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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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Xu J, Falkenstein MJ, Kuckertz JM. Feeling more confident to encounter negative emotions: The mediating role of distress tolerance on the relationship between self-efficacy and outcomes of exposure and response prevention for OCD. J Affect Disord 2024; 353:19-26. [PMID: 38423365 PMCID: PMC11059676 DOI: 10.1016/j.jad.2024.02.091] [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: 10/18/2023] [Revised: 02/16/2024] [Accepted: 02/26/2024] [Indexed: 03/02/2024]
Abstract
BACKGROUND While exposure and response prevention (ERP) is the first-line treatment for obsessive-compulsive disorder (OCD), up to half of patients do not effectively respond. In an effort to better understand the mechanisms behind ERP, the inhibitory learning model emphasizes the roles of increasing perceived self-efficacy and distress tolerance. While self-efficacy and distress tolerance have separately been shown to predict OCD symptoms and treatment outcomes, no studies have assessed their joint effects in ERP. The current study examined distress tolerance as a mediator of the relationship between self-efficacy and ERP outcomes. METHODS Patients in an intensive ERP-based treatment program (N = 116) completed weekly self-report measures. RESULTS Over the course of treatment, as OCD symptoms reduced, self-efficacy and distress tolerance both significantly increased. Importantly, increases in self-efficacy and distress tolerance mediated each other in explaining symptom reduction, suggesting a possible bi-directional effect. LIMITATIONS The temporal relationship between changes in self-efficacy and distress tolerance is worthy of further investigation. In addition, the current sample had limited racial diversity and might not be representative of patients receiving lower levels of care. Findings merit replication to be ascertained of their reliability. CONCLUSIONS Findings suggest that during ERP, patients gain confidence in their abilities both to cope with general challenges and to withstand distress, potentially helping them engage with exposures and overcome initial fears. These findings provide support for the inhibitory learning model and highlight the mechanistic roles of self-efficacy and distress tolerance in ERP. Clinical implications to target both in treatment are discussed.
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Affiliation(s)
- Junjia Xu
- Obsessive Compulsive Disorder Institute, McLean Hospital, United States of America
| | - Martha J Falkenstein
- Obsessive Compulsive Disorder Institute, McLean Hospital, United States of America; Harvard Medical School, United States of America
| | - Jennie M Kuckertz
- Obsessive Compulsive Disorder Institute, McLean Hospital, United States of America; Harvard Medical School, United States of America.
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3
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Bezahler A, Kuckertz JM, McKay D, Falkenstein MJ, Feinstein BA. Emotion regulation and OCD among sexual minority people: Identifying treatment targets. J Anxiety Disord 2024; 101:102807. [PMID: 38101252 DOI: 10.1016/j.janxdis.2023.102807] [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: 06/23/2023] [Revised: 09/27/2023] [Accepted: 12/01/2023] [Indexed: 12/17/2023]
Abstract
Sexual minority individuals experience higher rates of psychopathology, such that sexual minority people are nine times more likely to receive a diagnosis or treatment for obsessive-compulsive disorder (OCD) compared to heterosexual people. Poor emotion regulation capacity is a risk factor for OCD, but little is known about sexual orientation differences in dimensions of emotion regulation and how dimensions of emotion regulation relate to OCD severity among sexual minority people. The aims of the current study include 1) comparing sexual minority to heterosexual people on OCD severity and emotion regulation capacity upon admission to treatment for OCD, and 2) examining emotion regulation in relation to OCD severity among sexual minority people. Participants (N = 470) were adults in partial hospital/residential treatment with an average stay of 59.7 days (SD = 25.3), including 22 % sexual minority people. Sexual minority people reported a lower emotion regulation capacity. Among the largest three subgroups (heterosexual, bi+, and gay/lesbian), bi+ individuals reported a lower emotion regulation capacity compared to heterosexual but not gay/lesbian people. Results suggest there are sexual orientation differences in emotion regulation capacity, and that bi+ people have the most difficulty with ER. There is a need for OCD treatment to directly target emotion regulation strategies and be affirming of sexual minority identities.
