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Reuter B, Miano A, Wassermann J, Elsner B. Why does exposure-based therapy fail in some individuals with obsessive-compulsive disorder? Expert Rev Neurother 2024; 24:723-726. [PMID: 38875186 DOI: 10.1080/14737175.2024.2365949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2024] [Accepted: 06/05/2024] [Indexed: 06/16/2024]
Affiliation(s)
- Benedikt Reuter
- MSB Medical School Berlin, Department of Human Medicine, Berlin, Germany
| | - Annemarie Miano
- MSB Medical School Berlin, Department of Human Medicine, Berlin, Germany
| | - Josepha Wassermann
- MSB Medical School Berlin, Department of Human Medicine, Berlin, Germany
| | - Björn Elsner
- Humboldt-Universität zu Berlin, Department of Psychology, Berlin, Germany
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Klein AM, Hagen A, Mobach L, Zimmermann R, Baartmans JMD, Rahemenia J, de Gier E, Schneider S, Ollendick TH. The Importance of Practicing at Home During and Following Cognitive Behavioral Therapy for Childhood Anxiety Disorders: A Conceptual Review and New Directions to Enhance Homework Using Mhealth Technology. Clin Child Fam Psychol Rev 2024; 27:602-625. [PMID: 38616213 PMCID: PMC11222243 DOI: 10.1007/s10567-024-00476-5] [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] [Accepted: 03/08/2024] [Indexed: 04/16/2024]
Abstract
Practicing newly acquired skills in different contexts is considered a crucial aspect of Cognitive Behavioral Therapy (CBT) for anxiety disorders (Peris et al. J Am Acad Child Adolesc Psychiatry 56:1043-1052, 2017; Stewart et al. Prof Psychol Res Pract 47:303-311, 2016). Learning to cope with feared stimuli in different situations allows for generalization of learned skills, and experiencing non-occurrence of the feared outcome helps in developing non-catastrophic associations that may enhance treatment outcomes (Bandarian-Balooch et al. J Behav Ther Exp Psychiatry 47:138-144, 2015; Cammin-Nowak et al. J Clin Psychol 69:616-629, 2013; Kendall et al. Cogn Behav Pract 12:136-148, 2005; Tiwari et al. J Clin Child Adolesc Psychol 42:34-43, 2013). To optimize treatment outcome, homework is often integrated into CBT protocols for childhood anxiety disorders during and following treatment. Nevertheless, practicing at home can be challenging, with low motivation, lack of time, and insufficient self-guidance often listed as reasons for low adherence (Tang and Kreindler, JMIR Mental Health 4:e20, 2017). This conceptual review provides an overview of (1) how existing CBT childhood programs incorporate homework, and empirical evidence for the importance of homework practice, (2) evidence-based key elements of practice, and (3) how mHealth apps could potentially enhance practice at home, including an example of the development and application of such an app. This review therefore sets the stage for new directions in developing more effective and engaging CBT-based homework programs for childhood anxiety disorders.
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Affiliation(s)
- Anke M Klein
- Developmental and Educational Psychology, Leiden University, Leiden, The Netherlands.
| | - Annelieke Hagen
- Developmental and Educational Psychology, Leiden University, Leiden, The Netherlands
| | - Lynn Mobach
- Developmental Psychology, University of Amsterdam, Amsterdam, The Netherlands
- Pro Persona Institute for Integrated Mental Health Care, Wolfheze, The Netherlands
| | - Robin Zimmermann
- Mental Health Research and Treatment Center (FBZ), Ruhr University, Bochum, Germany
| | | | - Jasmin Rahemenia
- Developmental and Educational Psychology, Leiden University, Leiden, The Netherlands
| | | | - Silvia Schneider
- Mental Health Research and Treatment Center (FBZ), Ruhr University, Bochum, Germany
| | - Thomas H Ollendick
- Department of Psychology, Child Study Center, Virginia Tech, Blacksburg, USA
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3
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Butler RM, Christian C, Girard JM, Vanzhula IA, Levinson CA. Are within- and between-session changes in distress associated with treatment outcomes? Findings from two clinical trials of exposure for eating disorders. Behav Res Ther 2024; 180:104577. [PMID: 38850690 DOI: 10.1016/j.brat.2024.104577] [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: 07/28/2023] [Revised: 05/30/2024] [Accepted: 05/31/2024] [Indexed: 06/10/2024]
Abstract
OBJECTIVE Imaginal exposure is a novel intervention for eating disorders (EDs) that has been investigated as a method for targeting ED symptoms and fears. Research is needed to understand mechanisms of change during imaginal exposure for EDs, including whether within- and between-session distress reduction is related to treatment outcomes. METHOD Study 1 tested four sessions of online imaginal exposure (N = 143). Study 2 examined combined imaginal and in vivo exposure, comprising six imaginal exposure sessions (N = 26). ED symptoms and fears were assessed pre- and posttreatment, and subjective distress and state anxiety were collected during sessions. RESULTS Subjective distress tended to increase within-session in both studies, and within-session reduction was not associated with change in ED symptoms or fears. In Study 1, between-session reduction of distress and state anxiety was associated with greater decreases in ED symptoms and fears pre-to posttreatment. In Study 2, between-session distress reduction occurred but was not related to outcomes. CONCLUSIONS Within-session distress reduction may not promote change during exposure for EDs, whereas between-session distress reduction may be associated with better treatment outcomes. These findings corroborate research on distress reduction during exposure for anxiety disorders. Clinicians might consider approaches to exposure-based treatment that focus on distress tolerance and promote between-session distress reduction.
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Affiliation(s)
- Rachel M Butler
- University of Louisville, Department of Psychological and Brain Sciences, USA.
| | - Caroline Christian
- University of Louisville, Department of Psychological and Brain Sciences, USA
| | | | - Irina A Vanzhula
- Johns Hopkins School of Medicine, Department of Psychiatry & Behavioral Sciences, USA
| | - Cheri A Levinson
- University of Louisville, Department of Psychological and Brain Sciences, USA
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Berg H, Webler RD, Klein S, Kushner MG. Extinction and beyond: an expanded framework for exposure and response prevention for obsessive-compulsive disorder. Front Psychol 2024; 15:1331155. [PMID: 38882510 PMCID: PMC11176611 DOI: 10.3389/fpsyg.2024.1331155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Accepted: 05/15/2024] [Indexed: 06/18/2024] Open
Abstract
Exposure therapy is a first-line, empirically validated treatment for anxiety, obsessive-compulsive, and trauma-related disorders. Extinction learning is the predominant theoretical framework for exposure therapy, whereby repeated disconfirmation of a feared outcome yields fear reduction over time. Although this framework has strong empirical support and substantial translational utility, extinction learning is unlikely to be the sole process underlying the therapeutic effects of exposure therapy. In our clinic, we commonly treat obsessive-compulsive disorder (OCD) patients successfully with exposure therapy even when some or all of their feared outcomes are not amenable to disconfirmation and, by extension, to extinction learning. Herein, we present a generic clinical vignette illustrating a commonly encountered feared outcome in OCD that cannot be disconfirmed through exposure (damnation resulting from blasphemous thoughts). We describe two specific non-extinction-based strategies we commonly employ in such cases, and we associate these strategies with known change mechanisms that might account for their effectiveness: (1) non-associative habituation to aversive stimuli, and (2) fear-memory elicitation and subsequent reconsolidation. We discuss the limitations inherent in the reverse-translational approach taken and its opportunities for expanding the framework of exposure therapy.
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Affiliation(s)
- Hannah Berg
- Department of Psychology, University of Minnesota Twin Cities, Minneapolis, MN, United States
- Laureate Institute for Brain Research, Tulsa, OK, United States
| | - Ryan D Webler
- Department of Psychology, University of Minnesota Twin Cities, Minneapolis, MN, United States
| | - Samuel Klein
- Department of Psychology, University of Minnesota Twin Cities, Minneapolis, MN, United States
| | - Matt G Kushner
- Department of Psychiatry, University of Minnesota Twin Cities, Minneapolis, MN, United States
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5
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Kühne F, Hobrecker LK, Heinze PE, Meißner C, Weck F. Exposure therapy tailored to inhibitory learning principles in a naturalistic setting: an open pilot trial in obsessive-compulsive outpatient care. Front Psychol 2024; 15:1328850. [PMID: 38803836 PMCID: PMC11129681 DOI: 10.3389/fpsyg.2024.1328850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Accepted: 04/08/2024] [Indexed: 05/29/2024] Open
Abstract
Inhibitory learning (IL) theory offers promising therapeutic strategies. However, more evidence is needed, especially regarding OCD treatment in routine care. The present pilot study investigated the positive and negative effects of IL-focused cognitive-behavioral therapy (CBT) in a university outpatient setting. A total of N = 21 patients (57.14% male, mean age 31.14, SD = 12.39 years) passed through manualized therapy delivered by licensed psychotherapists. Between the first and 20th IL-focused CBT session, obsessive-compulsive symptoms (Obsessive Compulsive Inventory-Revised, d = 3.71), obsessive beliefs (Obsessive-Beliefs Questionnaire, d = 1.17), depressive symptoms (Beck Depression Inventory, d = 3.49), and overall psychological distress (Global Severity Index, d = 3.40) decreased significantly (all ps < 0.01). However, individual patients reported some negative effects of therapy. The results underline the value of thorough investigations of novel therapeutic interventions in naturalistic settings.
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Affiliation(s)
- Franziska Kühne
- Department of Psychology, Clinical Psychology and Psychotherapy, University of Potsdam, Potsdam, Germany
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McCarty RJ, Downing ST, Guastello AD, Lazaroe LM, Ordway AR, MirHosseini T, Barthle-Herrera MA, Cooke DL, Mathews CA, McNamara JPH. Implementation and Preliminary Outcomes of an Exposure-Based Summer Camp for Pediatric OCD and Anxiety. Behav Ther 2024; 55:543-557. [PMID: 38670667 DOI: 10.1016/j.beth.2023.08.006] [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: 12/02/2022] [Revised: 08/16/2023] [Accepted: 08/18/2023] [Indexed: 04/28/2024]
Abstract
Despite the high prevalence of anxiety disorders in children and adolescents and the existence of effective evidence-based treatments for them, access to psychological care remains a major public health concern. Summer camps may provide an effective treatment avenue for youth who might not otherwise have access to care. This study describes the design and implementation of Fear Facers, a semistructured, 5-day, daytime exposure-therapy-based summer camp designed for youth with a primary diagnosis of obsessive-compulsive disorder (OCD), social anxiety, separation anxiety, or a specific phobia. Preliminary data regarding feasibility and patient outcomes is also reported. Among 52 children and adolescents aged 7 to 16 who attended one of six camp sessions between 2018 and 2021, significant reductions in anxiety (d = 0.54) and OCD symptoms (d = 0.57) were observed from pre-camp to immediately post-camp. A subset of campers who were followed for an additional 3 months post-camp (n = 22) showed maintenance of treatment gains. Retention rates for the intervention were high. Our investigation provides further support for the use of a camp-based design for cognitive-behavioral approaches, and may provide a unique setting to maximize elements of inhibitory learning in exposures. We also discuss a number of elements regarding feasibility that need consideration for those hoping to develop similar interventions.
