Treating obsessive-compulsive disorder in intimate relationships: a pilot study of couple-based cognitive-behavior therapy

Although cognitive-behavioral therapy (CBT) involving exposure and response prevention (ERP) is an established treatment for obsessive-compulsive disorder (OCD), not all patients respond optimally, and some show relapse upon discontinuation. Research suggests that for OCD patients in close relationships, targeting relationship dynamics enhances the effects of CBT. In the present study, we developed and pilot tested a 16-session couple-based CBT program for patients with OCD and their romantic partners. This program included (a) partner-assisted ERP, (b) techniques targeting maladaptive relationship patterns focal to OCD (e.g., symptom accommodation), and (c) techniques targeting non OCD-related relationship stressors. OCD, related symptoms, and relationship functioning were assessed at baseline, immediately following treatment (posttest), and at 6- and 12-month follow-up. At posttest, substantial improvements in OCD symptoms, relationship functioning, and depression were observed. Improvements in OCD symptoms were maintained up to 1year. Results are compared to findings from studies of individual CBT for OCD and discussed in terms of the importance of addressing interpersonal processes that maintain OCD symptoms.

Just to be certain: Confirming the factor structure of the intolerance of uncertainty scale in patients with obsessive-compulsive disorder

Intolerance of uncertainty (IU) is a cognitive construct in obsessive-compulsive disorder (OCD); yet no studies exist confirming the factor structure of the most widely used measure of IU, the intolerance of uncertainty scale (IUS), in OCD patients. Moreover, no studies have examined how scores on this measure relate to OCD symptom dimensions. Accordingly, the present study examined a 12-item two-factor revised version of the IUS (IUS-12) in 205 OCD patients. Confirmatory factor analysis verified the scale's two-factor structure. The measure also demonstrated high internal consistency and the IUS-12 was correlated moderately with another self-report measure of IU. Finally, theoretically consistent and specific relationships emerged between the IUS-12 and OCD symptom dimensions. These findings are discussed in terms of implications for the assessment and treatment of OCD, and specifically how elevated scores on the IUS-12 subscales may be utilized to identify subtleties in the presentation of OCD-related problems with IU.

The relationship between obsessive compulsive beliefs and symptoms, anxiety and disgust sensitivity, and Swine Flu fears

Using the 2009 Swine Flu outbreak as a contemporary example of pandemic fears, this study examined the relationship between various symptoms related to anxiety sensitivity and Swine Flu fears. It was hypothesized that both obsessive-compulsive (OC) beliefs and OC symptoms would significantly predict Swine Flu fears. It was also hypothesized that symptoms of anxiety, including measures of anxiety sensitivity and disgust sensitivity would significantly mediate the relationship between both OC beliefs and OC symptoms and Swine Flu fears. A total of 393 undergraduate students completed measures of Swine Flu fears, anxiety sensitivity, OC beliefs and symptoms, and disgust sensitivity. It was found that both OC beliefs and OC symptoms significantly predicted Swine Flu fears. While disgust sensitivity significantly mediated the relationship between both OC beliefs and OC symptoms and Swine Flu fears using the Sobel test, anxiety sensitivity was a significant mediator only for OC symptoms. Additionally, path modeling showed that anxiety sensitivity mediated the relationship between OC symptoms and Swine Flu fears best. The results of this study may be useful for treating individuals suffering from anxiety in light of future pandemics, as well as continuing to research the role of anxiety symptoms in predicting pandemic fears.

Rigid Rules of Conduct and Duty: Prediction of Thought-Action Fusion

Cognitive biases, such as thought-action fusion (TAF), play a crucial role in the cognitive-behavioral model of obsessional symptoms and have been shown to prospectively increase the risk of developing such symptoms. Much less research, however, has examined factors that might lead to the development of the cognitive biases themselves. This study aimed to replicate and extend existing work on correlates of moral (thinking about something is the moral equivalent of the corresponding action) and likelihood (thinking about a particular event increases the probability that this event will occur) TAF. A large sample of unscreened participants (N = 407) completed a measure of TAF, as well as measures of religiosity, motivation for religion, parental psychological control, and parental guilt induction. Results indicated that religion-related variables predicted the moral TAF, whereas parenting strategies were associated with likelihood TAF. Intrinsic motivation for religion also mediated the relationship between religiosity and moral TAF. Findings are discussed in terms of developmental psychopathology and limitations are addressed.

