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Lee SJ, Lee SW, Choi M. Standardization of the Korean Version of the Acceptance and Action Questionnaire for Obsessions and Compulsions in University Students and Patients With Obsessive-Compulsive Disorder. Psychiatry Investig 2024; 21:275-283. [PMID: 38569585 PMCID: PMC10990626 DOI: 10.30773/pi.2023.0240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 11/09/2023] [Accepted: 12/21/2023] [Indexed: 04/05/2024] Open
Abstract
OBJECTIVE The Acceptance and Action Questionnaire for Obsessions and Compulsions (AAQ-OC) is a version of the Acceptance and Action Questionnaire (AAQ) that specifically measures unwanted intrusive thoughts and responses (e.g., experiential avoidance) to them. This study aimed to investigate the reliability and validity of the Korean version of the AAQ-OC in clinical and nonclinical Korean samples. METHODS In this study, 561 university students and 121 patients with obsessive-compulsive disorder (OCD) completed the AAQ-OC and several other psychological scales. Descriptive, correlation, and exploratory and confirmatory factor analyses as well as group comparisons were conducted. RESULTS The results of the exploratory and confirmatory factor analyses indicated a two-factor structure that best fits the data in the university sample: Factors 1 and 2 matched the original Valued Action and Willingness subscales, respectively. The reliability analyses revealed that the AAQ-OC and its factors had excellent internal consistencies. As regards the concurrent validity, the AAQ-OC and its factors had a positive correlation with the AAQ-II and Cognitive Fusion Questionnaire. Compared with the university students, the OCD patients had higher AAQ-OC scores, and their obsessive-compulsive symptoms, particularly the two symptom dimensions of responsibility for harm and mistakes and unacceptable thoughts, were significantly associated with the AAQ-OC and two subscales. CONCLUSION The findings of this study confirm the reliability and validity of the Korean version of the AAQ-OC.
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Affiliation(s)
- Seung Jae Lee
- Department of Psychiatry, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
- Department of Psychiatry, Kyungpook National University Hospital, Daegu, Republic of Korea
| | - Sang Won Lee
- Department of Psychiatry, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
- Department of Psychiatry, Kyungpook National University Chilgok Hospital, Daegu, Republic of Korea
| | - Mina Choi
- Institute of Biomedical Engineering Research, Kyungpook National University, Daegu, Republic of Korea
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Hoogerwerf E, Greeven A, Goekoop R, Spinhoven P. Personalized exposure and experience sampling method feedback versus exposure as usual for obsessive-compulsive disorder: a study protocol for a randomized controlled trial. Trials 2024; 25:43. [PMID: 38217045 PMCID: PMC10785525 DOI: 10.1186/s13063-023-07780-5] [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] [Received: 03/20/2023] [Accepted: 11/06/2023] [Indexed: 01/14/2024] Open
Abstract
BACKGROUND Patients with obsessive-compulsive disorder (OCD) suffer from repetitive fearful intrusions which they try to neutralize by performing compulsions. OCD is considered to be the most resistant anxiety disorder with a remission rate of only 53% after a year of an evidence-based treatment. Therefore, it remains an obligation to develop and investigate more effective treatment interventions. This study aims to compare personalized exposure with response prevention (ERP) using experience sampling methodology-based feedback to ERP as usual in patients with OCD. Personalized exposure will be provided screen-to-screen in an ecologically valid (real time and real place) context by means of a smartphone application. This app will also be used to collect both objective and subjective data by means of experience sampling methodology (ESM). This ESM data will be used to identify triggers and protective factors for symptom severity, provide personalized feedback and optimize the effect of ERP. The primary goal of this RCT is to compare the effectiveness of personalized ERP to ERP as usual in the traditional context of a therapist's room in patients with OCD in OCD symptom severity, as well as differences in quality of life, depressive symptoms and anxiety states. Since both self-efficacy and experiential avoidance are known to influence symptom severity in OCS, a secondary goal is to examine if a possible treatment effect is mediated by self-efficacy or experiential avoidance. METHODS This study involves a randomized controlled trial with 20 weekly sessions by 2 groups (ERP as usual versus personalized ERP), repeated measurements at baseline (T0), 5 weeks of treatment (T1), 10 weeks of treatment (T2), 15 weeks of treatment (T3), posttest at 20 weeks (T4), 6 weeks follow-up (T5), 3 months follow-up (T6), 6 months follow-up (T7) and a year follow-up (T8). A hundred and sixty patients with an OCD diagnosis according to DSM-5 criteria will participate. Half of the group will receive exposure with response prevention as usual, the other half will receive personalized exposure with response prevention with a smartphone application and personalized feedback sessions based on experience sampling data. Multilevel mixed modelling analysis will be used to investigate differences in treatment effect, as well as differences in quality of life, depressive symptoms and anxiety states. We will use the macro of Preacher and Hayes and apply bootstrapping methods to assess the possible mediating effect of changes in self-efficacy and experiential avoidance on subsequent treatment effects. DISCUSSION This randomized controlled trial is the first to assess the influence of delivering ERP through video-calling and the use of an ESM intervention on the symptom severity of OCD. Since the global pandemic COVID-19, the use of video-calling to deliver psychological treatments has become more common, increasing the relevance of this study. TRIAL REGISTRATION ICTRP Trial NL8254. Registered on 2019-12-24.
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Affiliation(s)
- Elena Hoogerwerf
- Parnassia Groep Academie, Dadelplein 1, 2552DS, The Hague, The Netherlands.
- Institute of Psychology, Section of Clinical Psychology, Leiden University, Wassenaarseweg 52, 2333 AK, Leiden, The Netherlands.
| | - Anja Greeven
- Parnassia Groep Academie, Dadelplein 1, 2552DS, The Hague, The Netherlands
| | - Rutger Goekoop
- Parnassia Groep Academie, Dadelplein 1, 2552DS, The Hague, The Netherlands
| | - Philip Spinhoven
- Institute of Psychology, Section of Clinical Psychology, Leiden University, Wassenaarseweg 52, 2333 AK, Leiden, The Netherlands
- Department of Psychiatry, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, Leiden, the Netherlands
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Ferrão JVB, do Rosário MC, Fontenelle LF, Ferrão YA. Prevalence and psychopathology features of mental rituals in patients with obsessive-compulsive disorder: A descriptive exploratory study of 1001 patients. Clin Psychol Psychother 2023; 30:1520-1533. [PMID: 37554049 DOI: 10.1002/cpp.2890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Revised: 07/04/2023] [Accepted: 07/17/2023] [Indexed: 08/10/2023]
Abstract
INTRODUCTION Mental rituals (MR) are compulsions with no overt behavioural or motoric signs. It is presently unclear whether MR found in obsessive-compulsive disorder are associated with a distinctive clinical profile. OBJECTIVES The main objectives of this paper were to assess the prevalence and psychopathological correlates of mental rituals in a large sample of OCD patients. METHODS This exploratory case-control study compared 519 patients with versus 447 without MR in terms of sociodemographics, presence and severity of obsessive-compulsive symptoms, psychiatric comorbidities, sensory phenomena, suicidality, and insight. RESULTS Current MR were found in 51.8%, while lifetime MR were found in 55.4% of the sample. The multiple logistic regression model determined that the most relevant clinical factors independently associated with current MR in OCD patients were the absence of any sensory phenomena and the presence of lifetime suicide ideation. CONCLUSION Due to its relation to OCD clinical aspects, MR are a frequent feature among OCD patients. It also seems to be associated with a range of features that are probably relevant for treatment, especially sensory phenomena and suicidality.
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Affiliation(s)
- João Vítor Bueno Ferrão
- Medical School, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, Brazil
| | - Maria Conceição do Rosário
- Brazilian Consortium for Research on Obsessive-Compulsive Spectrum Disorders (C-TOC), Unidade de Psiquiatria da Infância e Adolescência (UPIA), Escola Paulista de Medicina, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
| | - Leonardo F Fontenelle
- Brazilian Consortium for Research on Obsessive-Compulsive Spectrum Disorders (C-TOC), Departamento de Psiquiatria e Medicina Legal da Faculdade de Medicina da Universidade Federal do Rio de Janeiro (UFRJ) e da Faculdade de Medicina da Universidade Federal Fluminense (UFF), Instituto DOr de Pesquisa e Ensino (IDOR), Rio de Janeiro, Brazil
| | - Ygor Arzeno Ferrão
- Brazilian Consortium for Research on Obsessive-Compulsive Spectrum Disorders (C-TOC), Clinical Neurosciences, Medical School, Programa de Pós- Graduação em Ciências da Saúde, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, Brazil
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Hellberg SN, DuBois C, Myers NS, Rodriguez C, Butcher M, Ojalehto HJ, Riemann B, Abramowitz JS. The contribution of guilt sensitivity in the prediction of obsessive-compulsive disorder symptom dimensions: Replication and extension. J Anxiety Disord 2023; 97:102728. [PMID: 37236070 DOI: 10.1016/j.janxdis.2023.102728] [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: 06/08/2022] [Revised: 02/05/2023] [Accepted: 05/17/2023] [Indexed: 05/28/2023]
Abstract
BACKGROUND Obsessive-compulsive disorder (OCD) is associated with particular cognitive processes, such as beliefs about the importance of intrusive thoughts. The present study examined the explanatory power of guilt sensitivity to OCD symptom dimensions after controlling for well-established cognitive predictors. METHODS 164 patients with OCD completed self-reported measures of OCD and depressive symptoms, obsessive beliefs, and guilt sensitivity. Bivariate correlations were examined, and latent profile analysis (LPA) was used to generate groups based on symptom severity scores. Differences in guilt sensitivity were examined across latent profiles. RESULTS Guilt sensitivity was most strongly associated with unacceptable thoughts and responsibility for harm OCD symptoms, and moderately with symmetry. After controlling for depression and obsessive beliefs, guilt sensitivity added explanatory power to the prediction of unacceptable thoughts. LPA identified 3 profiles; profile-based subgroups significantly differed from one another in terms of guilt sensitivity, depression, and obsessive beliefs. CONCLUSIONS Guilt sensitivity is relevant to various OCD symptom dimensions. Above and beyond depression and obsessive beliefs, guilt sensitivity contributed to the explanation of repugnant obsessions. Theory, research, and treatment implications are discussed.