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Affiliation(s)
- Ryan J McCarty
- College of Medicine, University of Florida; College of Public Health and Health Professions, University of Florida; University of Florida Center for OCD, Anxiety and Related Disorders.
| | - Seth T Downing
- College of Medicine, University of Florida; College of Public Health and Health Professions, University of Florida; University of Florida Center for OCD, Anxiety and Related Disorders
| | - Andrea D Guastello
- College of Medicine, University of Florida; University of Florida Center for OCD, Anxiety and Related Disorders
| | - Lacie M Lazaroe
- College of Medicine, University of Florida; College of Public Health and Health Professions, University of Florida; University of Florida Center for OCD, Anxiety and Related Disorders
| | - Ashley R Ordway
- College of Medicine, University of Florida; University of Florida Center for OCD, Anxiety and Related Disorders
| | - Tannaz MirHosseini
- College of Medicine, University of Florida; College of Public Health and Health Professions, University of Florida; University of Florida Center for OCD, Anxiety and Related Disorders
| | - Megan A Barthle-Herrera
- College of Medicine, University of Florida; University of Florida Center for OCD, Anxiety and Related Disorders
| | - Danielle L Cooke
- College of Medicine, University of Florida; College of Public Health and Health Professions, University of Florida; University of Florida Center for OCD, Anxiety and Related Disorders
| | - Carol A Mathews
- College of Medicine, University of Florida; University of Florida Center for OCD, Anxiety and Related Disorders
| | - Joseph P H McNamara
- College of Medicine, University of Florida; University of Florida Center for OCD, Anxiety and Related Disorders
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Christian C, Vanzhula IA, Ciotti V, Levinson CA. Development and Validation of a Broad and Fear-Adaptable Measure of Fear Approach and Application to Common Eating Disorder Fears. Assessment 2024; 31:602-616. [PMID: 37226768 DOI: 10.1177/10731911231174469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Fear approach is a theorized mechanism of exposure treatment for anxiety-based disorders. However, there are no empirically established self-report instruments measuring the tendency to approach feared stimuli. Because clinical fears are heterogeneous, it is important to create a measure that is adaptable to person- or disorder-specific fears. The current study (N = 455) tests the development, factor structure, and psychometric properties of a self-report instrument of fear approach broadly and the adaptability of this measure to specific eating disorder fears (i.e., food, weight gain). Factor analyses identified a unidimensional, nine-item factor structure as the best fitting model. This measure had good convergent, divergent, and incremental validity and good internal consistency. The eating disorder adaptations retained good fit and strong psychometric properties. These results suggest that this measure is a valid, reliable, and adaptable measure of fear approach, which can be used in research and exposure therapy treatment for anxiety-based disorders.
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Weiss F, Schwarz K, Endrass T. Exploring the relationship between context and obsessions in individuals with obsessive-compulsive disorder symptoms: a narrative review. Front Psychiatry 2024; 15:1353962. [PMID: 38419899 PMCID: PMC10899460 DOI: 10.3389/fpsyt.2024.1353962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Accepted: 01/31/2024] [Indexed: 03/02/2024] Open
Abstract
Obsessions in obsessive-compulsive disorder (OCD) have long been proposed to differ from intrusive thoughts in unaffected individuals based on appraisal of the thoughts. However, more recent research indicates that cognitive processes behind obsessions may differ significantly from those in healthy individuals concerning their contextual relationship. This narrative literature review summarizes current evidence for the role of context-relatedness for obsessions in OCD and intrusive thoughts in affected and unaffected individuals. The review encompasses a total of five studies, two of which include individuals diagnosed with OCD (one study also includes a group of unaffected control individuals), while the other three studies investigate the relationship between OCD symptoms and context in unaffected individuals. As assessed by mainly self-reports, the review examines the connection between thoughts and their context, shedding light on how the repetition and automaticity of thoughts, as well as their detachment from context over time contribute to defining obsessions in contrast to intrusive thoughts. However, the link with context depends on the content of the obsessions. We propose the term "decontextualization of thoughts" to describe the phenomenon that obsessions gradually lose their connection with external context during the development of OCD. Future research should investigate whether this hypothesis can be supported by experimental evidence and identify whether this shift might be more likely a cause or a consequence of the disorder.
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Affiliation(s)
- Franziska Weiss
- Chair of Addiction Research, Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany
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Himle JA, Grogan-Kaylor A, Hiller MA, Mannella KA, Norman LJ, Abelson JL, Prout A, Shunnarah AA, Becker HC, Russman Block SR, Taylor SF, Fitzgerald KD. Exposure and response prevention versus stress management training for adults and adolescents with obsessive compulsive disorder: A randomized clinical trial. Behav Res Ther 2024; 172:104458. [PMID: 38103359 DOI: 10.1016/j.brat.2023.104458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 11/24/2023] [Accepted: 12/06/2023] [Indexed: 12/19/2023]
Abstract
OBJECTIVE Though exposure and response prevention (ERP) is a well-proven treatment for OCD across the lifespan, prior RCTs have not studied adolescent and adult patients with the same ERP protocol relative to an active comparator that controls for non-specific effects of treatment. This approach assesses differences in the effect of OCD-specific exposures in affected adolescents and adults and in response to ERP compared to a stress-management control therapy (SMT). METHODS This assessor-blinded, parallel, 2-arm, randomized, ambulatory clinical superiority trial randomized adolescents (aged 12-18) and adults (24-46) with OCD (N = 126) to 12 weekly sessions of ERP or SMT. OCD severity was measured before, during and after treatment using the child or adult version of the Yale-Brown Obsessive Compulsive Scale (C/Y-BOCS), depending on participant age. We predicted that ERP would produce greater improvement in OCD symptoms than SMT and that there would be no significant post-treatment differences across age groups. RESULTS ERP (n = 63) produced significantly greater improvements on C/Y-BOCS scores at post-treatment than SMT (n = 63) (Effect size = -0.72, CI = -0.52 to -0.91, p < .001). ERP also produced more treatment responders (ERP = 86%, SMT = 32%; χ2 = 46.37, p < .001) and remitters than SMT (ERP = 39%, SMT = 7%; χ2 = 16.14, p < .001). Finally, there were no statistically significant post-treatment differences in C/Y-BOCS scores between adolescents and adults assigned to ERP. CONCLUSION A single ERP protocol is superior to SMT in treating both adolescents and adults with OCD. OCD-specific therapy is necessary across the lifespan for optimal outcomes in this highly disabling disorder, though non-specific treatments like SMT are still all-too-commonly provided.
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Affiliation(s)
- Joseph A Himle
- School of Social Work, University of Michigan, 1080 South University Ave, Ann Arbor, MI, 48109, USA; Department of Psychiatry, Medical School, University of Michigan, 1500 East Medical Center Dr., Ann Arbor, MI, 48109, USA.
| | - Andrew Grogan-Kaylor
- School of Social Work, University of Michigan, 1080 South University Ave, Ann Arbor, MI, 48109, USA
| | - Matthew A Hiller
- School of Social Work, University of Michigan, 1080 South University Ave, Ann Arbor, MI, 48109, USA
| | - Kristin A Mannella
- Department of Psychiatry, Medical School, University of Michigan, 1500 East Medical Center Dr., Ann Arbor, MI, 48109, USA
| | - Luke J Norman
- Department of Psychiatry, Medical School, University of Michigan, 1500 East Medical Center Dr., Ann Arbor, MI, 48109, USA
| | - James L Abelson
- Department of Psychiatry, Medical School, University of Michigan, 1500 East Medical Center Dr., Ann Arbor, MI, 48109, USA
| | - Aileen Prout
- Department of Psychiatry, Medical School, University of Michigan, 1500 East Medical Center Dr., Ann Arbor, MI, 48109, USA
| | - Angela A Shunnarah
- Department of Psychiatry, Medical School, University of Michigan, 1500 East Medical Center Dr., Ann Arbor, MI, 48109, USA
| | - Hannah C Becker
- Department of Psychiatry, Medical School, University of Michigan, 1500 East Medical Center Dr., Ann Arbor, MI, 48109, USA
| | - Stefanie R Russman Block
- Department of Psychiatry, Medical School, University of Michigan, 1500 East Medical Center Dr., Ann Arbor, MI, 48109, USA
| | - Stephan F Taylor
- Department of Psychiatry, Medical School, University of Michigan, 1500 East Medical Center Dr., Ann Arbor, MI, 48109, USA
| | - Kate D Fitzgerald
- Department of Psychiatry, College of Physicians and Surgeons, Columbia University, 630 W 168th St, New York, NY, 10032, USA
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Adams TG, Kelmendi B, George JR, Forte J, Hubert TJJ, Wild H, Rippey CS, Pittenger C. Frontopolar multifocal transcranial direct current stimulation reduces conditioned fear reactivity during extinction training: A pilot randomized controlled trial. Neurobiol Learn Mem 2023; 205:107825. [PMID: 37699439 PMCID: PMC10872945 DOI: 10.1016/j.nlm.2023.107825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 08/16/2023] [Accepted: 09/03/2023] [Indexed: 09/14/2023]
Abstract
Exposure-based therapies for anxiety and related disorders are believed to depend on fear extinction learning and corresponding changes in extinction circuitry. Frontopolar multifocal transcranial direct current stimulation (tDCS) has been shown to improve therapeutic safety learning during in vivo exposure and may modulate functional connectivity of networks implicated in fear processing and inhibition. A pilot randomized controlled trial was completed to determine the effects of frontopolar tDCS on extinction learning and memory. Community volunteers (n = 35) completed a 3-day fear extinction paradigm with measurement of electrodermal activity. Participants were randomized (single-blind) to 20-min of sham (n = 17, 30 s. ramp in/out) or active (n = 18) frontopolar (anode over Fpz, 10-10 EEG) multifocal tDCS (20-min, 1.5 mA) prior to extinction training. Mixed ANOVAs revealed a significant group*trial effect on skin conductance response (SCR) to the conditioned stimulus (CS + ) during extinction training (p = 0.007, Cohen's d = 0.55). The effects of frontopolar tDCS were greatest during the first two extinction trials, suggesting that tDCS may have promoted fear inhibition prior to safety learning. Return of fear to the CS + during tests were comparable across conditions (ps > 0.50). These findings suggest that frontopolar tDCS may modulate the processing of threat cues and associated circuitry or promote the inhibition of fear. This has clear implications for the treatment of anxiety and related disorders with therapeutic exposure.
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Affiliation(s)
- Thomas G Adams
- Department of Psychology, University of Kentucky, United States; Department of Psychiatry, Yale University School of Medicine, United States.
| | - Benjamin Kelmendi
- Department of Psychiatry, Yale University School of Medicine, United States; Clinical Neuroscience Division of the National Center for PTSD, West Haven VA Medical Center, United States
| | - Jamilah R George
- Department of Psychiatry, Yale University School of Medicine, United States; Department of Psychological Sciences, University of Connecticut, United States
| | - Jennifer Forte
- Department of Psychiatry, Yale University School of Medicine, United States; Department of Psychology, Binghamton University, United States
| | - Troy J J Hubert
- Department of Psychology, University of Kentucky, United States
| | - Hannah Wild
- Department of Psychology, University of Kentucky, United States
| | - Colton S Rippey
- Department of Psychology, University of Kentucky, United States
| | - Christopher Pittenger
- Department of Psychiatry, Yale University School of Medicine, United States; Child Study Center, Yale University, United States; Department of Psychology, Center for Brain and Mind Health, Yale University, United States
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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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12
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Jalal B, Chamberlain SR, Sahakian BJ. Obsessive-compulsive disorder: Etiology, neuropathology, and cognitive dysfunction. Brain Behav 2023; 13:e3000. [PMID: 37137502 PMCID: PMC10275553 DOI: 10.1002/brb3.3000] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 03/14/2023] [Accepted: 03/24/2023] [Indexed: 05/05/2023] Open
Abstract
BACKGROUND This review provides an overview of obsessive-compulsive disorder (OCD) symptoms, including the four partially distinct subtypes of the disorder, current diagnostic criteria, and common comorbidities. Critically, it focuses on the etiology of OCD, including its underlying neuropathology, and examines cognitive dysfunction in OCD. METHODS This review study was conducted by library method. RESULTS We show how dysfunction in cortico-striato-thalamo-cortical (CSTC) circuits may underpin symptoms; and shed light on the putative neurochemistry within these loops such as the role of serotonin, dopamine, and glutamate systems. We also show how OCD is characterized by cognitive dysfunction including problems in cognitive flexibility, visuospatial memory, response inhibition, and goal-directed behavior, linked to aberrant activity within CSTC circuits. CONCLUSIONS In brief, research questions we shed light on include (1) what are the symptoms in OCD; (2) what is the etiology of the disorder and do existing models explain OCD; and (3) what are key cognitive deficits in OCD and do these improve with treatment?
