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Ong CW, Sheehan KG, Xu J, Falkenstein MJ, Kuckertz JM. A network analysis of mechanisms of change during exposures over the course of intensive OCD treatment. J Affect Disord 2024; 354:385-396. [PMID: 38508457 DOI: 10.1016/j.jad.2024.03.089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 02/27/2024] [Accepted: 03/15/2024] [Indexed: 03/22/2024]
Abstract
Exposure and response prevention (ERP) is an evidence-based treatment for obsessive-compulsive disorder (OCD). Theories for how it works vary in their emphasis on active mechanisms of change. The current study aimed to clarify mechanisms of change in ERP for OCD using network analysis, comparing ERP networks at the start and end of intensive treatment (partial hospital and residential). In our sample of 182 patients, the most central node in both networks was engagement with exposure, which was consistently related to greater understanding of ERP rationale, higher willingness, and less ritualization, accounting for all other variables in the network. There were no significant differences in networks between the start and end of treatment. These results suggest that nonspecific parameters like facilitating engagement in exposures without ritualizing and providing a clear rationale to clients may be key to effective treatment. As such, it may be useful for clinicians to spend adequate time underscoring the need to eliminate rituals to fully engage in exposure tasks and explaining the rationale for ERP prior to doing exposures, regardless of theoretical orientation. Nonetheless, findings represent group-level statistics and more fine-grained idiographic analyses may reveal individual-level differences with respect to central mechanisms of change. Other limitations include demographic homogeneity of our sample.
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Affiliation(s)
- Clarissa W Ong
- Department of Psychology, University of Toledo, United States.
| | - Kate G Sheehan
- Department of Psychology, University of Toledo, United States
| | - Junjia Xu
- Obsessive Compulsive Disorder Institute, McLean Hospital, United States
| | - Martha J Falkenstein
- Obsessive Compulsive Disorder Institute, McLean Hospital, United States; Department of Psychiatry, Harvard Medical School, United States
| | - Jennie M Kuckertz
- Obsessive Compulsive Disorder Institute, McLean Hospital, United States; Department of Psychiatry, Harvard Medical School, United States
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2
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Johannesson C, Nehlin C, Gordh T, Hysing EB, Bothelius K. Patients' experiences of treatment-relevant processes in multimodal pain rehabilitation for severe complex regional pain syndrome - a qualitative study. Disabil Rehabil 2024; 46:1862-1869. [PMID: 37191973 DOI: 10.1080/09638288.2023.2209744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Accepted: 04/28/2023] [Indexed: 05/17/2023]
Abstract
PURPOSE Complex regional pain syndrome (CRPS) is a longstanding condition with spontaneous and evoked pain, that usually occurs in an upper or lower extremity. Although it often resolves within the first year, it may for a minority progress to a chronic and occasionally severely disabling condition. The aim of this study was to explore patients' experiences and perceived effects of a specific treatment, designed for patients with severe and highly disabling CRPS, in order to identify possible treatment-relevant processes. METHODS The method used was a qualitative design, using semi-structured interviews with open-ended questions to capture participants' experiences and perceptions. Ten interviews were analyzed using applied thematic analysis. RESULTS Despite the fact that participants had a severe conditions, including nerve damage and a long duration of illness, they reported having been helped to increase flexible persistence, reduce fear and avoidance, and improve connections. This helped participants to significant improvements in daily life functioning. CONCLUSIONS The participants described distinct possible treatment-relevant processes leading to a substantial improvement in everyday life. The results imply that there is hope for this group that has been severely disabled for many years. This may help guide future clinical treatment trials.
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Affiliation(s)
| | - Christina Nehlin
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Torsten Gordh
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Eva-Britt Hysing
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
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3
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Lee SJ, Lee SW, Choi M. Standardization of the Korean Version of the Acceptance and Action Questionnaire for Obsessions and Compulsions in University Students and Patients With Obsessive-Compulsive Disorder. Psychiatry Investig 2024; 21:275-283. [PMID: 38569585 PMCID: PMC10990626 DOI: 10.30773/pi.2023.0240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 11/09/2023] [Accepted: 12/21/2023] [Indexed: 04/05/2024] Open
Abstract
OBJECTIVE The Acceptance and Action Questionnaire for Obsessions and Compulsions (AAQ-OC) is a version of the Acceptance and Action Questionnaire (AAQ) that specifically measures unwanted intrusive thoughts and responses (e.g., experiential avoidance) to them. This study aimed to investigate the reliability and validity of the Korean version of the AAQ-OC in clinical and nonclinical Korean samples. METHODS In this study, 561 university students and 121 patients with obsessive-compulsive disorder (OCD) completed the AAQ-OC and several other psychological scales. Descriptive, correlation, and exploratory and confirmatory factor analyses as well as group comparisons were conducted. RESULTS The results of the exploratory and confirmatory factor analyses indicated a two-factor structure that best fits the data in the university sample: Factors 1 and 2 matched the original Valued Action and Willingness subscales, respectively. The reliability analyses revealed that the AAQ-OC and its factors had excellent internal consistencies. As regards the concurrent validity, the AAQ-OC and its factors had a positive correlation with the AAQ-II and Cognitive Fusion Questionnaire. Compared with the university students, the OCD patients had higher AAQ-OC scores, and their obsessive-compulsive symptoms, particularly the two symptom dimensions of responsibility for harm and mistakes and unacceptable thoughts, were significantly associated with the AAQ-OC and two subscales. CONCLUSION The findings of this study confirm the reliability and validity of the Korean version of the AAQ-OC.
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Affiliation(s)
- Seung Jae Lee
- Department of Psychiatry, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
- Department of Psychiatry, Kyungpook National University Hospital, Daegu, Republic of Korea
| | - Sang Won Lee
- Department of Psychiatry, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
- Department of Psychiatry, Kyungpook National University Chilgok Hospital, Daegu, Republic of Korea
| | - Mina Choi
- Institute of Biomedical Engineering Research, Kyungpook National University, Daegu, Republic of Korea
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Morris OJ, Wiese AD, Pinciotti CM, Pacheco R, Mallen MCM, Schweissing EJ, Soileau KJ, Crowley JJ, Storch EA. Obsessive-compulsive disorder among individuals of Hispanic and Latin American ancestry: Cultural considerations for assessment and psychotherapy. Bull Menninger Clin 2024; 88:148-170. [PMID: 38836850 DOI: 10.1521/bumc.2024.88.2.148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/06/2024]
Abstract
Research specific to obsessive-compulsive disorder (OCD) among individuals of Hispanic and Latin American (H/L) ancestry is limited, as are culturally relevant assessment and treatment recommendations. This article discusses the implications of underrepresentation of H/L populations in OCD research and emphasizes the need to consider issues related to assessment, treatment, and structural barriers that hinder delivery of culturally appropriate first-line psychotherapy. Recommendations for assessment and treatment are provided to aid clinicians in distinguishing culturally normative thoughts and behaviors from OCD, as well as to inform the implementation of psychotherapeutic interventions with cultural humility. This manuscript offers recommendations for future research to tackle health equity concerns with respect to assessment and treatment and structural factors limiting access to culturally appropriate psychotherapy. Wide-scale efforts are needed to comprehensively understand how H/L cultures intersect with various OCD presentations and to further disseminate treatments to populations that have historically lacked access to mental health care.
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Affiliation(s)
- Olivia J Morris
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas
| | - Andrew D Wiese
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas
| | - Caitlin M Pinciotti
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas
| | | | | | | | - Keaton J Soileau
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas
| | - James J Crowley
- Department of Genetics and with the and the Department of Psychiatry, University of North Carolina, Chapel Hill, North Carolina
| | - Eric A Storch
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas
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5
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Kolar DR, Meule A, Zisler EM, Schwartz C, Voderholzer U. Effects of acceptance-based strategies on psychological responses to disorder-relevant stimuli in inpatients with obsessive-compulsive disorder: An experimental study. J Behav Ther Exp Psychiatry 2023; 81:101890. [PMID: 37429125 DOI: 10.1016/j.jbtep.2023.101890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 06/05/2023] [Accepted: 06/25/2023] [Indexed: 07/12/2023]
Abstract
BACKGROUND AND OBJECTIVES Preliminary findings suggest that acceptance and commitment therapy-informed exposure therapy may be an effective treatment for obsessive-compulsive disorder (OCD). However, there is a lack of experimental studies that have examined immediate effects of acceptance-based strategies during exposure to disorder-relevant stimuli in persons with OCD. METHODS Fifty-three inpatients (64% female) with OCD participated in an experimental study during which they were exposed to obsessive-compulsive washing-relevant pictures and were instructed to either passively view these pictures for 5 s (neutral condition), to accept their feelings (acceptance condition) or to intensify their feelings (exposure condition) for 90 s each. RESULTS The acceptance condition led to higher acceptance and lower unpleasantness of patients' current feelings compared to the neutral condition and to lower strength of obsessions and urge to perform compulsions but only when compared to the exposure condition. Higher self-reported OCD symptom severity related to higher unpleasantness and strength of obsessions, particularly in the neutral condition. LIMITATIONS Future studies need to test whether the current findings translate to other stimuli and other forms of obsessions and compulsions. Due to the short duration, the exposure condition might have only mimicked the early phase of exposure and response prevention. CONCLUSIONS Acceptance-based strategies during cue exposure immediately increase acceptance of and reduce unpleasant feelings. In line with the rationale of acceptance-based treatment approaches, which do not aim at immediate disorder-specific symptom reductions, effects on obsessions and compulsions may be more delayed or require repeated training sessions.
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Affiliation(s)
- David R Kolar
- Department of Psychology, University of Regensburg, Regensburg, Germany
| | - Adrian Meule
- Department of Psychiatry and Psychotherapy, LMU University Hospital, LMU Munich, Munich, Germany; Schoen Clinic Roseneck, Prien Am Chiemsee, Germany; Institute of Medical Psychology, Faculty of Medicine, LMU Munich, Germany
| | - Eva M Zisler
- Department of Psychiatry and Psychotherapy, LMU University Hospital, LMU Munich, Munich, Germany; Schoen Clinic Roseneck, Prien Am Chiemsee, Germany.
| | - Caroline Schwartz
- Department of Psychiatry and Psychotherapy, LMU University Hospital, LMU Munich, Munich, Germany
| | - Ulrich Voderholzer
- Department of Psychiatry and Psychotherapy, LMU University Hospital, LMU Munich, Munich, Germany; Schoen Clinic Roseneck, Prien Am Chiemsee, Germany; Medical Center, Department of Psychiatry and Psychotherapy, Faculty of Medicine, University of Freiburg, Freiburg, Germany
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Wang D, Lin B, Xiong F, Deng Y, Zhang L. Effectiveness of Internet-delivered self-help acceptance and commitment therapy (iACT) on nurses' obsessive-compulsive symptoms and sleep quality: A randomized controlled trial with 3-month follow-up. J Affect Disord 2023; 341:319-328. [PMID: 37659615 DOI: 10.1016/j.jad.2023.08.125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 08/14/2023] [Accepted: 08/27/2023] [Indexed: 09/04/2023]
Abstract
BACKGROUND Frontline nurses suffered unprecedented mental distress during the COVID-19 pandemic. It's essential to explore new and more accessible alternatives to improve the availability of psychological treatments. This study aimed to investigate the influence of online self-help iACT linear intervention and iACT loop intervention on sleep quality (SQ), obsessive-compulsive symptoms (OCS), and psychological flexibility (PF) in nurses. METHODS A randomized controlled trial was conducted at a hospital in China. 602 participants were randomly assigned to the iACT linear intervention, iACT loop intervention, or wait list control group, and required to complete the questionnaires of OCS, PF and SQ. The linear mixed effects analysis (LMM) was used to analyze the impact of the intervention on outcome variables. RESULTS LMM analyses demonstrated that both two intervention had significant improvement on OCS (t = -38.235, p < 0.001), PF (t = 28.156, p < 0.001), as well as SQ (t = -16.336, p < 0.001). There were significant differences between the linear group and loop group on the PF in T2 (t = -8.271, p < 0.001), T3 (t = -8.366, p < 0.001), T4 (t = -8.302, p < 0.001), with the iACT loop model (Cohen's d = 1.652) showing a slight advantage over the iACT linear model (Cohen's d = 1.134). CONCLUSIONS The findings indicate that two interventions positively impact OCS, PF, and SQ. Compared to the iACT linear psychotherapy model, the iACT loop model shows greater effectiveness in enhancing PF, making it helpful to promote significant improvements in psychotherapy planning.