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Affiliation(s)
| | - Chase DuBois
- University of North Carolina at Chapel Hill, United States
| | | | | | - Megan Butcher
- University of North Carolina at Chapel Hill, United States
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Claus N, Miegel F, Jelinek L, Landmann S, Moritz S, Külz AK, Rubel J, Cludius B. Perfectionism as Possible Predictor for Treatment Success in Mindfulness-Based Cognitive Therapy and Metacognitive Training as Third-Wave Treatments for Obsessive-Compulsive Disorder. COGNITIVE THERAPY AND RESEARCH 2023. [DOI: 10.1007/s10608-023-10361-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/28/2023]
Abstract
Abstract
Background
Identifying predictors of treatment outcome can guide treatment selection and optimize use of resources. In patients affected by obsessive-compulsive disorder (OCD), perfectionism has emerged as one possible predictor, with some data suggesting that cognitive-behavioral therapy outcomes are poorer for more perfectionistic patients. Findings so far are inconsistent, however, and research has yet to be extended to newer treatment approaches.
Methods
We administered measures of concern over mistakes, clinical perfectionism, as well as OCD and depression symptom severity to a sample of OCD patients in out-patient group treatments (N = 61), namely, metacognitive training (MCT-OCD) or mindfulness-based cognitive therapy (MBCT) for OCD. Hierarchical data over time was submitted to multi-level analysis.
Results
Neither concern over mistakes nor clinical perfectionism at baseline predicted OCD symptoms across time points. However, concern over mistakes at baseline did significantly predict comorbid depressive symptoms. Furthermore, exploratory analysis revealed change in clinical perfectionism during treatment as a predictor of OCD symptoms at follow-up.
Conclusion
These results suggest that initial concern over mistakes may not prevent patients with OCD from benefitting from third-wave treatments. Change in clinical perfectionism may present a putative process of therapeutic change. Limitations and avenues for future research are discussed.
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Kadivari F, Najafi M, Khosravani V. Childhood emotional maltreatment, maladaptive coping and obsessive-compulsive symptoms in patients with obsessive-compulsive disorder. Clin Psychol Psychother 2023. [PMID: 36639957 DOI: 10.1002/cpp.2829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 12/30/2022] [Accepted: 01/09/2023] [Indexed: 01/15/2023]
Abstract
Previous studies have reported childhood emotional maltreatment (CEM) to be associated with specific obsessive-compulsive (OC) symptoms, but maladaptive coping, which may be the underlying mechanism in this relationship, has not been evaluated yet. Thus, the present study aimed to examine the effects of CEM on the OC symptoms of responsibility for harm and unacceptable thoughts, as well as obsessive-compulsive disorder (OCD) severity, through maladaptive coping, including cognitive avoidance, experiential avoidance and emotional suppression in OCD patients (n = 360). The results showed that CEM had direct effects, as well as indirect effects via cognitive and experiential avoidance and emotional suppression, on responsibility for harm and unacceptable thoughts. In addition, the indirect effect of CEM on OCD severity was significantly mediated by the roles of cognitive avoidance and experiential avoidance. The present study adds new literature to evidence indicating the role of early childhood events in developing and maintaining OCD in which adverse maladaptive coping related to unpleasant childhood abuse plays an important role in OCD. More precisely, OCD patients who experience a history of CEM may further use maladaptive coping to cope with their distress and subsequently experience responsibility for harm, unacceptable thoughts and severe OCD.
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Affiliation(s)
- Faranak Kadivari
- Department of Clinical Psychology, Faculty of Psychology and Educational Sciences, Semnan University, Semnan, Iran
| | - Mahmoud Najafi
- Department of Clinical Psychology, Faculty of Psychology and Educational Sciences, Semnan University, Semnan, Iran
| | - Vahid Khosravani
- Behavioral Sciences Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Moreton SG, Burden-Hill A, Menzies RE. Reduced death anxiety and obsessive beliefs as mediators of the therapeutic effects of psychedelics on obsessive compulsive disorder symptomology. CLIN PSYCHOL-UK 2022. [DOI: 10.1080/13284207.2022.2086793] [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)
- Sam G. Moreton
- School of Psychology, University of Wollongong, Wollongong, Australia
| | - Amber Burden-Hill
- School of Psychology, University of Wollongong, Wollongong, Australia
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Anti-Disgust Cognitive Behavioral Therapy for Contamination-Based Obsessive Compulsive Disorder: A Randomized Controlled Clinical Trial. J Clin Med 2022; 11:jcm11102875. [PMID: 35629000 PMCID: PMC9145879 DOI: 10.3390/jcm11102875] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2022] [Revised: 05/15/2022] [Accepted: 05/18/2022] [Indexed: 02/01/2023] Open
Abstract
Background: Disgust is a strong and persistent emotion that frequently occurs during exposure-based treatments for contamination-based obsessive compulsive disorder (C-OCD). This study aimed to examine the efficacy of augmenting cognitive behavioral therapy (CBT) with a novel type of anti-disgust cognitive intervention in reducing the severity of OCD, disgust propensity/sensitivity, and refusal rate of exposure and response prevention, while simultaneously increasing acceptance of disgust. Materials and Methods: Fifty-five individuals with C-OCD (mean age 28.1 years, SD = 3.52; 77% female) were randomly assigned to 15 weekly sessions of anti-disgust plus CBT (AD-CBT) or CBT alone. They were evaluated for outcomes four times (pretreatment, prior to exposure and response prevention (ERP) sessions, posttreatment, and three-month follow-up), and mixed-design ANOVAs were used to analyze the data. Results: The findings indicated that when compared to CBT alone, AD-CBT significantly reduced OCD severity, disgust propensity/sensitivity, and concurrently increased disgust acceptance (p < 0.001). Additionally, engaging in an anti-disgust cognitive intervention was associated with lower ERP refusal rate (4% vs. 16%). The superiority of AD-CBT over CBT persisted through the three-month follow-up period. Conclusions: The current study suggests that supplementing CBT for C-OCD with an anti-disgust cognitive intervention significantly increased acceptance of disgust and decreased the refusal rate of ERP, OCD severity, and disgust-related factors.
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9
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Akbari M, Seydavi M, Hosseini ZS, Krafft J, Levin ME. Experiential avoidance in depression, anxiety, obsessive-compulsive related, and posttraumatic stress disorders: A comprehensive systematic review and meta-analysis. JOURNAL OF CONTEXTUAL BEHAVIORAL SCIENCE 2022. [DOI: 10.1016/j.jcbs.2022.03.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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10
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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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11
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Angelakis I, Pseftogianni F. Association between obsessive-compulsive and related disorders and experiential avoidance: A systematic review and meta-analysis. J Psychiatr Res 2021; 138:228-239. [PMID: 33866051 DOI: 10.1016/j.jpsychires.2021.03.062] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 03/26/2021] [Accepted: 03/29/2021] [Indexed: 12/22/2022]
Abstract
The associations between the distinct types of obsessive-compulsive and related disorders and experiential avoidance have received mixed evidence. We, thus, undertook this meta-analysis to i) re-examine the association between obsessive-compulsive disorder and experiential avoidance, ii) extend this association to hoarding disorder, trichotillomania, and body dysmorphic disorder, and iii) identify potential variables affecting these associations. Five databases, including Medline, Embase, PsychINFO, Web of Science and CINAHL, were searched until March 15th, 2021. Meta-analyses based on random-effect models were performed. Heterogeneity and publication bias tests were applied using the I2 statistic and the Egger's test. Meta-regression analyses were performed to identify potential moderators affecting the strength of these associations. Thirty-six unique studies based on n = 11,859 participants were identified. The association between obsessive-compulsive disorder and experiential avoidance was moderate (SMD = 0.75, 95% CI = 0.57-0.92), whereas the associations between individual obsessive-compulsive symptoms, including obsessions, responsibility for harm, ordering, checking, washing and neutralizing, and experiential avoidance ranged from low to strong (SMD ranged between 0.41 and 1.06, 95% CI = 0.25 to 1.40). The associations between hoarding disorder (SMD = 0.93, 95% CI = 0.46-1.40), trichotillomania (SMD = 0.56, 95% CI = 0.48-0.63), body dysmorphic disorder (SMD = 1.55, 95% CI = 0.72-2.37) and experiential avoidance were moderate to strong. Meta-regression analyses demonstrated that studies using the AAQ/AAQ-II scales for measuring experiential avoidance, and/or self-report scales for assessing OCRDs contributed smaller effect sizes. These findings suggest that reducing experiential avoidance may be a viable way of complementing exposure strategies in alleviating obsessive-compulsive and related symptoms.