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Affiliation(s)
- Baland Jalal
- Department of PsychiatryUniversity of Cambridge School of Clinical MedicineCambridgeUK
- Behavioural and Clinical Neuroscience Institute, Department of PsychologyUniversity of CambridgeCambridgeUK
| | - Samuel R. Chamberlain
- Faculty of Medicine, Department of PsychiatryUniversity of SouthamptonSouthamptonUK
- Specialist Clinic for Impulsive and Compulsive Disorders, and the Southern Gambling ServiceSouthern Health NHS Foundation TrustSouthamptonUK
| | - Barbara J. Sahakian
- Department of PsychiatryUniversity of Cambridge School of Clinical MedicineCambridgeUK
- Behavioural and Clinical Neuroscience Institute, Department of PsychologyUniversity of CambridgeCambridgeUK
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Woods DW, Himle MB, Stiede JT, Pitts BX. Behavioral Interventions for Children and Adults with Tic Disorder. Annu Rev Clin Psychol 2023; 19:233-260. [PMID: 37159286 DOI: 10.1146/annurev-clinpsy-080921-074307] [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: 05/10/2023]
Abstract
Over the past decade, behavioral interventions have become increasingly recognized and recommended as effective first-line therapies for treating individuals with tic disorders. In this article, we describe a basic theoretical and conceptual framework through which the reader can understand the application of these interventions for treating tics. The three primary behavioral interventions for tics with the strongest empirical support (habit reversal, Comprehensive Behavioral Intervention for Tics, and exposure and response prevention) are described. Research on the efficacy and effectiveness of these treatments is summarized along with a discussion of the research evaluating the delivery of these treatments in different formats and modalities. The article closes with a review of the possible mechanisms of change underlying behavioral interventions for tics and areas for future research.
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Affiliation(s)
- Douglas W Woods
- Department of Psychology, Marquette University, Milwaukee, Wisconsin, USA;
| | - Michael B Himle
- Department of Psychology, University of Utah, Salt Lake City, Utah, USA
| | - Jordan T Stiede
- Department of Psychiatry & Behavioral Sciences, Baylor College of Medicine, Houston, Texas, USA
| | - Brandon X Pitts
- Department of Psychology, Marquette University, Milwaukee, Wisconsin, USA;
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14
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Bach DR, Sporrer J, Abend R, Beckers T, Dunsmoor JE, Fullana MA, Gamer M, Gee DG, Hamm A, Hartley CA, Herringa RJ, Jovanovic T, Kalisch R, Knight DC, Lissek S, Lonsdorf TB, Merz CJ, Milad M, Morriss J, Phelps EA, Pine DS, Olsson A, van Reekum CM, Schiller D. Consensus design of a calibration experiment for human fear conditioning. Neurosci Biobehav Rev 2023; 148:105146. [PMID: 36990370 PMCID: PMC10618407 DOI: 10.1016/j.neubiorev.2023.105146] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 03/23/2023] [Accepted: 03/24/2023] [Indexed: 03/29/2023]
Abstract
Fear conditioning is a widely used laboratory model to investigate learning, memory, and psychopathology across species. The quantification of learning in this paradigm is heterogeneous in humans and psychometric properties of different quantification methods can be difficult to establish. To overcome this obstacle, calibration is a standard metrological procedure in which well-defined values of a latent variable are generated in an established experimental paradigm. These intended values then serve as validity criterion to rank methods. Here, we develop a calibration protocol for human fear conditioning. Based on a literature review, series of workshops, and survey of N = 96 experts, we propose a calibration experiment and settings for 25 design variables to calibrate the measurement of fear conditioning. Design variables were chosen to be as theory-free as possible and allow wide applicability in different experimental contexts. Besides establishing a specific calibration procedure, the general calibration process we outline may serve as a blueprint for calibration efforts in other subfields of behavioral neuroscience that need measurement refinement.
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Affiliation(s)
- Dominik R Bach
- Wellcome Centre for Human Neuroimaging and Max Planck UCL Centre for Computational Psychiatry and Ageing Research, University College London, United Kingdom; Hertz Chair for Artificial Intelligence and Neuroscience, Transdisciplinary Research Area "Life & Health", University of Bonn, Germany.
| | - Juliana Sporrer
- Wellcome Centre for Human Neuroimaging and Max Planck UCL Centre for Computational Psychiatry and Ageing Research, University College London, United Kingdom
| | - Rany Abend
- National Institute of Mental Health Intramural Research Program, Bethesda, MD, USA
| | - Tom Beckers
- KU Leuven, Faculty of Psychology and Educational Sciences/Leuven Brain Institute, Leuven, Belgium
| | - Joseph E Dunsmoor
- Department of Psychiatry and Behavioral Sciences, University of Texas at Austin, USA
| | - Miquel A Fullana
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), CIBERSAM, & Adult Psychiatry and Psychology Department, Institute of Neurosciences, Hospital Clínic, Barcelona, Spain
| | - Matthias Gamer
- Julius-Maximilians-University of Würzburg, Department of Psychology, Würzburg, Germany
| | - Dylan G Gee
- Yale University, Department of Psychology, New Haven, CT, USA
| | - Alfons Hamm
- Department of Psychology, University of Greifswald, Germany
| | | | - Ryan J Herringa
- Department of Psychiatry, University of Wisconsin School of Medicine & Public Health, USA
| | - Tanja Jovanovic
- Department of Psychiatry and Behavioral Neurosciences, Wayne State University, Detroit, MI, USA
| | - Raffael Kalisch
- Neuroimaging Center (NIC), Focus Program Translational Neuroscience (FTN), Johannes Gutenberg University Medical Center, Mainz, Germany; and Leibniz Institute for Resilience Research (LIR), Mainz, Germany
| | - David C Knight
- University of Alabama at Birmingham, Department of Psychology, Birmingham, AL, USA
| | - Shmuel Lissek
- Clinical Science and Psychopathology Research Program, Department of Psychology, University of Minnesota, Minneapolis, MN, USA
| | - Tina B Lonsdorf
- University Medical Center Hamburg-Eppendorf, Institute of Systems Neuroscience, Hamburg, Germany
| | - Christian J Merz
- Ruhr University Bochum, Faculty of Psychology, Institute of Cognitive Neuroscience, Department of Cognitive Psychology, Bochum, Germany
| | - Mohammed Milad
- Department of Psychiatry and Neuroscience Institute, NYU Grossman School of Medicine, New York, NY, USA; The Nathan S. Kline Institute for Psychiatric Research, Orangeburg, NY, USA
| | - Jayne Morriss
- School of Psychology and Clinical Language Sciences, University of Reading, United Kingdom
| | - Elizabeth A Phelps
- Department of Psychology, Harvard University, 52 Oxford St., Cambridge, MA, USA
| | - Daniel S Pine
- National Institute of Mental Health Intramural Research Program, Bethesda, MD, USA
| | - Andreas Olsson
- Karolinska Institutet, Department of Clinical Neuroscience, Division of Psychology, Stockholm, Sweden
| | - Carien M van Reekum
- School of Psychology and Clinical Language Sciences, University of Reading, United Kingdom
| | - Daniela Schiller
- Friedman Brain Institute, Department of Neuroscience, Department of Psychiatry, Icahn School of Medicine at Mt. Sinai, New York, NY, USA
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15
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Lebrun C, De Connor A, Dellouve C, Novara C, Adloff V, Capdevielle D, Bortolon C, Raffard S. Validation of a French version of the Vancouver Obsessional Compulsive Inventory-Mental Contamination scale (VOCI-MC) and the Contamination Thought-Action Fusion scale (CTAF) in non-clinical and clinical samples. Behav Cogn Psychother 2023:1-13. [PMID: 37185172 DOI: 10.1017/s1352465823000164] [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: 05/17/2023]
Abstract
The Vancouver Obsessional Compulsive Inventory-Mental Contamination scale (VOCI-MC) and the Contamination Thought-Action Fusion scale (CTAF) are two self-report instruments that assess symptoms of mental contamination and fusion between thoughts, and feelings and behaviours associated with contamination, respectively. The aim of this study was to investigate the psychometric properties of the French version of these two scales in non-clinical and clinical samples. We included 79 participants diagnosed with obsessive-compulsive disorder (OCD), 31 diagnosed with anxiety disorders, who were recruited from the University Department of Adult Psychiatry in Montpellier, and 320 non-clinical participants recruited from the general population. Psychometric properties of the French VOCI-MC and CTAF were investigated. Results showed that the French versions of the VOCI-MC and the CTAF had high internal consistency, good convergent and divergent validity, as well as good temporal stability. Exploratory and confirmatory factor analyses showed a one-factor structure for the two scales in both non-clinical and OCD samples. Adequate discriminative validity was established by comparing OCD patients with contamination-related symptoms and OCD patients who did not report contamination-related symptoms. The French VOCI-MC and CTAF are valid and appropriate tools for measuring mental contamination in both clinical and research contexts.
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Affiliation(s)
- Cindy Lebrun
- Université Paul Valéry Montpellier 3, Epsylon EA 4556, F34000, Montpellier, France
- Clinique Rhône Durance, groupe Elsan, 84000 Avignon, France
| | - Alexandre De Connor
- Université Paul Valéry Montpellier 3, Epsylon EA 4556, F34000, Montpellier, France
- University Department of Adult Psychiatry, CHU Montpellier, University Montpellier 1, Hôpital la Colombière, France
| | - Charline Dellouve
- University Department of Adult Psychiatry, CHU Montpellier, University Montpellier 1, Hôpital la Colombière, France
| | | | - Valentin Adloff
- Université Paul Valéry Montpellier 3, Epsylon EA 4556, F34000, Montpellier, France
| | - Delphine Capdevielle
- University Department of Adult Psychiatry, CHU Montpellier, University Montpellier 1, Hôpital la Colombière, France
| | - Catherine Bortolon
- Laboratoire Inter-universitaire de Psychologie: Personnalité, Cognition et Changement Social - Université Grenoble Alpes, Grenoble, France
- C3R - Réhabilitation psychosociale et remédiation cognitive, Centre Hospitalier Alpes Isère, Grenoble, France
| | - Stéphane Raffard
- Université Paul Valéry Montpellier 3, Epsylon EA 4556, F34000, Montpellier, France
- University Department of Adult Psychiatry, CHU Montpellier, University Montpellier 1, Hôpital la Colombière, France
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16
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Samantaray NN, Mishra A, Singh AR, Sudhir PM, Singh P. Anxiety sensitivity as a predictor, and non-specific therapeutic factors as predictors and mediators of CBT outcome for obsessive-compulsive disorder in a naturalistic mental health setting. J Affect Disord 2023; 324:92-101. [PMID: 36584701 DOI: 10.1016/j.jad.2022.12.085] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Revised: 08/09/2022] [Accepted: 12/18/2022] [Indexed: 12/28/2022]
Abstract
OBJECTIVE We examined the unique predictive strength of anxiety sensitivity (AS) and the role of expectancy, credibility, and therapeutic alliance (TA) as predictors and mediators of cognitive-behavioral treatment (CBT) outcomes in obsessive-compulsive disorder (OCD). METHOD The current study is a prospective cohort study. Participants (N = 116) were treatment-seeking individuals with a primary diagnosis of OCD. Independent raters assessed patients on Yale-Brown Obsessive-Compulsive Scale (YBOCS) and Anxiety Sensitivity Index-3 at baseline, post-intervention, and three-month follow-up. Participants responded to the Credibility and Expectancy questionnaire and Working Alliance Inventory-Short revised at baseline, first-session, and mid-session. RESULTS The individual addition of AS, end-of-first-session credibility and expectancy, mid-session credibility and expectancy, and therapeutic alliance predicted significant CBT outcomes. There was a moderate positive correlation between baseline OCD severity and the global score of AS, but a weak one with AS dimensions. Both expectancy and credibility significantly improved from baseline to end-of-first-session treatment. End-of-first and third-session outcome expectancies, not credibility, have significant, indirect effects on OCD CBT outcomes. CONCLUSIONS AS, within-session credibility and expectancies and TA independently predict CBT outcomes. Within-sessions outcome expectancies mediate CBT outcomes in OCD, not credibility. Expectancy and credibility both include state-like elements that can be influenced to enhance the outcomes of CBT. Proposals for reducing treatment barriers in CBT for OCD are offered.