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Affiliation(s)
- Difan Wang
- School of Psychology, Central China Normal University, China; Key Laboratory of Adolescent Cyberpsychology and Behavior, Ministry of Education, China; Key Laboratory of Human Development and Mental Health of Hubei Province, Wuhan, China; Department of Field Internal Medicine, Psychological Counseling and Service Center, Graduate School of Medical College of Chinese PLA General Hospital, China
| | - Bingyan Lin
- School of Foreign Languages, Harbin University of Science and Technology, China
| | - Fen Xiong
- School of Psychology, Central China Normal University, China; Key Laboratory of Adolescent Cyberpsychology and Behavior, Ministry of Education, China; Key Laboratory of Human Development and Mental Health of Hubei Province, Wuhan, China
| | - Yu Deng
- School of Foreign Languages, Harbin University of Science and Technology, China
| | - Lin Zhang
- School of Psychology, Central China Normal University, China; Key Laboratory of Adolescent Cyberpsychology and Behavior, Ministry of Education, China; Key Laboratory of Human Development and Mental Health of Hubei Province, Wuhan, China.
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Steuber ER, McGuire JF. A Meta-analysis of Transcranial Magnetic Stimulation in Obsessive-Compulsive Disorder. BIOLOGICAL PSYCHIATRY. COGNITIVE NEUROSCIENCE AND NEUROIMAGING 2023; 8:1145-1155. [PMID: 37343662 DOI: 10.1016/j.bpsc.2023.06.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 06/04/2023] [Accepted: 06/07/2023] [Indexed: 06/23/2023]
Abstract
BACKGROUND Obsessive-compulsive disorder (OCD) is a debilitating illness with substantial morbidity. Although pharmacological and behavioral evidence-based treatments have shown efficacy, many patients remain unresponsive to this first-line care. Repetitive transcranial magnetic stimulation (rTMS) has shown significant promise for patients with treatment-refractory affective disorders. Therefore, we conducted a meta-analysis of randomized controlled trials to examine the therapeutic benefit of rTMS in patients with OCD and explore moderators of its treatment effects. METHODS PubMed (1997-Dec 31, 2022) and PsycINFO were searched for randomized sham-controlled trials of rTMS to treat OCD using the following terms: "obsessive-compulsive disorder," "transcranial magnetic stimulation," and "randomized controlled trial." Clinical characteristics and effect sizes were extracted from 25 randomized controlled trials (860 participants). A random effects model calculated the effect sizes for treatment efficacy and treatment response using the clinician-rated Yale-Brown Obsessive Compulsive Scale. RESULTS Across randomized controlled trials, rTMS exhibited a moderate therapeutic effect (g = 0.65) on OCD symptom severity and a 3-fold increased likelihood of treatment response (relative risk = 3.15) compared with sham conditions. Greater improvement in comorbid depression severity corresponded with greater treatment effects of rTMS on OCD symptom severity. In addition, longer rTMS sessions and fewer overall sessions predicted greater clinical improvement. CONCLUSIONS rTMS is moderately effective for reducing OCD symptom severity. It holds potential to serve as a therapeutic intervention, particularly for patients with OCD who have failed standard treatments and those with comorbid depression. Further research is needed to optimize rTMS protocols and evaluate the long-term efficacy of rTMS for OCD.
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Affiliation(s)
- Elizabeth R Steuber
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Joseph F McGuire
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland.
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Evey KJ, Steinman SA. A Systematic Review of the Use of Acceptance and Commitment Therapy to Treat Adult Obsessive-Compulsive Disorder. Behav Ther 2023; 54:1006-1019. [PMID: 37863582 DOI: 10.1016/j.beth.2022.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 02/25/2022] [Accepted: 02/28/2022] [Indexed: 10/22/2023]
Abstract
The present review aims to critically evaluate available literature on the use of acceptance and commitment therapy (ACT) to treat adult obsessive-compulsive disorder (OCD) and to draw conclusions about using ACT to reduce OCD symptoms in adults with OCD. Databases (PsycINFO, PsycARTICLES, MEDLINE, and PubMed), Google Scholar, and article references were used to identify relevant studies through October 10, 2020. This review includes both peer-reviewed, published articles (n = 15) and unpublished theses and dissertations (n = 2) to increase the breadth of the review as suggested by PRISMA guidelines. Reviewed articles utilized ACT and at least one measure of OCD symptom severity. Information on methodological, measurement, statistical, and analytical characteristics of the included studies were extracted to determine the quality of the available studies and to inform the conclusions of this review. Seventeen studies (n = 17) with 336 participants from three countries were evaluated. The current evidence suggests that ACT can be used to reduce symptoms of OCD in adults. A conclusion supporting the use of ACT to reduce OCD symptoms can be made because of several strengths within this body of literature (e.g., use of validated OCD symptom measures, inclusion of treatment manuals, use of multiple assessment points, etc.). However, because a majority of the included studies are quasi-experimental and single-subject studies, more stringent research (i.e., randomized controlled trials) with large, diverse samples is needed to strengthen this conclusion. Additionally, dismantling studies exploring the components of ACT that lead to OCD symptom improvement are needed.
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McKay D, O'Donohue W. Conceptual, Psychometric, Methodological and Value Problems in Acceptance and Commitment Therapy: Introduction to the Special Section, "A Critical Appraisal of Acceptance and Commitment Therapy". Behav Ther 2023; 54:929-938. [PMID: 37863585 DOI: 10.1016/j.beth.2023.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 06/23/2023] [Accepted: 07/10/2023] [Indexed: 10/22/2023]
Abstract
There is a voluminous and expanding literature regarding ACT, from descriptions of its theory to its stated roots in relational frame theory, the particulars of its therapy techniques and exercises, favored metaphors, randomized controlled trials, to many self-help books for a wide variety of problems. The therapy is widely marketed through workshops and many self-help books. ACT is associated with its own journal and its own professional organization, the Association for Contextual Behavioral Science (ACBS). This literature is interpreted by ACT proponents as demonstrating the causal efficacy of ACT for a wide range of problems and, at times, even being superior to treatment as usual, which are often more traditional forms of cognitive behavior therapy (CBT). This special section contains a series of 6 papers examining these claims. Correctly understanding and evaluating the claims of ACT proponents is warranted because these can have direct implications for treatment decisions by therapists attempting to deliver the most effective treatment for their clients' problems. The papers, individually and as a whole, urge considerable caution, particularly because much of its research has involved serious measurement problems, problematic research designs, and a unique and problematic conceptualization and perhaps the practice of values and ethics. These papers call for methodological improvements and a commitment to more traditional values associated with science so that ACT can be more fairly evaluated to accurately understand its assets and limitations.
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Buchholz JL, Abramowitz JS, Hellberg SN, Ojalehto HJ, Twohig M. Different Psychological Processes in Traditional and ACT-Enhanced ERP for Obsessive-Compulsive Disorder. J Cogn Psychother 2023; 37:239-251. [PMID: 37463698 DOI: 10.1891/jcp-2021-0004] [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: 07/20/2023]
Abstract
Background: Acceptance and commitment therapy (ACT) has been shown to promote willingness to experience intrusive thoughts among individuals with obsessive-compulsive disorder (OCD). Exposure with response prevention (ERP) delivered from an ACT framework (i.e., ACT+ERP) may facilitate changes in how patients relate to their unwanted internal experiences.Aims: Accordingly, the present study aimed to examine the effect of ACT+ERP on appraisals of intrusive thoughts, relative to standard ERP.Methods: Forty-eight adults who received 16 treatment sessions as part of a randomized controlled trial comparing standard ERP to ACT+ERP completed the Interpretation of Intrusions Inventory (III) at pre-treatment, post-treatment, and follow-up.Results: Results showed a significant main effect of time for all III subscales, suggesting that appraisals of intrusive thoughts shift over the course of treatment. The effect of the condition × time interaction, however, differed between the III subscales. Specifically, a significant interaction emerged for the control of thoughts subscale, such that individuals who received ACT+ERP experienced greater reductions in beliefs about the need to control thoughts. The interaction term was not significant for importance of thoughts or responsibility subscales.Conclusions: Findings suggest that augmenting ERP with ACT enhances change in beliefs about the need to control thoughts, but not in beliefs about responsibility and the importance of thoughts. Clinical implications and future research directions will be discussed.
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Affiliation(s)
| | | | | | - Heidi J Ojalehto
- University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Wang D, Lin B, Liang H, Deng Y, Zhang L. Mediating role of psychological flexibility in the effect of obsessive-compulsive symptoms on sleep quality among nurses during the COVID-19 pandemic. CURRENT PSYCHOLOGY 2023:1-10. [PMID: 37359595 PMCID: PMC10097520 DOI: 10.1007/s12144-023-04546-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/10/2023] [Indexed: 06/28/2023]
Abstract
Front-line nurses suffered unprecedented mental distress and severe insomnia during the COVID-19 pandemic. Present study aimed to explore the relationship between obsessive-compulsive symptoms and sleep quality and examine the potential mediating role of psychological flexibility between obsessive-compulsive symptoms and sleep quality. A total of 496 nurses from a Chinese large-scale Class 3 A Comprehensive Hospital were included in an online cross-sectional survey and completed the revised obsessive-compulsive inventory (OCI-R), Multidimensional Psychological Flexibility Inventory (MPFI) and Pittsburgh Sleep Quality Index (PSQI). As predicted, obsessive-compulsive symptoms were negatively associated with psychological flexibility and sleep quality, and psychological flexibility was positively associated with sleep quality. In addition, the relationship between obsessive-compulsive symptoms and sleep quality was partially mediated by psychological flexibility, which can provide some reference for the treatment of the obsessive-compulsive disorder (OCD) and insomnia, and lead to improvements in clinical and psychotherapy planning.