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Affiliation(s)
| | - Jennie M Kuckertz
- Obsessive Compulsive Disorder Institute, McLean Hospital, USA; Department of Psychiatry, Harvard Medical School, USA
| | - Dean McKay
- Psychology Department, Fordham University, USA
| | - Martha J Falkenstein
- Obsessive Compulsive Disorder Institute, McLean Hospital, USA; Department of Psychiatry, Harvard Medical School, USA
| | - Brian A Feinstein
- Department of Psychology, Rosalind Franklin University of Medicine and Science, USA
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4
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Mattson SA, D’Souza J, Wojcik KD, Guzick AG, Goodman WK, Storch EA. A systematic review of treatments for misophonia. PERSONALIZED MEDICINE IN PSYCHIATRY 2023; 39-40:100104. [PMID: 37333720 PMCID: PMC10276561 DOI: 10.1016/j.pmip.2023.100104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/20/2023]
Abstract
Research into misophonia treatments has been limited and it is unclear what treatment approaches may be effective. This systematic review extracted and synthesized relevant treatment research on misophonia to examine the efficacy of various intervention modalities and identify current trends in order to guide future treatment research. PubMed, PsycINFO, Google Scholar, and Cochrane Central were searched 4using the keywords "misophonia," "decreased sound tolerance," "selective sound sensitivity," or "decreased sound sensitivity." Of the 169 records available for initial screening, 33 studied misophonia treatment specifically. Data were available for one randomized controlled trial, one open label trial, and 31 case studies. Treatments included various forms of psychotherapy, medication, and combinations of the two. Cognitive-behavioral therapy (CBT) incorporating various components has been the most often utilized and effective treatment for reduction of misophonia symptoms in one randomized trial and several case studies/series. Beyond CBT, various case studies suggested possible benefit from other treatment approaches depending on the patient's symptom profile, although methodological rigor was limited. Given the limitations in the literature to date, including overall lack of rigor, lack of comparative studies, limited replication, and small sample size, the field would benefit from the development of mechanism-informed treatments, rigorous randomized trials, and treatment development with an eye towards dissemination and implementation.
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Affiliation(s)
- Seth A. Mattson
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, United States
| | - Johann D’Souza
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, United States
| | - Katharine D. Wojcik
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, United States
| | - Andrew G. Guzick
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, United States
| | - Wayne K. Goodman
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, United States
| | - Eric A. Storch
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, United States
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5
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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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6
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Bezahler A, Kuckertz JM, Schreck M, Narine K, Dattolico D, Falkenstein MJ. Examination of Outcomes among Sexual Minorities in Treatment for Obsessive-Compulsive and Related Disorders. J Obsessive Compuls Relat Disord 2022; 33:100724. [PMID: 37220532 PMCID: PMC10201929 DOI: 10.1016/j.jocrd.2022.100724] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The first-line psychological treatment for obsessive-compulsive and related disorders (OCRDs) is exposure and response prevention (ERP). As the first study to examine treatment outcomes for sexual minorities, it is crucial to examine: (1) how treatment-seeking individuals who identify as sexual minorities compare to heterosexual individuals in symptom severity at admission, length of stay in treatment, and (2) whether ERP is equally effective for sexual minorities. The current study explored these questions in an intensive/residential treatment (IRT) program for OCRDs. Adult participants (N = 191) completed self-reported measures of OCD severity, distress tolerance, and depression at program admission, in the first four weeks of treatment, and at discharge. No differences were found between groups for treatment outcome, although slight differences (non-significant) emerged at baseline for OCRD severity, distress tolerance, and depression. Sexual orientation was not predictive of OCRD severity at weeks 1-4, and number of days spent in treatment was not associated with sexual orientation. This is the first study exploring whether sexual orientation is predictive of treatment outcomes for individuals diagnosed with OCRDs. Results suggest that outcomes did not differ and participation in the program resulted in an overall improvement of symptoms regardless of sexual orientation, however several study limitations are discussed. Future studies should replicate these findings, attempt to collect a larger sample, incorporate qualitative feedback from treatment, and examine outcomes in gender minorities.