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Affiliation(s)
- Narendra Nath Samantaray
- Dept. of Clinical Psychology, School of Medical and Paramedical Science, Mizoram University, Aizawl 796004, India.
| | - Abinash Mishra
- Dept. of Clinical Psychology, Mental Health Institute (Centre of Excellence), SCB Medical College & Hospital, Cuttack 753007, India
| | | | - Paulomi M Sudhir
- Department of Clinical Psychology, National Institute of Mental Health & Neuro Sciences (NIMHANS), Bengaluru 560029, India
| | - Preeti Singh
- Dept. of Psychiatry, Pt. Jawahar Lal Nehru Memorial Medical College, Raipur 492001, India
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17
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Kemp J, Benito K, Herren J, Brown Z, Frank HE, Freeman J. Exposure to exposure: A protocol for leveraging exposure principles during training to address therapist-level barriers to exposure implementation. Front Psychiatry 2023; 14:1096259. [PMID: 36873204 PMCID: PMC9975163 DOI: 10.3389/fpsyt.2023.1096259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Accepted: 01/17/2023] [Indexed: 02/17/2023] Open
Abstract
BACKGROUND Exposure therapy is a highly effective but underutilized treatment for anxiety disorders. A primary contributor to its underutilization is therapist-level negative beliefs about its safety and tolerability for patients. Given functional similarities between anxious beliefs among patients and negative beliefs among therapists, the present protocol describes how exposure principles can be leveraged during training to target and reduce therapist negative beliefs. METHODS The study will take place in two phases. First, is a case-series analysis to fine-tune training procedures that is already complete, and the second is an ongoing randomized trial that tests the novel exposure to exposure (E2E) training condition against a passive didactic approach. A precision implementation framework will be applied to evaluate the mechanism(s) by which training influences aspects of therapist delivery following training. ANTICIPATED RESULTS It is hypothesized that the E2E training condition will produce greater reductions in therapists' negative beliefs about exposure during training relative to the didactic condition, and that greater reduction in negative beliefs will be associated with higher quality exposure delivery as measured by coding of videotaped delivery with actual patients. CONCLUSION Implementation challenges encountered to date are discussed along with recommendations for future training interventions. Considerations for expansion of the E2E training approach are also discussed within the context of parallel treatment and training processes that may be tested in future training trials.
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Affiliation(s)
- Joshua Kemp
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School, Brown University, Providence, RI, United States.,Pediatric Anxiety Research Center at Bradley Hospital, Riverside, RI, United States
| | - Kristen Benito
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School, Brown University, Providence, RI, United States.,Pediatric Anxiety Research Center at Bradley Hospital, Riverside, RI, United States
| | - Jennifer Herren
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School, Brown University, Providence, RI, United States.,Pediatric Anxiety Research Center at Bradley Hospital, Riverside, RI, United States
| | - Zoe Brown
- Pediatric Anxiety Research Center at Bradley Hospital, Riverside, RI, United States
| | - Hannah E Frank
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School, Brown University, Providence, RI, United States.,Pediatric Anxiety Research Center at Bradley Hospital, Riverside, RI, United States
| | - Jennifer Freeman
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School, Brown University, Providence, RI, United States.,Pediatric Anxiety Research Center at Bradley Hospital, Riverside, RI, United States
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18
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Knowles KA, Jessup SC, Olatunji BO. Facing Uncertainty: A Comparison of Hierarchical and Variable Exposure Interventions for Contamination Fear. J Obsessive Compuls Relat Disord 2023; 36:100777. [PMID: 36582425 PMCID: PMC9794192 DOI: 10.1016/j.jocrd.2022.100777] [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: 12/08/2022]
Abstract
Consistent with the inhibitory retrieval approach, one proposed modification to improve the effectiveness of exposure-based interventions is to maximize variability by not proceeding linearly up an exposure hierarchy. Accordingly, the present study compares hierarchical and variable exposure interventions for contamination-fearful individuals and examines the role of uncertainty to predict intervention outcomes. Participants (N=73) were randomly assigned to complete a single-session exposure intervention using a standard hierarchy or a variable exposure intervention in which hierarchy items were randomly presented. Participants completed a behavioral approach task (BAT) at baseline and two follow-up visits over a two-week period. Both interventions resulted in a significant decrease in anxiety and disgust as well as more BAT steps completed but did not differ from one another. However, individuals in the variable exposure condition reported less variability in uncertainty during exposure compared to those in the standard condition, d=.78. Furthermore, lower levels of variability in uncertainty predicted greater reductions in anxiety and disgust post-intervention. Consistent with previous studies, variable exposure did not convey additional benefit over standard, hierarchical exposure. The experience of uncertainty during exposure is an important yet understudied process that warrants additional investigation.
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19
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Farrell LJ, Nabinger de Diaz NA, Mathieu S, McKenzie ML, Miyamoto T, Donovan CL, Waters AM, March S, Bothma N, Kroon R, Simcock G, Ware RS, Selles RR, Storch EA, Ollendick T. FAST CBT for pediatric OCD: A multiple-baseline controlled pilot trial of parent training in exposure and response prevention delivered via telehealth. Front Psychol 2022; 13:1009735. [PMID: 36591101 PMCID: PMC9795832 DOI: 10.3389/fpsyg.2022.1009735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 11/17/2022] [Indexed: 12/14/2022] Open
Abstract
Objective The current study utilized a single case series, non-concurrent multiple baseline design to examine the efficacy of training parents via telehealth videoconferencing in exposure and response prevention (ERP) for home delivery of the treatment for their children and adolescents with obsessive compulsive disorder (OCD). Method There were nine participants aged 8 to 14 years who had received a primary diagnosis of OCD. The design involved a series of AB replications, whereby following pre-treatment assessments participants were randomly assigned to either a 2-week (n = 4) or 3-week (n = 5) baseline condition with weekly monitoring of their child's OCD symptoms. Following baseline, parents participated four weekly telehealth parent-training modules in delivering FAST (Families Accessing Skills Training) cognitive behavior therapy (CBT) with ERP (CBT-ERP) to children with OCD via videoconferencing with the clinician. Primary outcome measures were OCD symptom severity, diagnostic severity, and global functioning, which were assessed post-treatment and at 2 month follow-up. Results The stability of the baseline period from pre-treatment to week 2 (for the 2-week condition) or to week 3 (for the 3-week condition) was established as there were no significant differences across baseline scores for parent target obsessions or parent target compulsions ratings. Significant improvements on the primary outcomes of clinician assessed symptom severity, diagnostic ratings, and global functioning were observed from baseline to post-treatment, and continued to 2 months follow-up. Conclusion These data suggest that brief, parent training in FAST CBT-ERP via telehealth provides an overall effective intervention that is likely to be of most benefit to children and youth who are mild to moderate in severity.
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Affiliation(s)
- Lara J. Farrell
- School of Applied Psychology & Griffith University Centre for Mental Health, Griffith University, South Port, QLD, Australia,*Correspondence: Lara J. Farrell,
| | - Natalja A. Nabinger de Diaz
- School of Applied Psychology & Griffith University Centre for Mental Health, Griffith University, South Port, QLD, Australia
| | - Sharna Mathieu
- School of Applied Psychology & Griffith University Centre for Mental Health, Griffith University, South Port, QLD, Australia
| | - Matthew L. McKenzie
- School of Applied Psychology & Griffith University Centre for Mental Health, Griffith University, South Port, QLD, Australia
| | - Taka Miyamoto
- School of Applied Psychology & Griffith University Centre for Mental Health, Griffith University, South Port, QLD, Australia
| | - Caroline L. Donovan
- School of Applied Psychology & Griffith University Centre for Mental Health, Griffith University, Mount Gravatt, QLD, Australia
| | - Allison M. Waters
- School of Applied Psychology & Griffith University Centre for Mental Health, Griffith University, Mount Gravatt, QLD, Australia
| | - Sonja March
- Centre for Health Research & School of Psychology and Wellbeing, University of Southern Queensland (USQ), Darling Heights, QLD, Australia
| | - Nicole Bothma
- School of Applied Psychology & Griffith University Centre for Mental Health, Griffith University, South Port, QLD, Australia
| | - Rianca Kroon
- School of Applied Psychology & Griffith University Centre for Mental Health, Griffith University, South Port, QLD, Australia
| | - Gabrielle Simcock
- School of Applied Psychology & Griffith University Centre for Mental Health, Griffith University, South Port, QLD, Australia
| | - Robert S. Ware
- Menzies Health Institute Queensland, Griffith University, South Port, QLD, Australia
| | - Robert R. Selles
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - Eric A. Storch
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, United States
| | - Thomas Ollendick
- Child Study Centre, Virginia Polytechnic University, Blacksburg, VA, United States
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20
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Maloney G, Kelmendi B, Pittenger C. Imagery Rescripting (ImRs) as an Adjunctive Treatment to Exposure and Response Prevention (ERP)-Resistant Obsessive-Compulsive Disorder: A Case Study. Clin Case Stud 2022. [DOI: 10.1177/15346501221123797] [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
Exposure and response prevention (ERP), a specific type of Cognitive and Behaviour Therapy, is well recognised as the first-line psychological treatment in obsessive-compulsive disorder (OCD), either alone or in combination with selective serotonin reuptake inhibitor pharmacotherapy. However, given that up to half of patients suffering from OCD do not experience a clinically significant reduction in symptoms following ERP, further treatment options for treatment-resistant OCD are needed. Initial research into using ImRs as a psychological adjunct for treatment-resistant OCD has been encouraging. We provide a detailed case study of a 61-year-old male who continued, following ERP treatment, to suffer debilitating OCD symptoms of compulsive checking to prevent making mistakes. Following ERP, the individual received two sessions of ImRs as a therapy adjunct, which resulted in a further reduction of 56% in OCD symptoms. The individual reported associated improvements in mood, life satisfaction, and occupational and interpersonal relationships. This case study describes how ImRs can be incorporated into ERP treatment for OCD. Details of the ERP and ImRs treatment are provided, along with transcript excerpts to highlight the ImRs process. Further research is needed to enhance understanding of mechanisms and optimal deployment of ImRs in treatment sequencing for OCD sufferers.
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Affiliation(s)
- Gayle Maloney
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
- Perth OCD Clinic, Perth, Australia
| | - Benjamin Kelmendi
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| | - Christopher Pittenger
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
- Yale Child Study Center and Interdepartmental Neuroscience Program, Yale University School of Medicine, New Haven, CT, USA
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21
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Petri JM, Cullum KA, Hunnicutt-Ferguson K. Exposure Therapy for Multiple Anxiety Targets: Clinical Decisions Guided by Functional Assessment. FOCUS (AMERICAN PSYCHIATRIC PUBLISHING) 2022; 20:307-308. [PMID: 37205022 PMCID: PMC10172524 DOI: 10.1176/appi.focus.20220050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Affiliation(s)
- Jessica M Petri
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta
| | - Katherine A Cullum
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta
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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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Abstract
Our habits constantly influence the environment, often in negative ways that amplify global environmental and health risks. Hence, change is urgent. To facilitate habit change, inhibiting unwanted behaviors appears to be a natural human reaction. Here, we use a novel experimental design to test how inhibitory control affects two key components of changing (rewiring) habit-like behaviors in healthy humans: the acquisition of new habit-like behavior and the simultaneous unlearning of an old one. We found that, while the new behavior was acquired, the old behavior persisted and coexisted with the new. Critically, inhibition hindered both overcoming the old behavior and establishing the new one. Our findings highlight that suppressing unwanted behaviors is not only ineffective but may even further strengthen them. Meanwhile, actively engaging in a preferred behavior appears indispensable for its successful acquisition. Our design could be used to uncover how new approaches affect the cognitive basis of changing habit-like behaviors.