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Affiliation(s)
- Ioannis Angelakis
- University of South Wales, School of Psychology, Pontypridd, Wales, UK.
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12
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Pittenger C, Brennan BP, Koran L, Mathews CA, Nestadt G, Pato M, Phillips KA, Rodriguez CI, Simpson HB, Skapinakis P, Stein DJ, Storch EA. Specialty knowledge and competency standards for pharmacotherapy for adult obsessive-compulsive disorder. Psychiatry Res 2021; 300:113853. [PMID: 33975093 PMCID: PMC8536398 DOI: 10.1016/j.psychres.2021.113853] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Accepted: 03/01/2021] [Indexed: 12/12/2022]
Abstract
Obsessive-compulsive disorder (OCD) affects approximately one person in 40 and causes substantial suffering. Evidence-based treatments can benefit many; however, optimal treatment can be difficult to access. Diagnosis is frequently delayed, and pharmacological and psychotherapeutic interventions often fail to follow evidence-based guidelines. To ameliorate this distressing situation, the International OCD Accreditation Task Force of the Canadian Institute for Obsessive-Compulsive Disorders has developed knowledge and competency standards for specialized treatments for OCD through the lifespan. These are foundational to evidence-based practice and will form the basis for upcoming ATF development of certification/accreditation programs. Here, we present specialty standards for the pharmacological treatment of adult OCD. We emphasize the importance of integrating pharmacotherapy with clear diagnosis, appreciation of complicating factors, and evidence-based cognitive behavioral therapy. Clear evidence exists to inform first- and second-line pharmacological treatments. In disease refractory to these initial efforts, multiple strategies have been investigated, but the evidence is more equivocal. These standards summarize this limited evidence to give the specialist practitioner a solid basis on which to make difficult decisions in complex cases. It is hoped that further research will lead to development of a clear, multi-step treatment algorithm to support each step in clinical decision-making.
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Affiliation(s)
- Christopher Pittenger
- Department of Psychiatry and Yale Child Study Center, Yale University School of Medicine, New Haven, CT, United States.
| | - Brian P Brennan
- Biological Psychiatry Laboratory and Obsessive-Compulsive Disorder Institute, McLean Hospital, Belmont, MA, United States; Department of Psychiatry, Harvard Medical School, Boston, MA, United States
| | - Lorrin Koran
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, United States
| | - Carol A Mathews
- Department of Psychiatry, University of Florida, Gainesville, FL, United States
| | - Gerald Nestadt
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Michele Pato
- Institute for Genomic Health and Department of Psychiatry, SUNY Downstate College of Medicine, Brooklyn, NY, United States
| | - Katharine A Phillips
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI, and Department of Psychiatry, Weill Cornell Medical College, New York, NY, United States
| | - Carolyn I Rodriguez
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, United States; Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, United States
| | - H Blair Simpson
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, United States; Office of Mental Health, Research Foundation for Mental Hygiene, New York Psychiatric Institute, New York, NY, United States
| | - Petros Skapinakis
- Department of Psychiatry, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - Dan J Stein
- Department of Psychiatry and Neuroscience Institute, University of Cape Town, Cape Town, South Africa
| | - Eric A Storch
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, United States
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13
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The Role of Disgust and Threat in Contamination-Related Obsessive–Compulsive Disorder. BEHAVIOUR CHANGE 2021. [DOI: 10.1017/bec.2021.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AbstractTheoretical models suggest that the emotion disgust or threat overestimates are important in the aetiology and maintenance of contamination-based obsessive–compulsive disorder. In the current study, both threat and disgust were manipulated and 115 non-clinical participants (mean age 20.46 years, 94 females) were randomly allocated to one of four conditions: high-disgust/low-threat (n = 29), high-disgust/high-threat (n = 29), low-disgust/low-threat (n = 27), and low-disgust/high-threat (n = 30). Participants completed a hierarchical Behavioural Avoidance Task (BAT). Those in the high-threat and high-disgust conditions completed less BAT steps and showed more latency to begin each step than those in the low-threat and low-disgust conditions. A significant interaction effect was observed for the high-disgust/high-threat condition as significantly more task avoidance was found. However, handwashing duration was not significantly different between the high and low-disgust conditions or the high and low-threat conditions. The overall low mean washing duration of 30 s possibly due to the testing conditions and/or the ethnic heterogeneity of the sample may account for these results. There were also no significant differences in the level of anxiety for participants in the high-threat compared with the low-threat conditions. It is possible that anxiety remained relatively low across conditions as a result of the graduated BAT. Future research and theoretical and clinical implications are discussed.
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Kim JE, Lee SJ. Thought-Action Fusion as Predictors of Obsessive-Compulsive Symptom Dimensions. Psychiatry Investig 2020; 17:1226-1235. [PMID: 34724603 PMCID: PMC8560337 DOI: 10.30773/pi.2020.0292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Accepted: 10/11/2020] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE There have been several studies investigating the relationships between dysfunctional beliefs and obsessive-compulsive (OC) symptoms in obsessive-compulsive disorder (OCD). However, studies about the relationships between dysfunctional beliefs, especially thought-action fusion (TAF), and OC symptom dimensions have been scarce. Therefore, this study examined to what extent and how TAF subcomponents account for unique variability in four OC symptom dimensions. METHODS Sixty-five patients with OCD and 45 healthy controls aged between 18 and 30 years completed measures for OC symptom dimensions, OC symptoms, and dysfunctional beliefs such as TAF, trait-guilt, and inflated responsibility. RESULTS Three facets of TAF were exclusively associated with two symptom domains, namely, responsibility for harm and unacceptable thoughts, and explained the additional but small amount of variance to predict these two domains. In particular, the likelihood-others TAF positively predicted the unacceptable thoughts domain, whereas the likelihood-self TAF negatively predicted the aforementioned domain. For OC symptoms measured by the OC Inventory, no TAF components predicted the corresponding obsessing and mental neutralizing symptoms. CONCLUSION This study provides supporting evidence that the three TAF subcomponents may be differently associated with certain OC symptom dimensions, and a dimensional approach may complement typical symptom-oriented OC measures.
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Affiliation(s)
- Ji Eun Kim
- Department of Psychiatry, School of Medicine, Kyungpook National University, Daegu, Republic of Korea.,Kim Ji Eun Psychiatric Clinic, Daegu, Republic of Korea
| | - Seung Jae Lee
- Department of Psychiatry, School of Medicine, Kyungpook National University, Daegu, Republic of Korea.,Department of Psychiatry, Kyungpook National University Hospital, Daegu, Republic of Korea
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Den Ouden L, Tiego J, Lee RS, Albertella L, Greenwood LM, Fontenelle L, Yücel M, Segrave R. The role of Experiential Avoidance in transdiagnostic compulsive behavior: A structural model analysis. Addict Behav 2020; 108:106464. [PMID: 32428802 DOI: 10.1016/j.addbeh.2020.106464] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Revised: 05/05/2020] [Accepted: 05/06/2020] [Indexed: 12/15/2022]
Abstract
Compulsivity is recognized as a transdiagnostic phenotype, underlying a variety of addictive and obsessive-compulsive behaviors. However, current understanding of how it should be operationalized and the processes contributing to its development and maintenance is limited. The present study investigated if there was a relationship between the affective process Experiential Avoidance (EA), an unwillingness to tolerate negative internal experiences, and the frequency and severity of transdiagnostic compulsive behaviors. A large sample of adults (N = 469) completed online questionnaires measuring EA, psychological distress and the severity of seven obsessive-compulsive and addiction-related behaviors. Using structural equation modelling, results indicated a one-factor model of compulsivity was superior to the two-factor model (addictive- vs OCD-related behaviors). The effect of EA on compulsivity was fully mediated by psychological distress, which in turn had a strong direct effect on compulsivity. This suggests distress is a key mechanism in explaining why people with high EA are more prone to compulsive behaviors. The final model explained 41% of the variance in compulsivity, underscoring the importance of these constructs as likely risk and maintenance factors for compulsive behavior. Implications for designing effective psychological interventions for compulsivity are discussed.
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Angelakis I, Gooding P. Obsessive-Compulsive Disorder and Suicidal Experiences: The Role of Experiential Avoidance. Suicide Life Threat Behav 2020; 50:359-371. [PMID: 31553082 DOI: 10.1111/sltb.12593] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Accepted: 08/26/2019] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Obsessive-compulsive disorder (OCD) is a disabling mental health problem that affects a significant proportion of the general population. Experiential avoidance appears to account for the development of anxiety and depressive symptoms. However, its relationship with OCD has yielded contradictory results. Furthermore, although OCD-specific thoughts and behaviors, including obsessing, checking, washing, and ordering, have been suggested to significantly predict suicidal ideation and behaviors, this line of research has received scant empirical attention. The overarching aim of this study was to explore the relationship between OCD, OCD-specific behaviors, experiential avoidance, and suicidal experiences. METHODS Overall, 1,046 adults from the community who completed self-report scales participated. RESULTS Strong links between overall OCD severity, obsessing, experiential avoidance, and suicidal experiences were established. Results from mediational analyses showed that overall OCD severity and individual obsessive-compulsive thoughts and behaviors were both directly and indirectly linked with suicidal experiences, via experiential avoidance. Obsessing was among the critical obsessive-compulsive symptoms leading to suicidal experiences. CONCLUSIONS These findings are important because they identify experiential avoidance as a potential key explanatory construct in accounting for the development of OCD and suicidal experiences. However, future research using longitudinal and/or experimental designs is needed to infer causality.