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Affiliation(s)
- Andreas Bezahler
- McLean Hospital/Harvard Medical School. 115 Mill St, Belmont, MA 02478, USA
| | - Jennie M. Kuckertz
- McLean Hospital/Harvard Medical School. 115 Mill St, Belmont, MA 02478, USA
| | - Meghan Schreck
- McLean Hospital/Harvard Medical School. 115 Mill St, Belmont, MA 02478, USA
| | - Kevin Narine
- William James College. 1 Wells Ave, Newton, MA 02459, USA
| | - Devin Dattolico
- McLean Hospital/Harvard Medical School. 115 Mill St, Belmont, MA 02478, USA
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7
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Donahue S, Quinn DK, Cukor D, Kimmel PL. Anxiety Presentations and Treatments in Populations With Kidney Disease. Semin Nephrol 2022; 41:516-525. [PMID: 34973696 DOI: 10.1016/j.semnephrol.2021.10.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Anxiety is common in patients with chronic kidney disease, but in its extreme expressions, anxiety can also be a complicating comorbid psychiatric illness. There is only a small literature base on anxiety disorders in patients with renal disease, and many of the studies are not sufficiently specific about which anxiety disorders are being studied. Larger epidemiological studies are required to delineate the incidence, prevalence, and outcomes associated with the varied anxiety disorders. In addition, the impact of the co-occurrence of anxiety with other chronic psychiatric or medical problems, needs further study. Anxiety is a clinical condition that warrants treatment, primarily due to its association with mortality in end-stage renal disease patients, and its negative impact on perceived quality of life. Therapeutic options for patients with anxiety and kidney disease include both pharmacologic and nonpharmacologic approaches. Current treatment strategies for anxiety specific to patients with renal disease are provided.
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Affiliation(s)
| | - Davin K Quinn
- Department of Psychiatry and Behavioral Sciences, University of New Mexico School of Medicine, Albuquerque, NM
| | | | - Paul L Kimmel
- Department of Medicine, George Washington University, Washington, DC
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8
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Michelini G, Palumbo IM, DeYoung CG, Latzman RD, Kotov R. Linking RDoC and HiTOP: A new interface for advancing psychiatric nosology and neuroscience. Clin Psychol Rev 2021; 86:102025. [PMID: 33798996 PMCID: PMC8165014 DOI: 10.1016/j.cpr.2021.102025] [Citation(s) in RCA: 98] [Impact Index Per Article: 32.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 03/11/2021] [Accepted: 03/19/2021] [Indexed: 12/14/2022]
Abstract
The Research Domain Criteria (RDoC) and the Hierarchical Taxonomy of Psychopathology (HiTOP) represent major dimensional frameworks proposing two alternative approaches to accelerate progress in the way psychopathology is studied, classified, and treated. RDoC is a research framework rooted in neuroscience aiming to further the understanding of transdiagnostic biobehavioral systems underlying psychopathology and ultimately inform future classifications. HiTOP is a dimensional classification system, derived from the observed covariation among symptoms of psychopathology and maladaptive traits, which seeks to provide more informative research and treatment targets (i.e., dimensional constructs and clinical assessments) than traditional diagnostic categories. This article argues that the complementary strengths of RDoC and HiTOP can be leveraged in order to achieve their respective goals. RDoC's biobehavioral framework may help elucidate the underpinnings of the clinical dimensions included in HiTOP, whereas HiTOP may provide psychometrically robust clinical targets for RDoC-informed research. We present a comprehensive mapping between dimensions included in RDoC (constructs and subconstructs) and HiTOP (spectra and subfactors) based on narrative review of the empirical literature. The resulting RDoC-HiTOP interface sheds light on the biobehavioral correlates of clinical dimensions and provides a broad set of dimensional clinical targets for etiological and neuroscientific research. We conclude with future directions and practical recommendations for using this interface to advance clinical neuroscience and psychiatric nosology. Ultimately, we envision that this RDoC-HiTOP interface has the potential to inform the development of a unified, dimensional, and biobehaviorally-grounded psychiatric nosology.