A Comparison of Two Brief Interventions for Obsessional Thoughts: Exposure and Acceptance

Exposure and response prevention (ERP) is the most effective psychological treatment for unwanted, intrusive thoughts associated with obsessive-compulsive disorder (OCD). However, the procedures involved in ERP (i.e., exposure) are challenging, provoke high levels of anxiety, and may contribute to treatment refusal and dropout (Franklin & Foa, 1998). To address this problem, researchers have begun to evaluate alternative treatments for OCD, such as Acceptance and Commitment Therapy (ACT). Despite the value of both techniques, little is known about the differential impact of these strategies. This study examined the relative effects of a single session of ACT or exposure for obsessional thoughts. There were 56 undergraduate participants with obsessional thoughts randomly assigned to receive a brief intervention with the core components of exposure, ACT, or an expressive writing control condition. Obsessional symptoms and related process variables were assessed at baseline and at 1-week follow-up. There were no statistical differences in believability or acceptability of the 3 conditions. Significant reductions in obsessional severity, behavioral tests of distress and willingness to experience intrusive thoughts, and negative appraisals of intrusive thoughts occurred in all conditions, but no differences were found between these conditions. Furthermore, changes in dysfunctional beliefs, but not in willingness to experience intrusive thoughts, predicted changes in obsessional symptoms in both the ACT and exposure conditions.

The relationship between anxiety sensitivity and obsessive-compulsive symptom dimensions

BACKGROUND AND OBJECTIVES

Anxiety sensitivity (AS), the tendency to fear arousal-related body sensations based on beliefs that they are dangerous, is a cognitive vulnerability factor for certain anxiety symptoms such as panic and posttraumatic stress symptoms. Very little research, however, has examined the relationship between AS and obsessive-compulsive (OC) symptoms, which was the objective of the current research.

METHODS

We administered dimensional measures of AS and OC symptoms to a large sample of undergraduate students (N = 636). We also included measures of general distress and cognitive distortions related to OCD (i.e., obsessive beliefs) as control variables.

RESULTS

Regression analyses indicated that AS was predictive of OC symptoms even after controlling for general distress and obsessive beliefs. In addition, the three domains of AS (physical, social, and cognitive concerns) were differentially associated with the four dimensions of OC symptoms (contamination, responsibility for harm, symmetry, and unacceptable thoughts).

LIMITATIONS

Our findings are based on a non-clinical student sample and their generalization to OCD requires replication with a sample of OCD patients.

CONCLUSIONS

These results provide preliminary evidence that AS plays a role in OC symptoms. Implications for clinical practice and for future research are discussed.

Enhancing Exposure and Response Prevention for OCD

The effectiveness of individual therapy by exposure and response prevention (ERP) for obsessive–compulsive disorder (OCD) is well established, yet not all patients respond well, and some show relapse on discontinuation. This article begins by providing an overview of the personal and interpersonal experiences of OCD, focusing on interpersonal processes that maintain OCD symptoms and interfere with ERP. The study then describes a couple-based treatment program that the authors have developed to enhance ERP for individuals with OCD who are in long-term relationships. This program involves psychoeducation, partner-assisted exposure therapy, couple-based interventions aimed at changing maladaptive relationship patterns regarding OCD (i.e., symptom accommodation), and general couple therapy. Three case examples are presented to illustrate the couple-based techniques used in this treatment program.

Decreased caudate N-acetyl-l-aspartic acid in pediatric obsessive-compulsive disorder and the effects of behavior therapy

The current study used magnetic resonance spectroscopy (MRS) to investigate differences in absolute levels of neurochemicals in the head of the caudate nucleus (HOC) and anterior cingulate cortex (ACC) between 15 children with obsessive-compulsive disorder (OCD) and a matched control group, as well as the effects of behavior therapy on these chemicals. At baseline, absolute levels of N-acetyl-l-aspartate (NAA) in the left HOC were significantly lower in non-medicated patients (N=8) with OCD compared to medicated patients (N=5) and compared to matched controls (N=9). Exploratory analyses provided preliminary data suggesting that behavior therapy is associated with a decrease in Glx (glutamate+glutamine) in the right HOC (N=7). The baseline differences in NAA replicate previous finding from the adult literature and show a relationship between NAA in OCD across the lifespan. The changes in Glx raise the possibility that behavior therapy and medication treat OCD symptoms through similar pathways.