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Affiliation(s)
| | - Patricia Gooding
- School of Psychological Sciences, University of Manchester, Manchester, UK
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17
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Falkenstein MJ, Schreck M, Potluri S, Nota JA, Kelley KN, Beard C, Elias JA. Longitudinal Relations of Obsessive Beliefs, Obsessions, and Compulsions During Treatment for Obsessive Compulsive Disorder. COGNITIVE THERAPY AND RESEARCH 2020. [DOI: 10.1007/s10608-020-10093-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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18
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García-Gómez M, Guerra J, López-Ramos VM, Mestre JM. Cognitive Fusion Mediates the Relationship between Dispositional Mindfulness and Negative Affects: A Study in a Sample of Spanish Children and Adolescent School Students. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:E4687. [PMID: 31775280 PMCID: PMC6926870 DOI: 10.3390/ijerph16234687] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Revised: 11/20/2019] [Accepted: 11/21/2019] [Indexed: 11/17/2022]
Abstract
Nowadays, mindfulness-based interventions (MBI) have experienced a remarkable development of studies among childhood and adolescent interventions. For this reason, dispositional mindfulness (DM) measures for children and adolescents have been developed to determine the effectiveness of MBI at this age stage. However, little is known about how key elements of DM (for example, cognitive de/fusion or experiential avoidance that both confirm psychological inflexibility) are involved in the mechanisms of the children and adolescents' mental health outcomes. This research examined the mediating effect of cognitive fusion between DM and anxiety and other negative emotional states in a sample of 318 Spanish primary-school students (aged between 8 and 16 years, M = 11.24, SD = 2.19, 50.8% males). Participants completed the AFQ-Y (Avoidance and Fusion Questionnaire for youth), which is a measure of psychological inflexibility that encompasses cognitive defusion and experiential avoidance; CAMM (DM for children and adolescents), PANAS-N (positive and negative affect measure for children, Spanish version of PANASC), and STAIC (an anxiety measure for children). The study accomplished ethical standards. As MBI relevant literature has suggested, cognitive defusion was a significant mediator between DM and symptoms of both negative emotions and anxiety in children and adolescents. However, experiential avoidance did not show any significant mediating relationship. Probably, an improvement of the assessment of experiential avoidance is needed. MBI programs for children and adolescents may include more activities for reducing effects of the cognitive defusion on their emotional distress.
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Affiliation(s)
- María García-Gómez
- Departamento de Psicobiología, Universidad de Murcia, 30001 Murcia, Spain;
| | - Joan Guerra
- Departamento de Psicología, Universidad de Extremadura, 10071 Cáceres, Spain; (J.G.); (V.M.L.-R.)
| | - Víctor M. López-Ramos
- Departamento de Psicología, Universidad de Extremadura, 10071 Cáceres, Spain; (J.G.); (V.M.L.-R.)
| | - José M. Mestre
- Instituto de Investigación y Desarrollo Social Sostenible (INDESS), Universidad de Cádiz, 11405 Jerez de la Frontera, Spain
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Leeuwerik T, Cavanagh K, Strauss C. The Association of Trait Mindfulness and Self-compassion with Obsessive-Compulsive Disorder Symptoms: Results from a Large Survey with Treatment-Seeking Adults. COGNITIVE THERAPY AND RESEARCH 2019. [DOI: 10.1007/s10608-019-10049-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Abstract
Little is known about the role of mindfulness and self-compassion in obsessive-compulsive disorder. This cross-sectional study examined associations of mindfulness and self-compassion with obsessive-compulsive disorder symptoms and with the obsessive beliefs and low distress tolerance thought to maintain them. Samples of treatment-seeking adults (N = 1871) and non-treatment-seeking adults (N = 540) completed mindfulness, self-compassion, obsessive-compulsive disorder, anxiety, depression, obsessive beliefs and distress tolerance questionnaires. Participants with clinically significant obsessive-compulsive disorder symptoms reported lower trait mindfulness and self-compassion compared to participants with clinically significant anxiety/depression and to non-clinical controls. Among the clinical sample, there were medium-large associations between mindfulness and self-compassion and obsessive-compulsive disorder symptoms, obsessive beliefs and distress tolerance. Mindfulness and self-compassion were unique predictors of obsessive-compulsive disorder symptoms, controlling for depression severity. Once effects of obsessive beliefs and distress tolerance were controlled, a small effect remained for mindfulness (facets) on obsessing symptoms and for self-compassion on washing and checking symptoms. Directions for future research and clinical implications are considered in conclusion.
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20
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Using an Acceptance and Commitment Therapy Approach When Exposure and Cognitive Therapy Become Rituals in the Treatment of Obsessive-Compulsive Disorder. J Cogn Psychother 2019; 33:256-268. [PMID: 32746431 DOI: 10.1891/0889-8391.33.3.256] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Exposure and response prevention (ERP) for obsessive-compulsive disorder (OCD) is often highly effective, yet some patients experience relapses following a seemingly successful course of treatment. In this article we describe the conceptual basis of ERP, and then present a client who relapsed after seemingly achieving substantial improvement following 11 sessions of ERP. Likely reasons for the relapse and strategies for enhancing ERP to achieve better long-term treatment outcomes are discussed from the perspective of acceptance and commitment therapy (ACT). These strategies mainly apply to the implementation of situational (in vivo) and imaginal exposure therapy, but also include suggestions for optimizing the use of cognitive therapy for OCD.
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21
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Manjula M, Sudhir PM. New-wave behavioral therapies in obsessive-compulsive disorder: Moving toward integrated behavioral therapies. Indian J Psychiatry 2019; 61:S104-S113. [PMID: 30745683 PMCID: PMC6343420 DOI: 10.4103/psychiatry.indianjpsychiatry_531_18] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
New-wave behavioral therapies in obsessive-compulsive disorders (OCDs) comprise of third-wave therapies and newer cognitive therapies (CTs). This review covers outcome studies published in English until December 2017. A total of forty articles on mindfulness-based CT, metacognitive therapy, acceptance and commitment therapy, and danger ideation reduction therapy in the form of single-case studies, case series, open-label trials, two-group comparison studies, and randomized controlled studies were included. Results show that studies on these therapies are limited in number. Methodological limitations including lack of active control groups, randomized controlled trials, small sample sizes, and short follow-up periods were also noted. However, the available literature demonstrates the feasibility and utility of these therapies in addressing the issues unresolved by exposure and response prevention (ERP) and cognitive behavior therapy (CBT). These therapies were often combined with traditional ERP and CBT based on the profile and response of the client; hence, it is unclear whether they can be used as standalone therapies in the larger segment of the OCD population. Supplementary use of these strategies alongside established therapies could provide better utilization of resources. In view of the need for such integration, further research is warranted. The use of sound methodologies and establishing the mechanism of action of these therapies would assist in choosing the techniques for integration.
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Affiliation(s)
- M. Manjula
- Department of Clinical Psychology, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India
| | - Paulomi M. Sudhir
- Department of Clinical Psychology, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India
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22
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Reuman L, Buchholz J, Abramowitz JS. Obsessive beliefs, experiential avoidance, and cognitive fusion as predictors of obsessive-compulsive disorder symptom dimensions. JOURNAL OF CONTEXTUAL BEHAVIORAL SCIENCE 2018. [DOI: 10.1016/j.jcbs.2018.06.001] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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23
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Difficulties in emotion regulation and symptom dimensions in patients with obsessive-compulsive disorder. CURRENT PSYCHOLOGY 2018. [DOI: 10.1007/s12144-018-9859-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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24
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Selles RR, Franklin M, Sapyta J, Compton SN, Tommet D, Jones RN, Garcia A, Freeman J. Children's and Parents' Ability to Tolerate Child Distress: Impact on Cognitive Behavioral Therapy for Pediatric Obsessive Compulsive Disorder. Child Psychiatry Hum Dev 2018; 49:308-316. [PMID: 28756555 PMCID: PMC6007877 DOI: 10.1007/s10578-017-0748-6] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The present study explored the concept of tolerance for child distress in 46 children (ages 5-8), along with their mothers and fathers, who received family-based CBT for OCD. The study sought to describe baseline tolerance, changes in tolerance with treatment, and the predictive impact of tolerance on symptom improvement. Tolerance was rated by clinicians on a single item and the CY-BOCS was used to measure OCD severity. Descriptive results suggested that all participants had some difficulty tolerating the child's distress at baseline while paired t tests indicated large improvements were made over treatment (d = 1.2-2.0). Fathers' initial tolerance was significantly related to symptom improvement in a multivariate regression as were fathers' and children's changes in distress tolerance over the course of treatment. Overall, results provide support for examining tolerance of child distress including its predictive impact and potential as a supplemental intervention target.
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Affiliation(s)
- Robert R Selles
- University of British Columbia, Vancouver, Canada.