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Affiliation(s)
- Giorgia Michelini
- Semel Institute for Neuroscience & Human Behavior, Department of Psychiatry & Biobehavioral Sciences, University of California Los Angeles, Los Angeles, CA 90024, United States of America.
| | - Isabella M Palumbo
- Department of Psychology, Georgia State University, Atlanta, GA 30303, United States of America
| | - Colin G DeYoung
- Department of Psychology, University of Minnesota, Minneapolis, MN 55455, United States of America
| | - Robert D Latzman
- Department of Psychology, Georgia State University, Atlanta, GA 30303, United States of America
| | - Roman Kotov
- Department of Psychiatry & Behavioral Health, Stony Brook University, Stony Brook, NY 11790, United States of America
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9
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Cervin M, Lázaro L, Martínez-González AE, Piqueras JA, Rodríguez-Jiménez T, Godoy A, Aspvall K, Barcaccia B, Pozza A, Storch EA. Obsessive-compulsive symptoms and their links to depression and anxiety in clinic- and community-based pediatric samples: A network analysis. J Affect Disord 2020; 271:9-18. [PMID: 32312700 DOI: 10.1016/j.jad.2020.03.090] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Revised: 01/26/2020] [Accepted: 03/25/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Symptoms of depression and anxiety are common in children with obsessive-compulsive disorder (OCD) and associated with more severe OCD, greater impairment, and worse treatment outcome. Beyond twin studies showing that genetic factors contribute to the high co-occurrence, few studies have examined how OCD, depression, and anxiety are linked in youth, and current studies often fail to account for OCD and anxiety heterogeneity. METHODS Network analysis was used to investigate how OCD were linked to depression and anxiety in multinational youth diagnosed with OCD (total n = 419) and in school-recruited, community-based samples of youth (total n = 2 991). RESULTS Initial results aligned with earlier work showing that severity of obsession-related symptoms are important in linking OCD to depression in youth with OCD. However, when symptom content of OCD (e.g., washing, ordering) was fully taken into account and when measures of anxiety were included, specific OCD symptom dimensions (primarily obsessing and doubting/checking) were linked to specific anxiety dimensions (primarily panic and generalized anxiety) which in turn were linked to depression. These results were replicated in three separate community-based samples from Chile, Italy, and Spain using different measures of anxiety and depression. LIMITATIONS Cross-sectional data were analyzed which precludes causal inference. Self-report measures were used. CONCLUSIONS Youth with OCD with symptoms related to doubting/checking and obsessing should be carefully assessed for symptoms of panic and generalized anxiety. Non-responders to standard OCD treatment may benefit from interventions targeting panic and generalized anxiety, but more research is needed to test this hypothesis.
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Affiliation(s)
- Matti Cervin
- Lund University and Skane Child and Adolescent Psychiatry, Lund, Sweden.
| | - Luisa Lázaro
- Hospital Clínic, IDIBAPS, CIBERSAM, University of Barcelona, Barcelona, Spain
| | | | | | | | | | - Kristina Aspvall
- Karolinska Institutet and Stockholm Health Care Services, Stockholm, Sweden
| | | | | | - Eric A Storch
- Baylor College of Medicine, Houston, TX, United States
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10
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Nazeer A, Latif F, Mondal A, Azeem MW, Greydanus DE. Obsessive-compulsive disorder in children and adolescents: epidemiology, diagnosis and management. Transl Pediatr 2020; 9:S76-S93. [PMID: 32206586 PMCID: PMC7082239 DOI: 10.21037/tp.2019.10.02] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Obsessive-compulsive disorder (OCD) can be found in about 4% of the general population and is characterized by various compulsions and obsessions that interfere with the person's quality of life from a mild to severe degree. The following discussion reflects on current concepts in this condition, including its epidemiology and etiologic underpinnings (behavioral, neurological, immunological, gastroenterological, as well as genetic). The interplay of PANS and PANDAS are included in this review. In addition, the core concepts of OCD diagnosis, differential diagnosis, and co-morbidities are considered. It is stressed that the quality of life for persons with pediatric OCD as well as for family members can be quite limited and challenged. Thus, principles of management are presented as a guide to improve the quality of life for these persons as much as possible.
