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Bernstein EE, Klare D, Weingarden H, Greenberg JL, Snorrason I, Hoeppner SS, Vanderkruik R, Harrison O, Wilhelm S. Impact of sleep disruption on BDD symptoms and treatment response. J Affect Disord 2024; 346:206-213. [PMID: 37952909 PMCID: PMC10842714 DOI: 10.1016/j.jad.2023.11.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 08/08/2023] [Accepted: 11/09/2023] [Indexed: 11/14/2023]
Abstract
BACKGROUND Body dysmorphic disorder (BDD) is severe, undertreated, and relatively common. Although gold-standard cognitive behavioral therapy (CBT) for BDD has strong empirical support, a significant number of patients do not respond. More work is needed to understand BDD's etiology and modifiable barriers to treatment response. Given its high prevalence and impact on the development, maintenance, and treatment of related, frequently comorbid disorders, sleep disruption is a compelling, but not-yet studied factor. METHODS Data were drawn from a randomized controlled trial of guided smartphone app-based CBT for BDD. Included participants were offered 12-weeks of treatment, immediately (n = 40) or after a 12-week waitlist (n = 37). Sleep disruption and BDD symptom severity were assessed at baseline, week-6, and week-12. RESULTS Hypotheses and analysis plan were pre-registered. Two-thirds of patients reported significant insomnia symptoms at baseline. Baseline severity of sleep disruption and BDD symptoms were not related (r = 0.02). Pre-treatment sleep disruption did not predict BDD symptom reduction across treatment, nor did early sleep improvements predict greater BDD symptom improvement. Early BDD symptom improvement also did not predict later improvements in sleep. LIMITATIONS Limitations include the small sample, restricted ranges of BDD symptom severity and treatment response, and few metrics of sleep disruption. CONCLUSIONS Although insomnia was disproportionately high in this sample and both BDD symptoms and sleep improved in treatment, results suggest sleep and BDD symptoms may function largely independent of one another. More work is encouraged to replicate and better understand findings as well as potential challenges and benefits of addressing sleep in BDD.
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Affiliation(s)
- Emily E Bernstein
- Massachusetts General Hospital, United States of America; Harvard Medical School, United States of America.
| | - Dalton Klare
- Massachusetts General Hospital, United States of America
| | - Hilary Weingarden
- Massachusetts General Hospital, United States of America; Harvard Medical School, United States of America
| | - Jennifer L Greenberg
- Massachusetts General Hospital, United States of America; Harvard Medical School, United States of America
| | - Ivar Snorrason
- Massachusetts General Hospital, United States of America; Harvard Medical School, United States of America
| | - Susanne S Hoeppner
- Massachusetts General Hospital, United States of America; Harvard Medical School, United States of America
| | - Rachel Vanderkruik
- Massachusetts General Hospital, United States of America; Harvard Medical School, United States of America
| | | | - Sabine Wilhelm
- Massachusetts General Hospital, United States of America; Harvard Medical School, United States of America
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Cox RC, Olatunji BO. Delayed circadian rhythms and insomnia symptoms in obsessive-compulsive disorder. J Affect Disord 2022; 318:94-102. [PMID: 36057288 PMCID: PMC10201922 DOI: 10.1016/j.jad.2022.08.118] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 05/09/2022] [Accepted: 08/26/2022] [Indexed: 11/19/2022]
Abstract
BACKGROUND Accumulating evidence implicates sleep and circadian rhythm disturbance in obsessive-compulsive disorder (OCD). However, a multimethod characterization of sleep and circadian rhythms in OCD, their association with symptom severity, and the functional relationship between these variables is lacking. METHODS The present study measured multiple indicators of sleep and circadian rhythms in a sample of adults with OCD, adults without OCD, and healthy controls (n = 74). Participants completed measures of morningness-eveningness, delayed sleep-wake phase disorder (DSWPD), insomnia symptoms, and OCD symptoms, as well as one week of sleep monitoring via a sleep diary and actigraphy. RESULTS Delayed circadian rhythms (higher eveningness, later mid-sleep timing, and higher rates of DSWPD) and higher insomnia symptoms were observed in those with OCD compared to healthy controls, as well as associations between delayed circadian rhythms and insomnia symptoms and OCD symptom severity across the full sample. Further, insomnia symptoms mediated the relationship between delayed circadian rhythms and OCD symptoms. In contrast, there were no links between total sleep time or sleep quality and OCD. LIMITATIONS Data collection during COVID-19 pandemic, correlational data, no physiological measure of circadian rhythms. CONCLUSIONS These findings highlight a robust association between delayed circadian rhythms and OCD and suggest insomnia symptoms may be one mechanism in this relationship. Sleep and circadian rhythm disturbance may be novel targets for OCD treatment.
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Affiliation(s)
- Rebecca C Cox
- Vanderbilt University, United States of America; University of Colorado Boulder, United States of America.