- BC Children's Hospital Research Institute, Vancouver, Canada.
| | | | | | | | - Doug Tommet
- Alpert Medical School, Brown University, Providence, USA
| | | | - Abbe Garcia
- Alpert Medical School, Brown University, Providence, USA
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25
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Tibi L, van Oppen P, van Balkom AJLM, Eikelenboom M, Hendriks GJ, Anholt GE. The relationship between cognitions and symptoms in obsessive-compulsive disorder. J Affect Disord 2018; 225:495-502. [PMID: 28865371 DOI: 10.1016/j.jad.2017.08.072] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2017] [Revised: 08/18/2017] [Accepted: 08/27/2017] [Indexed: 01/10/2023]
Abstract
BACKGROUND The cognitive theory of obsessive-compulsive disorder (OCD) ascertains that catastrophic (mis)interpretations of normally occurring intrusive thoughts are related to the maintenance of OCD. Nonetheless, findings supporting the relationship between cognitive biases and OCD symptoms are largely inconsistent. In the present study we examined the relationship between OCD cognitions and symptoms among 382 OCD patients participating in the longitudinal Netherlands Obsessive Compulsive Disorder Association (NOCDA) study. METHODS OCD cognitions and OC, anxiety and depressive symptoms were assessed using self-report questionnaires at baseline and at two-year follow-up. Baseline multiple regression analyses assessed the specificity of OC cognitions to OCD symptoms. Cross-lagged analyses examined whether cognitions predict OCD symptoms at two-year follow up. RESULTS Baseline analyses demonstrated significant relationships between comorbid anxiety, depressive severity and OC cognitions, adjusted for OCD symptoms (β = .283, p < .001 and β = .246, p < .001, respectively). OCD severity adjusted for comorbid symptoms was unrelated to cognitions at baseline (β = .040, p = n.s). Unique associations were found between cognitions and two OCD symptom subtypes (Impulses: β = .215, p < .001; Rumination/doubting: β = .205, p < .001). Longitudinal analyses yielded non-significant associations between OCD cognitions and symptom severity. Prospective analyses of cognitions and OCD symptom subtypes yielded significant effects for both bidirectional and unidirectional associations (β = .11-.16, p < .05). LIMITATIONS Given the naturalistic design of the study, we did not assess therapeutic interventions between baseline and follow-up. CONCLUSIONS Results only partially concord with the predictions of the cognitive theory of OCD. Future studies should focus on mechanisms alternative to cognitions when investigating the course of OCD.
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Affiliation(s)
- Lee Tibi
- Department of Psychology, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
| | - Patricia van Oppen
- Department of Psychiatry and EMGO Institute for Health and Care Research, VU University Medical Center, GGZ InGeest, Amsterdam, The Netherlands
| | - Anton J L M van Balkom
- Department of Psychiatry and EMGO Institute for Health and Care Research, VU University Medical Center, GGZ InGeest, Amsterdam, The Netherlands
| | - Merijn Eikelenboom
- Department of Psychiatry and EMGO Institute for Health and Care Research, VU University Medical Center, GGZ InGeest, Amsterdam, The Netherlands
| | - Gert-Jan Hendriks
- Institute of Integrated Mental Health Care "Pro Persona", Centre for Anxiety Disorders "Overwaal", Lent, The Netherlands; University Center for Psychiatry, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands; Department of Psychiatry, Radboud University Medical Centre, Radboud University Nijmegen, Nijmegen, The Netherlands
| | - Gideon E Anholt
- Department of Psychology, Ben-Gurion University of the Negev, Beer-Sheva, Israel
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26
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Miller ML, Brock RL. The effect of trauma on the severity of obsessive-compulsive spectrum symptoms: A meta-analysis. J Anxiety Disord 2017; 47:29-44. [PMID: 28242410 DOI: 10.1016/j.janxdis.2017.02.005] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2016] [Revised: 02/03/2017] [Accepted: 02/08/2017] [Indexed: 01/27/2023]
Abstract
It is important to consider trauma-related sequelae in the etiology and maintenance of psychopathology, namely understudied disorders such as those belonging to the Obsessive-Compulsive Spectrum (OCS). This meta-analysis examined the association between past trauma exposure and current severity of OCS disorder symptoms. A systematic literature search was conducted with 24 (N=4557) articles meeting inclusion criteria. A significant overall effect size was obtained (r=0.20), indicating that exposure to past trauma is associated with a higher severity of OCS symptoms, with a stronger association for females (β=0.01, p<.001) but not varying as a function of relationship status. Four types of interpersonal trauma (violence, emotional abuse, sexual abuse, and neglect) were associated with OCS symptom severity (r=0.19 -0.24) and past trauma was significantly associated with more severe compulsions (r=0.17), but not obsessions. Results suggest an important link between multiple types of past trauma exposure and OCS symptoms.
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27
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Reuman L, Jacoby RJ, Abramowitz JS. Cognitive Fusion, Experiential Avoidance, and Obsessive Beliefs as Predictors of Obsessive-Compulsive Symptom Dimensions. Int J Cogn Ther 2016. [DOI: 10.1521/ijct_2016_09_13] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Affiliation(s)
| | | | - Jonathan S. Abramowitz
- Department of Psychology and Neuroscience, University of North Carolina – Chapel Hill, Chapel Hill, North Carolina
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28
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Hezel DM, McNally RJ. A Theoretical review of cognitive biases and deficits in obsessive–compulsive disorder. Biol Psychol 2016; 121:221-232. [DOI: 10.1016/j.biopsycho.2015.10.012] [Citation(s) in RCA: 62] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2015] [Revised: 10/29/2015] [Accepted: 10/29/2015] [Indexed: 11/28/2022]
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29
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Diedrich A, Sckopke P, Schwartz C, Schlegl S, Osen B, Stierle C, Voderholzer U. Change in obsessive beliefs as predictor and mediator of symptom change during treatment of obsessive-compulsive disorder - a process-outcome study. BMC Psychiatry 2016; 16:220. [PMID: 27388205 PMCID: PMC4937602 DOI: 10.1186/s12888-016-0914-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2015] [Accepted: 06/08/2016] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Cognitive models of obsessive-compulsive disorder suggest that changes in obsessive beliefs are a key mechanism of treatments for obsessive-compulsive disorder. Thus, in the present process-outcome study, we tested whether changes in obsessive beliefs during a primarily cognitive behavioral inpatient treatment predicted treatment outcome and whether these changes mediated symptom changes over the course of treatment. METHODS Seventy-one consecutively admitted inpatients with obsessive-compulsive disorder were assessed with the Yale-Brown Obsessive-Compulsive Scale and the Obsessive Beliefs Questionnaire at treatment intake, after six weeks of treatment and at discharge, and with the Beck-Depression-Inventory-II at intake and discharge. RESULTS Changes in obsessive beliefs during the first six weeks of treatment predicted obsessive-compulsive symptoms at discharge when controlling for obsessive-compulsive and depressive symptoms at intake in a hierarchical regression analysis. Multilevel mediation analyses showed that reductions in obsessive beliefs partially mediated improvements in obsessive-compulsive symptoms over time. CONCLUSIONS Our findings indicate that decreasing obsessive beliefs in inpatient cognitive behavioral therapy for obsessive-compulsive disorder might be a promising treatment approach.
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Affiliation(s)
- Alice Diedrich
- Department of Psychiatry and Psychotherapy, University of Munich (LMU), Nußbaumstr. 7, 80336, Munich, Germany.
| | - Philipp Sckopke
- Department of Psychology, University of Munich (LMU), Leopoldstr. 13, 80802 Munich, Germany
| | - Caroline Schwartz
- Department of Psychiatry and Psychotherapy, University of Munich (LMU), Nußbaumstr. 7, 80336 Munich, Germany
| | - Sandra Schlegl
- Department of Psychiatry and Psychotherapy, University of Munich (LMU), Nußbaumstr. 7, 80336 Munich, Germany
| | - Bernhard Osen
- Schön Clinic Bad Bramstedt, Birkenweg 10, 24576 Bad Bramstedt, Germany
| | - Christian Stierle
- Schön Clinic Bad Bramstedt, Birkenweg 10, 24576 Bad Bramstedt, Germany
| | - Ulrich Voderholzer
- Schön Clinic Roseneck, Am Roseneck 6, 83209 Prien am Chiemsee, Germany ,Department of Psychiatry and Psychotherapy, University of Freiburg, Hauptstr. 5, 79104 Freiburg, Germany
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Wu MS, McGuire JF, Horng B, Storch EA. Further psychometric properties of the Yale-Brown Obsessive Compulsive Scale - Second Edition. Compr Psychiatry 2016; 66:96-103. [PMID: 26995242 DOI: 10.1016/j.comppsych.2016.01.007] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2015] [Revised: 12/08/2015] [Accepted: 01/14/2016] [Indexed: 01/04/2023] Open
Abstract
The Yale-Brown Obsessive Compulsive Scale (Y-BOCS) is a widely used clinician-rated measure for assessing obsessive-compulsive symptoms. Although numerous studies have supported its reliability and validity, improved phenomenological understanding of obsessive-compulsive disorder (OCD) suggests the need for modifications to item content, structure, and scoring. Consequently, the Yale-Brown Obsessive Compulsive Scale - Second Edition (Y-BOCS-II) was developed. While the Y-BOCS-II shows initial promise, minimal data exist in examining the psychometric properties of the Y-BOCS-II English version. In response, the Y-BOCS-II was administered to 61 adult patients with a principal diagnosis of obsessive-compulsive disorder. The internal consistency for the scores on the Obsession Severity (α=.83), Compulsion Severity (α=.75), and Total Severity (α=.86) scales were acceptable to good. The inter-rater reliability for the severity scale scores was excellent (ICC=.97-99) and the test-retest reliability was acceptable (r=.64-81). Strong convergent validity was observed between the Y-BOCS-II Total Severity scale and other measures of obsessive-compulsive symptom severity and related impairment. Good divergent validity was supported by non-significant correlations between the Total Severity score and measures of anxiety and impulsiveness, though a moderate correlation was observed with depressive symptoms. Collectively, the Y-BOCS-II generally possesses sound psychometric properties and appears to be a viable alternative to the original Y-BOCS.