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Affiliation(s)
- Ahsan Nazeer
- Department of Psychiatry, Division of Child and Adolescent Psychiatry, Sidra Medicine, Doha, Qatar
| | - Finza Latif
- Division of Psychiatry and Behavioral Sciences, George Washington University, Children's National Medical Center, Washington, DC, USA
| | - Aisha Mondal
- Division of Psychiatry and Behavioral Sciences, George Washington University, Children's National Medical Center, Washington, DC, USA
| | | | - Donald E Greydanus
- Department of Pediatric and Adolescent Medicine, Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, MI, USA
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11
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Cameron DH, Streiner DL, Summerfeldt LJ, Rowa K, McKinnon MC, McCabe RE. A comparison of cluster and factor analytic techniques for identifying symptom-based dimensions of obsessive-compulsive disorder. Psychiatry Res 2019; 278:86-96. [PMID: 31163302 DOI: 10.1016/j.psychres.2019.05.040] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Revised: 05/17/2019] [Accepted: 05/24/2019] [Indexed: 01/05/2023]
Abstract
A growing body of literature suggests that obsessive-compulsive disorder (OCD) is a heterogeneous condition. The studies investigating symptom dimensions have been limited by numerous methodological differences and sample characteristics. The purpose of this study was to compare the two most commonly applied statistical techniques used in addressing this question in the same large cohort of individuals with OCD. Both cluster analysis and factor analysis were used to examine OCD symptom data as measured by the Yale-Brown Obsessive Compulsive Scale (Y-BOCS) Symptom Checklist for 355 individuals with a primary diagnosis of OCD. The factor analysis revealed a three-factor model best described as symmetry obsessions/ordering compulsions, contamination obsessions/cleaning compulsions and aggressive obsessions/checking compulsions. In contrast, the cluster analysis yielded a stable four-cluster solution best described as symmetry obsessions/ordering compulsions, contamination obsessions/cleaning compulsions, aggressive-somatic-religious obsessions/checking compulsions and a mixed symptom profile. Although there was overlap in the models resulting from these two statistical approaches, cluster analysis better captured the dimensional nature of OCD by demonstrating the prevalence of symptom categories in each subgroup. Though both analyses are capable of providing similar outputs, the validity of these results is limited given the input of a priori symptom categories from the Y-BOCS.
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Affiliation(s)
- Duncan H Cameron
- Anxiety Treatment and Research Clinic, St. Joseph's Healthcare Hamilton, Canada.
| | - David L Streiner
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Canada; Department of Psychiatry, University of Toronto, Canada
| | | | - Karen Rowa
- Anxiety Treatment and Research Clinic, St. Joseph's Healthcare Hamilton, Canada; Department of Psychiatry and Behavioural Neurosciences, McMaster University, Canada
| | - Margaret C McKinnon
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Canada; Mood Disorders Program, St. Joseph's Healthcare Hamilton, Canada
| | - Randi E McCabe
- Anxiety Treatment and Research Clinic, St. Joseph's Healthcare Hamilton, Canada; Department of Psychiatry and Behavioural Neurosciences, McMaster University, Canada
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12
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Thiséus J, Perrin S, Cervin M. Intrusive thoughts and compulsive behaviors in postpartum women: Psychometric properties of the Parental Thoughts and Behaviors Checklist. Psychiatry Res 2019; 278:194-198. [PMID: 31212232 DOI: 10.1016/j.psychres.2019.06.015] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Revised: 06/11/2019] [Accepted: 06/12/2019] [Indexed: 10/26/2022]
Abstract
Validated measures to assess intrusive thoughts and compulsive behaviors in postpartum women are few. In the present study, we investigated the psychometric properties of such a measure - a self-report version of the Parental Thoughts and Behaviors Checklist (PTBC). Via an online survey platform, 488 women who had given birth during the last year completed the PTBC along with measures of general obsessive-compulsive symptoms, depression, anxiety, parental stress and quality of life. Scores on the PTBC and its subscales showed good to excellent internal consistency, correlated in the expected direction with the other measures in the study, and discriminated between women with and without a history of OCD. Finally, exploratory factor analyses yielded nine thematic factors of intrusive thoughts and compulsive behaviors which largely corresponded to the themes identified by the developers of the interview-based version of the PTBC. This self-report version of the PTBC was found to possess good psychometric properties and to have a factor structure that largely overlapped with the structure of the interview-based version. Further evaluation of this version is needed, but the measure holds promise as a tool that may aid in the assessment of postpartum OCD in primary care and in psychiatric settings.