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Affiliation(s)
- Difan Wang
- School of Psychology, Central China Normal University, Luoyu Road No.152, Hongshan District, Wuhan, 430079 China
- Key Laboratory of Adolescent Cyberpsychology and Behavior, Ministry of Education, Wuhan, China
- Key Laboratory of Human Development and Mental Health of Hubei Province, Wuhan, China
- Department of field internal medicine, Psychological Counseling and Health Management Center, Graduate School of Medical College of Chinese PLA Hospital, Beijing, 100853 China
| | - Bingyan Lin
- School of Foreign Languages, Harbin University of Science and Technology, Harbin, 150000 China
| | - Heting Liang
- School of Psychology, Central China Normal University, Luoyu Road No.152, Hongshan District, Wuhan, 430079 China
- Key Laboratory of Adolescent Cyberpsychology and Behavior, Ministry of Education, Wuhan, China
- Key Laboratory of Human Development and Mental Health of Hubei Province, Wuhan, China
| | - Yu Deng
- School of Foreign Languages, Harbin University of Science and Technology, Harbin, 150000 China
| | - Lin Zhang
- School of Psychology, Central China Normal University, Luoyu Road No.152, Hongshan District, Wuhan, 430079 China
- Key Laboratory of Adolescent Cyberpsychology and Behavior, Ministry of Education, Wuhan, China
- Key Laboratory of Human Development and Mental Health of Hubei Province, Wuhan, China
- Shanghai Key Laboratory of Mental Health and Psychological Crisis Intervention, School of Psychology and Cognitive Science, East China Normal University, Shanghai, China
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12
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Spencer SD, Stiede JT, Wiese AD, Guzick AG, Cervin M, McKay D, Storch EA. Things that make you go Hmm: Myths and misconceptions within cognitive-behavioral treatment of obsessive-compulsive disorder. J Obsessive Compuls Relat Disord 2023; 37:100805. [PMID: 37193037 PMCID: PMC10168610 DOI: 10.1016/j.jocrd.2023.100805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/18/2023]
Abstract
The past four decades have yielded a robust body of evidence supporting the efficacy and effectiveness of cognitive-behavioral therapy (CBT) as a gold-standard treatment for obsessive-compulsive disorder (OCD) across the lifespan. Exposure and response prevention (E/RP) has been identified as a key component of this approach. Despite robust research support for CBT with E/RP, several myths and misconceptions continue to proliferate in both research and practice settings. Such myths and misconceptions are concerning, as they lack empirical basis, may hinder widespread dissemination and implementation of CBT for OCD, and run contrary to the practice of evidence-based psychological medicine. Focusing on the importance of promoting evidence-based practice and generative clinical science, the present review article synthesizes relevant research within the field of treatments for OCD to address the following myths / misconceptions: (a) uncertainty exists concerning the evidence base supporting CBT for OCD, (b) E/RP attrition and dropout rates are unacceptably high due to excessive risk and perceived patient intolerability, and (c) alternative treatments for OCD need to be expeditiously developed due to major limitations of E/RP. Recommendations for future research and clinical dissemination and implementation to further advance a generative clinical science of OCD treatment are discussed.
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Affiliation(s)
- Samuel D. Spencer
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
| | - Jordan T. Stiede
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
| | - Andrew D. Wiese
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
| | - Andrew G. Guzick
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
| | - Matti Cervin
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
- Department of Clinical Sciences Lund, Lund University, Lund Sweden
| | - Dean McKay
- Department of Psychology, Fordham University, Bronx, NY, USA
| | - Eric A. Storch
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
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13
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Swierkosz-Lenart K, Dos Santos JFA, Elowe J, Clair AH, Bally JF, Riquier F, Bloch J, Draganski B, Clerc MT, Pozuelo Moyano B, von Gunten A, Mallet L. Therapies for obsessive-compulsive disorder: Current state of the art and perspectives for approaching treatment-resistant patients. Front Psychiatry 2023; 14:1065812. [PMID: 36873207 PMCID: PMC9978117 DOI: 10.3389/fpsyt.2023.1065812] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 01/25/2023] [Indexed: 02/18/2023] Open
Abstract
Even though obsessive compulsive disorder (OCD) is one of the ten most disabling diseases according to the WHO, only 30-40% of patients suffering from OCD seek specialized treatment. The currently available psychotherapeutic and pharmacological approaches, when properly applied, prove ineffective in about 10% of cases. The use of neuromodulation techniques, especially Deep Brain Stimulation, is highly promising for these clinical pictures and knowledge in this domain is constantly evolving. The aim of this paper is to provide a summary of the current knowledge about OCD treatment, while also discussing the more recent proposals for defining resistance.
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Affiliation(s)
- Kevin Swierkosz-Lenart
- Department of Psychiatry, Service Universitaire de Psychiatrie de l’Age Avancé (SUPAA), Centre Hospitalier Universitaire Vaudois, Prilly, Switzerland
| | | | - Julien Elowe
- Department of Psychiatry, Lausanne University Hospital, University of Lausanne, West Sector, Prangins, Switzerland
- Department of Psychiatry, Lausanne University Hospital, University of Lausanne, North Sector, Yverdon-les-Bains, Switzerland
| | - Anne-Hélène Clair
- Sorbonne University, UPMC Paris 06 University, INSERM, CNRS, Institut du Cerveau et de la Moelle Épinière, Paris, France
| | - Julien F. Bally
- Department of Clinical Neurosciences, Service of Neurology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Françoise Riquier
- Department of Clinical Neuroscience, Service of Neurosurgery, Lausanne University Hospital (CHUV), University of Lausanne (UNIL), Lausanne, Switzerland
| | - Jocelyne Bloch
- Department of Clinical Neuroscience, Service of Neurosurgery, Lausanne University Hospital (CHUV), University of Lausanne (UNIL), Lausanne, Switzerland
| | - Bogdan Draganski
- Laboratory for Research in Neuroimaging (LREN), Department of Clinical Neurosciences, Centre for Research in Neurosciences, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
- Department of Neurology, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany
| | - Marie-Thérèse Clerc
- Department of Psychiatry, Service Universitaire de Psychiatrie de l’Age Avancé (SUPAA), Centre Hospitalier Universitaire Vaudois, Prilly, Switzerland
| | - Beatriz Pozuelo Moyano
- Department of Psychiatry, Service Universitaire de Psychiatrie de l’Age Avancé (SUPAA), Centre Hospitalier Universitaire Vaudois, Prilly, Switzerland
| | - Armin von Gunten
- Department of Psychiatry, Service Universitaire de Psychiatrie de l’Age Avancé (SUPAA), Centre Hospitalier Universitaire Vaudois, Prilly, Switzerland
| | - Luc Mallet
- Department of Mental Health and Psychiatry, Geneva University Hospital, Geneva, Switzerland
- Univ Paris-Est Créteil, DMU IMPACT, Département Médical-Universitaire de Psychiatrie et d’Addictologie, Hôpitaux Universitaires Henri Mondor - Albert Chenevier, Assistance Publique-Hôpitaux de Paris, Créteil, France
- Sorbonne Université, Institut du Cerveau - Paris Brain Institute - ICM, Inserm, CNRS, Paris, France
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14
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Fang S, Ding D, Zhang R, Huang M. Psychological mechanism of acceptance and commitment therapy and rational emotive behavior therapy for treating hoarding: Evidence from randomized controlled trials. Front Public Health 2023; 11:1084467. [PMID: 36844862 PMCID: PMC9950404 DOI: 10.3389/fpubh.2023.1084467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Accepted: 01/16/2023] [Indexed: 02/12/2023] Open
Abstract
Hoarding is a common problem behavior worldwide and is detrimental to the physical and mental health of individuals and groups. Currently, effective interventions for hoarding are cognitive-behavioral therapies, but their post-intervention efficacy is questionable, and the available research does not examine the mediating variables of the effects of interventions on clinical outcomes. Moreover, current research on hoarding has focused on Western countries. Therefore, there is a need to investigate the efficacy of other forms of cognitive behavioral therapy on hoarding as well as other psychological outcomes related to hoarding and mediating variables that contribute to its effectiveness in different cultural contexts. One hundred thirty-nine college students with higher hoarding behaviors were randomly divided into three groups: 45 in the Acceptance and Commitment Therapy (ACT) group, 47 in the Rational Emotive Behavior Therapy (REBT) group, and 47 in the control group. They completed the Saving Inventory-Revised (SI-R), Obsessive-Compulsive Symptom Scale (OCSS), Difficulties in Emotion Regulation Scale (DERS), Experiences in Close Relationships Inventory-Attachment Anxiety Subscale (ECR), Depression Anxiety Stress Scales (DASS-21), Acceptance and Action Questionnaire II (AAQ-II), and Cognitive Fusion Questionnaire (CFQ) before and immediately after the intervention. The results showed that ACT and REBT improved individuals' psychological flexibility, cognitive fusion, acquisition-difficulty discarding, clutter, negative affect (anxiety, depression, stress), attachment anxiety, obsessive-compulsive disorder, and difficulty in emotion regulation compared to the control group. In addition, ACT was more effective than REBT in improving psychological flexibility and reducing hoarding, cognitive fusion, depression, stress, and obsessive-compulsive disorder; there were no significant differences between the two in anxiety and emotion regulation difficulties. Furthermore, psychological flexibility is a mediator of the effect of ACT and REBT on some behavioral and psychological outcomes (hoarding, negative affect, attachment anxiety). Limitations were discussed.
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Affiliation(s)
- Shuanghu Fang
- School of Educational Science, Anhui Normal University, Wuhu, China
| | - Dongyan Ding
- School of Educational Science, Anhui Normal University, Wuhu, China
| | - Ru Zhang
- School of Educational Science, Anhui Normal University, Wuhu, China
| | - Mingjie Huang
- School of Educational Science, Anhui Normal University, Wuhu, China
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15
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Kadivari F, Najafi M, Khosravani V. Childhood emotional maltreatment, maladaptive coping and obsessive-compulsive symptoms in patients with obsessive-compulsive disorder. Clin Psychol Psychother 2023. [PMID: 36639957 DOI: 10.1002/cpp.2829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 12/30/2022] [Accepted: 01/09/2023] [Indexed: 01/15/2023]
Abstract
Previous studies have reported childhood emotional maltreatment (CEM) to be associated with specific obsessive-compulsive (OC) symptoms, but maladaptive coping, which may be the underlying mechanism in this relationship, has not been evaluated yet. Thus, the present study aimed to examine the effects of CEM on the OC symptoms of responsibility for harm and unacceptable thoughts, as well as obsessive-compulsive disorder (OCD) severity, through maladaptive coping, including cognitive avoidance, experiential avoidance and emotional suppression in OCD patients (n = 360). The results showed that CEM had direct effects, as well as indirect effects via cognitive and experiential avoidance and emotional suppression, on responsibility for harm and unacceptable thoughts. In addition, the indirect effect of CEM on OCD severity was significantly mediated by the roles of cognitive avoidance and experiential avoidance. The present study adds new literature to evidence indicating the role of early childhood events in developing and maintaining OCD in which adverse maladaptive coping related to unpleasant childhood abuse plays an important role in OCD. More precisely, OCD patients who experience a history of CEM may further use maladaptive coping to cope with their distress and subsequently experience responsibility for harm, unacceptable thoughts and severe OCD.
