive-Compulsive Scale for Separating Obsessive-Compulsive Disorder From Anxiety Disorders. Assessment 2018; 27:810-821. [PMID: 30043619 DOI: 10.1177/1073191118791039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective: We investigated the diagnostic efficiency and clinical utility of the Dimensional Obsessive-Compulsive Scale (DOCS) and subscales for distinguishing obsessive-compulsive disorder (OCD) from anxiety disorders (ADs). Method: A total of 369 participants (167 male, Mage = 29.61 years) diagnosed with DSM-IV OCD or AD, recruited from specialty clinics across the United States, completed clinical interviews and self-report questionnaires, including the DOCS. Receiver operating characteristic analyses and diagnostic likelihood ratios (DiLRs) determined discriminative validity and provided clinical utility. Logistic regressions tested for incremental validity in the DOCS-total scale and subscales in predicting OCD status. Results: The DOCS-total scale and Contamination subscale performed best in differentiating between OCD and AD diagnosis (DOCS-total: Area under curve [AUC] = .75, p < .001; Contamination: AUC = .70, p < .001) as compared with the other subscales. At high scores (DOCS-total: 28+, Contamination: 6+), Contamination was more effective than the DOCS-total in differentiating OCD from ADs, with high scores in Contamination quadrupling OCD odds and DOCS-total by about threefold (Contamination DiLR+ = 4.04, DOCS-total DiLR+ = 2.82). At low scores (DOCS-total: 0-9, Contamination: 0-2), the converse was true, with low scores in Contamination cutting OCD odds by half and DOCS-total by one fifths (Contamination DiLR- = 0.52, DOCS-total DiLR- = 0.23). Conclusion: At high scores, the Contamination subscale is the most helpful subscale to differentiate OCD and ADs. For low scores, the DOCS-total scale performs the best among the scales.
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Reuman L, Buchholz J, Abramowitz JS. Obsessive beliefs, experiential avoidance, and cognitive fusion as predictors of obsessive-compulsive disorder symptom dimensions. JOURNAL OF CONTEXTUAL BEHAVIORAL SCIENCE 2018. [DOI: 10.1016/j.jcbs.2018.06.001] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Twohig MP, Abramowitz JS, Smith BM, Fabricant LE, Jacoby RJ, Morrison KL, Bluett EJ, Reuman L, Blakey SM, Ledermann T. Adding acceptance and commitment therapy to exposure and response prevention for obsessive-compulsive disorder: A randomized controlled trial. Behav Res Ther 2018; 108:1-9. [PMID: 29966992 DOI: 10.1016/j.brat.2018.06.005] [Citation(s) in RCA: 62] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Revised: 05/31/2018] [Accepted: 06/21/2018] [Indexed: 01/17/2023]
Abstract
The objective of this study was to test whether treatment acceptability, exposure engagement, and completion rates could be increased by integrating acceptance and commitment therapy (ACT) with traditional exposure and response prevention (ERP). 58 adults (68% female) diagnosed with obsessive-compulsive disorder (OCD; M age = 27, 80% white) engaged in a multisite randomized controlled trial of 16 individual twice-weekly sessions of either ERP or ACT + ERP. Assessors unaware of treatment condition administered assessments of OCD, depression, psychological flexibility, and obsessional beliefs at pretreatment, posttreatment, and six-month follow-up. Treatment acceptability, credibility/expectancy, and exposure engagement were also assessed. Exposure engagement was high in both conditions and there were no significant differences in exposure engagement, treatment acceptability, or dropout rates between ACT + ERP and ERP. OCD symptoms, depression, psychological inflexibility, and obsessional beliefs decreased significantly at posttreatment and were maintained at follow-up in both conditions. No between-group differences in outcome were observed using intent to treat and predicted data from multilevel modeling. ACT + ERP and ERP were both highly effective treatments for OCD, and no differences were found in outcomes, processes of change, acceptability, or exposure engagement.
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Abramowitz JS, Blakey SM, Reuman L, Buchholz JL. New Directions in the Cognitive-Behavioral Treatment of OCD: Theory, Research, and Practice. Behav Ther 2018; 49:311-322. [PMID: 29704962 DOI: 10.1016/j.beth.2017.09.002] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2017] [Revised: 09/02/2017] [Accepted: 09/04/2017] [Indexed: 01/01/2023]
Abstract
The beneficial effects of cognitive-behavioral interventions (particularly exposure and response prevention) for OCD are among the most consistent research findings in the mental health literature. Nevertheless, even after an adequate trial, many individuals experience residual symptoms, and others never receive adequate treatment due to limited access. These and other issues have prompted clinicians and researchers to search for ways to improve the conceptual and practical aspects of existing treatment approaches, as well as look for augmentation strategies. In the present article, we review a number of recent developments and new directions in the psychological treatment of OCD, including (a) the application of inhibitory learning approaches to exposure therapy, (b) the development of acceptance-based approaches, (c) involvement of caregivers (partners and parents) in treatment, (d) pharmacological cognitive enhancement of exposure therapy, and (e) the use of technology to disseminate effective treatment. We focus on both the conceptual/scientific and practical aspects of these topics so that clinicians and researchers alike can assess their relative merits and disadvantages.