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Hellberg SN, Abramowitz JS, Ojalehto HJ, Butcher MW, Buchholz JL, Riemann BC. Co-occurring depression and obsessive-compulsive disorder: A dimensional network approach. J Affect Disord 2022; 317:417-426. [PMID: 36055534 DOI: 10.1016/j.jad.2022.08.101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2021] [Revised: 05/26/2022] [Accepted: 08/26/2022] [Indexed: 10/31/2022]
Abstract
BACKGROUND Depressive and obsessive-compulsive (OCD) symptoms often co-occur and a number of possible explanations for this co-occurrence have been explored, including shared biological and psychosocial risk factors. Network approaches have offered a novel hypothesis for the link between depression and OCD: functional inter-relationships across the symptoms of these conditions. The few network studies in this area have relied largely on item, rather than process-level constructs, and have not examined relationships dimensionally. METHODS Network analytic methods were applied to data from 463 treatment-seeking adults with OCD. Patients completed self-report measures of OCD and depression. Factor analysis was used to derive processes (i.e., nodes) to include in the network. Networks were computed, and centrality, bridge, and stability statistics examined. RESULTS Networks showed positive relations among specific OCD and depressive symptoms. Obsessions (particularly repugnant thoughts), negative affectivity, and cognitive-somatic changes (e.g., difficulty concentrating) were central to the network. Unique relations were observed between symmetry OCD symptoms and cognitive-somatic changes. No direct link between harm-related OCD symptoms and depression was observed. CONCLUSIONS Our results bring together prior findings, suggesting that both negative affective and psychomotor changes are important to consider in examining the relationship between OCD and depression. Increased consideration of heterogeneity in the content of OCD symptoms is key to improving clinical conceptualizations, particularly when considering the co-occurrence of OCD with other disorders.
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Affiliation(s)
- Samantha N Hellberg
- Department of Psychology & Neuroscience, University of North Carolina, Chapel Hill, USA.
| | - Jonathan S Abramowitz
- Department of Psychology & Neuroscience, University of North Carolina, Chapel Hill, USA
| | - Heidi J Ojalehto
- Department of Psychology & Neuroscience, University of North Carolina, Chapel Hill, USA
| | - Megan W Butcher
- Department of Psychology & Neuroscience, University of North Carolina, Chapel Hill, USA
| | - Jennifer L Buchholz
- Department of Psychology & Neuroscience, University of North Carolina, Chapel Hill, USA
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Hagen K, Nordahl H, Launes G, Kvale G, Öst LG, Hystad S, Hansen B, Solem S. Does Concentrated Exposure Treatment for Obsessive-Compulsive Disorder Improve Insomnia Symptoms? Results From a Randomized Controlled Trial. Front Psychiatry 2021; 12:625631. [PMID: 34489744 PMCID: PMC8417230 DOI: 10.3389/fpsyt.2021.625631] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 07/19/2021] [Indexed: 11/13/2022] Open
Abstract
Insomnia is a substantial problem in patients with obsessive-compulsive disorder (OCD). There is, however, a lack of studies investigating changes in concurrent symptoms of insomnia in OCD after concentrated treatment. A recent randomized controlled trial randomized participants to the Bergen 4-day treatment (B4DT, n = 16), or 12 weeks of unguided self-help (SH, n = 16), or waitlist (WL, n = 16). Patients from the SH- and WL-group who wanted further treatment after the 12 weeks were then offered the B4DT (total of 42 patients treated with the B4DT). There were no significant differences in symptoms of insomnia between the conditions at post-treatment, but a significant moderate improvement at 3-month follow-up for patients who received the B4DT. Insomnia was not associated with OCD-treatment outcome, and change in symptoms of insomnia was mainly related to changes in depressive symptoms. The main conclusion is that concentrated exposure treatment is effective irrespective of comorbid insomnia, and that insomnia problems are moderately reduced following treatment.
