1
|
Kahya Y, Inozu M, Clark DA. Thematic Content Analysis of Repugnant Intrusions in Highly Religious Canadian and Turkish Samples. JOURNAL OF RELIGION AND HEALTH 2024; 63:2821-2846. [PMID: 36737537 DOI: 10.1007/s10943-023-01747-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/17/2023] [Indexed: 06/18/2023]
Abstract
The degree of religiosity, a culturally relevant concept, has been associated with obsessive phenomena such as obsessional symptoms, the nature of unwanted intrusive thoughts, and responses to intrusive thoughts. Although previous research reported that repugnant (i.e., sexual and religious) intrusions had the lowest endorsement rates, these were also the most difficult to control and more likely to turn into obsessions. Highly religious individuals are more likely to be distressed by repugnant intrusions as the repugnant nature of intrusive thoughts critically threatens the perceived self. Thus, individuals with high religiosity may be more likely to respond to repugnant intrusions with dysfunctional strategies and thus become more vulnerable to OCD. This study presents the endorsement rates and qualitative features of sexual and religious intrusions among highly religious Canadian and Turkish samples. Highly religious participants were interviewed using the International Intrusive Thoughts Interview Schedule (IITIS). Thematic content analysis of the IITIS data was conducted with MAXQDA. Sexual intrusion themes of Forceful Sex, Gay Sex, Immoral Sex, and Sex with Undesirable People were identified in both samples. Religious intrusion themes of Questioning, How They Are Perceived by God, Violating Religious Doctrines, Punishment by God, and Worship also emerged in both samples. The percentages of these themes suggested the presence of cross-cultural qualitative similarities and differences.
Collapse
Affiliation(s)
- Yasemin Kahya
- Department of Psychology, Faculty of Social Sciences and Humanities, Social Sciences University of Ankara, Hükümet Meydanı No: 2, 06050, Ulus, Altındağ, Ankara, Turkey.
| | - Mujgan Inozu
- Department of Psychology, Hacettepe University, Ankara, Turkey
| | - David A Clark
- Department of Psychology, University of New Brunswick, Fredericton, Canada
| |
Collapse
|
2
|
Smárason O, Selles RR, Højgaard DRMA, Best JR, Melin K, Ivarsson T, Thomsen PH, Weidle B, McBride NM, Storch EA, Geller D, Wilhelm S, Farrell LJ, Waters AM, Mathieu S, Soreni N, Stewart SE, Skarphedinsson G. Exploring latent clusters in pediatric OCD based on symptoms, severity, age, gender, and comorbidity. Eur Child Adolesc Psychiatry 2024:10.1007/s00787-024-02431-9. [PMID: 38634862 DOI: 10.1007/s00787-024-02431-9] [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: 09/06/2022] [Accepted: 03/25/2024] [Indexed: 04/19/2024]
Abstract
Given diverse symptom expression and high rates of comorbid conditions, the present study explored underlying commonalities among OCD-affected children and adolescents to better conceptualize disorder presentation and associated features. Data from 830 OCD-affected participants presenting to OCD specialty centers was aggregated. Dependent mixture modeling was used to examine latent clusters based on their age- and gender adjusted symptom severity (as measured by the Children's Yale-Brown Obsessive-Compulsive Scale; CY-BOCS), symptom type (as measured by factor scores calculated from the CY-BOCS symptom checklist), and comorbid diagnoses (as assessed via diagnostic interviews). Fit statistics favored a four-cluster model with groups distinguished primarily by symptom expression and comorbidity type. Fit indices for 3-7 cluster models were only marginally different and characteristics of the clusters remained largely stable between solutions with small clusters of distinct presentations added in more complex models. Rather than identifying a single classification system, the findings support the utility of integrating dimensional, developmental, and transdiagnostic information in the conceptualization of OCD-affected children and adolescents. Identified clusters point to the centrality of contamination concerns to OCD, relationships between broader symptom expression and higher levels of comorbidity, and the potential for complex/neurodevelopmental presentations.
Collapse
Affiliation(s)
- Orri Smárason
- Faculty of Psychology, University of Iceland, Reykjavik, Iceland.
- Department of Child and Adolescent Psychiatry, Landspitali-The National University Hospital of Iceland, Reykjavik, Iceland.
| | - Robert R Selles
- University of British Columbia, Vancouver, BC, Canada
- BC Children's Hospital, Vancouver, BC, Canada
| | - Davíð R M A Højgaard
- Department of Child and Adolescent Psychiatry, Aarhus University Hospital, Psychiatry, Denmark
| | - John R Best
- University of British Columbia, Vancouver, BC, Canada
- BC Children's Hospital, Vancouver, BC, Canada
| | - Karin Melin
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Region Västra Götaland, Department of Child and Adolescent Psychiatry, Sahlgrenska University Hospital, Gothenburg, Sweden
| | | | - Per Hove Thomsen
- Department of Child and Adolescent Psychiatry, Aarhus University Hospital, Psychiatry, Denmark
| | - Bernhard Weidle
- Regional Center for Child Mental Health and Child Welfare, Norwegian University of Science and Technology, Trondheim, Norway
- St. Olavs University Hospital, Trondheim, Norway
| | - Nicole Michelle McBride
- Embedded Preventive Behavioral Health Capability, III MEF, United States Marine Corps, Okinawa, Japan
| | | | - Daniel Geller
- Harvard Medical School, Boston, MA, USA
- Massachusetts General Hospital, Boston, MA, USA
| | - Sabine Wilhelm
- Harvard Medical School, Boston, MA, USA
- Massachusetts General Hospital, Boston, MA, USA
| | | | | | | | - Noam Soreni
- St. Joseph's Hospital, Hamilton, ON, Canada
- McMaster University, Hamilton, ON, Canada
| | - S Evelyn Stewart
- University of British Columbia, Vancouver, BC, Canada
- BC Children's Hospital, Vancouver, BC, Canada
- BC Mental Health and Substance Use Services, Burnaby, BC, Canada
| | | |
Collapse
|
3
|
Weiss F, Schwarz K, Endrass T. Exploring the relationship between context and obsessions in individuals with obsessive-compulsive disorder symptoms: a narrative review. Front Psychiatry 2024; 15:1353962. [PMID: 38419899 PMCID: PMC10899460 DOI: 10.3389/fpsyt.2024.1353962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Accepted: 01/31/2024] [Indexed: 03/02/2024] Open
Abstract
Obsessions in obsessive-compulsive disorder (OCD) have long been proposed to differ from intrusive thoughts in unaffected individuals based on appraisal of the thoughts. However, more recent research indicates that cognitive processes behind obsessions may differ significantly from those in healthy individuals concerning their contextual relationship. This narrative literature review summarizes current evidence for the role of context-relatedness for obsessions in OCD and intrusive thoughts in affected and unaffected individuals. The review encompasses a total of five studies, two of which include individuals diagnosed with OCD (one study also includes a group of unaffected control individuals), while the other three studies investigate the relationship between OCD symptoms and context in unaffected individuals. As assessed by mainly self-reports, the review examines the connection between thoughts and their context, shedding light on how the repetition and automaticity of thoughts, as well as their detachment from context over time contribute to defining obsessions in contrast to intrusive thoughts. However, the link with context depends on the content of the obsessions. We propose the term "decontextualization of thoughts" to describe the phenomenon that obsessions gradually lose their connection with external context during the development of OCD. Future research should investigate whether this hypothesis can be supported by experimental evidence and identify whether this shift might be more likely a cause or a consequence of the disorder.
Collapse
Affiliation(s)
- Franziska Weiss
- Chair of Addiction Research, Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany
| | | | | |
Collapse
|
4
|
Haque UM, Kabir E, Khanam R. Early detection of paediatric and adolescent obsessive-compulsive, separation anxiety and attention deficit hyperactivity disorder using machine learning algorithms. Health Inf Sci Syst 2023; 11:31. [PMID: 37489154 PMCID: PMC10363094 DOI: 10.1007/s13755-023-00232-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Accepted: 07/04/2023] [Indexed: 07/26/2023] Open
Abstract
Purpose Mental health issues of young minds are at the threshold of all development and possibilities. Obsessive-compulsive disorder (OCD), separation anxiety disorder (SAD), and attention deficit hyperactivity disorder (ADHD) are three of the most common mental illness affecting children and adolescents. Several studies have been conducted on approaches for recognising OCD, SAD and ADHD, but their accuracy is inadequate due to limited features and participants. Therefore, the purpose of this study is to investigate the approach using machine learning (ML) algorithms with 1474 features from Australia's nationally representative mental health survey of children and adolescents. Methods Based on the internal cross-validation (CV) score of the Tree-based Pipeline Optimization Tool (TPOTClassifier), the dataset has been examined using three of the most optimal algorithms, including Random Forest (RF), Decision Tree (DT), and Gaussian Naïve Bayes (GaussianNB). Results GaussianNB performs well in classifying OCD with 91% accuracy, 76% precision, and 96% specificity as well as in detecting SAD with 79% accuracy, 62% precision, 91% specificity. RF outperformed all other methods in identifying ADHD with 91% accuracy, 94% precision, and 99% specificity. Conclusion Using Streamlit and Python a web application was developed based on the findings of the analysis. The application will assist parents/guardians and school officials in detecting mental illnesses early in their children and adolescents using signs and symptoms to start the treatment at the earliest convenience.