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Affiliation(s)
- Faranak Kadivari
- Department of Clinical Psychology, Faculty of Psychology and Educational Sciences, Semnan University, Semnan, Iran
| | - Mahmoud Najafi
- Department of Clinical Psychology, Faculty of Psychology and Educational Sciences, Semnan University, Semnan, Iran
| | - Vahid Khosravani
- Behavioral Sciences Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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16
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Castle D, Feusner J, Laposa JM, Richter PMA, Hossain R, Lusicic A, Drummond LM. Psychotherapies and digital interventions for OCD in adults: What do we know, what do we need still to explore? Compr Psychiatry 2023; 120:152357. [PMID: 36410261 PMCID: PMC10848818 DOI: 10.1016/j.comppsych.2022.152357] [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: 04/18/2022] [Revised: 08/07/2022] [Accepted: 11/14/2022] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Despite significant advances in the understanding and treatment of obsessive compulsive disorder (OCD), current treatment options are limited in terms of efficacy for symptom remission. Thus, assessing the potential role of iterative or alternate psychotherapies is important. Also, the potential role of digital technologies to enhance the accessibility of these therapies, should not be underestimated. We also need to embrace the idea of a more personalized treatment choice, being cognisant of clinical, genetic and neuroimaging predictors of treatment response. PROCEDURES Non-systematic review of current literature on emerging psychological and digital therapies for OCD, as well as of potential biomarkers of treatment response. FINDINGS A number of 'third wave' therapies (e.g., Acceptance and Commitment Therapy, Mindfulness-Based Cognitive Therapy) have an emerging and encouraging evidence base in OCD. Other approaches entail employment of elements of other psychotherapies such as Dialectical Behaviour Therapy; or trauma-focussed therapies such as Eye Movement Desensitisation and Reprocessing, and Imagery Rescripting and Narrative Therapy. Further strategies include Danger Ideation Reduction Therapy and Habit Reversal. For these latter approaches, large-scale randomised controlled trials are largely lacking, and the precise role of these therapies in treating people with OCD, remains to be clarified. A concentrated 4-day program (the Bergen program) has shown promising short- and long-term results. Exercise, music, and art therapy have not been adequately tested in people with OCD, but may have an adjunctive role. Digital technologies are being actively investigated for enhancing reach and efficacy of psychological therapies for OCD. Biomarkers, including genetic and neuroimaging, are starting to point to a future with more 'personalised medicine informed' treatment strategizing for OCD. CONCLUSIONS There are a number of potential psychological options for the treatment of people with OCD who do not respond adequately to exposure/response prevention or cognitive behaviour therapy. Adjunctive exercise, music, and art therapy might be useful, albeit the evidence base for these is very small. Consideration should be given to different ways of delivering such interventions, including group-based, concentrated, inpatient, or with outreach, where appropriate. Digital technologies are an emerging field with a number of potential applications for aiding the treatment of OCD. Biomarkers for treatment response determination have much potential capacity and deserve further empirical testing.
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Affiliation(s)
- David Castle
- Centre for Addiction and Mental Health, 60 White Squirrel Way, Toronto, Ontario M6J 1H4, Canada; Department of Psychiatry, University of Toronto, 250 College Street, Toronto, Ontario M5T 1R8, Canada.
| | - Jamie Feusner
- Department of Psychiatry, University of Toronto, 250 College Street, Toronto, Ontario M5T 1R8, Canada; Centre for Addiction and Mental Health, 250 College Street, Toronto, Ontario M5T 1RB, Canada
| | - Judith M Laposa
- Department of Psychiatry, University of Toronto, 250 College Street, Toronto, Ontario M5T 1R8, Canada; Campbell Family Mental Health Research Institute, Center for Addiction and Mental Health, 100 Stokes St., Toronto, Ontario M6J 1H4, Canada
| | - Peggy M A Richter
- Department of Psychiatry, University of Toronto, 250 College Street, Toronto, Ontario M5T 1R8, Canada; Frederick W Thompson Anxiety Disorders Centre, Sunnybrook Health Sciences Centre, 2075 Bayview, Toronto, Ontario M4N 3M5, Canada
| | - Rahat Hossain
- Department of Psychiatry, University of Toronto, 250 College Street, Toronto, Ontario M5T 1R8, Canada
| | - Ana Lusicic
- Centre for Addiction and Mental Health, 60 White Squirrel Way, Toronto, Ontario M6J 1H4, Canada; Department of Psychiatry, University of Toronto, 250 College Street, Toronto, Ontario M5T 1R8, Canada
| | - Lynne M Drummond
- Service for OCD/ BDD, South-West London and St George's NHS Trust, Glenburnie Road, London SW17 7DJ, United Kingdom
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17
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Tabrizi FF, Larsson AB, Grönvall H, Söderstrand L, Hallén E, Champoux-Larsson MF, Lundgren T, Sundström F, Lavefjord A, Buhrman M, Sundin Ö, McCracken L, Åhs F, Jansson B. Psychometric evaluation of the Swedish Multidimensional Psychological Flexibility Inventory (MPFI). Cogn Behav Ther 2022:1-22. [PMID: 36562150 DOI: 10.1080/16506073.2022.2153077] [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: 12/24/2022]
Abstract
Psychiatric disorders are common, and reliable measures are crucial for research and clinical practice. A cross-diagnostic construct that can be used to index treatment outcomes as well as prevalence of psychological ill health is psychological flexibility. The aim of this study was to validate a Swedish version of the Multidimensional Psychological Flexibility Inventory (MPFI). The MPFI has 12 subscales, six of which measure flexibility, and six that measure inflexibility. Using confirmatory factor analysis in a community sample of 670 participants, we found that a model with two higher order factors had satisfactory fit (CFI = .933) and a 12-factor model had the best fit to the data (CFI = .955). All 12 subscales showed adequate reliability (CRs = .803-.933) and the factor structure was similar across age groups and gender. Findings suggest that the Swedish version of the MPFI is a reliable instrument that can be used to index psychological flexibility. Potential areas for improvement of the instrument are discussed.
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Affiliation(s)
- Fara F Tabrizi
- Department of Psychology & Social Work, Mittuniversitetet, Östersund, Sweden
| | - Andreas B Larsson
- Department of Psychology & Social Work, Mittuniversitetet, Östersund, Sweden
| | - Hampus Grönvall
- Department of Psychology & Social Work, Mittuniversitetet, Östersund, Sweden
| | - Lux Söderstrand
- Department of Psychology & Social Work, Mittuniversitetet, Östersund, Sweden
| | - Ellen Hallén
- Department of Psychology & Social Work, Mittuniversitetet, Östersund, Sweden
| | | | - Tobias Lundgren
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, & Stockholm Health Care Services, Stockholm, Sweden
| | - Felicia Sundström
- Department of Psychology, Clinical Psychology, Uppsala Universitet, Uppsala, Sweden
| | - Amani Lavefjord
- Department of Psychology, Clinical Psychology, Uppsala Universitet, Uppsala, Sweden
| | - Monica Buhrman
- Department of Psychology, Clinical Psychology, Uppsala Universitet, Uppsala, Sweden
| | - Örjan Sundin
- Department of Psychology & Social Work, Mittuniversitetet, Östersund, Sweden
| | - Lance McCracken
- Department of Psychology, Clinical Psychology, Uppsala Universitet, Uppsala, Sweden
| | - Fredrik Åhs
- Department of Psychology & Social Work, Mittuniversitetet, Östersund, Sweden
| | - Billy Jansson
- Department of Psychology & Social Work, Mittuniversitetet, Östersund, Sweden
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18
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Effective – and tolerable: Acceptance and Side Effects of Intensified Exposure for Anxiety Disorders. Behav Ther 2022; 54:427-443. [PMID: 37088502 DOI: 10.1016/j.beth.2022.11.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 09/19/2022] [Accepted: 11/02/2022] [Indexed: 11/11/2022]
Abstract
Despite striking empirical support, exposure-based treatments for anxiety disorders are underutilized. This is partially due to clinicians' concerns that patients may reject exposure or experience severe side effects, particularly in intensive forms of exposure. We examined acceptance and side effects of two randomly assigned variants of prediction error-based exposure treatment differing in temporal density (1 vs. 3 sessions/week) in 681 patients with panic disorder, agoraphobia, social anxiety disorder, and multiple specific phobias. Treatment acceptance included treatment satisfaction and credibility, engagement (i.e., homework completion), and tolerability (i.e., side effects, dropout, and perceived treatment burden). Side effects were measured with the Inventory for the Balanced Assessment of Negative Effects of Psychotherapy (INEP). We found treatment satisfaction, credibility, and engagement to be equally high in both variants of exposure-based treatment, despite higher treatment burden (β = 0.25) and stronger side effects (β = 0.15) in intensified treatment. 94.1% of patients reported positive effects in the INEP. 42.2% reported side effects, with treatment stigma (16.6%), low mood (14.8%) and the experience to depend on the therapist (10.9%) being the most frequently reported. The mean intensity of side effects was low. We conclude that prediction error-based exposure treatment is well accepted by patients with different anxiety disorders and that patients also tolerate temporally intensified treatment, despite higher perceived treatment burden and stronger side effects. Clinicians should be aware of the most frequent side effects to take appropriate countermeasures. In sum, temporal intensification appears to be an acceptable strategy to achieve faster symptom reduction, given patients' well-informed consent.
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19
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Akbari M, Seydavi M, Davis CH, Levin ME, Twohig MP, Zamani E. The current status of acceptance and commitment therapy (ACT) in Iran: A systematic narrative review. JOURNAL OF CONTEXTUAL BEHAVIORAL SCIENCE 2022. [DOI: 10.1016/j.jcbs.2022.08.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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20
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Does the network structure of obsessive-compulsive symptoms at treatment admission identify patients at risk for non-response? Behav Res Ther 2022; 156:104151. [PMID: 35728274 PMCID: PMC9810266 DOI: 10.1016/j.brat.2022.104151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 05/12/2022] [Accepted: 06/10/2022] [Indexed: 01/05/2023]
Abstract
Exposure and response prevention is the gold-standard treatment for obsessive compulsive disorder (OCD), yet up to half of patients do not adequately respond. Thus, different approaches to identifying and intervening with non-responders are badly needed. One approach would be to better understand the functional connections among aspects of OCD symptoms and, ultimately, how to target those associations in treatment. In a large sample of patients who completed intensive treatment for OCD and related disorders (N = 1343), we examined whether differences in network structure of OCD symptom aspects existed at baseline between treatment responders versus non-responders. A network comparison test indicated a significant difference between OCD network structure for responders versus non-responders (M = 0.19, p = .02). Consistent differences emerged between responders and non-responders in how they responded to emotional distress. This pattern of associations suggests that non-responders may have been more reactive to their distress by performing compulsions, thereby worsening their functioning. By examining the association between baseline distress intolerance with other symptom aspects that presumably maintain the disorder (e.g., ritualizing), clinicians can more effectively target those associations in treatment.
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21
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Lee SM, Suh HW, Kwak HY, Kim JW, Chung SY. Meditation-based intervention for obsessive-compulsive disorder: A PRISMA-compliant systematic review and meta-analysis. Medicine (Baltimore) 2022; 101:e29147. [PMID: 35905202 PMCID: PMC9333541 DOI: 10.1097/md.0000000000029147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND The purpose of this study was to investigate the effects of the meditation-based intervention on obsessive-compulsive disorder (OCD). METHODS The following databases were searched up to April 2021: the Cochrane Central Register of Controlled Trials (CENTRAL), EMBASE, Medline (via PubMed), PsycARTICLES, 4 Korean databases (Korean Medical Database [KMbase], Koreanstudies Information Service System [KISS], National Digital Science Library [NDSL], and Oriental Medicine Advanced Searching Integrated System [OASIS]), and China National Knowledge Infrastructure (CNKI). The search terms related to meditation-based intervention and OCD were used. This systematic review was based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. The selected articles were evaluated using the Cochrane risk of bias tool. The Review Manager (RevMan) 5.4 was used to perform the meta-analysis. RESULTS In all, 16 randomized controlled trials were selected. The meta-analysis showed that the group receiving the treatment combining medication and meditation-based intervention for OCD showed a more significant post-treatment improvement in Yale-Brown obsessive compulsive scale than the group receiving medication only. Compared with other non-medication interventions that are known to be effective in treating OCD, the Yale-Brown obsessive compulsive scale showed a significant improvement immediately after the meditation-based intervention. However, no significant difference was found in the follow-up monitoring data across all examined cases. CONCLUSION This study was conducted to verify the effects of meditation-based intervention on OCD. The results suggested that combined treatment with medication and meditation-based intervention was more effective in treating OCD than medication alone; the positive effects of meditation-based intervention may be greater than the effects of other non-medication interventions. However, the lack of significant difference in the follow-up indicates that long-term effect of meditation-based interventions is unclear. TRIAL REGISTRATION NUMBER PROSPERO CRD42021244408.