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Affiliation(s)
- Kristen Hagen
- Department of Psychiatry, Molde Hospital, Møre og Romsdal Hospital Trust, Molde, Norway.,Bergen Center for Brain Plasticity, Haukeland University Hospital, Bergen, Norway.,Department of Mental Health, Norwegian University of Science and Technology, Trondheim, Norway
| | - Håkon Nordahl
- Department of Clinical Psychology, University of Bergen, Bergen, Norway.,Clinic for B4DT, Haukeland University Hospital, Bergen, Norway
| | - Gunvor Launes
- Department of Clinical Psychology, University of Bergen, Bergen, Norway.,Sørlandet Sykehus, Department of Psychiatry, Kristiansand, Norway
| | - Gerd Kvale
- Bergen Center for Brain Plasticity, Haukeland University Hospital, Bergen, Norway.,Department of Clinical Psychology, University of Bergen, Bergen, Norway.,Clinic for B4DT, Haukeland University Hospital, Bergen, Norway
| | - Lars-Göran Öst
- Bergen Center for Brain Plasticity, Haukeland University Hospital, Bergen, Norway.,Department of Psychology, Stockholm University, Stockholm, Sweden
| | - Sigurd Hystad
- Faculty of Psychology, Center for Crisis Psychology, University of Bergen, Bergen, Norway
| | - Bjarne Hansen
- Bergen Center for Brain Plasticity, Haukeland University Hospital, Bergen, Norway.,Sørlandet Sykehus, Department of Psychiatry, Kristiansand, Norway.,Faculty of Psychology, Center for Crisis Psychology, University of Bergen, Bergen, Norway
| | - Stian Solem
- Bergen Center for Brain Plasticity, Haukeland University Hospital, Bergen, Norway.,Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway
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Cox RC, Olatunji BO. Linking insomnia and OCD symptoms during the coronavirus pandemic: Examination of prospective associations. J Anxiety Disord 2021; 77:102341. [PMID: 33285369 PMCID: PMC7689352 DOI: 10.1016/j.janxdis.2020.102341] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 10/18/2020] [Accepted: 11/18/2020] [Indexed: 12/13/2022]
Abstract
There is considerable concern in the mental health community about the psychological consequences of the coronavirus pandemic and who may be most vulnerable. Obsessive-compulsive disorder (OCD) symptoms may be particularly sensitive to the context of the pandemic. Previous research suggests insomnia symptoms may contribute to increased OCD symptoms over time, particularly during times of stress, such as the pandemic. The present study examined pre-coronavirus outbreak insomnia symptoms as a predictor of post-coronavirus outbreak OCD symptoms in a sample of community adults who completed a 2016 survey study and were re-contacted on April 1, 2020 (N = 369). Results revealed a small significant increase in OCD symptoms following the coronavirus outbreak and a small significant decrease in insomnia symptoms. Pre-coronavirus outbreak insomnia symptoms significantly predicted increases in post-coronavirus outbreak OCD symptoms. Similar results were found for specific OCD symptom facets with the exception of washing and hoarding symptoms, which were unrelated to pre-coronavirus insomnia symptoms. There was no evidence for a reverse effect of prior OCD symptoms on insomnia symptoms during the pandemic. These findings suggest those with insomnia symptoms prior to the coronavirus pandemic may be vulnerable to increases in some OCD symptoms during the pandemic. The implications for preventing adverse psychological responses during the coronavirus pandemic are discussed.
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Affiliation(s)
- Rebecca C. Cox
- Corresponding author at: Department of Psychology, Vanderbilt University, 301 Wilson Hall, 111 21st Avenue South, Nashville, TN, 37240, United States
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Naftalovich H, Tauber N, Kalanthroff E. But first, coffee: The roles of arousal and inhibition in the resistance of compulsive cleansing in individuals with high contamination fears. J Anxiety Disord 2020; 76:102316. [PMID: 33137602 DOI: 10.1016/j.janxdis.2020.102316] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Revised: 08/13/2020] [Accepted: 09/16/2020] [Indexed: 01/26/2023]
Abstract
Inhibition plays a crucial role in reducing intrusive thoughts and compulsive behaviors, such as handwashing, in response to the feeling of disgust. The current study examines whether manipulating arousal can facilitate inhibition and the resistance of compulsive cleansing. Forty-seven participants with high contamination fears were recruited for this study. Participants were divided into a caffeine group or a no-caffeine group. Participants touched a potentially contaminated and disgusting stimulus ("dirty" diapers) and were asked to wait as long as they could before washing their hands. Only the caffeine group exhibited greater pre-post stop-signal reaction time improvement in the stop-signal task, indicating improved inhibition. Participants in the caffeine group exhibited significantly lower subjective distress and urges-to-wash their hands both after touching the stimulus and while waiting to engage in the cleansing behavior. Similarly, the caffeine group resisted the urge to compulsively cleanse for about twice as long as those in the no-caffeine group. Time spent washing, subjective distress levels, and urge-to-wash levels after participants washed their hands were similar between groups. The current findings support the notion that increased arousal improves inhibition, which may play a role in improving our ability to resist intrusive disgust and compulsive cleansing behaviors.
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Affiliation(s)
- Hadar Naftalovich
- Department of Psychology, The Hebrew University of Jerusalem, Israel, Jerusalem, Israel.
| | - Noa Tauber
- Department of Psychology, The Hebrew University of Jerusalem, Israel, Jerusalem, Israel
| | - Eyal Kalanthroff
- Department of Psychology, The Hebrew University of Jerusalem, Israel, Jerusalem, Israel
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Cox RC, Parmar AM, Olatunji BO. Sleep in obsessive-compulsive and related disorders: a selective review and synthesis. Curr Opin Psychol 2020; 34:23-26. [DOI: 10.1016/j.copsyc.2019.08.018] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Revised: 08/07/2019] [Accepted: 08/16/2019] [Indexed: 02/07/2023]
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