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Affiliation(s)
- Monica S Wu
- Department of Pediatrics, University of South Florida, St. Petersburg, FL, USA; Department of Psychology, University of South Florida, Tampa, FL, USA.
| | - Joseph F McGuire
- Department of Pediatrics, University of South Florida, St. Petersburg, FL, USA; Department of Psychology, University of South Florida, Tampa, FL, USA
| | - Betty Horng
- Department of Pediatrics, University of South Florida, St. Petersburg, FL, USA
| | - Eric A Storch
- Department of Pediatrics, University of South Florida, St. Petersburg, FL, USA; Department of Psychology, University of South Florida, Tampa, FL, USA; Department of Psychiatry and Behavioral Neurosciences, University of South Florida, Tampa, FL, USA; Department of Health Management and Policy, University of South Florida, Tampa, FL, USA; Rogers Behavioral Health-Tampa Bay, Tampa, FL, USA; All Children's Hospital-Johns Hopkins Medicine, St. Petersburg, FL, USA
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31
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Chang WH, Chi L, Lin SH, Ye YC. Psychometric Properties of the Acceptance and Action Questionnaire – II for Taiwanese College Students and Elite Athletes. CURRENT PSYCHOLOGY 2015. [DOI: 10.1007/s12144-015-9395-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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32
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The Relative Contributions of Experiential Avoidance and Distress Tolerance to OC Symptoms. Behav Cogn Psychother 2015; 44:460-71. [PMID: 26639901 DOI: 10.1017/s1352465815000703] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Obsessive beliefs account for substantial (but not all) obsessive-compulsive (OC) symptoms. Intolerance of internal experiences (IIE), which encompasses the constructs of experiential avoidance (EA) and distress tolerance (DT), refers to difficulty managing unwanted thoughts, emotions, and other internal states, and might add to current explanatory models. Although IIE appears to be conceptually relevant to obsessive-compulsive (OC) symptoms, scant research has examined this relationship empirically. AIM The present study examined the relative contributions of EA and DT as predictors of OC symptom dimensions. METHOD A nonclinical sample (n = 496) completed self-report questionnaires measuring general distress, EA, DT and OC symptom dimensions. RESULTS All variables of interest were significantly (all ps ≤ .001) correlated with one another, such that higher general distress, higher EA, and lower DT were associated with greater OC symptom severity for all symptom dimensions; however, only EA independently predicted obsessional symptoms, but not other OC symptom dimensions. CONCLUSIONS One's willingness to endure (i.e. EA), rather than their ability to tolerate (i.e. DT) unpleasant internal experiences best predicts obsessional symptoms (i.e. obsessing) above and beyond general distress. Potential implications for understanding, assessing, and treating OC symptoms are discussed.
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Noorian Z, Deu AF, Romero K, Ferreira E, Domenèch-Llaberia E. The Contribution of Dysfunctional Obsessive Beliefs in Obsessive-Compulsive Symptoms Among Adolescents. Int J Cogn Ther 2015. [DOI: 10.1521/ijct.2015.8.3.271] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Melli G, Avallone E, Moulding R, Pinto A, Micheli E, Carraresi C. Validation of the Italian version of the Yale-Brown Obsessive Compulsive Scale-Second Edition (Y-BOCS-II) in a clinical sample. Compr Psychiatry 2015; 60:86-92. [PMID: 25842194 DOI: 10.1016/j.comppsych.2015.03.005] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2014] [Revised: 02/24/2015] [Accepted: 03/19/2015] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE The Yale-Brown Obsessive Compulsive Scale (Y-BOCS) is the most widely accepted measure of obsessive-compulsive disorder (OCD) symptom severity. Recently, the scale has been revised into a second edition (Y-BOCS-II) in order to improve its measurement properties. The present study aimed to evaluate the psychometric properties of the Italian version of the Y-BOCS-II Severity Scale (SS) in a large clinical sample. METHOD The original version of the Y-BOCS-II was translated into Italian, which involved forward and back-translation procedures. The Italian Y-BOCS-II-SS was administered to one hundred twenty-five treatment-seeking adults with OCD, together with the original Y-BOCS-SS and a battery of self-report measures assessing OCD symptom severity and depressive and anxious symptomology. The factor structure, internal consistency, temporal stability, and construct validity were investigated on the whole sample, while inter-rater and test-retest reliability were assessed on a subsample of participants. RESULTS Factor analyses revealed a two-factor structure different from those of the original scale, comprising (1) symptom severity; and (2) interference from symptoms. Internal consistency, test-retest reliability over a 2-week period and inter-rater reliability were satisfactory. The Y-BOCS-II-SS also showed excellent construct validity (and better than the Y-BOCS-SS), with good convergent and discriminant validity when assessed against other OCD symptom measures and measures of depression, anxiety and worry. CONCLUSIONS These findings suggest that the Italian version of the Y-BOCS-II-SS retains the adequate psychometric properties of the original and that it can be confidently used as an assessment tool of OCD symptoms in both clinical and research settings.
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Affiliation(s)
- Gabriele Melli
- Institute of Behavioral and Cognitive Psychology and Psychotherapy, Florence, Italy; University of Pisa, Pisa, Italy.
| | | | - Richard Moulding
- Centre for Mental Health and Wellbeing Research, Deakin University, Melbourne, Australia
| | - Antonio Pinto
- Cognitive and Behavioral Psychotherapy Center, Naples, Italy
| | - Elena Micheli
- Institute of Behavioral and Cognitive Psychology and Psychotherapy, Florence, Italy
| | - Claudia Carraresi
- Institute of Behavioral and Cognitive Psychology and Psychotherapy, Florence, Italy
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Vakili Y, Gharaee B, Habibi M. Acceptance and Commitment Therapy, Selective Serotonin Reuptake Inhibitors and Their Combination in the Improvement of Obsessive-Compulsive Symptoms and Experiential Avoidance in Patients With Obsessive-Compulsive Disorder. IRANIAN JOURNAL OF PSYCHIATRY AND BEHAVIORAL SCIENCES 2015; 9:e845. [PMID: 26288647 PMCID: PMC4539588 DOI: 10.17795/ijpbs845] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/20/2013] [Revised: 06/20/2014] [Accepted: 09/05/2014] [Indexed: 11/25/2022]
Abstract
BACKGROUND Selective serotonin reuptake inhibitors (SSRIs) and exposure with response prevention for treatment of obsessive-compulsive disorder (OCD) have demonstrated empirical support; however, a substantial number of patients remain with clinically significant OCD symptoms after such treatments. OBJECTIVES The aim of this study was to compare the effectiveness of acceptance and commitment therapy (ACT), selective serotonin reuptake inhibitors (SSRIs) and combination of ACT and SSRIs in the treatment of adults with obsessive-compulsive disorder (OCD). PATIENTS AND METHODS Thirty-two outpatients meeting Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision criteria for OCD were randomly assigned to one of the three treatment conditions: ACT, SSRIs and combined treatment. The Yale-Brown Obsessive-Compulsive Scale and Acceptance and Action Questionnaire were administered at pre-treatment and post-treatment. Twenty-seven patients completed the study. Data was analyzed using one-way analysis of variance (ANOVA) and one-way analysis of covariance (ANCOVA), clinically significant change (CSC) and complete remission status. RESULTS ANCOVA revealed that patients treated with ACT and combined treatment experienced a significantly greater improvement in obsessive-compulsive (OC) symptoms and experiential avoidance (EA) at post-treatment compared to those treated with SSRIs alone. However, there were no significant differences between ACT and combined treatment on OC symptoms and EA. CSC and complete remission status results showed that unlike SSRI, ACT and combined treatment led to more improvement in OC symptoms. CONCLUSIONS ACT and combined treatment are more effective than SSRIs alone in treating OC symptoms and EA. However, it appears that adding SSRIs to ACT does not increase the effectiveness of ACT in the treatment of adults with OCD in the short-term.