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Blakey SM, Abramowitz JS. Interoceptive Exposure: An Overlooked Modality in the Cognitive-Behavioral Treatment of OCD. COGNITIVE AND BEHAVIORAL PRACTICE 2018. [DOI: 10.1016/j.cbpra.2017.01.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Abramowitz JS. Presidential Address: Are the Obsessive-Compulsive Related Disorders Related to Obsessive-Compulsive Disorder? A Critical Look at DSM-5's New Category. Behav Ther 2018; 49:1-11. [PMID: 29405915 DOI: 10.1016/j.beth.2017.06.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Revised: 06/08/2017] [Accepted: 06/08/2017] [Indexed: 12/18/2022]
Abstract
The 5th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM) includes a new class of obsessive-compulsive and related disorders (OCRDs) that includes obsessive-compulsive disorder (OCD) and a handful of other putatively related conditions. Although this new category promises to raise awareness of underrecognized and understudied problems, the empirical validity and practical utility of this new DSM category is questionable. This article critically examines the arguments underlying the new OCRD class, illuminates a number of problems with this class, and then discusses implications for clinicians and researchers.
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Blakey SM, Abramowitz JS, Reuman L, Leonard RC, Riemann BC. Anxiety sensitivity as a predictor of outcome in the treatment of obsessive-compulsive disorder. J Behav Ther Exp Psychiatry 2017; 57:113-117. [PMID: 28505489 DOI: 10.1016/j.jbtep.2017.05.003] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2016] [Revised: 02/20/2017] [Accepted: 05/02/2017] [Indexed: 11/19/2022]
Abstract
BACKGROUND AND OBJECTIVES To address the fact that not all individuals who receive cognitive-behavioral therapy (CBT) for obsessive-compulsive disorder (OCD) exhibit complete symptom reduction, research has examined factors that predict outcome; however, no studies have examined anxiety sensitivity (AS) as a predictor of outcome of CBT for OCD. AS refers to the fear of anxious arousal that results from mistaken beliefs about the dangerousness of anxiety-related body sensations. It is important to understand whether AS influences OCD treatment outcome, considering that (a) some obsessions directly relate to AS, and (b) OCD patients with high AS may be reluctant to engage in anxiety-provoking components of CBT for OCD. METHODS Patients (N = 187) with a primary diagnosis of OCD who received residential CBT for OCD participated in this study, which involved completing a self-report battery at pre- and post-treatment. RESULTS Results supported study hypotheses, in that (a) baseline AS positively correlated with baseline OCD severity, and (b) greater baseline AS prospectively predicted higher posttreatment OCD symptom severity even after controlling for pretreatment OCD and depression severity. LIMITATIONS The study was limited by its use of an older measure of AS, reliance on self-report measures, and nonstandardized treatment across participants. CONCLUSIONS Findings highlight the importance of AS in the nature and treatment of OCD. Clinical implications and future directions are discussed.
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Abstract
The threat of a United States (U.S.) Zika virus pandemic during 2015-2016 was associated with public anxiety. Such threats represent opportunities to examine hypotheses about health anxiety. The present study investigated psychological predictors of Zika-related anxiety during the 2015-2016 outbreak. U.S. adults (N = 216) completed a battery of measures assessing Zika-related anxiety as well as psychological variables hypothesized to predict anxious responding to the threat of a domestic Zika outbreak. Contrary to hypotheses, regression analyses indicated that only contamination severity overestimates and greater Zika knowledge significantly predicted Zika-related anxiety. Study limitations and clinical implications are discussed.
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Reuman L, Jacoby RJ, Blakey SM, Riemann BC, Leonard RC, Abramowitz JS. Predictors of illness anxiety symptoms in patients with obsessive compulsive disorder. Psychiatry Res 2017; 256:417-422. [PMID: 28697487 DOI: 10.1016/j.psychres.2017.07.012] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Revised: 06/01/2017] [Accepted: 07/04/2017] [Indexed: 10/19/2022]
Abstract
Illness anxiety and OCD symptoms appear to overlap in their presentation as well as in other conceptually important ways (e.g., dysfunctional cognitions). Little research, however, has directly examined these putative relationships. The present study examined the extent to which illness anxiety symptoms were associated with OCD symptom dimensions and relevant cognitive factors in a large treatment-seeking sample of patients with OCD. Patients completed a battery of self-report measures of OCD and health anxiety symptoms and related cognitive biases. Results from regression analyses indicated that illness anxiety symptoms were associated with harm obsessions and checking rituals, as well as with the tendency to overestimate threat and responsibility for harm. Illness anxiety was not associated with perfectionism. Conceptual and clinical implications of these findings are discussed.