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24
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Wendt J, Morriss J. An examination of Intolerance of Uncertainty and contingency instruction on multiple indices during threat acquisition and extinction training. Int J Psychophysiol 2022; 177:171-178. [DOI: 10.1016/j.ijpsycho.2022.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 05/06/2022] [Accepted: 05/09/2022] [Indexed: 12/01/2022]
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25
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Effects of intolerance of uncertainty on subjective and psychophysiological measures during fear acquisition and delayed extinction. Int J Psychophysiol 2022; 177:249-259. [DOI: 10.1016/j.ijpsycho.2022.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 04/19/2022] [Accepted: 05/09/2022] [Indexed: 10/18/2022]
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26
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Thurston MD, Cassaday HJ. Safety Learning in Anxiety, Pavlovian Conditioned Inhibition and COVID Concerns. Front Psychol 2022; 13:866771. [PMID: 35444592 PMCID: PMC9014209 DOI: 10.3389/fpsyg.2022.866771] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 03/10/2022] [Indexed: 11/24/2022] Open
Abstract
Experimental studies of fear conditioning have identified the effectiveness of safety signals in inhibiting fear and maintaining fear-motivated behaviors. In fear conditioning procedures, the presence of safety signals means that the otherwise expected feared outcome will not now occur. Differences in the inhibitory learning processes needed to learn safety are being identified in various psychological and psychiatric conditions. However, despite early theoretical interest, the role of conditioned inhibitors as safety signals in anxiety has been under-investigated to date, in part because of the stringent test procedures required to confirm the demonstration of conditioned inhibition as such. Nonetheless, the theoretical implications of an inhibitory learning perspective continue to influence clinical practice. Moreover, our understanding of safety signals is of additional importance in the context of the increased health anxiety and safety behaviors generated by the COVID-19 pandemic.
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Affiliation(s)
- Meghan D Thurston
- School of Psychology, University of Nottingham, Nottingham, United Kingdom.,Department of Clinical Psychology, The Royal Derby Hospital, Derby, United Kingdom
| | - Helen J Cassaday
- School of Psychology, University of Nottingham, Nottingham, United Kingdom
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27
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Pollard-Wright H. Feelings of Knowing - Fundamental Interoceptive Patterns (FoK-FIP): a magnetic monopole-like "pure mental" process fundamental to subjective feelings and self-awareness. Commun Integr Biol 2022; 15:1-54. [PMID: 35186178 PMCID: PMC8855850 DOI: 10.1080/19420889.2021.2023280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Abstract
The Feelings of Knowing - Fundamental Interoceptive Patterns (FoK-FIP) is a transdisciplinary theory developed to explain elusive phenomena suspected to exist that do not easily lend themselves to empirical measurement. The FoK-FIP theory posits that specialized self-generated biomagnetism and "pure mental" process share similarities with the hypothetical elementary particle described in particle physics, magnetic monopoles with a magnetic charge. Feelings of Knowing (FoK) are "awareness charge" that are self-generated events. Fundamental Interoceptive Patterns (FIP) are restricted oscillatory magnetic fields that are FoK caused phenomena. Further, FoK produces "cognitive force," an observing ego representing specialized interoceptive awareness. Through embodied states, FoK-FIP acts as a "biological node," an informational processing unit in which physiological signals and an observing ego's sensations or feelings are centered. An observing ego cognitively broadcasts using specialized small magnetic signals and four phases of a narrowed range of interoceptive signals. By defining interoceptive signals (i.e., signals of the body's internal state) using FoK-FIP through cognitive broadcasting, an observing ego creates a world it projects around itself. This process is understood through the components map with interoceptive markers (IMs), a novel algorithm based on biological evolution. FoK-FIP-related predictions are described as are empirical studies to test aspects of the theory. The FoK-FIP theory details a path to wellbeing based on a sense of control and capacity for self-care. Mental stability is thought to change as a function of an observing ego's volitional reactions.
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Affiliation(s)
- Holly Pollard-Wright
- Institute of Electrical and Electronics Engineers (IEEE), The National Coalition of Independent Scholars (NCIS)
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28
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Kannis-Dymand L, Grace E, McDonald L, Chambers R. Australian and New Zealand psychologists’ perceptions and use of therapist-guided exposure for panic disorder. CLIN PSYCHOL-UK 2022. [DOI: 10.1080/13284207.2022.2035651] [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]
Affiliation(s)
- Lee Kannis-Dymand
- School of Health and Behavioural Sciences, University of the Sunshine Coast, Sunshine Coast, Australia
| | - Emma Grace
- School of Health and Behavioural Sciences, University of the Sunshine Coast, Sunshine Coast, Australia
| | - Lindsay McDonald
- School of Health and Behavioural Sciences, University of the Sunshine Coast, Sunshine Coast, Australia
| | - Ron Chambers
- CDHB, Anxiety Disorders Service, Christchurch, New Zealand
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Elsner B, Jacobi T, Kischkel E, Schulze D, Reuter B. Mechanisms of exposure and response prevention in obsessive-compulsive disorder: effects of habituation and expectancy violation on short-term outcome in cognitive behavioral therapy. BMC Psychiatry 2022; 22:66. [PMID: 35086513 PMCID: PMC8793233 DOI: 10.1186/s12888-022-03701-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 12/23/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Exposure and response prevention is effective and recommended as the first choice for treating obsessive-compulsive disorders (OCD). Its mechanisms of action are rarely studied, but two major theories make distinct assumptions: while the emotional processing theory assumes that treatment effects are associated with habituation within and between exposure sessions, the inhibitory learning approach highlights the acquisition of additional associations, implying alternative mechanisms like expectancy violation. The present study aimed to investigate whether process variables derived from both theories predict short-term outcome. METHOD In a university outpatient unit, 110 patients (63 female) with OCD received manual-based cognitive-behavioral therapy with high standardization of the first two exposure sessions. Specifically, therapists repeated the first exposure session identically and assessed subjective units of distress as well as expectancy ratings in the course of exposure sessions. Based on these data, individual scores for habituation and distress-related expectancy violation were calculated and used for prediction of both percentage change on the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) and remission status after 20 therapy sessions. RESULTS In a multiple regression model for percentage change, within-session habituation during the first exposure was a significant predictor, while in a logistic regression predicting remission status, distress-related expectancy violation during the first exposure revealed significance. A path model further supported these findings. CONCLUSIONS The results represent first evidence for distress-related expectancy violation and confirm preliminary findings for habituation, suggesting that both processes contribute to treatment benefits of exposure in OCD, and both mechanisms appear to be independent.
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Affiliation(s)
- Björn Elsner
- Department of Psychology, Humboldt-Universität zu Berlin, Rudower Chaussee 18, 12489 Berlin, Germany
| | - Tanja Jacobi
- Department of Psychology, Humboldt-Universität zu Berlin, Rudower Chaussee 18, 12489 Berlin, Germany
| | - Eva Kischkel
- Department of Psychology, Humboldt-Universität zu Berlin, Rudower Chaussee 18, 12489 Berlin, Germany
| | - Daniel Schulze
- Department of Psychology, Humboldt-Universität zu Berlin, Rudower Chaussee 18, 12489 Berlin, Germany
- Department of Psychology, Freie Universität Berlin, Habelschwerdter Allee 45, 14195 Berlin, Germany
| | - Benedikt Reuter
- Department of Psychology, Humboldt-Universität zu Berlin, Rudower Chaussee 18, 12489 Berlin, Germany
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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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Van Noppen B, Sassano-Higgins S, Appasani R, Sapp F. Cognitive-Behavioral Therapy for Obsessive-Compulsive Disorder: 2021 Update. FOCUS (AMERICAN PSYCHIATRIC PUBLISHING) 2021; 19:430-443. [PMID: 35747293 PMCID: PMC9063577 DOI: 10.1176/appi.focus.20210015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
In this update of a previous review, the authors discuss cognitive-behavioral therapy (CBT) with exposure and response prevention for obsessive-compulsive disorder (OCD). This efficacious modality avoids side effects common to psychotropic medication and reduces risk of relapse once treatment has ended. Psychotherapy involves identification and ranking of stimuli that provoke obsessions, exposure to these stimuli while preventing compulsions, and cognitive restructuring. The family of the OCD patient plays a significant role in treatment. This article includes expanded research on family-focused CBT and treatment of pediatric OCD. The family's accommodation and emotional response to a patient's symptoms may interfere with therapy and perpetuate the disorder. The treatment of pediatric OCD involves the same considerations. However, the form of obsessions and compulsions may differ and therapeutic techniques are modified to make them age appropriate.
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Affiliation(s)
- Barbara Van Noppen
- Department of Psychiatry and Behavioral Sciences, Keck School of Medicine, University of Southern California, Los Angeles (Van Noppen); private practice, Los Angeles (Sassano-Higgins, Appasani); OCD and Anxiety Psychological Services, Calgary, Alberta, Canada (Sapp)
| | - Sean Sassano-Higgins
- Department of Psychiatry and Behavioral Sciences, Keck School of Medicine, University of Southern California, Los Angeles (Van Noppen); private practice, Los Angeles (Sassano-Higgins, Appasani); OCD and Anxiety Psychological Services, Calgary, Alberta, Canada (Sapp)
| | - Raghu Appasani
- Department of Psychiatry and Behavioral Sciences, Keck School of Medicine, University of Southern California, Los Angeles (Van Noppen); private practice, Los Angeles (Sassano-Higgins, Appasani); OCD and Anxiety Psychological Services, Calgary, Alberta, Canada (Sapp)
| | - Felicity Sapp
- Department of Psychiatry and Behavioral Sciences, Keck School of Medicine, University of Southern California, Los Angeles (Van Noppen); private practice, Los Angeles (Sassano-Higgins, Appasani); OCD and Anxiety Psychological Services, Calgary, Alberta, Canada (Sapp)
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Cooper SE, Dunsmoor JE. Fear conditioning and extinction in obsessive-compulsive disorder: A systematic review. Neurosci Biobehav Rev 2021; 129:75-94. [PMID: 34314751 PMCID: PMC8429207 DOI: 10.1016/j.neubiorev.2021.07.026] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 06/04/2021] [Accepted: 07/23/2021] [Indexed: 11/29/2022]
Abstract
Laboratory experiments using fear conditioning and extinction protocols help lay the groundwork for designing, testing, and optimizing innovative treatments for anxiety-related disorders. Yet, there is limited basic research on fear conditioning and extinction in obsessive-compulsive disorder (OCD). This is surprising because exposure-based treatments based on associative learning principles are among the most popular and effective treatment options for OCD. Here, we systematically review and critically assess existing aversive conditioning and extinction studies of OCD. Across 12 studies, there was moderate evidence that OCD is associated with abnormal acquisition of conditioned responses that differ from comparison groups. There was relatively stronger evidence of OCD's association with impaired extinction processes. This included multiple studies finding elevated conditioned responses during extinction learning and poorer threat/safety discrimination during recall, although a minority of studies yielded results inconsistent with this conclusion. Overall, the conditioning model holds value for OCD research, but more work is necessary to clarify emerging patterns of results and increase clinical translational utility to the level seen in other anxiety-related disorders. We detail limitations in the literature and suggest next steps, including modeling OCD with more complex conditioning methodology (e.g., semantic/conceptual generalization, avoidance) and improving individual-differences assessment with dimensional techniques.
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Affiliation(s)
- Samuel E Cooper
- Department of Psychiatry and Behavioral Sciences, University of Texas at Austin, Austin, TX, 78712, USA.
| | - Joseph E Dunsmoor
- Department of Psychiatry and Behavioral Sciences, University of Texas at Austin, Austin, TX, 78712, USA.