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Affiliation(s)
| | - Sean Perrin
- Lund University, Department of Psychology, Lund, Sweden
| | - Matti Cervin
- Lund University, Faculty of Medicine, Department of Clinical Sciences Lund, Child and Adolescent Psychiatry, Lund, Sweden; Skåne Child and Adolescent Psychiatry, Lund, Sweden.
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13
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Congruence and discrepancy between self-rated and clinician-rated symptom severity on the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) before and after a low-intensity intervention. Psychiatry Res 2019; 273:595-602. [PMID: 30716599 DOI: 10.1016/j.psychres.2019.01.092] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Revised: 01/28/2019] [Accepted: 01/28/2019] [Indexed: 11/21/2022]
Abstract
The Yale-Brown Obsessive Compulsive Scale (Y-BOCS) is the most common measure of Obsessive-Compulsive symptom severity. The Y-BOCS interview is considered gold standard, but its self-rating format is increasingly used in clinical trials. Few studies investigated congruency and potential changes over treatment. This question is highly relevant, as a systematic bias might obscure results of clinical trials. We examined the relationship of self- and clinician-rated Y-BOCS scores in participants with obsessive-compulsive disorder in pre (N = 128), post, (4 weeks, n = 104) and follow-up (6 months, n = 98) assessments of a randomized-controlled clinical trial. We administered Y-BOCS interview via telephone paralleling online administration of the self-report form. Analyses showed medium-to-strong correlations of Y-BOCS interview and self-rating scores at pre-assessment. Patients rated symptoms lower than clinicians. Larger discrepancies were associated with hoarding and age. Congruency was inferior for obsessions relative to compulsions, largely owing to the "resistance against obsessions" item. Agreement strongly increased at post and follow-up. Though overall congruency between the two Y-BOCS forms was satisfactory, results suggest a "correction over time" effect. Such bias may distort the precise interpretation of treatment effects. Therefore, we made several suggestions to improve the reliability of change scores assessed with the Y-BOCS self-rating.
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14
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du Mortier JAM, Visser HAD, van Balkom AJLM, van Megen HJGM, Hoogendoorn AW, Glas G, van Oppen P. Examining the factor structure of the self-report Yale-Brown Obsessive Compulsive Scale Symptom Checklist. Psychiatry Res 2019; 271:299-305. [PMID: 30521999 DOI: 10.1016/j.psychres.2018.11.042] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Revised: 10/18/2018] [Accepted: 11/18/2018] [Indexed: 12/20/2022]
Abstract
Obsessive-compulsive symptom dimensions are important in studies about the pathogenesis and treatment of obsessive-compulsive disorder. More than 30 factor analytic studies using the Yale-Brown Obsessive Compulsive Scale Symptom Checklist (Y-BOCS-SC) interview version have been published. However, a drawback of the Y-BOCS-SC interview is that it is time-consuming for the clinician. Baer's self-report version of the Y-BOCS-SC could be a less time-consuming alternative. The purpose of this study was to examine the factor structure of Baer's self-report Y-BOCS-SC. In a sample of 286 patients, we performed two factor analyses, one using categories and one using items of the Y-BOCS-SC. Using category-level data, we identified four factors; when using items we identified six factors. Symptom dimensions for contamination/cleaning, symmetry/repeating/counting/ordering and hoarding were found in both analyses. The impulsive aggression, pathological doubt, sexual, religious somatic and checking categories formed one factor in the analysis using category-level data and divided into three factors using item-level data. These factors correspond with studies using the interview version and support our hypothesis that the self-report version of the Y-BOCS-SC could be an alternative for the interview version.