Collapse
Affiliation(s)
- Umme Marzia Haque
- School of Mathematics, Physics and Computing, University of Southern Queensland, Toowoomba, Australia
| | - Enamul Kabir
- School of Mathematics, Physics and Computing, University of Southern Queensland, Toowoomba, Australia
| | - Rasheda Khanam
- School of Business, University of Southern Queensland, Toowoomba, Australia
| |
Collapse
|
5
|
Audet JS, Bourguignon L, Aardema F. What makes an obsession? A systematic-review and meta-analysis on the specific characteristics of intrusive cognitions in OCD in comparison with other clinical and non-clinical populations. Clin Psychol Psychother 2023; 30:1446-1463. [PMID: 37482945 DOI: 10.1002/cpp.2887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 07/06/2023] [Accepted: 07/07/2023] [Indexed: 07/25/2023]
Abstract
The Diagnostic and Statistical Manual 5th ed. defines obsessions in obsessive-compulsive disorder (OCD) as frequent, persistent, intrusive, unwanted thoughts that provoke anxiety and distress and lead to attempts to neutralize them with either thoughts or actions. However, no systematic review has yet evaluated characteristics that are specific to obsessions occurring in OCD. The aim of the current systematic review and meta-analysis was to investigate the specific features of obsessions occurring in OCD by comparing them to both obsessionally and non-obsessionally-themed intrusions in non-clinical and other clinical populations. Based on a registered protocol, 832 records were found, of which 15 were included in the systematic review and meta-analysis, with a total of 1891 participants. Obsessionally-themed intrusions that occur among those with OCD caused more distress, guilt, negative emotion and interference as compared to similarly-themed intrusions that occur within the general population. The distinction between obsessionally-themed intrusions among those with OCD as compared to those occurring in anxiety and depressive disorder primarily revolves around a higher level of persistence, pervasiveness and distress associated with their occurrence. Further, unacceptability, uncontrollability, ego-dystonicity, alienness, guilt, the form of the intrusion, association with the self and lack of any basis in reality also differentiates between obsessions and intrusions occurring in other disorders. Obsessions share many characteristics with thoughts occurring in other disorders and can be distinguished using a combination of characteristics specific to individual disorders.
Collapse
Affiliation(s)
- Jean-Sébastien Audet
- Montreal Mental Health University Institute Research Center, Montreal, Quebec, Canada
- Department of Psychiatry and Addictology, University of Montréal, Montreal, Quebec, Canada
| | - Lysandre Bourguignon
- Montreal Mental Health University Institute Research Center, Montreal, Quebec, Canada
- Department of Psychology, Université du Québec à Montréal, Montreal, Quebec, Canada
| | - Frederick Aardema
- Montreal Mental Health University Institute Research Center, Montreal, Quebec, Canada
- Department of Psychiatry and Addictology, University of Montréal, Montreal, Quebec, Canada
| |
Collapse
|
6
|
Fink-Lamotte J, Hoyer J, Platter P, Stierle C, Exner C. Shame on Me? Love Me Tender! Inducing and Reducing Shame and Fear in Social Anxiety in an Analogous Sample. CLINICAL PSYCHOLOGY IN EUROPE 2023; 5:e7895. [PMID: 38356896 PMCID: PMC10863638 DOI: 10.32872/cpe.7895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 06/28/2023] [Indexed: 02/16/2024] Open
Abstract
Background Shame is considered an important factor in the development and maintenance of many psychological disorders, e.g., social anxiety disorder, and an interesting target point for therapeutic intervention. Method In the present experimental study, we used an online-adopted Autobiographical Emotional Memory Task (AEMT) to induce shame and tested different micro-interventions (self-compassion, cognitive reappraisal, and a control intervention) with respect to their potential to reduce shame intensity. One-hundred-and-fifteen healthy subjects participated in the study and completed a series of self-report questionnaires on self-compassion, shame, and social anxiety. Results The experimental shame induction was well accepted and successful (with significantly heightened feelings of shame); there were no study drop-outs. There was a significant time*condition interaction, which was due the self-compassion-based intervention resulting in a significantly larger reduction of shame than the control condition (counting fishes). In addition, the main effect of the factor experimental condition was further moderated (enhanced) by trait social anxiety and trait self-compassion. Conclusion The findings demonstrate the usefulness of online-adopted AEMT for the experimental induction of shame. They suggest that especially self-compassion interventions can be beneficial in alleviating intense shame experiences, which is in accordance with self-compassion theory. Overall, the results are promising in the context of experimental shame research and its potential clinical impacts call for further replication.
Collapse
Affiliation(s)
- Jakob Fink-Lamotte
- Clinical Psychology, University of Potsdam, Potsdam, Germany
- Clinical Psychology and Psychotherapy, University of Leipzig, Leipzig, Germany
| | - Jürgen Hoyer
- Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany
| | - Pauline Platter
- Clinical Psychology and Psychotherapy, University of Leipzig, Leipzig, Germany
| | | | - Cornelia Exner
- Clinical Psychology and Psychotherapy, University of Leipzig, Leipzig, Germany
| |
Collapse
|
7
|
Worden BL, Tolin DF. Co-occurring Obsessive-Compulsive Disorder and Hoarding Disorder: A Review of the Current Literature. J Cogn Psychother 2022; 36:271-286. [PMID: 36635053 DOI: 10.1891/jcp-2021-0010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Current research suggests obsessive-compulsive disorder (OCD) co-occurs in around 20% of people with hoarding disorder (HD). The article discusses the theoretical conceptualization of co-occurring HD and OCD (HD+OCD), highlighting similarities between the disorders that may contribute to comorbidity, such as potentially overlapping etiological factors, comorbidity profiles, and phenomenological aspects; and differences that are important to consider in differential diagnosis and conceptualization, such as belief patterns, ego-syntonicty/dystonicity, and trajectory. The combination of HD+OCD versus either disorder alone appears to be associated with a profile characterized by higher nonhoarding OCD symptoms, anxiety symptoms, depression, and tic disorders, and which may be more treatment-refractory. The authors discuss some commonly used measures to assess hoarding that may be relevant in the context of OCD, as differential diagnosis of hoarding behaviors is often difficult, and hoarding may be difficult to detect in patients with OCD, especially in children. The article ends with a discussion on considerations for the treatment of HD+OCD with cognitive-behavioral therapy, as hoarding symptoms are less likely to respond to gold-standard exposure and response prevention, and there are no established treatment protocols that are designed to treat co-occurring HD and OCD.
Collapse
Affiliation(s)
| | - David F Tolin
- Institute of Living, Hartford, CT.,Yale University School of Medicine, New Haven, CT
| |
Collapse
|
8
|
Aardema F, Bouchard S, Koszycki D, Lavoie ME, Audet JS, O'Connor K. Evaluation of Inference-Based Cognitive-Behavioral Therapy for Obsessive-Compulsive Disorder: A Multicenter Randomized Controlled Trial with Three Treatment Modalities. PSYCHOTHERAPY AND PSYCHOSOMATICS 2022; 91:348-359. [PMID: 35584639 DOI: 10.1159/000524425] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 03/30/2022] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Inference-based cognitive-behavioral therapy (I-CBT) is a specialized psychological treatment for obsessive-compulsive disorder (OCD) without deliberate and prolonged exposure and response prevention (ERP) that focuses on strengthening reality-based reasoning and correcting the dysfunctional reasoning giving rise to erroneous obsessional doubts and ideas. OBJECTIVE The present study aimed to evaluate the effectiveness of I-CBT through a comparison with appraisal-based cognitive behavioral therapy (A-CBT) and an adapted mindfulness-based stress reduction (MBSR) intervention. METHODS This was a two-site, parallel-arm randomized controlled trial (RCT) comparing I-CBT with A-CBT. The MBSR intervention acted as a non-specific active control condition. Following formal evaluation, 111 participants diagnosed with OCD were randomly assigned. The principal outcome measure was the Yale-Brown Obsessive-Compulsive Scale. RESULTS All treatments significantly reduced general OCD severity and specific symptom dimensions without a significant difference between treatments. I-CBT was associated with significant reductions in all symptom dimensions at post-test. Also, I-CBT led to significantly greater improvement in overvalued ideation, as well as significantly higher rates of remission as compared to MBSR at mid-test. CONCLUSIONS I-CBT and MBSR appear to be effective, alternative treatment options for those with OCD that yield similar outcomes as A-CBT. I-CBT may have an edge in terms of the rapidity by which patients reach remission, its generalizability across symptom dimension, its potentially higher level of acceptability, and effectiveness for overvalued ideation. Future research is needed to assess whether additional alternative treatments options can help to increase the number of people successfully treated.