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Sookman D, Phillips KA, Anholt GE, Bhar S, Bream V, Challacombe FL, Coughtrey A, Craske MG, Foa E, Gagné JP, Huppert JD, Jacobi D, Lovell K, McLean CP, Neziroglu F, Pedley R, Perrin S, Pinto A, Pollard CA, Radomsky AS, Riemann BC, Shafran R, Simos G, Söchting I, Summerfeldt LJ, Szymanski J, Treanor M, Van Noppen B, van Oppen P, Whittal M, Williams MT, Williams T, Yadin E, Veale D. Knowledge and competency standards for specialized cognitive behavior therapy for adult obsessive-compulsive disorder. Psychiatry Res 2021; 303:113752. [PMID: 34273818 DOI: 10.1016/j.psychres.2021.113752] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Accepted: 01/21/2021] [Indexed: 12/19/2022]
Abstract
Obsessive-Compulsive Disorder (OCD) is a leading cause of disability world-wide (World Health Organization, 2008). Treatment of OCD is a specialized field whose aim is recovery from illness for as many patients as possible. The evidence-based psychotherapeutic treatment for OCD is specialized cognitive behavior therapy (CBT, NICE, 2005, Koran and Simpson, 2013). However, these treatments are not accessible to many sufferers around the world. Currently available guidelines for care are deemed to be essential but insufficient because of highly variable clinician knowledge and competencies specific to OCD. The phase two mandate of the 14 nation International OCD Accreditation Task Force (ATF) created by the Canadian Institute for Obsessive Compulsive Disorders is development of knowledge and competency standards for specialized treatments for OCD through the lifespan deemed by experts to be foundational to transformative change in this field. This paper presents knowledge and competency standards for specialized CBT for adult OCD developed to inform, advance, and offer a model for clinical practice and training for OCD. During upcoming ATF phases three and four criteria and processes for training in specialized treatments for OCD through the lifespan for certification (individuals) and accreditation (sites) will be developed based on the ATF standards.
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Affiliation(s)
- Debbie Sookman
- Department of Psychology, McGill University Health Center, 1025 Pine Ave W, Montreal, Quebec, H3A 1A1, Canada; Department of Psychiatry, McGill University, 845 Sherbrooke St W, Montreal, Quebec, H3A 0G4, Canada.
| | - Katharine A Phillips
- Department of Psychiatry, Weill Cornell Medicine, 1300 York Ave, New York, NY 10065, United States.
| | - Gideon E Anholt
- Department of Psychology, Marcus Family Campus, Ben-Gurion University of the Negev, Beer Sheva, P.O.B. 653 Beer-Sheva, 8410501, Israel.
| | - Sunil Bhar
- Department of Psychological Sciences, Faculty of Health, Arts and Design, Swinburne University of Technology, 1 John St, Hawthorn, Victoria, 3122, Australia.
| | - Victoria Bream
- Oxford Health Specialist Psychological Interventions Clinic and Oxford Cognitive Therapy Centre, Warneford Hospital, Oxford, OX3 7JX, United Kingdom.
| | - Fiona L Challacombe
- Institute of Psychiatry, Psychology and Neuroscience, Kings College London, De Crespigny Park, London, SE5 8AF, United Kingdom.
| | - Anna Coughtrey
- Great Ormond Street Hospital for Children, London WC1N 3JH, United Kingdom; UCL Great Ormond Street Institute of Child Health, 30 Guilford St, Holborn, London, WC1N 1EH, United Kingdom.
| | - Michelle G Craske
- Anxiety and Depression Research Center, Depression Grant Challenge, Innovative Treatment Network, Staglin Family Music Center for Behavioral and Brain Health, UCLA Department of Psychology and Department of Psychiatry and Biobehavioral Sciences, Box 951563, 1285 Franz Hall, Los Angeles, CA, United States.
| | - Edna Foa
- Center for the Treatment and Study of Anxiety, University of Pennsylvania Perelman SOM, 3535 Market Street, Philadelphia, PA 19104, United States.
| | - Jean-Philippe Gagné
- Department of Psychology, Concordia University, 7141 Sherbrooke St, West, Montreal, Quebec H4B 1R6, Canada.
| | - Jonathan D Huppert
- Department of Psychology, The Hebrew University of Jerusalem, Mt. Scopus, Jerusalem, 91905, Israel.
| | - David Jacobi
- Rogers Behavioral Health, 34700 Valley Road, Oconomowoc, WI, 53066, United States.
| | - Karina Lovell
- Division of Nursing, Midwifery and Social Work, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Oxford Rd, Manchester, M13 9PL, United Kingdom; Manchester Academic Health Science Centre, Greater Manchester Mental Health NHS Foundation Trust, Manchester, M13 9PL, United Kingdom.
| | - Carmen P McLean
- National Center for PTSD, Dissemination and Training Division, VA Palo Alto Healthcare System, 795 Willow Road, Menlo Park, CA, 94025, United States; Department of Psychiatry and Behavioral Sciences, Stanford University, 450 Serra Mall, Stanford, CA, 94305, United States.
| | - Fugen Neziroglu
- Bio-Behavioral Institute, 935 Northern Boulevard, Suite 102, Great Neck, NY, 11021, United States.
| | - Rebecca Pedley
- Division of Nursing, Midwifery and Social Work, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, M13 9PL, United Kingdom.
| | - Sean Perrin
- Department of Psychology, Lund University, Box 213, 22100, Lund, Sweden.
| | - Anthony Pinto
- Zucker School of Medicine at Hofstra/Northwell, Zucker Hillside Hospital - Northwell Health, 265-16 74th Avenue, Glen Oaks, NY, 11004, United States.
| | - C Alec Pollard
- Center for OCD and Anxiety-Related Disorders, Saint Louis Behavioral Medicine Institute, 1129 Macklind Ave, St. Louis, MO, 63110, United States; Department of Family and Community Medicine, Saint Louis University School of Medicine, Saint Louis, MO, 63110, United States.
| | - Adam S Radomsky
- Department of Psychology, Concordia University, 7141 Sherbrooke St, West, Montreal, Quebec H4B 1R6, Canada.
| | - Bradley C Riemann
- 34700 Valley Road, Rogers Behavioral Health, Oconomowoc, WI, 53066, United States.
| | - Roz Shafran
- Population, Policy and Practice Research and Teaching Department, UCL Great Ormond Street Hospital Institute of Child Health, Holborn, London, WC1N 1EH, United Kingdom.
| | - Gregoris Simos
- Department of Educational and Social Policy, University of Macedonia, 156 Egnatia Street, 54636 Thessaloniki, Greece.
| | - Ingrid Söchting
- Departments of Psychology, University of British Columbia, 2136 West Mall, Vancouver, British Columbia, V6T 1Z4, Canada.
| | - Laura J Summerfeldt
- Department of Psychology, Trent University, 1600 West Bank Drive, Peterborough, K9L 0G2 Ontario, Canada.
| | - Jeff Szymanski
- International OCD Foundation, 18 Tremont Street, #308, Boston MA, 02108, United States.
| | - Michael Treanor
- Anxiety and Depression Research Center, University of California, Los Angeles, Box 951563, 1285 Franz Hall, Los Angeles, CA, United States.
| | - Barbara Van Noppen
- Clinical Psychiatry and Behavioral Sciences, OCD Southern California, 2514 Jamacha Road Ste, 502-35 El Cajon, CA, 92019, United States; Department of Psychiatry and Behavioral Sciences, Keck School of Medicine, University of Southern California, 2250 Alcazar Street, Suite 2200, Los Angeles, CA, 90033, United States.
| | - Patricia van Oppen
- Department of Psychiatry, Amsterdam UMC, location VUmc, Netherlands; Amsterdam Public Health Research Institute - Mental Health, Netherlands; GGZ inGeest Specialized Mental Health Care, Netherlands.
| | - Maureen Whittal
- Vancouver CBT Centre, 302-1765 W8th Avenue, Vancouver, British Columbia, V6J5C6, Canada; Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada.
| | - Monnica T Williams
- School of Psychology, University of Ottawa, 136 Jean-Jacques Lussier Pvt, Ottawa, K1N 6N5, Ontario, Canada.
| | - Timothy Williams
- Department of Psychology, University of Reading, PO Box 217, Reading, Berkshire, RG6 6AH, United Kingdom.
| | - Elna Yadin
- Department of Psychiatry, University of Pennsylvania, 3535 Market Street, 2nd Floor, Philadelphia, PA 19104, United States.
| | - David Veale
- South London and the Maudsley NHS Foundation Trust & King's College London, Denmark Hill, London, SE5 8 AZ, United Kingdom.
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I Doubt It Is Safe: A Meta-analysis of Self-reported Intolerance of Uncertainty and Threat Extinction Training. BIOLOGICAL PSYCHIATRY GLOBAL OPEN SCIENCE 2021; 1:171-179. [PMID: 36325301 PMCID: PMC9616306 DOI: 10.1016/j.bpsgos.2021.05.011] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 05/28/2021] [Accepted: 05/29/2021] [Indexed: 02/07/2023] Open
Abstract
Background Intolerance of uncertainty (IU), the tendency to find uncertainty distressing, is an important transdiagnostic dimension in mental health disorders. Higher self-reported IU has been linked to poorer threat extinction training (i.e., the updating of threat to safe associations), a key process that is targeted in exposure-based therapies. However, it remains to be seen whether IU-related effects during threat extinction training are reliably and specifically driven by the IU construct or a particular subcomponent of the IU construct over other self-reported measures of anxiety. Methods A meta-analysis of studies from different laboratories (18 experiments; sample N = 1006) was conducted on associations between different variants of self-reported IU (i.e., 27-item, 12-item, inhibitory, and prospective subscales), trait anxiety, and threat extinction training via skin conductance response. The specificity of IU and threat extinction training was assessed against measures of trait anxiety. Results All the self-reported variants of IU, but not trait anxiety, were associated with threat extinction training via skin conductance response (i.e., continued responding to the old threat cue). Specificity was observed for the majority of self-reported variants of IU over trait anxiety. Conclusions The findings suggest that the IU construct broadly accounts for difficulties in threat extinction training and is specific over other measures of self-reported anxiety. These findings demonstrate the robustness and specificity of IU-related effects during threat extinction training and highlight potential opportunities for translational work to target uncertainty in therapies that rely on threat extinction principles such as exposure therapy.
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McInerney J, Brown P, Bird JC, Nickless A, Brown G, Freeman D. Does raising heart rate prior to a behavioural test enhance learning in cognitive therapy for anxiety? An experimental test for the treatment of fear of heights using virtual reality. Behav Res Ther 2021; 144:103928. [PMID: 34246887 DOI: 10.1016/j.brat.2021.103928] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2020] [Revised: 06/18/2021] [Accepted: 06/29/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND A key clinical issue is how to maximise the belief change central to cognitive therapy. Physiological arousal is a key internal cue confirming threat beliefs in anxiety disorders. Deeper extinction of anxiety may occur if catastrophizing responses to physiological arousal are inhibited prior to joint exposure with external phobic stimuli. The aim of the study was to test whether increasing physiological arousal using exercise increases the benefits of behavioural tests. METHODS Sixty individuals with a fear of heights had one session of VR cognitive treatment. They were randomised to have the treatment either with periods of intense physical exercise (cycling at 80% of maximum heart rate) prior to exposures or without. Linear mixed effects models were used to check the manipulation and test the primary hypothesis of a group difference in degree of conviction in the phobic threat belief. RESULTS Heart rate was significantly higher in the exercise group throughout compared with the control group. Both groups showed significant reductions in threat beliefs after the VR treatment (d = 1.0, p < 0.001) but there was no significant group difference (d = 0.1, p = 0.56). DISCUSSION An increase in physiological arousal achieved via exercise did not enhance cognitive change in beliefs about feared stimuli.