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Affiliation(s)
- Si Myeong Lee
- Department of Clinical Korean Medicine, Graduate School, Kyung Hee University, 26 Kyungheedae-ro, Dongdaemoon-gu, Seoul, Republic of Korea
| | - Hyo-Weon Suh
- College of Korean Medicine, Kyung Hee University, 26 Kyungheedae-ro, Dongdaemoon-gu, Seoul, Republic of Korea
| | - Hui-Yong Kwak
- Department of Clinical Korean Medicine, Graduate School, Kyung Hee University, 26 Kyungheedae-ro, Dongdaemoon-gu, Seoul, Republic of Korea
| | - Jong Woo Kim
- Department of Clinical Korean Medicine, Graduate School, Kyung Hee University, 26 Kyungheedae-ro, Dongdaemoon-gu, Seoul, Republic of Korea
- Department of Neuropsychiatry, Kyung Hee University Korean Medicine Hospital at Gangdong, 892 Dongnam-ro, Gangdong-gu, Seoul, Republic of Korea
| | - Sun-Yong Chung
- Department of Clinical Korean Medicine, Graduate School, Kyung Hee University, 26 Kyungheedae-ro, Dongdaemoon-gu, Seoul, Republic of Korea
- Department of Neuropsychiatry, Kyung Hee University Korean Medicine Hospital at Gangdong, 892 Dongnam-ro, Gangdong-gu, Seoul, Republic of Korea
- *Correspondence: Sun-Yong Chung, Department of Clinical Korean Medicine, Graduate School, Kyung Hee University, 26 Kyungheedae-ro, Dongdaemoon-gu, Seoul 02447, Republic of Korea (e-mail: )
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22
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OCD and Comorbid Depression: Assessment, Conceptualization, and Cognitive Behavioral Treatment. J Cogn Psychother 2022; 36:191-206. [PMID: 35882535 DOI: 10.1891/jcp-2022-0003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Many individuals with obsessive-compulsive disorder (OCD) also meet criteria for additional diagnoses. Among the most common co-occurring diagnoses are mood disorders-especially depression. This article focuses on the comorbidity between OCD and major depression. After discussing nature of OCD and depression, the rates and clinical impact of depression on OCD, the conceptualization, assessment, and treatment of OCD when it appears along with depression is covered in detail. The derivation and implementation of a cognitive behavioral treatment program specifically for depressed OCD patients is described and illustrated using a case example.
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23
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Grove L, Roche AI, Doyle R, Stowe ZN, Thomas EBK. ACT-Informed Treatment of Co-morbid Psychiatric Disorders in the Postpartum Period: A Case Report. Clin Case Stud 2022. [DOI: 10.1177/15346501221091273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The literature describing psychological interventions for co-occurring obsessive-compulsive disorder (OCD) and post-traumatic stress disorder (PTSD) is limited. Acceptance and Commitment Therapy (ACT) is a transdiagnostic intervention that targets functionally avoidant behavior underlying both OCD and PTSD. The current case report describes how an ACT-informed approach to treatment was implemented over 14 sessions to treat co-occurring OCD and PTSD in a 9-months postpartum adult woman. The patient was initially referred to psychotherapy by her psychiatrist and showed high motivation to engage in treatment. This case presentation outlines how the intervention targeted core ACT processes while also incorporating components from both exposure and response prevention (ERP) and cognitive processing therapy (CPT) to address the patient’s presenting concerns. Measurements of OCD and PTSD symptom severity, as well as of depressive and anxiety symptoms, over the course of treatment are included. Health-related comorbidities, psychiatric medications, and implications are discussed.
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Affiliation(s)
- Lindsey Grove
- Department of Psychiatry, University of Wisconsin-Madison School of Medicine, Madison, WI, USA
| | - Anne I. Roche
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA
| | - Rena Doyle
- Department of Psychiatry, University of Wisconsin-Madison School of Medicine, Madison, WI, USA
| | - Zachary N. Stowe
- Department of Psychiatry, University of Wisconsin-Madison School of Medicine, Madison, WI, USA
| | - Emily B. K. Thomas
- Department of Psychological and Brain Sciences, University of Iowa, Iowa City, IA, USA
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24
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Soondrum T, Wang X, Gao F, Liu Q, Fan J, Zhu X. The Applicability of Acceptance and Commitment Therapy for Obsessive-Compulsive Disorder: A Systematic Review and Meta-Analysis. Brain Sci 2022; 12:brainsci12050656. [PMID: 35625042 PMCID: PMC9139700 DOI: 10.3390/brainsci12050656] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 05/12/2022] [Indexed: 12/04/2022] Open
Abstract
Background: Acceptance and commitment therapy (ACT), a third-generation cognitive behavioral therapy (CBT), has proved its efficacy amidst various mental disorders. A growing body of studies has shown that ACT can improve obsessive-compulsive disorder (OCD) severity in recent years. To assess the effect of ACT on OCD, we carried out a systematic review and meta-analysis to provide a basis for therapists to use different psychological dimensions of ACT for OCD. Methods: PubMed, the Cochrane Library, EMBASE, EBSCO Host, and literature references were searched until May 2021. Randomized controlled trials (RCTs) and other study designs assessing the effect of ACT among adults suffering from OCD were examined. Results: Fourteen studies, including 413 participants, published between 2010 and 2021 were identified. ACT made statistically significant progress in the Yale–Brown Obsessive–Compulsive Scale (YBOCS) compared with control conditions. Conclusion: After reviewing all the ACT studies, we acknowledge the plausibility of ACT in treating OCD and improving its symptoms for the clinical population. ACT can also be an adjunct therapy for other well-established treatments. It also favors targeting psychological inflexibility. Further well-controlled and high-quality RCTs are required for a better conclusion in further studies.
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Affiliation(s)
- Tamini Soondrum
- Medical Psychological Center, The Second Xiangya Hospital of Central South University, Renmin Middle Road 139#, Furong District, Changsha 410011, China; (T.S.); (X.W.); (F.G.); (Q.L.); (J.F.)
- Medical Psychological Institute of Central South University, Changsha 410011, China
| | - Xiang Wang
- Medical Psychological Center, The Second Xiangya Hospital of Central South University, Renmin Middle Road 139#, Furong District, Changsha 410011, China; (T.S.); (X.W.); (F.G.); (Q.L.); (J.F.)
- Medical Psychological Institute of Central South University, Changsha 410011, China
- National Clinical Research Center for Mental Health Disorders, Changsha 410011, China
| | - Feng Gao
- Medical Psychological Center, The Second Xiangya Hospital of Central South University, Renmin Middle Road 139#, Furong District, Changsha 410011, China; (T.S.); (X.W.); (F.G.); (Q.L.); (J.F.)
- Medical Psychological Institute of Central South University, Changsha 410011, China
- National Clinical Research Center for Mental Health Disorders, Changsha 410011, China
| | - Qian Liu
- Medical Psychological Center, The Second Xiangya Hospital of Central South University, Renmin Middle Road 139#, Furong District, Changsha 410011, China; (T.S.); (X.W.); (F.G.); (Q.L.); (J.F.)
- Medical Psychological Institute of Central South University, Changsha 410011, China
- National Clinical Research Center for Mental Health Disorders, Changsha 410011, China
| | - Jie Fan
- Medical Psychological Center, The Second Xiangya Hospital of Central South University, Renmin Middle Road 139#, Furong District, Changsha 410011, China; (T.S.); (X.W.); (F.G.); (Q.L.); (J.F.)
- Medical Psychological Institute of Central South University, Changsha 410011, China
- National Clinical Research Center for Mental Health Disorders, Changsha 410011, China
| | - Xiongzhao Zhu
- Medical Psychological Center, The Second Xiangya Hospital of Central South University, Renmin Middle Road 139#, Furong District, Changsha 410011, China; (T.S.); (X.W.); (F.G.); (Q.L.); (J.F.)
- Medical Psychological Institute of Central South University, Changsha 410011, China
- National Clinical Research Center for Mental Health Disorders, Changsha 410011, China
- Correspondence: ; Tel.: +86-135-7485-2322
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25
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Thompson BL. Is ACT-Informed Exposure a Viable Treatment for Excoriation Disorder? A Multiple Baseline Study. Behav Modif 2022; 47:71-92. [PMID: 35485352 DOI: 10.1177/01454455221091778] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This study piloted the use of ACT-informed exposure as an adjunct to habit reversal training (HRT) for excoriation disorder (ExD). Using a nonconcurrent multiple baseline single case design, four participants completed sessions of exposure and HRT. Repeated measures and self-report data were collected on skin picking and psychological flexibility. Two participants completed HRT followed by exposure, and two participants completed exposure followed by HRT. Results support the effectiveness of HRT in reducing picking. Results suggest exposure may have some impact in reducing picking, but effects were weaker compared to HRT. Contrary to predictions, repeated measures and self-report data did not indicate consistent improvement in psychological flexibility during exposure phases. As any reduction in picking may be clinically meaningful and all participants maintained gains at follow-up, there is some indication that exposure may be a second-line treatment worth further study. Limitations and future areas of research are discussed.
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Affiliation(s)
- Brian L Thompson
- Portland Psychotherapy Clinic, Research, & Training Center, OR, USA
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Nelson J, Kelly JM, Wadsworth L, Maloney E. Co-occurring OCD and Panic Disorder: A Review of Their Etiology and Treatment. J Cogn Psychother 2022; 36:JCP-2021-0009.R2. [PMID: 35470149 DOI: 10.1891/jcp-2021-0009] [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: 11/25/2022]
Abstract
Estimated rates of co-occurrence between obsessive and compulsive disorder (OCD) and panic disorder (PD) are notable, but vary considerably, with rates from epidemiological and clinical studies ranging from 1.8% to 22% (Rector et al., 2017). We reviewed the current empirical literature on the etiology, treatment, diagnostic assessment, and differential diagnosis of co-occurring OCD/PD. Best practices for cognitive-behavioral treatment, including identifying and addressing treatment barriers are also addressed. Although it is acknowledged in current literature that co-occurring OCD and PD levels may be clinically significant, there remains a need to thoroughly examine the possible consequences and future research directions of this overlap. Future research must continue to elucidate the biological and environmental causes of OCD/PD co-occurrence.