Collapse
Affiliation(s)
- Frederick Aardema
- Department of Psychiatry and Addictology, University of Montreal, Montreal, Québec, Canada.,Montreal Mental Health University Institute Research Center, Montreal, Québec, Canada
| | - Stéphane Bouchard
- Department of Psychoeducation and Psychology, University of Quebec in Outaouais, Gatineau, Québec, Canada
| | - Diana Koszycki
- Counselling Psychology Concentration, Faculty of Education and Department of Psychiatry, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada.,Institut du Savoir Montfort, Ottawa, Ontario, Canada
| | - Marc E Lavoie
- Department of Psychiatry and Addictology, University of Montreal, Montreal, Québec, Canada.,Montreal Mental Health University Institute Research Center, Montreal, Québec, Canada
| | - Jean-Sebastien Audet
- Department of Psychiatry and Addictology, University of Montreal, Montreal, Québec, Canada.,Montreal Mental Health University Institute Research Center, Montreal, Québec, Canada
| | - Kieron O'Connor
- Department of Psychiatry and Addictology, University of Montreal, Montreal, Québec, Canada.,Montreal Mental Health University Institute Research Center, Montreal, Québec, Canada
| |
Collapse
|
9
|
OCD and Comorbid Depression: Assessment, Conceptualization, and Cognitive Behavioral Treatment. J Cogn Psychother 2022; 36:191-206. [PMID: 35882535 DOI: 10.1891/jcp-2022-0003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Many individuals with obsessive-compulsive disorder (OCD) also meet criteria for additional diagnoses. Among the most common co-occurring diagnoses are mood disorders-especially depression. This article focuses on the comorbidity between OCD and major depression. After discussing nature of OCD and depression, the rates and clinical impact of depression on OCD, the conceptualization, assessment, and treatment of OCD when it appears along with depression is covered in detail. The derivation and implementation of a cognitive behavioral treatment program specifically for depressed OCD patients is described and illustrated using a case example.
Collapse
|
10
|
A remote cognitive behavioural therapy approach to treating hoarding disorder in an older adult. COGNITIVE BEHAVIOUR THERAPIST 2022. [DOI: 10.1017/s1754470x22000204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Abstract
Hoarding disorder (HD) is characterised by excessive acquisition and distress associated with discarding objects, resulting in significant clutter. At present, cognitive behavioural therapy (CBT) represents the strongest evidence base for treating HD, although some limitations exist. Little research has examined the effectiveness of remote-CBT interventions for HD in older adults. This case study focuses on Mary, an older female adult presenting with clinically significant hoarding behaviours which severely impact her daily functioning and quality of life. Assessment and intervention followed a structured CBT approach. Despite the complicating factor of COVID-19, Mary responded well to a remote-CBT intervention, with progress indicators suggesting modest improvements in personal, social and occupational functioning. These findings support the use of remote-CBT for HD in both reducing frequency and intensity of hoarding behaviours and improving wellbeing.
Key learning aims
(1)
Hoarding disorder (HD) is a poorly understood disorder that can significantly impact an individual’s personal, social and occupational functioning.
(2)
According to a cognitive behavioural model, HD emanates from information-processing deficits, emotional attachment difficulties, behavioural avoidance and maladaptive beliefs about objects and the self (Frost and Hartl, 1996).
(3)
Observations from this case study suggest the acceptability and effectiveness of a remote cognitive behavioural therapy (CBT) intervention for HD, with outcomes appearing congruous with those produced by face-to-face intervention.
(4)
While research attests to the effectiveness of a CBT intervention for HD, an augmented account of the mechanisms through which these outcomes are achieved is required.
Collapse
|
11
|
Messina G, Vetrano IG, Bonomo G, Broggi G. Role of deep brain stimulation in management of psychiatric disorders. PROGRESS IN BRAIN RESEARCH 2022; 270:61-96. [PMID: 35396031 DOI: 10.1016/bs.pbr.2022.01.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Nowadays, most of patients affected by psychiatric disorders are successfully treated with conservative therapies. Still, a variable percentage of them demonstrate resistance to conventional treatments, and alternative methods can then be considered. During the last 20 years, there is a progressive interest in use of deep brain stimulation (DBS) in mental illnesses. It has become clear nowadays, that this modality may be effectively applied under specific indications in some patients with major depressive disorder, obsessive-compulsive disorder, anorexia nervosa and other eating disorders, Tourette syndrome, schizophrenia, substance use disorder, and even pathologically aggressive behavior. Despite the fact that the efficacy of neuromodulation with DBS, as well as of various lesional interventions, in cases of mental illnesses is still not fully established, there are several premises for wider applications of such "unclassical" psychiatric treatments in the future. Novel technologies of DBS, developments in non-invasive lesioning using stereotactic radiosurgery and transcranial magnetic resonance-guided focused ultrasound, and advances of neurophysiological and neuroimaging modalities may bolster further clinical applications of psychiatric neurosurgery, improve its results, and allow for individually selected treatment strategies tailored to specific needs of the patient.
Collapse
Affiliation(s)
- Giuseppe Messina
- Functional Neurosurgery Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy.
| | - Ignazio G Vetrano
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Giulio Bonomo
- Functional Neurosurgery Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Giovanni Broggi
- Functional Neurosurgery Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy; Department of Neurosurgery, M Cecilia Hospital-GVM, Ravenna, Italy
| |
Collapse
|
12
|
Palo A, D'Souza JM. The impact of COVID-19 on the treatment of obsessive-compulsive disorder. Bull Menninger Clin 2022; 86:35-47. [PMID: 35258344 DOI: 10.1521/bumc.2022.86.1.35] [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] [Indexed: 11/20/2022]
Abstract
The COVID-19 pandemic has led to challenges in providing cognitive-behavioral therapy for patients with obsessive-compulsive disorder (OCD). Despite the presence of the pandemic and the risk of contracting illness, therapists can continue to utilize exposure with response prevention (ERP), which is the gold standard psychotherapy treatment for OCD. Therapists can ethically implement ERP by focusing on core treatment tenets while incorporating guidelines recommended by the Centers for Disease Control and Prevention to mitigate risk for COVID-19 exposure. The pandemic has also provided an opportunity to more widely implement ERP through virtual telehealth appointments, which have notable benefits as well as some drawbacks.
Collapse
Affiliation(s)
- Amanda Palo
- Assistant professor in the Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas
| | - Johann M D'Souza
- Practicum student at Baylor College of Medicine and a graduate student in the Department of Psychology at the University of Houston, Houston, Texas
| |
Collapse
|
13
|
Visvalingam S, Crone C, Street S, Oar EL, Gilchrist P, Norberg MM. The causes and consequences of shame in obsessive-compulsive disorder. Behav Res Ther 2022; 151:104064. [DOI: 10.1016/j.brat.2022.104064] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 02/01/2022] [Accepted: 02/11/2022] [Indexed: 11/02/2022]
|
14
|
Stern ER, Eng GK, De Nadai AS, Iosifescu DV, Tobe RH, Collins KA. Imbalance between default mode and sensorimotor connectivity is associated with perseverative thinking in obsessive-compulsive disorder. Transl Psychiatry 2022; 12:19. [PMID: 35022398 PMCID: PMC8755709 DOI: 10.1038/s41398-022-01780-w] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Revised: 12/07/2021] [Accepted: 12/20/2021] [Indexed: 11/09/2022] Open
Abstract
Obsessive-compulsive disorder (OCD) is highly heterogeneous. Although perseverative negative thinking (PT) is a feature of OCD, little is known about its neural mechanisms or relationship to clinical heterogeneity in the disorder. In a sample of 85 OCD patients, we investigated the relationships between self-reported PT, clinical symptom subtypes, and resting-state functional connectivity measures of local and global connectivity. Results indicated that PT scores were highly variable within the OCD sample, with greater PT relating to higher severity of the "unacceptable thoughts" symptom dimension. PT was positively related to local connectivity in subgenual anterior cingulate cortex (ACC), pregenual ACC, and the temporal poles-areas that are part of, or closely linked to, the default mode network (DMN)-and negatively related to local connectivity in sensorimotor cortex. While the majority of patients showed higher local connectivity strengths in sensorimotor compared to DMN regions, OCD patients with higher PT scores had less of an imbalance between sensorimotor and DMN connectivity than those with lower PT scores, with healthy controls exhibiting an intermediate pattern. Clinically, this imbalance was related to both the "unacceptable thoughts" and "symmetry/not-just-right-experiences" symptom dimensions, but in opposite directions. These effects remained significant after accounting for variance related to psychiatric comorbidity and medication use in the OCD sample, and no significant relationships were found between PT and global connectivity. These data indicate that PT is related to symptom and neural variability in OCD. Future work may wish to target this circuity when developing personalized interventions for patients with these symptoms.