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Affiliation(s)
- Josephine McInerney
- Royal Holloway, University of London, UK; Broadmoor Hospital, West London NHS Trust, UK.
| | - Poppy Brown
- Department of Psychiatry, University of Oxford, UK
| | - Jessica C Bird
- Department of Psychiatry, University of Oxford, UK; Oxford Health NHS Foundation Trust, UK
| | | | - Gary Brown
- Royal Holloway, University of London, UK
| | - Daniel Freeman
- Department of Psychiatry, University of Oxford, UK; Oxford Health NHS Foundation Trust, UK
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Morriss J, Zuj DV, Mertens G. The role of intolerance of uncertainty in classical threat conditioning: Recent developments and directions for future research. Int J Psychophysiol 2021; 166:116-126. [PMID: 34097936 DOI: 10.1016/j.ijpsycho.2021.05.011] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 05/14/2021] [Accepted: 05/31/2021] [Indexed: 11/25/2022]
Abstract
Intolerance of uncertainty (IU), the tendency to find uncertainty aversive, is an important transdiagnostic dimension in mental health disorders. Over the last decade, there has been a surge of research on the role of IU in classical threat conditioning procedures, which serve as analogues to the development, treatment, and relapse of anxiety, obsessive-compulsive, and trauma- and stressor-related disorders. This review provides an overview of the existing literature on IU in classical threat conditioning procedures. The review integrates findings based on the shared or discrete parameters of uncertainty embedded within classical threat conditioning procedures. Under periods of unexpected uncertainty, where threat and safety contingencies change, high IU, over other self-reported measures of anxiety, is specifically associated with poorer threat extinction learning and retention, as well as overgeneralisation. Under periods of estimation and expected uncertainty, where the parameters of uncertainty are being learned or have been learned, such as threat acquisition training and avoidance learning, the findings are mixed for IU. These findings provide evidence that individual differences in IU play a significant role in maintaining learned fear and anxiety, particularly under volatile environments. Recommendations for future research are outlined, with discussion focusing on how parameters of uncertainty can be better defined to capture how IU is involved in the maintenance of learned fear and anxiety. Such work will be crucial for understanding the role of IU in neurobiological models of uncertainty-based maintenance of fear and anxiety and inform translational work aiming to improve the diagnosis and treatment of relevant psychopathology.
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Affiliation(s)
- Jayne Morriss
- Centre for Integrative Neuroscience and Neurodynamics, School of Psychology and Clinical Language Sciences, University of Reading, Reading, UK
| | - Daniel V Zuj
- Experimental Psychopathology Lab, Department of Psychology, Swansea University, Swansea, UK
| | - Gaëtan Mertens
- Department of Medical and Clinical Psychology, Tilburg University, Tilburg, the Netherlands.
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Benito KG, Machan J, Freeman JB, Garcia AM, Walther M, Frank H, Wellen B, Stewart E, Edmunds J, Sapyta J, Franklin ME. Therapist Behavior During Exposure Tasks Predicts Habituation and Clinical Outcome in Three Randomized Controlled Trials for Pediatric OCD. Behav Ther 2021; 52:523-538. [PMID: 33990231 PMCID: PMC8124089 DOI: 10.1016/j.beth.2020.07.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Revised: 07/07/2020] [Accepted: 07/12/2020] [Indexed: 12/13/2022]
Abstract
This study measured therapist behaviors in relation to subsequent habituation within exposure tasks, and also tested their direct and indirect relationships (via habituation) with clinical outcomes of exposure therapy. We observed 459 videotaped exposure tasks with 111 participants in three clinical trials for pediatric obsessive-compulsive disorder (POTS trials). Within exposure tasks, therapist behaviors and patient fear were coded continuously. Outcomes were habituation and posttreatment change in symptom severity, global improvement, and treatment response. More therapist behaviors that encourage approach-and less use of accommodation, unrelated talk, and externalizing language-predicted greater subsequent habituation during individual exposure tasks (exposure-level), and also predicted improved patient clinical outcomes via higher "total dose" of habituation across treatment (patient-level indirect effect). For six of seven therapist behaviors analyzed, the relationship with subsequent habituation within exposure differed by patient fear (low, moderate, or high) at the time the behavior was used. Two therapist behaviors had direct effects in the opposite direction expected; more unrelated talk and less intensifying were associated with greater patient symptom reduction. Results shed light on the "black box" of in-session exposure activities and point to specific therapist behaviors that may be important for clinical outcomes. These behaviors might be best understood in the context of changing patient fear during exposure tasks. Future studies should test whether therapist behaviors can be experimentally manipulated to produce improvement in clinical outcomes.
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Affiliation(s)
| | - Jason Machan
- Lifespan Biostatistics Core, Lifespan Hospitals; Warren Alpert Medical School of Brown University; University of Rhode Island
| | | | | | | | | | | | | | - Julie Edmunds
- Massachusetts General Hospital, Harvard Medical School
| | | | - Martin E Franklin
- Perelman School of Medicine, University of Pennsylvania, & Rogers Behavioral Health
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Armstrong T, Federman S, Hampson K, Crabtree O, Olatunji BO. Fear Learning in Veterans With Combat-Related PTSD Is Linked to Anxiety Sensitivity: Evidence From Self-Report and Pupillometry. Behav Ther 2021; 52:149-161. [PMID: 33483112 DOI: 10.1016/j.beth.2020.03.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Revised: 03/24/2020] [Accepted: 03/26/2020] [Indexed: 11/30/2022]
Abstract
Several studies have observed heightened Pavlovian fear conditioning in PTSD. However, it is unclear how fear conditioning in PTSD is related to risk factors for the disorder, such as anxiety sensitivity. Fifty-one combat-exposed veterans (20 with PTSD, 31 without PTSD) completed a differential fear conditioning task in which one colored rectangle (CS+) predicted a loud scream (US), whereas a different colored rectangle (CS-) predicted no US. Veterans with PTSD were characterized by greater anxiety to the CS+ but not the CS- during acquisition and extinction, and greater US expectancy during the CS+ but not the CS- at extinction. Also, veterans with PTSD had greater pupil dilation to both CSs at extinction, but not at acquisition. Anxiety sensitivity was correlated with anxiety and US expectancy in response to the CS+, but not the CS-, at both acquisition and extinction, and also with pupil diameter to both the CS+ and CS- at extinction. Nearly all of these relations held when covarying for PTSD symptoms and trait anxiety. These findings suggest that increased fear conditioning in PTSD may be related to elevated anxiety sensitivity.
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Innovations in the Delivery of Exposure and Response Prevention for Obsessive-Compulsive Disorder. Curr Top Behav Neurosci 2021; 49:301-329. [PMID: 33590457 DOI: 10.1007/7854_2020_202] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Obsessive-Compulsive Disorder is an important cause of global health-related disability. In the last several decades, exposure and response prevention (EX/RP) has emerged as one of the most evidence-based treatments for adult and pediatric OCD. Recommended as a first-line treatment in practice guidelines for OCD, EX/RP, when expertly delivered, can be superior to serotonin reuptake inhibitor (SRI) medications alone and superior to adding antipsychotic medication to augment SRI treatment response. Despite a robust evidence base, EX/RP is not widely available. Moreover, although effective, only about half of patients who receive a standard course of EX/RP will achieve remission.This chapter will review innovations in delivering EX/RP, focusing on technology-based methods designed to increase access to EX/RP and translational neuroscience approaches to personalizing and optimizing EX/RP. Technology-based innovations to deliver EX/RP include video conferencing, internet-based treatment, and smartphone apps. Of these, internet-based, clinician-supported treatment has the most evidence base to date. Relevant to all technology-based innovations are the need for advances in the ethical, regulatory and financial aspects of understanding how access to EX/RP may be delivered to individuals of diverse socioeconomic backgrounds in accordance with professional standards and regulations and covered by healthcare.Advances in our understanding of the neural processes underlying learning and memory have led to new ways to combine EX/RP with medications, behavioral interventions, or neuromodulatory methods, with the goal of enhancing the functioning of brain circuits that subserve fear processing and cognitive control. Among the pharmacological approaches to enhancing EX/RP outcome, both ketamine and cannabinoids show promise in small open trials but are in need of further study. Studies to train cognitive control are at an early stage of development yet provide preliminary evidence that training neural processes may be a new path to personalize treatment. How best to combine EX/RP with different types of neuromodulation is being actively studied.Together these innovations in the delivery of EX/RP for OCD hold great promise for improving outcomes of care for individuals with OCD by increasing the availability and the individual treatment effects of this already effective treatment.
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Herzog P, Jelinek L. Die Rolle von Verhaltensexperimenten in der Behandlung von Zwangsstörungen: Ein Update zur effektiven Gestaltung und Durchführung in der Praxis. VERHALTENSTHERAPIE 2020. [DOI: 10.1159/000511923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Das Ziel des Artikels ist es, den neuesten Stand zum effektiven Einsatz von Verhaltensexperimenten im Rahmen der Psychotherapie für Zwangsstörungen darzulegen. Dazu werden im ersten Teil die evidenzbasierten Psychotherapien zur Behandlung von Zwangsstörungen vorgestellt sowie die Probleme bei der Implementierung dieser Verfahren aufgezeigt. Dabei zeigt sich, dass trotz der guten Evidenzlage die Verfahren zu selten eingesetzt werden und so die Forschungs-Praxis-Lücke fördern. Im Anschluss werden die zugrundeliegenden Rationale zur Durchführung von Verhaltensexperimenten erläutert, in Bezug zu aktuellen Forschungsarbeiten gestellt und damit die Bedeutung von Verhaltensexperimenten in der Therapie von Zwangsstörungen unterstrichen. Daraus werden Empfehlungen für die effektive Umsetzung von Verhaltensexperimenten in der Praxis abgeleitet. Die Funktionsanalyse der zwangsspezifischen Symptomatik stellt das zentrale Element im Rahmen der Behandlung von Zwangsstörungen dar. Dabei müssen die Verhaltensexperimente an die individuell befürchtete Konsequenz bei Unterlassen von Ritualen und Sicherheitsverhalten (d.h. die furchtbasierte Überzeugung) ausgerichtet sein, um eine maximale Erwartungsverletzung zu ermöglichen. Klinische Fallbeispiele werden skizziert, anhand deren effektive Verhaltensexperimente anschaulich und praxisnah dargestellt werden. Abschließend werden noch Hinweise, Tipps und Fallstricke für Praktiker zur Durchführung von effektiven Verhaltensexperimenten beleuchtet und die Grenzen von Verhaltensexperimenten benannt.
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Holly PW. Interoception the foundation for: mind's sensing of 'self,' physiological responses, cognitive discrimination and dysregulation. Commun Integr Biol 2020; 13:198-213. [PMID: 33343801 PMCID: PMC7734082 DOI: 10.1080/19420889.2020.1846922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 11/02/2020] [Accepted: 11/02/2020] [Indexed: 11/25/2022] Open
Abstract
This article presents a theory of mind whereby interoception (i.e., a sense of signals originating from the body) provides a transdisciplinary framework in which theories from diverse fields may be conformed to ideas from other areas of science. Through a science of interoception, the mind itself investigates the mind and thus can explore how the universe and consciousness came about and understand how interoceptive processing is shaped by experience. Interoception provides a metastable network that enables individuals to compute the significance of stimuli as physiological changes in its complex global context. Both sensory and much cognitive discrimination and integration are affected by the flow of interoceptive information that acts as cues whereby unconscious events may be correlated with conscious events and the reportable content of mental life. Heightened interoceptive sensitivity and individuals who show augmented interoceptive sensitivity are susceptible to a wide range of neuropsychiatric as well as general medical conditions. Physiological responses can be measured and interoceptive awareness cultivated to generate well-being and stress resilience in the treatment of emotional dysregulation and interoceptive abnormalities.