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Laurito LD, Loureiro CP, Faro L, Dias RV, Torres B, Moreira-de-Oliveira ME, Santos-Ribeiro SD, de Menezes GB, Fontenelle LF, Davis CH, Twohig MP. Acceptance and Commitment Therapy for obsessive compulsive disorder in a Brazilian context: Treatment of three cases. JOURNAL OF CONTEXTUAL BEHAVIORAL SCIENCE 2022. [DOI: 10.1016/j.jcbs.2022.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Pozza A, Casale S, Dèttore D. Therapists’ Emotional Reactions to Patients with Obsessive–Compulsive Disorder: The Role of Therapists’ Orientation and Perfectionism. JOURNAL OF RATIONAL-EMOTIVE AND COGNITIVE-BEHAVIOR THERAPY 2022. [DOI: 10.1007/s10942-022-00443-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
AbstractTherapist’s emotional response towards patients with obsessive–compulsive disorder (OCD) is under-investigated. This aspect might provide valuable information about therapists’ difficulties during sessions and support supervisory practice, since a proportion of OCD patients drop out due to issues related to the therapeutic relationship. In a sample of therapists, we explored the effects of therapists’ orientation (cognitive behavioural versus psychodynamic) and perfectionistic traits on their emotional responses towards patients with OCD, controlling for other variables potentially related to emotional response towards patients (i.e., therapists’ gender/age and patient’s comorbid personality disorders). Ninety-four therapists (74 women and 20 men; mean age = 42.07 ± 10.17 years), of which 47 (50%) had a cognitive behavioural therapy (CBT) and 47 (50%) a psychodynamic orientation matched on gender and age, completed the Therapist Response Questionnaire and Frost Multidimensional Perfectionism Scale. Therapists with a CBT orientation reported less negative emotional responses, i.e., lower overwhelmed/disorganized, hostile/angry, criticised/devalued, parental/protective and special/over-involved emotions towards patients than therapists with a psychodynamic orientation. Therapists with higher perfectionistic traits (i.e., parents’ expectations/evaluation) had higher hostile/angry reactions, those with higher concerns over mistakes and doubts about actions had more intense criticised/devalued emotions, while those with stronger concerns with precision, order and organization had lower disengagement responses. The present study is the first investigation which sheds some light on the emotional responses of therapists towards OCD patients. Therapists’ CBT orientation and lower perfectionistic traits might be associated with better emotions. Therapists’ emotional responses, their psychotherapeutic orientation and levels of perfectionism should be considered during supervisory practice.
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Psychological flexibility as a potential change factor in cognitive behavioural therapy of OCD. Behav Cogn Psychother 2022; 50:381-391. [PMID: 35241198 DOI: 10.1017/s1352465822000091] [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: 11/05/2022]
Abstract
BACKGROUND To gain a better understanding about which aspects of the treatment work for obsessive-compulsive disorders (OCD), the investigation of possible change factors is essential. Psychological flexibility (PsyF) has been of interest in research on successful OCD therapy for some time. Exposure interventions and cognitive strategies in cognitive behavioural therapy (CBT) for OCD may enhance PsyF. To date, however, no process studies have been published that clarify the role of PsyF as a possible change factor for the reduction of OCD symptoms. AIMS This study investigates whether PsyF works as a mediator in successful CBT treatment of OCD. METHOD The study recruited 112 adults diagnosed with OCD in a multi-modal in-patient treatment with specific CBT including exposure and response prevention (ERP). The Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) was used to measure OCD symptoms and three self-constructed items to assess PsyF. PsyF was conceptualised as the capability of patients to accept stressful feelings and thoughts. Data were collected weekly. For statistical analysis at the process level, longitudinal multi-level models (MLMs) with random intercepts and linear growth curves were estimated to test for mediation of PsyF on Y-BOCS. RESULTS OCD symptoms decreased significantly and PsyF increased in patients throughout the course of therapy. MLM revealed that higher average values in PsyF were associated with lower Y-BOCS sum values, but only values between subjects significantly predicted the degree of obsessions and compulsions. CONCLUSIONS Although research shows that PsyF is enhanced by CBT and also shows a connection with Y-BOCS values, its role as a mediator could not be confirmed.
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Ong CW, Petersen JM, Terry CL, Krafft J, Barney JL, Abramowitz JS, Twohig MP. The “How” of exposures: Examining the relationship between exposure parameters and outcomes in obsessive-compulsive disorder. JOURNAL OF CONTEXTUAL BEHAVIORAL SCIENCE 2022. [DOI: 10.1016/j.jcbs.2022.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Varinelli A, Caricasole V, Pellegrini L, Hall N, Garg K, Mpavaenda D, Dell'Osso B, Albert U, Fineberg NA. Functional interventions as augmentation strategies for obsessive-compulsive disorder (OCD): scoping review and expert survey from the international college of obsessive-compulsive spectrum disorders (ICOCS). Int J Psychiatry Clin Pract 2022; 26:92-107. [PMID: 33502269 DOI: 10.1080/13651501.2021.1872646] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
BACKGROUND Patients with obsessive-compulsive disorder (OCD) commonly exhibit a range of functional difficulties, presumed linked to neurocognitive changes. Evidence-based first-line treatments have limited effect on improving these cognitive-functional problems. Candidate interventions could be used to augment evidence-based treatments by the multi-professional mental health team. METHODS A scoping review was performed to identify any intervention with at least one peer-reviewed report of clinical improvement in any of the 13 functional domains of the Cognitive Assessment Instrument of Obsessions and Compulsions (CAIOC-13). Next, an online survey of experts of the International College of Obsessive-Compulsive Spectrum Disorders was conducted. RESULTS Forty-four studies were identified reporting a positive outcome for 27 different kinds of intervention. Twenty-six experts from 12 different countries, including at least one expert from each continent, completed the opinion survey. Five interventions were identified as 'highly promising', none of which was moderated by rater-related factors, suggesting global applicability. CONCLUSION Patients with OCD may benefit from a detailed functional assessment, to identify areas of unmet need. A variety of interventions show theoretical promise for treating the complex functional difficulties in OCD as adjuncts to first-line treatments, but the published evidence is weak. Randomised controlled trials are needed to determine the clinical effectiveness of these interventions.HighlightsFunctional-cognitive problems are common in patients with OCD.First-line evidence-based treatments have limited effect on these functionalcognitive difficulties.In our scoping review we found 44 studies reporting of improved clinical outcomes in any of the 13 functional domains of the Cognitive Assessment Instrument of Obsessions and Compulsions (CAIOC-13).An online survey of experts of the International College of Obsessive-Compulsive Spectrum Disorders (ICOCS) was conducted and identified five interventions as "highly promising" candidate treatments for functional-cognitive problems in OCD.Randomised controlled trials are needed to determine the clinical effectiveness of these interventions.
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Affiliation(s)
- Alberto Varinelli
- Department of Mental Health, Department of Biomedical and Clinical Sciences, Luigi Sacco, University of Milan, Milan, Italy
| | - Valentina Caricasole
- Department of Mental Health, Department of Biomedical and Clinical Sciences, Luigi Sacco, University of Milan, Milan, Italy
| | - Luca Pellegrini
- Hertfordshire Partnership University NHS Foundation Trust, Welwyn Garden City, UK.,School of Life and Medical Sciences, University of Hertfordshire, Hatfield, UK.,Department of Biomedical and Neuromotor Sciences, University of Bologna, Bologna, Italy
| | - Natalie Hall
- School of Life and Medical Sciences, University of Hertfordshire, Hatfield, UK
| | - Kabir Garg
- Hertfordshire Partnership University NHS Foundation Trust, Welwyn Garden City, UK
| | - Davis Mpavaenda
- Hertfordshire Partnership University NHS Foundation Trust, Welwyn Garden City, UK.,School of Life and Medical Sciences, University of Hertfordshire, Hatfield, UK
| | - Bernardo Dell'Osso
- Department of Mental Health, Department of Biomedical and Clinical Sciences, Luigi Sacco, University of Milan, Milan, Italy.,Department of Psychiatry and Behavioral Sciences, Bipolar Disorders Clinic, Stanford University, Stanford, CA, USA.,'Aldo Ravelli' Center for Neurotechnology and Brain Therapeutic, University of Milan, Milan, Italy
| | - Umberto Albert
- Department of Medicine, Surgery and Health Sciences, UCO Clinica Psichiatrica, University of Trieste, Trieste, Italy
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- International College of Obsessive-Compulsive Spectrum Disorders (ICOCS) Expert Survey Workgroup: Michael Van Ameringen (Canada), Leonardo Fontenelle (Brazil), Giacomo Grassi (Italy), Jamie Feusner (US), Lior Carmi (Israel), Edna Grunblatt (Switzerland), Susanne Walitza (Switzerland), Christine Lochner (South Africa), Carolyn Rodriguez (US), Alexander Bystritsky (US), Maria Ceica Rosario (US), Peter van Roessel (US), Dan Geller (US), Eric Hollander (US), Humberto Nicolini (Mexico), Joseph Zohar (Israel), José Menchón (Spain)
| | - Naomi A Fineberg
- Hertfordshire Partnership University NHS Foundation Trust, Welwyn Garden City, UK.,School of Life and Medical Sciences, University of Hertfordshire, Hatfield, UK.,School of Clinical Medicine, University of Cambridge, Cambridge, UK
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Farris SG, Kibbey MM. Be brave, BE-FIT! A pilot investigation of an ACT-informed exposure intervention to reduce exercise fear-avoidance in older adults. Cogn Behav Ther 2022; 51:273-294. [PMID: 35195055 DOI: 10.1080/16506073.2022.2037017] [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: 11/03/2022]
Abstract
Exercise sensitivity, fear of physical sensations of exertion, is particularly elevated in individuals with cardiovascular disease and can promote fear-avoidance of physical activity. We developed an ACT-informed exposure intervention to target exercise sensitivity, called Behavioral Exposure For Interoceptive Tolerance (BE-FIT). In this Stage I pilot trial, we developed and evaluated the feasibility, safety, and initial efficacy of BE-FIT in low active patients with elevated exercise sensitivity enrolled in outpatient cardiac rehabilitation. BE-FIT is a 6-session, manualized, program-adjunctive treatment delivered during the initial weeks of cardiac rehabilitation and involves exposure to feared bodily sensations and exercise situations, bolstered by acceptance and values-focused processes. Patients (Mage = 70.7 years) were assigned to BE-FIT (n = 12) or an activity monitoring-only control (n = 7). Patients in the BE-FIT condition reported high satisfaction, completed 100% of sessions, and 86.3% (SD = 16.4%) of homework exposures. There were no adverse events reported. BE-FIT produced large-sized effects on reductions in exercise sensitivity and increases in both average steps/day and moderate-to-vigorous physical activity (MVPA) mins/day, from baseline to end-of-treatment. In contrast, the monitoring-only cohort evidenced small-sized reductions in exercise sensitivity and no change in average steps/day or MVPA mins/day. BE-FIT is safe, feasible, acceptable with promising findings from this Stage I trial.
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Affiliation(s)
- Samantha G Farris
- Rutgers, The State University of New Jersey, 53 Avenue E, Piscataway, NJ 08854, USA
| | - Mindy M Kibbey
- Rutgers, The State University of New Jersey, 53 Avenue E, Piscataway, NJ 08854, USA
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Capel LK, Zurita Ona P, Moller C, Twohig MP. An Open Trial of Acceptance and Commitment Therapy With Exposure and Response Prevention in an Intensive Outpatient Setting for Adults With OCD. COGNITIVE AND BEHAVIORAL PRACTICE 2022. [DOI: 10.1016/j.cbpra.2022.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Petersen J, Ona PZ, Blythe M, Möller CM, Twohig M. Intensive outpatient acceptance and commitment therapy with exposure and response prevention for adolescents. JOURNAL OF CONTEXTUAL BEHAVIORAL SCIENCE 2022. [DOI: 10.1016/j.jcbs.2021.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Abstract
BACKGROUND Obsessive compulsive disorder (OCD) and depression commonly co-occur. Past research has evaluated underlying mechanisms of depression in the context of other diagnoses, but few to no studies have done this within OCD. AIMS This study examines the relationships between distress tolerance (DT), experiential avoidance (EA), depression, and OCD symptom severity across intensive/residential treatment (IRT) for OCD. It was hypothesized that all variables would be significantly moderately related and EA would emerge as a potential contributing factor to change in depression and OCD symptoms across IRT for OCD. METHOD The sample included 311 participants with a primary diagnosis of OCD seeking IRT. Correlations were performed between all variables at both admission and discharge. A two-step hierarchical regression with change in OCD symptoms and change in DT in the first block and change in EA in the second block examined if change in EA explained change in depression above and beyond change in OCD and DT ability. RESULTS At both admission and discharge, higher EA, lower DT, and higher OCD symptom severity were significantly associated with more depressive symptoms. Change in EA explained a significant amount of variance in change in depression above and beyond change in OCD symptom severity and change in DT. CONCLUSIONS This study expands past results within an OCD sample, emphasizing EA as an important treatment target in OCD. Future studies could utilize samples from other treatment contexts, use a measure of EA specific to OCD, and utilize a longitudinal model that takes temporal precedence into account.