Collapse
Affiliation(s)
- Emily R. Stern
- grid.240324.30000 0001 2109 4251Department of Psychiatry, New York University Grossman School of Medicine, New York, NY USA ,grid.250263.00000 0001 2189 4777Nathan S. Kline Institute for Psychiatric Research, Orangeburg, NY USA
| | - Goi Khia Eng
- grid.240324.30000 0001 2109 4251Department of Psychiatry, New York University Grossman School of Medicine, New York, NY USA ,grid.250263.00000 0001 2189 4777Nathan S. Kline Institute for Psychiatric Research, Orangeburg, NY USA
| | - Alessandro S. De Nadai
- grid.264772.20000 0001 0682 245XDepartment of Psychology, Texas State University, San Marcos, TX USA
| | - Dan V. Iosifescu
- grid.240324.30000 0001 2109 4251Department of Psychiatry, New York University Grossman School of Medicine, New York, NY USA ,grid.250263.00000 0001 2189 4777Nathan S. Kline Institute for Psychiatric Research, Orangeburg, NY USA
| | - Russell H. Tobe
- grid.250263.00000 0001 2189 4777Nathan S. Kline Institute for Psychiatric Research, Orangeburg, NY USA
| | - Katherine A. Collins
- grid.250263.00000 0001 2189 4777Nathan S. Kline Institute for Psychiatric Research, Orangeburg, NY USA
| |
Collapse
|
15
|
Pinciotti CM, Horvath G, Wetterneck CT, Riemann BC. Does a unique co-occurring OCD and PTSD factor structure exist?: Examination of overlapping OCD and PTSD symptom clusters. J Anxiety Disord 2022; 85:102511. [PMID: 34923293 DOI: 10.1016/j.janxdis.2021.102511] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 11/23/2021] [Accepted: 12/06/2021] [Indexed: 12/11/2022]
Abstract
OCD and PTSD share many commonalities, including phenotypic and functional overlap in symptoms. Specifically, both disorders are characterized by unwanted, intrusive, anxiety/distress-eliciting intrusive thoughts and evoking behaviors intended to control, neutralize, suppress, or outright avoid intrusive thoughts and associated anxiety/distress. Extant factor analytic research supports a model of PTSD at odds with current DSM-5 criteria, and no examination of the factor structure of comorbid OCD+PTSD currently exists despite the noted overlap in symptomatology and high rates of comorbidity. Using a sample of 4073 patients diagnosed with OCD and/or PTSD enrolled in intensive treatment programs for OCD or PTSD, multigroup confirmatory factor analysis (MGCFA) and measurement invariance tests were run to determine the best fitting model of OCD and PTSD symptoms in patients with OCD+PTSD. Four models were compared across patients with OCD, PTSD, and OCD+PTSD: DSM-5 and 7-factor hybrid PTSD models with OCD symptoms structured as either combined or comorbid constructs. The comorbid hybrid model proved the best fit, and both hybrid models evidenced better fit than DSM-5 models. The current study lends additional support for the hybrid model of PTSD and suggests that there is no existence of a unique factor structure of OCD and PTSD symptoms in individuals with the comorbid conditions.
Collapse
Affiliation(s)
- Caitlin M Pinciotti
- Rogers Behavioral Health System, 34700 Valley Rd, Oconomowoc, WI 53066, USA.
| | - Gregor Horvath
- Rogers Behavioral Health System, 34700 Valley Rd, Oconomowoc, WI 53066, USA
| | - Chad T Wetterneck
- Rogers Behavioral Health System, 34700 Valley Rd, Oconomowoc, WI 53066, USA
| | - Bradley C Riemann
- Rogers Behavioral Health System, 34700 Valley Rd, Oconomowoc, WI 53066, USA
| |
Collapse
|
16
|
Sookman D, Phillips KA, Anholt GE, Bhar S, Bream V, Challacombe FL, Coughtrey A, Craske MG, Foa E, Gagné JP, Huppert JD, Jacobi D, Lovell K, McLean CP, Neziroglu F, Pedley R, Perrin S, Pinto A, Pollard CA, Radomsky AS, Riemann BC, Shafran R, Simos G, Söchting I, Summerfeldt LJ, Szymanski J, Treanor M, Van Noppen B, van Oppen P, Whittal M, Williams MT, Williams T, Yadin E, Veale D. Knowledge and competency standards for specialized cognitive behavior therapy for adult obsessive-compulsive disorder. Psychiatry Res 2021; 303:113752. [PMID: 34273818 DOI: 10.1016/j.psychres.2021.113752] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Accepted: 01/21/2021] [Indexed: 12/19/2022]
Abstract
Obsessive-Compulsive Disorder (OCD) is a leading cause of disability world-wide (World Health Organization, 2008). Treatment of OCD is a specialized field whose aim is recovery from illness for as many patients as possible. The evidence-based psychotherapeutic treatment for OCD is specialized cognitive behavior therapy (CBT, NICE, 2005, Koran and Simpson, 2013). However, these treatments are not accessible to many sufferers around the world. Currently available guidelines for care are deemed to be essential but insufficient because of highly variable clinician knowledge and competencies specific to OCD. The phase two mandate of the 14 nation International OCD Accreditation Task Force (ATF) created by the Canadian Institute for Obsessive Compulsive Disorders is development of knowledge and competency standards for specialized treatments for OCD through the lifespan deemed by experts to be foundational to transformative change in this field. This paper presents knowledge and competency standards for specialized CBT for adult OCD developed to inform, advance, and offer a model for clinical practice and training for OCD. During upcoming ATF phases three and four criteria and processes for training in specialized treatments for OCD through the lifespan for certification (individuals) and accreditation (sites) will be developed based on the ATF standards.
Collapse
Affiliation(s)
- Debbie Sookman
- Department of Psychology, McGill University Health Center, 1025 Pine Ave W, Montreal, Quebec, H3A 1A1, Canada; Department of Psychiatry, McGill University, 845 Sherbrooke St W, Montreal, Quebec, H3A 0G4, Canada.
| | - Katharine A Phillips
- Department of Psychiatry, Weill Cornell Medicine, 1300 York Ave, New York, NY 10065, United States.
| | - Gideon E Anholt
- Department of Psychology, Marcus Family Campus, Ben-Gurion University of the Negev, Beer Sheva, P.O.B. 653 Beer-Sheva, 8410501, Israel.
| | - Sunil Bhar
- Department of Psychological Sciences, Faculty of Health, Arts and Design, Swinburne University of Technology, 1 John St, Hawthorn, Victoria, 3122, Australia.
| | - Victoria Bream
- Oxford Health Specialist Psychological Interventions Clinic and Oxford Cognitive Therapy Centre, Warneford Hospital, Oxford, OX3 7JX, United Kingdom.
| | - Fiona L Challacombe
- Institute of Psychiatry, Psychology and Neuroscience, Kings College London, De Crespigny Park, London, SE5 8AF, United Kingdom.
| | - Anna Coughtrey
- Great Ormond Street Hospital for Children, London WC1N 3JH, United Kingdom; UCL Great Ormond Street Institute of Child Health, 30 Guilford St, Holborn, London, WC1N 1EH, United Kingdom.
| | - Michelle G Craske
- Anxiety and Depression Research Center, Depression Grant Challenge, Innovative Treatment Network, Staglin Family Music Center for Behavioral and Brain Health, UCLA Department of Psychology and Department of Psychiatry and Biobehavioral Sciences, Box 951563, 1285 Franz Hall, Los Angeles, CA, United States.