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Affiliation(s)
| | - Henny A D Visser
- GGz Centraal, Innova Postbus 3051, 3800 DB Amersfoort, The Netherlands
| | - Anton J L M van Balkom
- Amsterdam UMC, Vrije Universiteit, APH-research Institute, Department of Psychiatry and GGZ inGeest, Oldenaller 1, 1081 HJ Amsterdam, The Netherlands
| | | | - Adriaan W Hoogendoorn
- Amsterdam UMC, Vrije Universiteit, APH-research Institute, Department of Psychiatry and GGZ inGeest, Oldenaller 1, 1081 HJ Amsterdam, The Netherlands
| | - Gerrit Glas
- Dimence Groep, Postbus 473, 8000 AL Zwolle, The Netherlands
| | - Patricia van Oppen
- Amsterdam UMC, Vrije Universiteit, APH-research Institute, Department of Psychiatry and GGZ inGeest, Oldenaller 1, 1081 HJ Amsterdam, The Netherlands
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15
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Kvale G, Hansen B, Björgvinsson T, Børtveit T, Hagen K, Haseth S, Kristensen UB, Launes G, Ressler KJ, Solem S, Strand A, van den Heuvel OA, Öst LG. Successfully treating 90 patients with obsessive compulsive disorder in eight days: the Bergen 4-day treatment. BMC Psychiatry 2018; 18:323. [PMID: 30286745 PMCID: PMC6172736 DOI: 10.1186/s12888-018-1887-4] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Accepted: 09/17/2018] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND Oslo University Hospital, Norway, had by autumn 2016, accumulated a waiting list of 101 patients with obsessive-compulsive disorder (OCD) who had a legal right to receive treatment by a specialized OCD team. In this challenging situation, the Bergen OCD-team suggested to solve the problem by offering all patients an option for the rapid Bergen 4-day treatment (B4DT). The B4DT is an individual treatment delivered during four consecutive days in a group of six patients with the same number of therapists. The approach has previously shown a post-treatment response rate of 90% and a 3-month remission rate of 70%. METHODS Ninety-seven of the wait-list patients were available for the scheduled time slots, and 90 received the 4-day format during 8 days (45 patients each week). The therapists were recruited from 22 different specialized OCD-teams from all over Norway, and 44 (68%) had not previously delivered the 4-day format. RESULTS Post-treatment; 91.1% of the patients were classified as responders, and 72.2% were in remission. At 3-month follow-up; 84.4 were classified as responders and the remission rate was 67.7%. Oslo University Hospital now offers the 4-day treatment as standard treatment for OCD. CONCLUSIONS We conclude that the B4DT is an acceptable and potentially effective OCD-treatment.
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Affiliation(s)
- Gerd Kvale
- Haukeland University Hospital, OCD-team, 5021 Bergen, Norway
- Department of Clinical Psychology, University of Bergen, Bergen, Norway
| | - Bjarne Hansen
- Haukeland University Hospital, OCD-team, 5021 Bergen, Norway
- Department of Clinical Psychology, University of Bergen, Bergen, Norway
| | | | - Tore Børtveit
- Haukeland University Hospital, OCD-team, 5021 Bergen, Norway
| | - Kristen Hagen
- Haukeland University Hospital, OCD-team, 5021 Bergen, Norway
- Molde Hospital, Molde, Norway
| | - Svein Haseth
- Nidaros DPS, Division of Psychiatry, St. Olav University Hospital, Trondheim, Norway
| | | | | | - Kerry J. Ressler
- McLean Hospital, Belmont, MA USA
- Harvard Medical School, Boston, MA USA
| | - Stian Solem
- Haukeland University Hospital, OCD-team, 5021 Bergen, Norway
- Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway
| | - Arne Strand
- Norwegian OCD-foundation, Ananke, Oslo, Norway
| | - Odile A. van den Heuvel
- Haukeland University Hospital, OCD-team, 5021 Bergen, Norway
- Department of Psychiatry and Department of Anatomy & Neurosciences, VU university medical center (VUmc), Amsterdam, The Netherlands
| | - Lars-Göran Öst
- Haukeland University Hospital, OCD-team, 5021 Bergen, Norway
- Department of Psychology, Stockholm University, Stockholm, Sweden
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