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Metacognitions and Obsessive Beliefs in Obsessive–Compulsive Disorder: A Study of Within- and Between-Person Effects on Long-Term Outcome. COGNITIVE THERAPY AND RESEARCH 2021. [DOI: 10.1007/s10608-021-10210-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Krafft J, Ong CW, Davis CH, Petersen JM, Levin ME, Twohig MP. An Open Trial of Group Acceptance and Commitment Therapy With an Adjunctive Mobile App for Generalized Anxiety Disorder. COGNITIVE AND BEHAVIORAL PRACTICE 2021. [DOI: 10.1016/j.cbpra.2021.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Bürkle JJ, Fendel JC, Schmidt S. Mindfulness-based and acceptance-based programmes in the treatment of obsessive-compulsive disorder: a study protocol for a systematic review and meta-analysis. BMJ Open 2021; 11:e050329. [PMID: 34172553 PMCID: PMC8237723 DOI: 10.1136/bmjopen-2021-050329] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
INTRODUCTION Cognitive-behavioural therapy (CBT) with exposure and response prevention is the recommended standard for the treatment of obsessive-compulsive disorder (OCD). However, a high proportion of patients refuse this treatment, do not respond or relapse shortly after treatment. Growing evidence suggests that mindfulness-based and acceptance-based programmes (MABPs) are an effective option for the treatment of OCD. This systematic review and meta-analysis will examine the effectiveness of MABPs in treating OCD. We also aimed to explore potential moderators of the programmes' effectiveness. METHODS AND ANALYSIS We will systematically search MEDLINE, Embase, PsycINFO, PSYINDEX, Web of Science, CINAHL and Cochrane Register of Controlled Trials (no language restrictions) for studies that evaluate the effect of MABPs on patients with OCD. We will conduct backward and forward citation searches of included studies and relevant reviews and contact corresponding authors. The primary outcome will be pre-post intervention change in symptom severity. A secondary outcome will be change in depressive symptoms. Two reviewers will independently screen the records, extract the data and rate the methodological quality of the studies. We will include both controlled and uncontrolled trials. Randomised controlled trials will be meta-analysed, separately assessing between-group effects. A second meta-analysis will assess the within-group effect of all eligible studies. We will explore moderators and sources of heterogeneity such as the specific programme, study design, changes in depressive symptoms, hours of guided treatment, control condition and prior therapy (eg, CBT) using metaregression and subgroup analyses. We will perform sensitivity analyses using follow-up data. A narrative synthesis will also be pursued. We will use the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system to assess the quality of the evidence. ETHICS AND DISSEMINATION Ethical approval is not required. Results will be published in peer-reviewed journals and presented at international conferences.
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Affiliation(s)
| | - Johannes Caspar Fendel
- Department of Psychosomatic Medicine and Psychotherapy, University of Freiburg, Freiburg, Germany
| | - Stefan Schmidt
- Department of Psychosomatic Medicine and Psychotherapy, University of Freiburg, Freiburg, Germany
- Institute for Frontier Areas of Psychology and Mental Health, Freiburg, Germany
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Angelakis I, Pseftogianni F. Association between obsessive-compulsive and related disorders and experiential avoidance: A systematic review and meta-analysis. J Psychiatr Res 2021; 138:228-239. [PMID: 33866051 DOI: 10.1016/j.jpsychires.2021.03.062] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 03/26/2021] [Accepted: 03/29/2021] [Indexed: 12/22/2022]
Abstract
The associations between the distinct types of obsessive-compulsive and related disorders and experiential avoidance have received mixed evidence. We, thus, undertook this meta-analysis to i) re-examine the association between obsessive-compulsive disorder and experiential avoidance, ii) extend this association to hoarding disorder, trichotillomania, and body dysmorphic disorder, and iii) identify potential variables affecting these associations. Five databases, including Medline, Embase, PsychINFO, Web of Science and CINAHL, were searched until March 15th, 2021. Meta-analyses based on random-effect models were performed. Heterogeneity and publication bias tests were applied using the I2 statistic and the Egger's test. Meta-regression analyses were performed to identify potential moderators affecting the strength of these associations. Thirty-six unique studies based on n = 11,859 participants were identified. The association between obsessive-compulsive disorder and experiential avoidance was moderate (SMD = 0.75, 95% CI = 0.57-0.92), whereas the associations between individual obsessive-compulsive symptoms, including obsessions, responsibility for harm, ordering, checking, washing and neutralizing, and experiential avoidance ranged from low to strong (SMD ranged between 0.41 and 1.06, 95% CI = 0.25 to 1.40). The associations between hoarding disorder (SMD = 0.93, 95% CI = 0.46-1.40), trichotillomania (SMD = 0.56, 95% CI = 0.48-0.63), body dysmorphic disorder (SMD = 1.55, 95% CI = 0.72-2.37) and experiential avoidance were moderate to strong. Meta-regression analyses demonstrated that studies using the AAQ/AAQ-II scales for measuring experiential avoidance, and/or self-report scales for assessing OCRDs contributed smaller effect sizes. These findings suggest that reducing experiential avoidance may be a viable way of complementing exposure strategies in alleviating obsessive-compulsive and related symptoms.
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Affiliation(s)
- Ioannis Angelakis
- University of South Wales, School of Psychology, Pontypridd, Wales, UK.
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Ong CW, Krafft J, Panoussi F, Petersen JM, Levin ME, Twohig MP. In-person and online-delivered acceptance and commitment therapy for hoarding disorder: A multiple baseline study. JOURNAL OF CONTEXTUAL BEHAVIORAL SCIENCE 2021. [DOI: 10.1016/j.jcbs.2021.02.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Ojalehto HJ, Hellberg SN, Butcher MW, Buchholz JL, Timpano KR, Abramowitz JS. Experiential avoidance and the misinterpretation of intrusions as prospective predictors of postpartum obsessive-compulsive symptoms in first-time parents. JOURNAL OF CONTEXTUAL BEHAVIORAL SCIENCE 2021. [DOI: 10.1016/j.jcbs.2021.04.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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Thompson BL, Twohig MP, Luoma JB. Psychological Flexibility as Shared Process of Change in Acceptance and Commitment Therapy and Exposure and Response Prevention for Obsessive-Compulsive Disorder: A Single Case Design Study. Behav Ther 2021; 52:286-297. [PMID: 33622500 DOI: 10.1016/j.beth.2020.04.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Revised: 03/12/2020] [Accepted: 04/17/2020] [Indexed: 10/24/2022]
Abstract
Changes in psychological flexibility were tracked in a combined protocol of exposure and response prevention (ERP) and acceptance and commitment therapy (ACT) for adults with OCD to assess if changes in psychological flexibility processes were unique to ACT intervention (e.g., not impacted by ERP). Using a nonconcurrent multiple baseline design, four participants received sessions of ERP and ACT while data was collected on psychological flexibility processes of change and OCD symptom severity. Results indicate treatment response for three of four participants based on OCD scores. Contrary to predictions, data suggest both ERP and ACT have positive effects on psychological flexibility. Implications of these findings are discussed in relation to recent research on ACT and ERP for OCD. This study also illustrates a type of research design that can be accomplished in clinical practice.
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Affiliation(s)
| | | | - Jason B Luoma
- Portland Psychotherapy Clinic, Research, & Training Center
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McKay D, Abramowitz JS, Storch EA. Mechanisms of harmful treatments for obsessive–compulsive disorder. CLINICAL PSYCHOLOGY-SCIENCE AND PRACTICE 2021. [DOI: 10.1111/cpsp.12337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Anger and aggressiveness in obsessive-compulsive disorder (OCD) and the mediating role of responsibility, non-acceptance of emotions, and social desirability. Eur Arch Psychiatry Clin Neurosci 2021; 271:1179-1191. [PMID: 33155153 PMCID: PMC8354876 DOI: 10.1007/s00406-020-01199-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 10/14/2020] [Indexed: 01/08/2023]
Abstract
According to psychodynamic and cognitive models of obsessive-compulsive disorder (OCD), anger and aggression play an important role in the development and maintenance of the disorder. (Sub-) clinical samples with OCD have reported higher anger and anger suppression. Patients with checking-related symptoms of OCD showed a less aggressive self-concept as assessed by an Implicit Association Test (IAT). This study assessed anger and aggressiveness self-concepts in OCD as well as possible mediators of the link between OCD and aggressiveness. A total of 48 patients with OCD and 45 healthy controls were included. Measures included the State-Trait Anger Expression Inventory-II and an aggressiveness self-concept IAT (Agg-IAT). An inflated sense of responsibility, non-acceptance of emotions, and social desirability were tested as mediators. As expected, patients with OCD reported higher trait anger and anger suppression compared to healthy controls. Contrary to hypotheses, the aggressiveness self-concept (Agg-IAT) did not differ between groups. The inflated sense of responsibility mediated the relationship between group and anger suppression. Non-acceptance of negative emotions mediated the relationship between group and trait anger, as well as anger suppression. However, comorbidities and medication may account for some effect in anger suppression. Elevated trait anger and anger suppression in OCD patients could be explained by dysfunctional beliefs or maladaptive emotion regulation strategies. Emotion regulation therapy might help to enhance awareness and acceptance of emotions and possibly improve treatment outcomes.
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Zemestani M, Salavati M, Seyedolshohadayi A, Petersen JM, Ong CW, Twohig MP, Ghaderi E. A Preliminary Examination of Acceptance and Commitment Therapy Versus Exposure and Response Prevention for Patients with Obsessive-Compulsive Disorder on an Optimal Dose of SSRIs: A Randomized Controlled Trial in Iran. Behav Modif 2020; 46:553-580. [DOI: 10.1177/0145445520982977] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
This study compared the effects of adding acceptance and commitment therapy (ACT) or exposure and response prevention (ERP) to adults diagnosed with obsessive compulsive disorder (OCD) already on an optimal and stable dose of selective serotonin reuptake inhibitors (SSRIs). Forty adults on SSRIs who were diagnosed with OCD participated in a randomized controlled trial in Iran of 12 individual weekly sessions of either ACT+SSRI, ERP+SSRI, or continued SSRI only. The results showed significant reductions in OCD symptom severity in ACT+SSRI and ERP+SSRI conditions at posttreatment with significantly greater reductions in both conditions compared to SSRI-only at follow-up. Additionally, psychological inflexibility and use of thought control strategies significantly decreased in the ACT+SSRI condition at posttreatment and follow-up compared to the ERP+SSRI and SSRI conditions. Both conditions led to decreases in perceived importance of stop signals. Results provide cross-cultural support for the treatment of OCD using ACT and ERP as adjuncts to SSRI and modest process of change differences between ACT and ERP. Future directions and study limitations are discussed.