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Kim JW, Kang HJ, Lee JY, Kim SW, Shin IS, Kim JM. Advanced Cognitive-Behavioral Treatment Model with Exposure-Response Prevention for Treating Obsessive-Compulsive Disorder. Psychiatry Investig 2020; 17:1060-1063. [PMID: 33198434 PMCID: PMC7711113 DOI: 10.30773/pi.2020.0340] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2020] [Revised: 09/14/2020] [Accepted: 09/15/2020] [Indexed: 12/05/2022] Open
Affiliation(s)
- Ju-Wan Kim
- Department of Psychiatry, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Hee-Ju Kang
- Department of Psychiatry, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Ju-Yeon Lee
- Department of Psychiatry, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Sung-Wan Kim
- Department of Psychiatry, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Il-Seon Shin
- Department of Psychiatry, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Jae-Min Kim
- Department of Psychiatry, Chonnam National University Medical School, Gwangju, Republic of Korea
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Leeuwerik T, Cavanagh K, Forrester E, Hoadley C, Jones AM, Lea L, Rosten C, Strauss C. Participant perspectives on the acceptability and effectiveness of mindfulness-based cognitive behaviour therapy approaches for obsessive compulsive disorder. PLoS One 2020; 15:e0238845. [PMID: 33085672 PMCID: PMC7577499 DOI: 10.1371/journal.pone.0238845] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Accepted: 08/25/2020] [Indexed: 01/13/2023] Open
Abstract
Cognitive behavioural therapy (CBT) which includes Exposure and Response (ERP) is a highly effective, gold standard treatment for Obsessive-Compulsive Disorder (OCD). Nonetheless, not all patients with OCD significantly benefit from CBT. This has generated interest in the potential benefits of Mindfulness-Based Interventions (MBIs), either integrated with CBT, to enhance engagement with ERP tasks, or delivered as a stand-alone, first-line or therapy to augment CBT. This paper reports on two qualitative studies that involved a thematic analysis of interview data with participants in a 10-week Mindfulness-Based ERP (MB-ERP) course (study 1) and a 9-week Mindfulness-Based Cognitive Therapy course adapted for OCD (MBCT-OCD) (study 2). Whilst MB-ERP integrated a mindfulness component into a standard ERP protocol, MBCT-OCD adapted the psychoeducational components of the standard MBCT for depression protocol to suit OCD, but without explicit ERP tasks. Three common main themes emerged across MB-ERP and MBCT-OCD: 'satisfaction with course features', 'acceptability of key therapeutic tasks 'and 'using mindfulness to respond differently to OCD'. Sub-themes identified under the first two main themes were mostly unique to MB-ERP or MBCT-OCD, with the exception of '(struggles with) developing a mindfulness practice routine' whilst most of the sub-themes under the last main theme were shared across MB-ERP and MBCT-OCD participants. Findings suggested that participants generally perceived both MBIs as acceptable and potentially beneficial treatments for OCD, in line with theorised mechanisms of change.
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Affiliation(s)
- Tamara Leeuwerik
- School of Psychology, University of Sussex, Brighton, United Kingdom
| | - Kate Cavanagh
- School of Psychology, University of Sussex, Brighton, United Kingdom
| | | | - Claire Hoadley
- School of Psychology, University of Sussex, Brighton, United Kingdom
| | - Anna-Marie Jones
- Sussex Partnership NHS Foundation Trust, Brighton, United Kingdom
| | - Laura Lea
- Sussex Partnership NHS Foundation Trust, Brighton, United Kingdom
| | - Claire Rosten
- School of Health Science, University of Brighton, Brighton, United Kingdom
| | - Clara Strauss
- School of Psychology, University of Sussex, Brighton, United Kingdom
- Sussex Partnership NHS Foundation Trust, Brighton, United Kingdom
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Wetterneck CT, Leonard RC, Adams TG, Riemann BC, Grau P, Franklin ME. The effects of depression on the treatment of OCD in a residential sample. Bull Menninger Clin 2020; 84:12-33. [PMID: 33074022 DOI: 10.1521/bumc.2020.84.suppa.12] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Studies investigating the impact of depressive symptoms on obsessive-compulsive disorder (OCD) treatment have yielded mixed findings. The purpose of the study is to extend previous research, which primarily used outpatient samples, to determine whether depression affects OCD treatment outcome among patients receiving intensive residential treatment. OCD patients receiving residential treatment based primarily on exposure and response prevention (ERP) provided data regarding symptoms of depression and OCD at admission and discharge. Patients reported large and significant reductions in OCD symptoms over the course of treatment. Change in OCD symptoms was not significantly affected by depressive symptoms, including patients with severe depressive symptoms. Change in depressive symptoms over the course of treatment was, however, robustly related to change in OCD symptoms, especially among patients who began treatment with severe symptoms of depression. These findings suggest that cognitive-behavior therapy delivered in a residential treatment setting drastically reduces OCD symptoms regardless of depressive symptoms.
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Affiliation(s)
- Chad T Wetterneck
- Trauma Recovery Services, Rogers Behavioral Health, Oconomowoc, Wisconsin
| | | | - Thomas G Adams
- Rogers Behavioral Health, Oconomowoc, Wisconsin.,Yale University School of Medicine, Department of Psychiatry, New Haven, Connecticut.,Rogers Behavioral Health, as well as the Clinical Neuroscience Division of the VA National Center for PTSD, West Haven, Connecticut
| | | | - Peter Grau
- Department of Counseling and Education at Marquette University, Milwaukee, Wisconsin
| | - Martin E Franklin
- Rogers Behavioral Health, Oconomowoc, Wisconsin.,Department of Psychiatry at the University of Pennsylvania, Philadelphia, Pennsylvania
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Abstract
BACKGROUND A growing body of research highlights the limitations of traditional methods for studying the process of change in psychotherapy. The science of complex systems offers a useful paradigm for studying patterns of psychopathology and the development of more functional patterns in psychotherapy. Some basic principles of change are presented from subdisciplines of complexity science that are particularly relevant to psychotherapy: dynamical systems theory, synergetics, and network theory. Two early warning signs of system transition that have been identified across sciences (critical fluctuations and critical slowing) are also described. The network destabilization and transition (NDT) model of therapeutic change is presented as a conceptual framework to import these principles to psychotherapy research and to suggest future research directions. DISCUSSION A complex systems approach has a number of implications for psychotherapy research. We describe important design considerations, targets for research, and analytic tools that can be used to conduct this type of research. CONCLUSIONS A complex systems approach to psychotherapy research is both viable and necessary to more fully capture the dynamics of human change processes. Research to date suggests that the process of change in psychotherapy can be nonlinear and that periods of increased variability and critical slowing might be early warning signals of transition in psychotherapy, as they are in other systems in nature. Psychotherapy research has been limited by small samples and infrequent assessment, but ambulatory and electronic methods now allow researchers to more fully realize the potential of concepts and methods from complexity science.
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Affiliation(s)
- Adele M Hayes
- Department of Psychological and Brain Sciences, University of Delaware, 108 Wolf Hall, Newark, DE, 19716, USA.
| | - Leigh A Andrews
- Department of Psychological and Brain Sciences, University of Delaware, 108 Wolf Hall, Newark, DE, 19716, USA
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Integration of Clozapine-associated Harm Obsessions into Cognitive Behavioral Conceptualization and Treatment Planning for Thought Broadcasting: A Case Study. J Psychiatr Pract 2020; 26:329-336. [PMID: 32692132 PMCID: PMC8191597 DOI: 10.1097/pra.0000000000000470] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND OBJECTIVES As many as 30% of individuals with a schizophrenia spectrum disorder experience obsessive-compulsive symptoms (OCS). Clozapine has demonstrated superior efficacy for the treatment of medication-resistant schizophrenia but it is also associated with an increased risk for OCS. Because pharmacologic management of clozapine-related OCS can be particularly challenging, cognitive behavioral therapy (CBT) should be considered. Nevertheless, there are few detailed accounts of CBT for OCS and schizophrenia. METHODS The authors describe the interdisciplinary outpatient care of a client who had a 25-year history of schizoaffective disorder, bipolar type, and OCS. The case formulation was used to guide interventions to target core schemas of being dangerous and defective. The case study describes the cognitive behavioral formulation, treatment targets, treatment course, and functional and symptom response. RESULTS The client received 21 sessions of a formulation-based CBT for psychosis protocol, which included a 6-session course of exposure with response prevention, consisting of imaginal and in vivo exposure to multiple salient harm stimuli. Reduced ratings of distress and a 50% reduction in OCS suggest that habituation and inhibitory learning occurred. The treatment of OCS resulted in the complete resolution of thought broadcasting. Subsequently, the client was more successful in his efforts to adhere to an action schedule. LIMITATIONS The use of both the treatment approach described in this clinical case report and contemporaneous medication management preclude comment on the mechanism(s) of the therapeutic change observed in this case. CONCLUSIONS This report presents a means of conceptualizing the interplay between thought broadcasting and harm obsessions and discusses considerations in identifying and treating individuals with similar comorbid conditions, particularly in the context of clozapine treatment for medication-resistant psychosis.
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Appetitive traits as targets for weight loss: The role of food cue responsiveness and satiety responsiveness. Physiol Behav 2020; 224:113018. [PMID: 32562711 DOI: 10.1016/j.physbeh.2020.113018] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Revised: 06/05/2020] [Accepted: 06/15/2020] [Indexed: 01/12/2023]
Abstract
Individuals with overweight or obesity (OW/OB) are at increased risk for significant physical and psychological comorbidities. The current treatment for OW/OB is behavioral weight loss, which provides psychoeducation on nutrition and physical activity, as well as behavior therapy skills. However, behavioral weight loss is not effective for the majority of the individuals who participate. Research suggests that overeating, or eating past nutritional needs, is one of the leading causes of weight gain. Accumulating evidence suggests that appetitive traits, such as food cue responsiveness and satiety responsiveness, are associated with overeating and weight in youth and adults. The following review presents the current literature on the relationship between food cue responsiveness, satiety responsiveness, overeating, and OW/OB. Research suggests that higher food cue responsiveness and lower satiety responsiveness are associated with overeating and OW/OB cross-sectionally and longitudinally. Emerging data suggest that food cue responsiveness and satiety responsiveness may exist along the same continuum and can be targeted to manage overeating and reduce weight. We have developed a treatment model targeting food cue responsiveness and satiety responsiveness to reduce overeating and weight and have preliminary feasibility, acceptability, and efficacy data, with testing currently being conducted in larger trials. Through programs targeting appetitive traits we hope to develop an alternative weight loss model to assist individuals with a propensity to overeat.
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Homework Completion in Treating Obsessive–Compulsive Disorder with Exposure and Ritual Prevention: A Review of the Empirical Literature. COGNITIVE THERAPY AND RESEARCH 2020. [DOI: 10.1007/s10608-020-10125-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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Electrochemical energy, primordial feelings and feelings of knowing (FOK): Mindfulness-based intervention for interoceptive experience related to phobic and anxiety disorders. Med Hypotheses 2020; 144:109909. [PMID: 32505847 DOI: 10.1016/j.mehy.2020.109909] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 05/16/2020] [Accepted: 05/28/2020] [Indexed: 11/23/2022]
Abstract
This article presents a hypothesis that primordial feelings (e.g., pleasant, unpleasant, or neutral) may be created by the cognizing and categorizing of brain electrochemical activity. The realization of action potentials generated by neurons that cause electrochemical signals to be released and cross synapses may create primordial feelings. A primordial feeling may precede image making and mark the first moment of subjectivity while thinking. It may produce a Feeling of Knowing (FOK) that when associated with physical sensations originating within the body (i.e., interoception) cause a broadly heightened awareness of thought and become a risk factor for certain aspects of mental afflictions. The strategy outlined in this article is to use mindfulness-based interventions (MBIs) and exposure activity to break up the automaticity of habitual reactions to primordial feelings as FOKs associated with interoception and do something different. Thus the individual does not move away from the unpleasant interoceptive experience but instead stays with it and learns to not push the not right experience away but instead just let it be. Through mindfulness-based interventions unpleasant interoception is used to focus one's reactivity to unpleasant primordial feelings and FOKs and break up the automaticity of being driven by them. Thereby, one decides to approach these internal sensations though exposure to the interoceptive not just right sense instead of engaging in neutralizing activity.
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Intolerance of Uncertainty–Focused Treatment for Adolescents With Excessive Worry: A Pilot Feasibility Study. COGNITIVE AND BEHAVIORAL PRACTICE 2020. [DOI: 10.1016/j.cbpra.2019.06.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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