| | - Edna Foa
- Center for the Treatment and Study of Anxiety, University of Pennsylvania Perelman SOM, 3535 Market Street, Philadelphia, PA 19104, United States.
| | - Jean-Philippe Gagné
- Department of Psychology, Concordia University, 7141 Sherbrooke St, West, Montreal, Quebec H4B 1R6, Canada.
| | - Jonathan D Huppert
- Department of Psychology, The Hebrew University of Jerusalem, Mt. Scopus, Jerusalem, 91905, Israel.
| | - David Jacobi
- Rogers Behavioral Health, 34700 Valley Road, Oconomowoc, WI, 53066, United States.
| | - Karina Lovell
- Division of Nursing, Midwifery and Social Work, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Oxford Rd, Manchester, M13 9PL, United Kingdom; Manchester Academic Health Science Centre, Greater Manchester Mental Health NHS Foundation Trust, Manchester, M13 9PL, United Kingdom.
| | - Carmen P McLean
- National Center for PTSD, Dissemination and Training Division, VA Palo Alto Healthcare System, 795 Willow Road, Menlo Park, CA, 94025, United States; Department of Psychiatry and Behavioral Sciences, Stanford University, 450 Serra Mall, Stanford, CA, 94305, United States.
| | - Fugen Neziroglu
- Bio-Behavioral Institute, 935 Northern Boulevard, Suite 102, Great Neck, NY, 11021, United States.
| | - Rebecca Pedley
- Division of Nursing, Midwifery and Social Work, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, M13 9PL, United Kingdom.
| | - Sean Perrin
- Department of Psychology, Lund University, Box 213, 22100, Lund, Sweden.
| | - Anthony Pinto
- Zucker School of Medicine at Hofstra/Northwell, Zucker Hillside Hospital - Northwell Health, 265-16 74th Avenue, Glen Oaks, NY, 11004, United States.
| | - C Alec Pollard
- Center for OCD and Anxiety-Related Disorders, Saint Louis Behavioral Medicine Institute, 1129 Macklind Ave, St. Louis, MO, 63110, United States; Department of Family and Community Medicine, Saint Louis University School of Medicine, Saint Louis, MO, 63110, United States.
| | - Adam S Radomsky
- Department of Psychology, Concordia University, 7141 Sherbrooke St, West, Montreal, Quebec H4B 1R6, Canada.
| | - Bradley C Riemann
- 34700 Valley Road, Rogers Behavioral Health, Oconomowoc, WI, 53066, United States.
| | - Roz Shafran
- Population, Policy and Practice Research and Teaching Department, UCL Great Ormond Street Hospital Institute of Child Health, Holborn, London, WC1N 1EH, United Kingdom.
| | - Gregoris Simos
- Department of Educational and Social Policy, University of Macedonia, 156 Egnatia Street, 54636 Thessaloniki, Greece.
| | - Ingrid Söchting
- Departments of Psychology, University of British Columbia, 2136 West Mall, Vancouver, British Columbia, V6T 1Z4, Canada.
| | - Laura J Summerfeldt
- Department of Psychology, Trent University, 1600 West Bank Drive, Peterborough, K9L 0G2 Ontario, Canada.
| | - Jeff Szymanski
- International OCD Foundation, 18 Tremont Street, #308, Boston MA, 02108, United States.
| | - Michael Treanor
- Anxiety and Depression Research Center, University of California, Los Angeles, Box 951563, 1285 Franz Hall, Los Angeles, CA, United States.
| | - Barbara Van Noppen
- Clinical Psychiatry and Behavioral Sciences, OCD Southern California, 2514 Jamacha Road Ste, 502-35 El Cajon, CA, 92019, United States; Department of Psychiatry and Behavioral Sciences, Keck School of Medicine, University of Southern California, 2250 Alcazar Street, Suite 2200, Los Angeles, CA, 90033, United States.
| | - Patricia van Oppen
- Department of Psychiatry, Amsterdam UMC, location VUmc, Netherlands; Amsterdam Public Health Research Institute - Mental Health, Netherlands; GGZ inGeest Specialized Mental Health Care, Netherlands.
| | - Maureen Whittal
- Vancouver CBT Centre, 302-1765 W8th Avenue, Vancouver, British Columbia, V6J5C6, Canada; Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada.
| | - Monnica T Williams
- School of Psychology, University of Ottawa, 136 Jean-Jacques Lussier Pvt, Ottawa, K1N 6N5, Ontario, Canada.
| | - Timothy Williams
- Department of Psychology, University of Reading, PO Box 217, Reading, Berkshire, RG6 6AH, United Kingdom.
| | - Elna Yadin
- Department of Psychiatry, University of Pennsylvania, 3535 Market Street, 2nd Floor, Philadelphia, PA 19104, United States.
| | - David Veale
- South London and the Maudsley NHS Foundation Trust & King's College London, Denmark Hill, London, SE5 8 AZ, United Kingdom.
| |
Collapse
|
17
|
Gagné JP, Puccinelli C, Gavric D, Milosevic I, McCabe R, Soreni N, Alcolado G, Wong SF, Rowa K. In vivo versus imaginal: Comparing therapists’ willingness to engage in both forms of exposure therapy for repugnant obsessions. CURRENT PSYCHOLOGY 2021. [DOI: 10.1007/s12144-021-02161-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
|
18
|
Abstract
The COVID-19 pandemic has led to challenges in providing cognitive-behavioral therapy for patients with obsessive-compulsive disorder (OCD). Despite the presence of the pandemic and the risk of contracting illness, therapists can continue to utilize exposure with response prevention (ERP), which is the gold standard psychotherapy treatment for OCD. Therapists can ethically implement ERP by focusing on core treatment tenets while incorporating guidelines recommended by the Centers for Disease Control and Prevention to mitigate risk for COVID-19 exposure. The pandemic has also provided an opportunity to more widely implement ERP through virtual telehealth appointments, which have notable benefits as well as some drawbacks.
Collapse
Affiliation(s)
- Amanda Palo
- Assistant professor in the Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas
| | - Johann M D'Souza
- Practicum student at Baylor College of Medicine and a graduate student in the Department of Psychology at the University of Houston, Houston, Texas
| |
Collapse
|
19
|
Feusner JD, Mohideen R, Smith S, Patanam I, Vaitla A, Lam C, Massi M, Leow A. Semantic Linkages of Obsessions From an International Obsessive-Compulsive Disorder Mobile App Data Set: Big Data Analytics Study. J Med Internet Res 2021; 23:e25482. [PMID: 33892466 PMCID: PMC8277342 DOI: 10.2196/25482] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 01/09/2021] [Accepted: 04/19/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Obsessive-compulsive disorder (OCD) is characterized by recurrent intrusive thoughts, urges, or images (obsessions) and repetitive physical or mental behaviors (compulsions). Previous factor analytic and clustering studies suggest the presence of three or four subtypes of OCD symptoms. However, these studies have relied on predefined symptom checklists, which are limited in breadth and may be biased toward researchers' previous conceptualizations of OCD. OBJECTIVE In this study, we examine a large data set of freely reported obsession symptoms obtained from an OCD mobile app as an alternative to uncovering potential OCD subtypes. From this, we examine data-driven clusters of obsessions based on their latent semantic relationships in the English language using word embeddings. METHODS We extracted free-text entry words describing obsessions in a large sample of users of a mobile app, NOCD. Semantic vector space modeling was applied using the Global Vectors for Word Representation algorithm. A domain-specific extension, Mittens, was also applied to enhance the corpus with OCD-specific words. The resulting representations provided linear substructures of the word vector in a 100-dimensional space. We applied principal component analysis to the 100-dimensional vector representation of the most frequent words, followed by k-means clustering to obtain clusters of related words. RESULTS We obtained 7001 unique words representing obsessions from 25,369 individuals. Heuristics for determining the optimal number of clusters pointed to a three-cluster solution for grouping subtypes of OCD. The first had themes relating to relationship and just-right; the second had themes relating to doubt and checking; and the third had themes relating to contamination, somatic, physical harm, and sexual harm. All three clusters showed close semantic relationships with each other in the central area of convergence, with themes relating to harm. An equal-sized split-sample analysis across individuals and a split-sample analysis over time both showed overall stable cluster solutions. Words in the third cluster were the most frequently occurring words, followed by words in the first cluster. CONCLUSIONS The clustering of naturally acquired obsessional words resulted in three major groupings of semantic themes, which partially overlapped with predefined checklists from previous studies. Furthermore, the closeness of the overall embedded relationships across clusters and their central convergence on harm suggests that, at least at the level of self-reported obsessional thoughts, most obsessions have close semantic relationships. Harm to self or others may be an underlying organizing theme across many obsessions. Notably, relationship-themed words, not previously included in factor-analytic studies, clustered with just-right words. These novel insights have potential implications for understanding how an apparent multitude of obsessional symptoms are connected by underlying themes. This observation could aid exposure-based treatment approaches and could be used as a conceptual framework for future research.