Dimensions of anxiety sensitivity in the anxiety disorders: evaluation of the ASI-3

Anxiety sensitivity (AS), the fear of sensations of anxious arousal based on beliefs about their harmful consequences, is increasingly recognized as a multidimensional construct. The recently developed Anxiety Sensitivity Index-3 [ASI-3; Taylor, S., Zvolensky, M., Cox, B., Deacon, B., Heimberg, R., Ledley, D. R., et al. (2007). Robust dimensions of anxiety sensitivity: Development and initial validation of the Anxiety Sensitivity Index-3 (ASI-3). Psychological Assessment, 19, 176-188] measures three dimensions of AS: physical concerns, social concerns, and cognitive concerns. The ASI-3 shows promise, although further evaluation of its psychometric properties and validity in independent samples is needed. We evaluated the ASI-3 in a mixed sample of anxiety disorder patients (N=506) and undergraduate student controls (N=315). The measure demonstrated a stable 3-factor structure and sound psychometric properties, with the three factors showing theoretically consistent patterns of associations with anxiety symptoms and diagnoses. ASI-3 total scores were less discriminative. Implications for conceptual models of anxiety are discussed.

The relationship between contamination cognitions, anxiety, and disgust in two ethnic groups

BACKGROUND AND OBJECTIVES

Obsessive-compulsive disorder (OCD) is understudied in African Americans, thus little is known about factors that might predispose this group to obsessive-compulsive anxiety. Prior research has shown that African Americans endorse more concerns about contamination, but it is not known how these differences relate to variables, such as beliefs or cognitions about contamination, the emotion of disgust, and anxiety sensitivity. The current study examined Black-White differences in contamination cognitions in a non-clinical sample (N = 245).

METHODS

European American and African American participants completed measures of contamination cognitions, anxiety, OCD, and disgust.

RESULTS

African Americans exhibited significantly stronger contamination cognitions, as measured by the Contamination Concerns Scale. Multiple regression analysis showed that contamination concerns were predicted by disgust sensitivity, ethnicity/race, and gender. Neither anxiety sensitivity nor pathological washing behaviors were significant factors in the model.

LIMITATIONS

Study should be replicated in additional populations as generalizability beyond a college student population is not known.

CONCLUSIONS

African Americans are no more sensitive to disgust or anxiety than European Americans, but nonetheless have greater concerns about the severity of contamination surrounding certain items. This may predispose African Americans with OCD to symptoms involving contamination.

The effect of behavior therapy on caudate N-acetyl-l-aspartic acid in adults with obsessive-compulsive disorder

Previous studies suggest that baseline differences in neuronal markers between patients with obsessive-compulsive disorder (OCD) and healthy controls no longer exist following successful pharmacotherapy. The current study used proton magnetic resonance spectroscopy (MRS) to investigate differences in absolute concentrations of neurochemicals (i.e., N-acetyl-l-aspartic; NAA) in the head of the caudate nucleus (HOC) and orbital frontal white matter (OFWM) between 15 adults with OCD and a sex- and age-matched control group, as well as the effects of behavior therapy on these chemicals. Behavior therapy was associated with a significant increase in left HOC NAA. When the analyses were restricted to only pairings with complete data (OCD patient, control, post-treatment), the levels of left HOC NAA were significantly lower in patients compared to controls, and increased significantly with treatment. Exploratory analyses suggested that levels of NAA and Cr (creatine) in the right OFWM may be significantly lower in the OCD group than the control group. The results raise the possibility that successful behavioral treatment may be associated with increases in markers of neuronal viability, although other associations found in the literature were not replicated.

Do Cognitive Reappraisal and Diaphragmatic Breathing Augment Interoceptive Exposure for Anxiety Sensitivity?