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Ferreira S, Pêgo JM, Morgado P. A Systematic Review of Behavioral, Physiological, and Neurobiological Cognitive Regulation Alterations in Obsessive-Compulsive Disorder. Brain Sci 2020; 10:E797. [PMID: 33138023 PMCID: PMC7692269 DOI: 10.3390/brainsci10110797] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 10/24/2020] [Accepted: 10/27/2020] [Indexed: 01/20/2023] Open
Abstract
Obsessive-compulsive disorder (OCD) is characterized by cognitive regulation deficits. However, the current literature has focused on executive functioning and emotional response impairments in this disorder. Herein, we conducted a systematic review of studies assessing the behavioral, physiological, and neurobiological alterations in cognitive regulation in obsessive-compulsive patients using the PubMed database. Most of the studies included explored behavioral (distress, arousal, and frequency of intrusive thoughts) and neurobiological measures (brain activity and functional connectivity) using affective cognitive regulation paradigms. Our results pointed to the advantageous use of reappraisal and acceptance strategies in contrast to suppression to reduce distress and frequency of intrusive thoughts. Moreover, we observed alterations in frontoparietal network activity during cognitive regulation. Our conclusions are limited by the inclusion of underpowered studies with treated patients. Nonetheless, our findings support the OCD impairments in cognitive regulation of emotion and might help to improve current guidelines for cognitive therapy.
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Affiliation(s)
- Sónia Ferreira
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, 4710-057 Braga, Portugal; (S.F.); (J.M.P.)
- ICVS-3B’s PT Government Associate Laboratory, 4710-057 Braga/Guimarães, Portugal
| | - José Miguel Pêgo
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, 4710-057 Braga, Portugal; (S.F.); (J.M.P.)
- ICVS-3B’s PT Government Associate Laboratory, 4710-057 Braga/Guimarães, Portugal
| | - Pedro Morgado
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, 4710-057 Braga, Portugal; (S.F.); (J.M.P.)
- ICVS-3B’s PT Government Associate Laboratory, 4710-057 Braga/Guimarães, Portugal
- Clinical Academic Center-Braga (2CA), 4710-243 Braga, Portugal
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47
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Kuckertz JM, Van Kirk N, Alperovitz D, Nota JA, Falkenstein MJ, Schreck M, Krompinger JW. Ahead of the Curve: Responses From Patients in Treatment for Obsessive-Compulsive Disorder to Coronavirus Disease 2019. Front Psychol 2020; 11:572153. [PMID: 33192865 PMCID: PMC7652992 DOI: 10.3389/fpsyg.2020.572153] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 09/30/2020] [Indexed: 12/14/2022] Open
Abstract
Alongside concern about the physical health impacts of the coronavirus disease 2019 (COVID-19) crisis, public health officials have also raised concerns about the potential for massive mental health impact. This has led many to wonder, how are individuals with obsessive-compulsive disorder (OCD), and especially those with contamination fears, doing in the era of COVID-19? We present data from eight patients in our residential treatment program for OCD who were admitted prior to any COVID-19 restrictions and continued in treatment at the facility during the pandemic. Much like the general population, our patients varied in the ways they were impacted by COVID-19, yet the majority experienced improvements in OCD symptoms despite the context. This is not to downplay the many ways in which our patients were personally affected by COVID-19. Rather our patients’ relatively resilient responses mirror our program’s treatment model, which emphasizes exposure and response prevention (ERP) within the complementary framework of acceptance and commitment therapy (ACT). The intention of this article is to challenge the notion that by definition this population will fare worse than the general public or that ERP cannot proceed effectively during this time. In contrast, we underscore that effective OCD treatment can and should continue in the era of COVID-19.
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Affiliation(s)
- Jennie M Kuckertz
- Obsessive Compulsive Disorder Institute, McLean Hospital, Belmont, MA, United States.,Department of Psychiatry, Harvard Medical School, Boston, MA, United States
| | - Nathaniel Van Kirk
- Obsessive Compulsive Disorder Institute, McLean Hospital, Belmont, MA, United States.,Department of Psychiatry, Harvard Medical School, Boston, MA, United States
| | - David Alperovitz
- Obsessive Compulsive Disorder Institute, McLean Hospital, Belmont, MA, United States.,Department of Psychiatry, Harvard Medical School, Boston, MA, United States
| | - Jacob A Nota
- Obsessive Compulsive Disorder Institute, McLean Hospital, Belmont, MA, United States.,Department of Psychiatry, Harvard Medical School, Boston, MA, United States
| | - Martha J Falkenstein
- Obsessive Compulsive Disorder Institute, McLean Hospital, Belmont, MA, United States.,Department of Psychiatry, Harvard Medical School, Boston, MA, United States
| | - Meghan Schreck
- Obsessive Compulsive Disorder Institute, McLean Hospital, Belmont, MA, United States.,Department of Psychiatry, Harvard Medical School, Boston, MA, United States
| | - Jason W Krompinger
- Obsessive Compulsive Disorder Institute, McLean Hospital, Belmont, MA, United States.,Department of Psychiatry, Harvard Medical School, Boston, MA, United States
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48
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Davazdahemami MH, Bayrami A, Petersen JM, Twohig MP, Bakhtiyari M, Noori M, Kheradmand A. Preliminary evidence of the effectiveness of acceptance and commitment therapy for death anxiety in Iranian clients diagnosed with obsessive-compulsive disorder. Bull Menninger Clin 2020; 84:1-11. [PMID: 33074020 DOI: 10.1521/bumc.2020.84.suppa.1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The authors investigated the effectiveness of acceptance and commitment therapy (ACT) for the treatment of death anxiety and obsessive-compulsive disorder (OCD) with eight adult women in Iran. The ACT protocol was conducted in weekly solo sessions with each participant for 8 weeks (45 minutes each). The results were analyzed by visual analysis method and improvement percentage. ACT resulted in a 60%-80% decrease in death anxiety and a 51%-60% decrease in obsessive-compulsive symptoms, thereby indicating promise for ACT as a treatment for OCD and death anxiety.
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Affiliation(s)
| | - Abolfazl Bayrami
- Taleghani Hospital Research Development Committee, Medical School, Shahid Beheshti Medical University, Tehran, Iran
| | | | | | - Maryam Bakhtiyari
- Taleghani Hospital Research Development Committee, Medical School, Shahid Beheshti Medical University, Tehran, Iran
| | - Mohammad Noori
- Taleghani Hospital Research Development Committee, Medical School, Shahid Beheshti Medical University, Tehran, Iran
| | - Ali Kheradmand
- Taleghani Hospital Research Development Committee, Medical School, Shahid Beheshti Medical University, Tehran, Iran
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49
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Mathes BM, Day TN, Wilver NL, Redden SA, Cougle JR. Indices of change in exposure and response prevention for contamination-based OCD. Behav Res Ther 2020; 133:103707. [PMID: 32758679 DOI: 10.1016/j.brat.2020.103707] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Revised: 06/04/2020] [Accepted: 07/29/2020] [Indexed: 01/29/2023]
Abstract
Few studies have examined indices of change in treatment for obsessive compulsive disorder (OCD). The current study evaluated within- and between-session trajectories of fear, disgust, and urge to wash in exposure and response prevention (ERP) for contamination-based OCD and tested whether change in these indices were associated with treatment outcomes. Forty-one participants (75.6% female) engaged in three sessions of ERP for contamination OCD. Participants provided ratings of fear, disgust, and urge to wash during each session, and contamination symptoms were assessed at pre- and post-treatment and two-week follow-up. Fear, disgust, and urge to wash all significantly decreased both within and between sessions. Both fear and disgust declined significantly faster than urge to wash within session, though declines in fear and disgust did not significantly differ from each other. Within-session changes in fear were significantly associated with reduced symptoms at post-treatment, whereas within-session changes in disgust were associated with symptoms at two-week follow-up. The current study highlights the roles of fear and disgust in the context of ERP as unique indicators of treatment outcome for contamination-based OCD. Only within-session fear was uniquely associated with treatment outcome at post, while within-session disgust predicted outcome at follow-up. Theoretical and clinical implications are discussed.
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Affiliation(s)
- Brittany M Mathes
- Florida State University, 1107 West Call Street, Tallahassee, FL, 32304, USA
| | - Taylor N Day
- Florida State University, 1107 West Call Street, Tallahassee, FL, 32304, USA
| | - Natalie L Wilver
- Florida State University, 1107 West Call Street, Tallahassee, FL, 32304, USA
| | - Sarah A Redden
- Florida State University, 1107 West Call Street, Tallahassee, FL, 32304, USA
| | - Jesse R Cougle
- Florida State University, 1107 West Call Street, Tallahassee, FL, 32304, USA.
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50
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Shaw TA, Juncos DG, Winter D. Piloting a New Model for Treating Music Performance Anxiety: Training a Singing Teacher to Use Acceptance and Commitment Coaching With a Student. Front Psychol 2020; 11:882. [PMID: 32547438 PMCID: PMC7270208 DOI: 10.3389/fpsyg.2020.00882] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2020] [Accepted: 04/09/2020] [Indexed: 12/23/2022] Open
Abstract
Thus far, treatments for music performance anxiety (MPA) have focused primarily on interventions administered by psychologists and mental health clinicians with training and education in psychotherapy. While these interventions are promising or even efficacious, many musicians prefer not to work with a psychotherapist due to stigma and lack of time/access. Student musicians are particularly vulnerable to developing MPA, and while they may prefer consulting with their teachers about MPA over psychotherapists, many teachers feel unqualified to help. Here, we investigated an alternative intervention model, in which a clinical psychologist with MPA expertise trained a singing teacher with no training or education in psychotherapy to use an evidence-based coaching model, Acceptance and Commitment Coaching (ACC), with a student vocalist with problematic MPA, in a single-subject design format. ACC is a version of Acceptance and Commitment Therapy (ACT) that has been used under various names with non-clinical populations to help enhance psychological flexibility, e.g., with athletes, at the workplace, with undergraduates, and others. The teacher received approximately seven hours of ACC training via Skype. In turn, she provided six one-hour ACC sessions to a university student vocalist. Materials for the training and coaching sessions were taken from an ACC book and an ACT-based self-help book for musicians, and the teacher also adhered to a GROW model of coaching. The student made clinically significant improvements in two ACT-based processes believed to correlate with improved psychological flexibility in previous ACT for MPA psychotherapy research, i.e., acceptance of MPA-related discomfort and defusion from MPA-related thoughts. The student also reported a significant shift had occurred in his thinking: he became more willing to have his MPA, and so he volunteered to sing in classes early in the upcoming semester, and he auditioned for & won a lead role in a musical, both of which he previously avoided doing. ACC appears to be a promising MPA intervention that can be administered by a music teacher without training or education in psychotherapy, and it may help schools who do not employ psychologists and are therefore unable to follow best practice guidelines for treating MPA.
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Affiliation(s)
- Teresa A Shaw
- Department of Music, University of Chichester, Chichester, United Kingdom
| | - David G Juncos
- Centre for Voice Studies, East Bergholt, United Kingdom.,Hornstein, Platt & Associates, Counseling and Wellness Centers, Philadelphia, PA, United States
| | - Debbie Winter
- Centre for Voice Studies, East Bergholt, United Kingdom.,Wales Academy for Professional Practice and Applied Research, University of Wales Trinity Saint David, Carmarthen, United Kingdom
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