Collapse
Affiliation(s)
- Jamie D Feusner
- Semel Institute for Neuroscience and Human Behavior, University of California Los Angeles, Los Angeles, CA, United States.,Centre for Addiction and Mental Health, Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | | | | | | | | | | | | | - Alex Leow
- Department of Psychiatry, University of Illinois College of Medicine, Chicago, IL, United States
| |
Collapse
|
20
|
Raines AM, Koscinski B, Mathes BM, Portero AK, Allan NP, Schmidt NB. Examination of a brief computerized Cognitive Anxiety Sensitivity intervention on obsessive-compulsive symptoms. BRITISH JOURNAL OF CLINICAL PSYCHOLOGY 2021; 61 Suppl 1:93-110. [PMID: 33945163 DOI: 10.1111/bjc.12298] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 04/14/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Despite the existence of several first-line treatments for obsessive-compulsive disorder (OCD), many patients fail to experience symptom reduction and/or do not complete treatment. As a result, the field has increasingly moved towards identifying and treating malleable underlying risk factors that may in turn improve treatment efficacy. One salient underlying risk factor, anxiety sensitivity (AS) cognitive concerns, has been found to be uniquely associated with obsessive-compulsive (OC) symptom dimensions. However, no studies have yet examined whether reductions in AS cognitive concerns will lead to subsequent reductions in OC symptoms. METHODS The current study attempted to fill this gap by recruiting individuals reporting elevations on both AS cognitive concerns and at least one OC symptom dimension. Participants were randomly assigned to receive either a one-session AS cognitive concerns intervention (n = 35) or a single health information control session (n = 37). AS cognitive concerns were assessed at post-intervention and one-month follow-up. RESULTS The active intervention produced significantly greater reductions in AS cognitive concerns post-intervention than the control intervention. However, this effect was no longer significant at one-month follow-up. Further, while there was not an effect of treatment condition on OC symptoms at one-month follow-up, changes in AS cognitive concerns from baseline to post-intervention mediated changes in OC symptoms at one-month follow-up. CONCLUSIONS Findings support previous research attesting to the malleable nature of AS. Extending this research, findings provide initial support for the efficacy of AS interventions among individuals with elevated OC symptoms. PRACTITIONER POINTS Clinicians should consider assessing anxiety sensitivity (AS) among patients with obsessive-compulsive disorder. If elevated, clinicians should consider targeting AS as an adjunct to treatment as usual.
Collapse
Affiliation(s)
- Amanda M Raines
- Department of Psychology, Florida State University, Tallahassee, Florida, USA.,Southeast Louisiana Veterans Health Care System (SLVHCS), New Orleans, Louisiana, USA.,South Central Mental Illness Research, Education and Clinical Center (MIRECC), New Orleans, Louisiana, USA
| | | | - Brittany M Mathes
- Department of Psychology, Florida State University, Tallahassee, Florida, USA
| | - Amberly K Portero
- Department of Psychology, Florida State University, Tallahassee, Florida, USA
| | | | - Norman B Schmidt
- Department of Psychology, Florida State University, Tallahassee, Florida, USA
| |
Collapse
|
21
|
Storch EA, Tendler A, Schneider SC, Guzick AG, La Buissonniere-Ariza V, Goodman WK. Moderators and predictors of response to deep transcranial magnetic stimulation for obsessive-compulsive disorder. J Psychiatr Res 2021; 136:508-514. [PMID: 33218749 DOI: 10.1016/j.jpsychires.2020.10.023] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 09/25/2020] [Accepted: 10/16/2020] [Indexed: 02/08/2023]
Abstract
Deep transcranial magnetic stimulation (dTMS) has emerged as a treatment option for adults with obsessive-compulsive disorder (OCD) who continue to exhibit impairing symptoms following an adequate response to first line interventions. Currently, little is known about the predictors or moderators of dTMS outcome for OCD. This paper examined if several theoretically relevant variables may predict and moderate treatment effects including OCD symptom severity, functional impairment, co-occurring depressive symptoms, age, gender, age of OCD onset, and family history of OCD. As part of a previously reported study, 100 patients received 29 dTMS or sham stimulation treatments over 6 weeks. dTMS was administered using a Magstim Rapid2 TMS (The Magstim Co. Ltd., Whitland, Carmarthenshire, United Kingdom) stimulator equipped with a H shaped coil design, which was specifically designed to stimulate the dorsal mPFC-ACC bilaterally. Findings suggest older participants and those with lower OCD severity and disability respond faster to both dTMS and sham stimulation. dTMS of the dorsal mPFC/ACC appeared to have larger benefits for individuals with greater OCD severity, whereas the difference between treatment arms was minimal in those with lower severity. Implications of these findings for treatment of OCD are discussed.
Collapse
Affiliation(s)
- Eric A Storch
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, USA.
| | | | - Sophie C Schneider
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, USA; BrainsWay Inc, USA
| | - Andrew G Guzick
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, USA; BrainsWay Inc, USA
| | | | - Wayne K Goodman
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, USA; BrainsWay Inc, USA
| |
Collapse
|
22
|
Rajabi Khamesi S, Najafi M, Khosravani V. The effect of childhood maltreatment on suicidal ideation through cognitive emotion regulation strategies and specific obsessive-compulsive symptoms in obsessive-compulsive disorder. Clin Psychol Psychother 2021; 28:1435-1444. [PMID: 33687749 DOI: 10.1002/cpp.2582] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 02/24/2021] [Accepted: 02/25/2021] [Indexed: 12/19/2022]
Abstract
Childhood maltreatment is thought to be associated with suicidality in patients with obsessive-compulsive disorder (OCD). Although the underlying mechanism of this relationship is not clear, cognitive emotion regulation strategies (CERSs) and the specific OC symptoms including unacceptable obsessional thoughts (UOTs) and responsibility for harm (RFH) may underlie this link. Accordingly, the study aimed to assess the effect of childhood maltreatment on suicidal ideation through UOTs, RFH and adaptive and maladaptive CERSs in OCD patients. Three hundred patients meeting a DSM-5 diagnosis of OCD were selected and completed the scales measuring childhood maltreatment, OCD, suicidality and depressive symptoms. After controlling for depressive symptoms and OCD severity, childhood maltreatment was shown to affect suicidal ideation directly. Also, the indirect effect of childhood maltreatment on suicidal ideation was mediated by adaptive CERSs, UOTs and RFH. The findings show that OCD patients with a history of childhood maltreatment, less use of adaptive CERSs and the experiences of UOTs and RFH should be carefully considered regarding suicidal risk.
Collapse
Affiliation(s)
- Shiva Rajabi Khamesi
- 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
| |
Collapse
|
23
|
Mancusi L, McKay D. Behavioral avoidance tasks for eliciting disgust and anxiety in contamination fear: An examination of a test for a combined disgust and fear reaction. J Anxiety Disord 2021; 78:102366. [PMID: 33578215 DOI: 10.1016/j.janxdis.2021.102366] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 01/21/2021] [Accepted: 01/26/2021] [Indexed: 11/28/2022]
Abstract
While research supports the role of disgust in contamination OCD, there is also an overlap with fear in motivating avoidance. The "heebie-jeebies" is an emotional response associated with fear and disgust that motivates avoidance of contact with skin-transmitted pathogens (e.g., parasites). This motivation aligns with characteristics of contamination OCD. From a screening of undergraduate students (N = 188), contamination fearful (n = 14), high trait-anxious (n = 14), and low trait-anxious (n = 18) groups were created. Participants engaged in disgust, fear, and "heebie-jeebies" behavioral avoidance tasks. Participants rated "heebie-jeebies" emotion, physical sensations, and behavioral urges. Duration or refusal of task was recorded. A significant interaction effect was found for disgust and anxiety. Participants with higher disgust reported higher "heebie-jeebies" emotion at high, but not low, levels of anxiety. Exploratory analyses revealed that many contamination fearful and high trait-anxious participants refused to complete the task. The interaction of disgust and anxiety significantly predicted the probability of refusal. Participants with higher disgust and anxiety were more likely to refuse to complete the task. Results suggest that the "heebie-jeebies" motivates avoidance of skin-transmitted pathogens. Future research is warranted to further investigate the "heebie-jeebies" and how it relates to contamination concerns.