Interoceptive exposure (IE) is an effective procedure for reducing anxiety sensitivity (AS) and the symptoms of panic disorder. However, considerable variance exists in how IE is delivered among clinicians, and the extent to which IE is enhanced by the concurrent use of cognitive reappraisal (CR) and diaphragmatic breathing (DB) is unclear. Participants (N = 58) with high AS were randomly assigned to one of four single-session interventions: (a) IE only, (b) IE 1 CR, (c) IE 1 CR 1 DB, or (d) expressive writing control. IE was superior to expressive writing in reducing AS and associated anxiety symptoms. The addition of CR and DB did not enhance the benefits of IE at either posttreatment or 1-week follow-up. These findings highlight the specific efficacy of IE in reducing AS and call into question the common practice of combining IE with cognitive and breathing strategies. Theoretical and clinical implications are discussed.

Postpartum obsessive-compulsive disorder

OBJECTIVE

To synthesize the extant literature on the prevalence, phenomenology, etiology and treatment of postpartum obsessive-compulsive disorder (OCD). A discussion of differential diagnosis between postpartum OCD and other postpartum psychiatric conditions (e.g., depression, psychosis) and nonpostpartum-onset OCD is provided.

DATA SOURCES, STUDY SELECTION AND DATA EXTRACTION

All studies addressing postpartum OCD between the years 1950 and 2011 were reviewed. Data from all pertinent studies was explored as it related to postpartum OCD.

DATA SYNTHESIS

Studies were organized based on their empirical technique (e.g., retrospective, prospective), population studied (e.g., clinical OCD, nonclinical populations, males), and etiological or treatment theory (e.g., cognitive-behavioral).

CONCLUSION

The prevalence, phenomenology, etiology, and treatment of postpartum OCD are reviewed. The limited data on treatment approaches and outcomes for postpartum OCD are highlighted with a discussion of the role of nurses in the prevention and identification of postpartum OCD.

Efficacy of a prevention program for postpartum obsessive-compulsive symptoms

Obsessive-Compulsive Disorder (OCD) has emerged as a common and impairing postpartum condition. Prospective studies have identified psychological vulnerabilities for the emergence of postpartum obsessive-compulsive symptoms (OCS), including general anxiety symptoms, pre-existing OCS, and specific cognitive distortions. The identification of these factors makes feasible the development of prevention programs that could reduce the impact of postpartum OCS. The present investigation examined a cognitive-behavioral prevention program using a randomized, double blind, controlled trial. Expecting mothers in their 2nd or 3rd trimester with an empirically established, malleable risk factor for postpartum OCS received either the prevention program (N=38) or a credible control program (N=33), both of which were incorporated into traditional childbirth education classes. Results revealed that at 1 month, 3 months, and 6 months postpartum, the prevention program was associated with significantly lower levels of obsessions and compulsions than was the control condition (all p's<0.05). Group differences remained significant even after controlling for baseline OCS and depression symptoms. Those in the prevention condition also reported decreasing levels of cognitive distortions, in contrast to the control condition (p's<0.05). Results support the potential utility of incorporating a CBT-based OCS prevention program into childbirth education classes.

Assessing psychological inflexibility: the psychometric properties of the Avoidance and Fusion Questionnaire for Youth in two adult samples

The current study examined whether the Avoidance and Fusion Questionnaire for Youth (AFQ-Y; L. A. Greco, W. Lambert, & R. A. Baer, 2008), a self-report measure of psychological inflexibility for children and adolescents, might be useful for measuring psychological inflexibility for adults. The psychometric properties of the AFQ-Y were examined using data from a college student sample (N = 387) and a clinical sample of patients with anxiety disorders (N = 115). The AFQ-Y, but not the Acceptance and Action Questionnaire-II (AAQ-II; F. W. Bond et al., in press), demonstrated a reading level at or below the recommended 5th or 6th grade reading level. The AFQ-Y also demonstrated adequate reliability (internal consistency), factorial validity, convergent and discriminant validity, and concurrent validity predicting psychological symptoms. Moreover, the AFQ-Y showed incremental validity over the AAQ-II in predicting several psychological symptom domains. Implications for the assessment of psychological inflexibility are discussed.