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Affiliation(s)
- Yaghoob Vakili
- Department of Clinical Psychology, School of Medicine, North Khorasan University of Medical Sciences, Bojnord, IR Iran
| | - Banafsheh Gharaee
- Department of Clinical Psychology, Tehran Psychiatric Institute, Iran University of Medical Sciences, Tehran, IR Iran
| | - Mojtaba Habibi
- Departments of Family Therapy, Family Research Institute, University of Shahid Beheshty, Tehran, IR Iran
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Kameg KM, Richardson L, Szpak JL. Pediatric obsessive-compulsive disorder: an update for advanced practice psychiatric nurses. JOURNAL OF CHILD AND ADOLESCENT PSYCHIATRIC NURSING 2015; 28:84-91. [PMID: 25950460 DOI: 10.1111/jcap.12111] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Obsessive-compulsive disorder (OCD) may have an onset in childhood or adolescence resulting in significant functional impairment and disability into adulthood. There are frequently developmental differences in the content of the obsessions and compulsions in youth compared to adults. Lack of insight or shame may result in failure of the youth to seek treatment. This delay in treatment may lead to the development of other psychiatric comorbidities, including suicide. Evidence-based treatments for OCD include cognitive behavioral therapy and exposure/response prevention, and in moderate to severe cases, use of selective serotonin reuptake inhibitors is indicated. Advanced practice psychiatric nurses are in a unique position to provide psychoeducation, psychotherapy, and medications, if indicated, to youth with this condition to improve functioning and reduce morbidity and mortality. This article will provide an overview of the diagnostic criteria for OCD, etiologies, assessment strategies, differential diagnoses, common comorbidities, and evidence-based treatment options.
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Andersson E, Ljótsson B, Hedman E, Hesser H, Enander J, Kaldo V, Andersson G, Lindefors N, Rück C. Testing the Mediating Effects of Obsessive Beliefs in Internet-Based Cognitive Behaviour Therapy for Obsessive-Compulsive Disorder: Results from a Randomized Controlled Trial. Clin Psychol Psychother 2014; 22:722-32. [PMID: 25418575 DOI: 10.1002/cpp.1931] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2014] [Revised: 10/21/2014] [Accepted: 10/22/2014] [Indexed: 11/05/2022]
Abstract
UNLABELLED Although cognitive interventions for obsessive-compulsive disorder (OCD) have been tested in randomized trials, there are few trials that have tested the specific mechanisms of cognitive interventions, i.e. how they achieve their effects. In this study, we aimed to investigate the mediating effects of a short cognitive intervention in the treatment of OCD and used data from a recently conducted randomized controlled trial where 101 participants were allocated to either Internet-based CBT (ICBT) or to a control condition. Obsessive beliefs were measured at pre-treatment, at the time they had received the cognitive intervention, and also at post-treatment. Weekly OCD symptoms were measured throughout the 10 weeks of treatment. We hypothesized that (1) the ICBT group would have greater reductions in obsessive beliefs (controlling for change in OCD symptoms) after completing the cognitive intervention, and that (2) this reduction would, in turn, predict greater OCD symptom reduction throughout the rest of the treatment period. Contrary to our expectations, the longitudinal mediation analysis indicated that (1) being randomized to ICBT actually increased the degree of obsessive beliefs after receiving the cognitive intervention at weeks 1-3, and (2) increase in obsessive beliefs predicted better outcome later in treatment. However, when repeating the analysis using cross-sectional data at post-treatment, the results were in line with the initial hypotheses. Results were replicated when the control condition received ICBT. We conclude that, although obsessive beliefs were significantly reduced at post-treatment for the ICBT group, early increase rather than decrease in obsessive beliefs predicted favourable outcome. KEY PRACTITIONER MESSAGE This study investigated the impact of cognitive interventions on obsessive beliefs for patients with obsessive-compulsive disorder. Results showed that a sudden increase in obsessive beliefs is not an indicator of worse treatment response. On the contrary, it is more likely that the patient is better off when having this sudden increase. Clinicians should not be alarmed if the patient has a sudden increase in obsessive beliefs, but we do recommend the clinician to investigate the reasons for this further.
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Affiliation(s)
- Erik Andersson
- Department of Clinical Neuroscience, Division of Psychiatry, Karolinska Institutet, Stockholm, Sweden.,Department of Clinical Neuroscience, Division of Psychology, Karolinska Institutet, Stockholm, Sweden
| | - Brjánn Ljótsson
- Department of Clinical Neuroscience, Division of Psychology, Karolinska Institutet, Stockholm, Sweden
| | - Erik Hedman
- Department of Clinical Neuroscience, Division of Psychology, Karolinska Institutet, Stockholm, Sweden.,Osher Center for Integrative Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Hugo Hesser
- Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden
| | - Jesper Enander
- Department of Clinical Neuroscience, Division of Psychiatry, Karolinska Institutet, Stockholm, Sweden
| | - Viktor Kaldo
- Department of Clinical Neuroscience, Division of Psychiatry, Karolinska Institutet, Stockholm, Sweden
| | - Gerhard Andersson
- Department of Clinical Neuroscience, Division of Psychiatry, Karolinska Institutet, Stockholm, Sweden.,Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden
| | - Nils Lindefors
- Department of Clinical Neuroscience, Division of Psychiatry, Karolinska Institutet, Stockholm, Sweden
| | - Christian Rück
- Department of Clinical Neuroscience, Division of Psychiatry, Karolinska Institutet, Stockholm, Sweden
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Bluett EJ, Homan KJ, Morrison KL, Levin ME, Twohig MP. Acceptance and commitment therapy for anxiety and OCD spectrum disorders: an empirical review. J Anxiety Disord 2014; 28:612-24. [PMID: 25041735 DOI: 10.1016/j.janxdis.2014.06.008] [Citation(s) in RCA: 151] [Impact Index Per Article: 15.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2013] [Revised: 06/10/2014] [Accepted: 06/15/2014] [Indexed: 01/04/2023]
Abstract
A fair amount of research exists on acceptance and commitment therapy (ACT) as a model and a treatment for anxiety disorders and OCD spectrum disorders; this paper offers a quantitative account of this research. A meta-analysis is presented examining the relationship between psychological flexibility, measured by versions of the Acceptance and Action Questionnaire (AAQ and AAQ-II) and measures of anxiety. Meta-analytic results showed positive and significant relationships between the AAQ and general measures of anxiety as well as disorder specific measures. Additionally, all outcome data to date on ACT for anxiety and OCD spectrum disorders are reviewed, as are data on mediation and moderation within ACT. Preliminary meta-analytic results show that ACT is equally effective as manualized treatments such as cognitive behavioral therapy. Future directions and limitations of the research are discussed.
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Schoendorff B, Purcell-Lalonde M, O'Connor K. [Third wave therapies in the treatment of obsessional compulsive disorder : applying acceptance and commitment therapy]. SANTE MENTALE AU QUEBEC 2014; 38:153-73. [PMID: 24719007 DOI: 10.7202/1023994ar] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
In terms of prevalence, Obsessive compulsive disorder is the 4th ranked psychiatric disorder. Current treatments include 1st and 2nd wave cognitive behavioural therapies involving exposure and cognitive restructuring. However, 3rd wave therapies such as mindfulness and acceptance and commitment therapy (ACT) are also increasingly recognized as treatments of choice. The current article describes the underlying theory of ACT including relational frame theory, its clinical target: experiential avoidance, its main processes and a tool for the delivery of ACT to patients, the matrix. Rather than aiming to restructure problematic thoughts and evaluations, ACT seeks to train psychological flexibility, the ability to distance from problematic thoughts and accept uncomfortable emotion in the service of engaging personally valued actions. This can help move patient behaviour away from the aversive control of anxiety and obsessions and toward the appetitive control of personal values. The application of ACT to OCD is illustrated by a successful case study.
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Emotion and internal experience in Obsessive Compulsive Disorder: Reviewing the role of alexithymia, anxiety sensitivity and distress tolerance. Clin Psychol Rev 2014; 34:256-71. [DOI: 10.1016/j.cpr.2014.03.003] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2013] [Revised: 02/03/2014] [Accepted: 03/07/2014] [Indexed: 11/17/2022]
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Strategies for Improving Long-Term Outcomes in Cognitive Behavioral Therapy for Obsessive-Compulsive Disorder: Insights From Learning Theory. COGNITIVE AND BEHAVIORAL PRACTICE 2014. [DOI: 10.1016/j.cbpra.2013.06.004] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Abramowitz JS. The practice of exposure therapy: relevance of cognitive-behavioral theory and extinction theory. Behav Ther 2013; 44:548-58. [PMID: 24094780 DOI: 10.1016/j.beth.2013.03.003] [Citation(s) in RCA: 119] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2012] [Revised: 02/18/2013] [Accepted: 03/01/2013] [Indexed: 10/27/2022]
Abstract
Exposure therapy is the most effective psychological intervention for people with anxiety disorders. While many therapists learn how to implement exposure techniques through clinical training programs or instructional workshops, not all of these educational efforts include a focus on the theory underlying this treatment. The availability of treatment manuals providing step-by-step instructions for how to implement exposure makes it easier for clinicians to use these techniques with less training than they might otherwise receive. This raises questions regarding whether it is necessary to understand the theory behind the use of exposure. This article argues that knowledge of the relevant theory is crucial to being able to implement exposure therapy in ways that optimize both short- and long-term outcome. Specific ways in which theory is relevant to using exposure techniques are discussed.