Collapse
|
24
|
Mathur S, Sharma MP, Balachander S, Kandavel T, Reddy YJ. A randomized controlled trial of mindfulness-based cognitive therapy vs stress management training for obsessive-compulsive disorder. J Affect Disord 2021; 282:58-68. [PMID: 33401124 DOI: 10.1016/j.jad.2020.12.082] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 11/12/2020] [Accepted: 12/22/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND Recently, mindfulness-based therapies have emerged as a treatment modality for OCD, but there is sparse controlled data. We report the efficacy of mindfulness-based cognitive therapy (MBCT) in treating OCD in comparison with stress management training (SMT). METHODS 60 outpatients with DSM-IV-TR OCD attending a specialty OCD clinic were randomly assigned in 1:1 ratio to either MBCT (n=30) or SMT (n= 30). Both the groups received 12 weekly sessions of assigned intervention. An independent blind rater assessed the primary outcome measure at baseline and at the end of 12 weeks. RESULTS Significantly greater proportion of patients responded to MBCT than to SMT (80% vs. 27%, P <0.001). In the linear mixed-effects modelling for intent-to-treat analysis, there was a significant reduction in the illness severity measured using the Yale-Brown Obsessive-Compulsive Scale, obsessive beliefs of 'responsibility/threat estimation' and 'perfectionism/intolerance of uncertainty' measured using the Obsessive Beliefs Questionnaire and anxiety. LIMITATIONS Small sample size with a relatively high attrition in the control group. Lack of a cognitive behaviour therapy (CBT) control group. CONCLUSIONS Mindfulness-based cognitive therapy is efficacious in the treatment of OCD. Future studies should compare MBCT with CBT in larger representative samples and also examine the sustainability of change in longitudinal studies.
Collapse
Affiliation(s)
- Sonal Mathur
- Department of Clinical Psychology, National Institute of Mental Health & Neuro Sciences (NIMHANS), Bangalore, India.
| | - Mahendra P Sharma
- Department of Clinical Psychology, National Institute of Mental Health & Neuro Sciences (NIMHANS), Bangalore, India.
| | - Srinivas Balachander
- Obsessive-Compulsive Disorder Clinic, Department of Psychiatry, National Institute of Mental Health & Neuro Sciences (NIMHANS), Bangalore, 560029, India.
| | | | - Yc Janardhan Reddy
- Obsessive-Compulsive Disorder Clinic, Department of Psychiatry, National Institute of Mental Health & Neuro Sciences (NIMHANS), Bangalore, 560029, India.
| |
Collapse
|
25
|
Alternatives to Pharmacological and Psychotherapeutic Treatments in Psychiatric Disorders. PSYCHIATRY INTERNATIONAL 2021. [DOI: 10.3390/psychiatryint2010001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Nowadays, most of the patients affected by psychiatric disorders are successfully treated with psychotherapy and pharmacotherapy. Nevertheless, according to the disease, a variable percentage of patients results resistant to such modalities, and alternative methods can then be considered. The purpose of this review is to summarize the techniques and results of invasive modalities for several treatment-resistant psychiatric diseases. A literature search was performed to provide an up-to-date review of advantages, disadvantages, efficacy, and complications of Deep-Brain Stimulation, Magnetic Resonance-guided Focused-Ultrasound, radiofrequency, and radiotherapy lesioning for depression, obsessive-compulsive disorder, schizophrenia, addiction, anorexia nervosa, and Tourette’s syndrome. The literature search did not strictly follow the criteria for a systematic review: due to the large differences in methodologies and patients’ cohort, we tried to identify the highest quality of available evidence for each technique. We present the data as a comprehensive, narrative review about the role, indication, safety, and results of the contemporary instrumental techniques that opened new therapeutic fields for selected patients unresponsive to psychotherapy and pharmacotherapy.
Collapse
|
26
|
Koumantanou L, Kasvikis Y, Giaglis G, Skapinakis P, Mavreas V. Differentiation of 2 Obsessive-Compulsive Disorder Subgroups with Regard to Demographic and Phenomenological Characteristics Combining Multiple Correspondence and Latent Class Analysis. Psychopathology 2021; 54:315-324. [PMID: 34749367 DOI: 10.1159/000518906] [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: 07/31/2020] [Accepted: 08/01/2021] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Classic factor analysis of obsessive-compulsive disorder (OCD) dimensions and attempts to identify valid subgroups have not yet produced definitive conclusions. OBJECTIVE AND METHODS This study aims to examine possible homogeneous subgrouping of demographic and phenomenological characteristics in 134 treatment-seeking OCD patients. A combination of multiple correspondence analysis (MCA) and latent class analysis (LCA) was used. RESULTS MCA showed 2 distinct subgroups of OCD patients and LCA confirmed this result by a two-class solution. Both analyses demonstrated (a) a clear subgroup of female patients with washing compulsions, obsessions related to contamination, and late age of onset and (b) a subgroup comprised mostly of male patients with earlier onset of OCD, checking rituals, and doubts or aggressive obsessions. Mental, ordering, hoarding compulsions, religious, or sexual obsessions and images appeared exclusively in this subgroup. CONCLUSIONS Using 2 different analytic methods, we confirmed at least 2 subgroups in a clinical sample of Greek OCD patients. Future research combining dimensional and latent approaches could facilitate our understanding of the heterogeneous phenotype of OCD.
Collapse
Affiliation(s)
- Lia Koumantanou
- Behavior Therapy Unit, Hellenic Center of Mental Health and Research, Athens, Greece
| | - Yiannis Kasvikis
- Behavior Therapy Unit, Hellenic Center of Mental Health and Research, Athens, Greece
| | - Georgios Giaglis
- School of Psychology, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Petros Skapinakis
- Department of Psychiatry, University of Ioannina, School of Medicine, Ioannina, Greece
| | - Venetsanos Mavreas
- Department of Psychiatry, University of Ioannina, School of Medicine, Ioannina, Greece
| |
Collapse
|
27
|
Cox RC, Olatunji BO. Linking insomnia and OCD symptoms during the coronavirus pandemic: Examination of prospective associations. J Anxiety Disord 2021; 77:102341. [PMID: 33285369 PMCID: PMC7689352 DOI: 10.1016/j.janxdis.2020.102341] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 10/18/2020] [Accepted: 11/18/2020] [Indexed: 12/13/2022]
Abstract
There is considerable concern in the mental health community about the psychological consequences of the coronavirus pandemic and who may be most vulnerable. Obsessive-compulsive disorder (OCD) symptoms may be particularly sensitive to the context of the pandemic. Previous research suggests insomnia symptoms may contribute to increased OCD symptoms over time, particularly during times of stress, such as the pandemic. The present study examined pre-coronavirus outbreak insomnia symptoms as a predictor of post-coronavirus outbreak OCD symptoms in a sample of community adults who completed a 2016 survey study and were re-contacted on April 1, 2020 (N = 369). Results revealed a small significant increase in OCD symptoms following the coronavirus outbreak and a small significant decrease in insomnia symptoms. Pre-coronavirus outbreak insomnia symptoms significantly predicted increases in post-coronavirus outbreak OCD symptoms. Similar results were found for specific OCD symptom facets with the exception of washing and hoarding symptoms, which were unrelated to pre-coronavirus insomnia symptoms. There was no evidence for a reverse effect of prior OCD symptoms on insomnia symptoms during the pandemic. These findings suggest those with insomnia symptoms prior to the coronavirus pandemic may be vulnerable to increases in some OCD symptoms during the pandemic. The implications for preventing adverse psychological responses during the coronavirus pandemic are discussed.