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Eilertsen T, Hansen B, Kvale G, Abramowitz JS, Holm SEH, Solem S. The Dimensional Obsessive-Compulsive Scale: Development and Validation of a Short Form (DOCS-SF). Front Psychol 2017; 8:1503. [PMID: 28928693 PMCID: PMC5591872 DOI: 10.3389/fpsyg.2017.01503] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Accepted: 08/18/2017] [Indexed: 11/13/2022] Open
Abstract
Accurately and reliably measuring the presence and severity of Obsessive-Compulsive Disorder (OCD) symptoms is essential for both routine clinical work and research. The current study investigated psychometric properties of the dimensional obsessive-compulsive scale-short form (DOCS-SF). DOCS-SF was developed and validated in Norwegian. DOCS-SF contains a checklist with four symptom categories and five severity items scored on a zero to eight scale yielding a total score of 0–40. Data were collected from adults with a current diagnosis of OCD (n = 204) and a community comparison group (n = 211). The results provided evidence of internal consistency and convergent validity, although evidence for discriminant validity was mixed. Evidence was also found for diagnostic sensitivity and specificity, and treatment sensitivity. The analyses suggested a cut-off score of 16. In summary, the data obtained proved similar to studies published on the original dimensional obsessive-compulsive scale. There is strong evidence for the reliability and validity of the DOCS-SF for assessing OCD symptoms in individuals with this condition and in non-clinical individuals.
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Blakey SM, Reuman L, Buchholz JL, Abramowitz JS. Experiential avoidance and dysfunctional beliefs in the prediction of body image disturbance in a nonclinical sample of women. Body Image 2017; 22:72-77. [PMID: 28667898 DOI: 10.1016/j.bodyim.2017.06.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Revised: 06/07/2017] [Accepted: 06/13/2017] [Indexed: 12/01/2022]
Abstract
Body image disturbance (BID) refers to persistent dissatisfaction, distress, and dysfunction related to some aspect(s) of one's physical appearance. Cognitive models of BID highlight the importance of dysfunctional beliefs in maintaining BID. Relational Frame Theory (RFT), in contrast, posits that psychological distress is sustained by the unwillingness to experience aversive internal experiences (i.e., experiential avoidance [EA]). The present study tested the hypothesis that both dysfunctional beliefs and EA uniquely predict BID even after accounting for general distress. A nonclinical female sample (N=100) completed measures of general distress, dysfunctional beliefs about appearance, EA, and BID in addition to providing in vivo anxiety ratings after looking at their most dissatisfactory facial feature in a vanity mirror. Linear regression analyses showed that dysfunctional beliefs, but not EA, accounted for significant unique variance in BID outcomes. Implications for understanding, assessing, and treating clinically significant BID are discussed.
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Abramovitch A, Anholt G, Raveh-Gottfried S, Hamo N, Abramowitz JS. Meta-Analysis of Intelligence Quotient (IQ) in Obsessive-Compulsive Disorder. Neuropsychol Rev 2017; 28:111-120. [PMID: 28864868 DOI: 10.1007/s11065-017-9358-0] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2017] [Accepted: 08/14/2017] [Indexed: 11/28/2022]
Abstract
Obsessive compulsive disorder (OCD) is associated with a moderate degree of underperformance on cognitive tests, including deficient processing speed. However, despite little research focusing on Intelligence Quotient (IQ) in OCD, it has long been speculated that the disorder is associated with elevated intellectual capacity. The present meta-analytic study was, therefore, conducted to quantitatively summarize the literature on IQ in OCD systematically. We identified 98 studies containing IQ data among individuals with OCD and non-psychiatric comparison groups, and computed 108 effect sizes for Verbal IQ (VIQ, n = 55), Performance IQ (PIQ, n = 13), and Full Scale IQ (FSIQ, n = 40). Across studies, small effect sizes were found for FSIQ and VIQ, and a moderate effect size for PIQ, exemplifying reduced IQ in OCD. However, mean IQ scores across OCD samples were in the normative range. Moderator analyses revealed no significant moderating effect across clinical and demographic indices. We conclude that, although lower than controls, OCD is associated with normative FSIQ and VIQ, and relatively lowered PIQ. These results are discussed in light of neuropsychological research in OCD, and particularly the putative impact of reduced processing speed in this population. Recommendations for utilization of IQ tests in OCD, and directions for future studies are offered.
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McKay D, Abramovitch A, Abramowitz JS, Deacon B. Association and Causation in Brain Imaging: The Case of OCD. Am J Psychiatry 2017; 174:597. [PMID: 28565955 DOI: 10.1176/appi.ajp.2017.17010019] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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