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Fernández de la Cruz L, Landau D, Iervolino AC, Santo S, Pertusa A, Singh S, Mataix-Cols D. Experiential avoidance and emotion regulation difficulties in hoarding disorder. J Anxiety Disord 2013; 27:204-9. [PMID: 23474910 DOI: 10.1016/j.janxdis.2013.01.004] [Citation(s) in RCA: 76] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2012] [Revised: 10/11/2012] [Accepted: 01/17/2013] [Indexed: 11/16/2022]
Abstract
Experiential avoidance can be defined as the tendency to avoid contact with unwanted internal experiences. Current conceptualizations of pathological hoarding appear broadly consistent with an experiential avoidant model. Eighty participants in four groups, namely hoarding disorder (HD) without comorbid obsessive-compulsive disorder (OCD), HD with comorbid OCD, non-hoarding OCD, and healthy controls, were administered measures of experiential avoidance and emotion regulation difficulties. Hoarding individuals reported higher levels of experiential avoidance and difficulties in emotion regulation compared to healthy but not to OCD participants. Both experiential avoidance and emotion regulation difficulties were significantly more prominent when HD was comorbid with OCD than when HD occurred without comorbid OCD. Correlation analyses further showed that both experiential avoidance and emotion regulation were moderately but significantly associated with obsessive-compulsive but not hoarding symptoms. Thus, experiential avoidance and emotion regulation difficulties are not specifically relevant to HD but to a broad range of psychopathologies. However, despite the lack of specificity, the findings raise some potentially useful clinical implications for the treatment of HD.
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Wheaton MG, Fabricant LE, Berman NC, Abramowitz JS. Experiential Avoidance in Individuals with Hoarding Disorder. COGNITIVE THERAPY AND RESEARCH 2012. [DOI: 10.1007/s10608-012-9511-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Stasik SM, Naragon-Gainey K, Chmielewski M, Watson D. Core OCD symptoms: exploration of specificity and relations with psychopathology. J Anxiety Disord 2012; 26:859-70. [PMID: 23026094 PMCID: PMC3490030 DOI: 10.1016/j.janxdis.2012.07.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2011] [Revised: 07/23/2012] [Accepted: 07/25/2012] [Indexed: 11/19/2022]
Abstract
Obsessive-compulsive disorder (OCD) is a heterogeneous condition, comprised of multiple symptom domains. This study used aggregate composite scales representing three core OCD dimensions (Checking, Cleaning, and Rituals), as well as Hoarding, to examine the discriminant validity, diagnostic specificity, and predictive ability of OCD symptom scales. The core OCD scales demonstrated strong patterns of convergent and discriminant validity - suggesting that these dimensions are distinct from other self-reported symptoms - whereas hoarding symptoms correlated just as strongly with OCD and non-OCD symptoms in most analyses. Across analyses, our results indicated that Checking is a particularly strong, specific marker of OCD diagnosis, whereas the specificity of Cleaning and Hoarding to OCD was less strong. Finally, the OCD Checking scale was the only significant predictor of OCD diagnosis in logistic regression analyses. Results are discussed with regard to the importance of assessing OCD symptom dimensions separately and implications for classification.
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Affiliation(s)
- Sara M. Stasik
- Department of Psychology, University of Notre Dame, 118 Haggar Hall, Notre Dame, IN 46556
| | - Kristin Naragon-Gainey
- Center for Anxiety and Related Disorders, Boston University, 648 Beacon St., Boston, MA 02215
| | - Michael Chmielewski
- Department of Psychology, Southern Methodist University, P.O. Box 750442, Dallas, TX 75275
| | - David Watson
- Department of Psychology, University of Notre Dame, 118 Haggar Hall, Notre Dame, IN 46556
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Yap K, Mogan C, Kyrios M. Obsessive-compulsive disorder and comorbid depression: the role of OCD-related and non-specific factors. J Anxiety Disord 2012; 26:565-73. [PMID: 22495108 DOI: 10.1016/j.janxdis.2012.03.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2010] [Revised: 02/17/2012] [Accepted: 03/06/2012] [Indexed: 10/28/2022]
Abstract
Although comorbid depression is a predictor of poor treatment response in obsessive-compulsive disorder (OCD), there is limited understanding of factors that contribute to depression severity in OCD. The current study examines the influence of OCD-related factors (autogenous obsessions and obsessional beliefs) and non-specific factors (avoidance and anxiety) on depression severity in a sample of OCD patients. There were 56 participants with only OCD and 46 with OCD and comorbid depression. Self-report questionnaires measuring depression, OCD-related factors, and non-specific factors were completed. Although there were no significant differences between the two groups on these variables, depression severity was positively correlated with anxiety, avoidance, obsessional beliefs, and autogenous obsessions in the whole sample. When entered into a multiple regression model to predict depression severity, these factors accounted for 51% of the variance. While OCD-related factors remained significant predictors after controlling for non-specific factors, the non-specific factors made the most significant contributions to the model. Our findings suggest that in addition to dealing with autogenous obsessions, addressing anxiety and avoidance might lead to improvements in the treatment of OCD with comorbid depression.
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Affiliation(s)
- Keong Yap
- School of Health Sciences, RMIT University, Plenty Road, Bundoora, Victoria 3083, Australia.
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The Contribution of Experiential Avoidance and Social Cognitions in the Prediction of Social Anxiety. Behav Cogn Psychother 2012; 41:52-65. [DOI: 10.1017/s1352465812000367] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Background: Cognitive models propose that social anxiety arises from specific dysfunctional cognitions about the likelihood and severity of embarrassment. Relational frame theory (RFT), on the other hand, posits that social anxiety arises from the unwillingness to endure unpleasant internal experiences (i.e. experiential avoidance [EA]). Although cognitive models have garnered empirical support, it may be that newer models such as RFT can improve our ability to predict and treat social anxiety. Aims: We aimed to elucidate the relationship between dysfunctional cognitions and EA, as well as their independent and relative contributions to the prediction of social anxiety symptoms. We hypothesized that dysfunctional cognitions and EA would each be associated with social anxiety, as well as with each other. We also predicted that both EA and dysfunctional cognitions would remain independent predictors of social anxiety symptoms after controlling for each other and general distress. Method: Undergraduates high (n = 173) and low (n = 233) in social anxiety completed measures of social anxiety, dysfunctional cognitions, EA, and general distress. The overall sample was 66.3% female; mean age = 20.01 years (SD = 2.06). Results: Correlational analyses revealed that EA, dysfunctional cognitions, and social anxiety symptoms were moderately correlated with one another. Additionally, hierarchical regression analyses revealed that dysfunctional cognitions predicted social anxiety symptoms even after controlling for EA; the reverse was not found. Conclusions: Results suggest that EA and social anxiety specific cognitive distortions overlap to a moderate extent. EA does not add to the prediction of social anxiety symptoms above and beyond dysfunctional cognitions. Additional theoretical and treatment implications of the results are discussed.
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McGuire JF, Lewin AB, Horng B, Murphy TK, Storch EA. The nature, assessment, and treatment of obsessive-compulsive disorder. Postgrad Med 2012; 124:152-65. [PMID: 22314125 DOI: 10.3810/pgm.2012.01.2528] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Obsessive-compulsive disorder (OCD) is an anxiety disorder that affects between 1% to 2% of individuals and causes considerable impairment and disability. Although > 50% of individuals experience symptom onset in childhood, symptoms can continue to develop throughout adulthood. Accurate and timely assessment of clinical presentation is critical to limit impairment and improve prognosis. Presently, there are 2 empirically supported treatments available for OCD in children and adults, namely cognitive-behavioral therapy and pharmacotherapy with serotonin reuptake inhibitors. This article provides an introduction to the phenomenology, etiology, and clinical course of OCD. Assessment practices used to evaluate symptom severity are described, and evidence-based treatment options are reviewed, with appropriate distinctions drawn between children and adults. Finally, recommendations for assessment and treatment practices for OCD are explicated.
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Affiliation(s)
- Joseph F McGuire
- Department of Psychology, University of South Florida, St. Petersburg, FL 33701, USA
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McGuire JF, Storch EA, Lewin AB, Price LH, Rasmussen SA, Goodman WK. The role of avoidance in the phenomenology of obsessive-compulsive disorder. Compr Psychiatry 2012; 53:187-94. [PMID: 21550030 DOI: 10.1016/j.comppsych.2011.03.002] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2010] [Revised: 02/27/2011] [Accepted: 03/12/2011] [Indexed: 10/18/2022] Open
Abstract
BACKGROUND Pathologic levels of ritualistic avoidance (also known as active avoidance) are common in the clinical presentation of obsessive-compulsive disorder (OCD). Despite its clinical relevance, there has been little examination of active avoidance as a ritualistic compulsion in adults with OCD. OBJECTIVE The objective of this study is to determine if adults with OCD who engage in ritualistic avoidance have greater obsessive-compulsive, anxiety, and depressive symptom severity and different comorbidity patterns than adults who do not engage in ritualistic avoidance. METHOD Adults with OCD (n = 133) completed an evaluation that included clinician ratings of obsessive-compulsive severity; overall illness severity; and self-reported ratings of anxiety, depression, and obsessive-compulsive severity. RESULTS Ritualized avoidance was endorsed by greater than 25% of the sample. Avoidant subjects and, more specifically, contaminant avoidant and reading-writing avoidant subjects presented with elevated levels of obsessive-compulsive symptom severity and greater overall clinical severity than comparison patients who did not engage in each respective avoidance ritual. CONCLUSIONS Patients who engage in ritualized avoidance exhibited greater obsessive-compulsive symptom severity than patients who did not. These findings suggest that ritualized avoidance functions as a compulsion for adults with OCD and that avoidance should receive careful consideration in assessment and treatment.
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Affiliation(s)
- Joseph F McGuire
- Department of Psychology, University of South Florida, Tampa, FL 33620, USA.
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