Collapse
Affiliation(s)
- Rebecca C. Cox
- Corresponding author at: Department of Psychology, Vanderbilt University, 301 Wilson Hall, 111 21st Avenue South, Nashville, TN, 37240, United States
| | | |
Collapse
|
28
|
Eppingstall J, Xenos S, Yap K. Acceptance and commitment therapy for hoarding disorder: A proposed treatment protocol for individuals. AUSTRALIAN PSYCHOLOGIST 2020. [DOI: 10.1111/ap.12438] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
- Jan Eppingstall
- School of Health & Biomedical Sciences, RMIT University, Melbourne, Victoria, Australia,
| | - Sophia Xenos
- School of Health & Biomedical Sciences, RMIT University, Melbourne, Victoria, Australia,
| | - Keong Yap
- School of Behavioural & Health Sciences, Australian Catholic University, Sydney, New South Wales, Australia,
| |
Collapse
|
29
|
Eng GK, Collins KA, Brown C, Ludlow M, Tobe RH, Iosifescu DV, Stern ER. Dimensions of interoception in obsessive-compulsive disorder. J Obsessive Compuls Relat Disord 2020; 27:100584. [PMID: 33194538 PMCID: PMC7665060 DOI: 10.1016/j.jocrd.2020.100584] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Interoceptive sensibility (IS) refers to the subjective experience of perceiving and being aware of one's internal body sensations, and is typically evaluated using self-report questionnaires or confidence ratings. Here we evaluated IS in 81 patients with OCD and 76 controls using the Multidimensional Scale of Interoceptive Awareness (MAIA), which contains 8 subscales assessing adaptive and maladaptive responses to sensation. Compared to controls, OCD patients showed hyperawareness of body sensations. Patients also demonstrated a more maladaptive profile of IS characterized by greater distraction from and worry about unpleasant sensations, and reduced tendency to experience the body as safe and trustworthy. These findings were independent of medication status and comorbidities in the patient group. Correlational analyses showed that subscales of the MAIA were differentially associated with OCD symptom dimensions. These findings indicate that patients with OCD show abnormality of IS that is independent of confounding factors related to medication and comorbidities and associated with different OCD symptom dimensions. Future work would benefit from examining neural correlates of these effects and evaluating whether dimensions of IS are impacted by treatments for the disorder.
Collapse
Affiliation(s)
- Goi Khia Eng
- Department of Psychiatry, New York University School of
Medicine, New York, NY
- Nathan S. Kline Institute for Psychiatric Research,
Orangeburg, NY
| | - Katherine A. Collins
- Nathan S. Kline Institute for Psychiatric Research,
Orangeburg, NY
- Department of Psychiatry, Icahn School of Medicine at Mount
Sinai, New York, NY
| | - Carina Brown
- Department of Psychiatry, New York University School of
Medicine, New York, NY
- Nathan S. Kline Institute for Psychiatric Research,
Orangeburg, NY
| | - Molly Ludlow
- Nathan S. Kline Institute for Psychiatric Research,
Orangeburg, NY
| | - Russell H. Tobe
- Nathan S. Kline Institute for Psychiatric Research,
Orangeburg, NY
| | - Dan V. Iosifescu
- Department of Psychiatry, New York University School of
Medicine, New York, NY
- Nathan S. Kline Institute for Psychiatric Research,
Orangeburg, NY
| | - Emily R. Stern
- Department of Psychiatry, New York University School of
Medicine, New York, NY
- Nathan S. Kline Institute for Psychiatric Research,
Orangeburg, NY
| |
Collapse
|
30
|
McCathern AG, Mathai DS, Cho RY, Goodman WK, Storch EA. Deep transcranial magnetic stimulation for obsessive compulsive disorder. Expert Rev Neurother 2020; 20:1029-1036. [PMID: 32684005 DOI: 10.1080/14737175.2020.1798232] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
INTRODUCTION Obsessive-compulsive disorder (OCD) is a common psychiatric disorder that can be chronic and debilitating if not properly treated. Current first-line treatments for OCD include cognitive-behavioral therapy with exposure and response prevention and serotonin uptake inhibitor medications; however, these therapies are not effective for all individuals. AREAS COVERED Deep transcranial magnetic stimulation (dTMS) has been hypothesized to be an effective alternative for individuals with treatment-resistant OCD. dTMS has thought to be favorable due to its low side effect profile and its minimally invasive nature. EXPERT OPINION This review evaluates the current research on effectiveness of dTMS therapy for individuals with treatment-resistant OCD. This review also investigates shortcomings in current dTMS research and the hypothesized future of dTMS therapy.
Collapse
Affiliation(s)
- Alexis G McCathern
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine , Houston, TX, USA
| | - David S Mathai
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine , Houston, TX, USA
| | - Raymond Y Cho
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine , Houston, TX, USA
| | - Wayne K Goodman
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine , Houston, TX, USA
| | - Eric A Storch
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine , Houston, TX, USA
| |
Collapse
|
31
|
Haciomeroglu B. The role of reassurance seeking in obsessive compulsive disorder: the associations between reassurance seeking, dysfunctional beliefs, negative emotions, and obsessive- compulsive symptoms. BMC Psychiatry 2020; 20:356. [PMID: 32635924 PMCID: PMC7339499 DOI: 10.1186/s12888-020-02766-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Accepted: 06/25/2020] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND This study investigates the association of reassurance seeking with obsessive compulsive (OC) symptoms, dysfunctional beliefs, and negative emotions. METHODS Reassurance Seeking Questionnaire, Obsessive-Compulsive Inventory, Obsessive Beliefs Questionnaire, Trait Anger Expression Inventory, and Guilt Inventory were applied to 53 obsessive compulsive disorder (OCD) patients and 591 non-clinical participants. RESULTS The results showed that the severity of the OC symptoms significantly predicted the carefulness of OCD patients during reassurance seeking, indicating increased carefulness during reassurance seeking as the severity of OC symptoms increased. Moreover, feelings of guilt increased with increasing intensity of reassurance seeking. In addition, carefulness during reassurance seeking significantly predicted the level of anxiety. Responsibility/threat estimation, perfectionism/need for certainty, and importance/control of thoughts significantly predicted the OC symptoms. Moreover, the dysfunctional beliefs directly associated with an increased need to seek reassurance from different sources and seek reassurance more carefully. In terms of mediational effect, the results revealed that the individuals who had distorted beliefs were more likely to have OC symptoms and, in turn, the OC symptoms increased carefulness during reassurance seeking. The analysis of the model test revealed mostly similar results to those obtained for the clinical sample. CONCLUSIONS The findings revealed a close relationship between OC symptoms and reassurance-seeking behaviors.
Collapse
Affiliation(s)
- Bikem Haciomeroglu
- Department of Psychology, Ankara Hacı Bayram Veli University, Emniyet Mahallesi Abant 1 Cad. No:10/2D Yenimahalle, Ankara, Turkey.
| |
Collapse
|
32
|
Khosravani V, Samimi Ardestani SM, Mohammadzadeh A, Sharifi Bastan F, Amirinezhad A. The Emotional Schemas and Obsessive-Compulsive Symptom Dimensions in People with Obsessive-Compulsive Disorder. Int J Cogn Ther 2020. [DOI: 10.1007/s41811-020-00075-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
|
33
|
Cameron DH, Rowa K, McKinnon MC, Rector NA, McCabe RE. Neuropsychological performance across symptom dimensions of obsessive-compulsive disorder: a comment on the state and critical review of the literature. Expert Rev Neurother 2020; 20:425-438. [PMID: 32200686 DOI: 10.1080/14737175.2020.1746644] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Introduction: Obsessive-compulsive disorder (OCD) is a heterogeneous disorder, with multiple symptom presentations. Delineating the neuropsychological characteristics associated with previously identified symptom clusters may therefore be useful in assisting to better define symptom subtypes of OCD.Areas covered: This review summarizes the existing literature on the assessment of neuropsychological performance in symptom-based dimensions of OCD. Results of 23 studies are described and the methodological issues and challenges present in this body of literature are discussed.Expert opinion: The current state of the literature precludes a meaningful meta-analysis of cognitive dysfunction across the breadth of symptom dimensions of OCD. This is due primarily to significant methodological differences observed between studies, both in terms of neuropsychological measures and symptom subtyping methods employed, and any resulting meta-analytic results would be biased by varying quality of evidence. Future studies addressing these limitations should include more consistent neuropsychology measures and methods of classifying OCD symptoms with the aim of reproducing the results of previous research to identify more concrete patterns of neuropsychological performance across dimensions; best practices and alternative approaches are discussed.
Collapse
Affiliation(s)
- Duncan H Cameron
- Anxiety Treatment and Research Clinic, St. Joseph's Healthcare Hamilton, Hamilton, ON, Canada
| | - Karen Rowa
- Anxiety Treatment and Research Clinic, St. Joseph's Healthcare Hamilton, Hamilton, ON, Canada.,Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada
| | - Margaret C McKinnon
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada.,Mood Disorders Program, St. Joseph's Healthcare Hamilton, Hamilton, ON, Canada
| | - Neil A Rector
- Frederick W. Thompson Anxiety Disorders Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.,Department of Psychiatry and Psychological Clinical Science, University of Toronto, Toronto, ON, Canada
| | - Randi E McCabe
- Anxiety Treatment and Research Clinic, St. Joseph's Healthcare Hamilton, Hamilton, ON, Canada.,Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada
| |
Collapse
|
34
|
Maguire J, McCormack C, Mitchell A, Monk C. Neurobiology of maternal mental illness. HANDBOOK OF CLINICAL NEUROLOGY 2020; 171:97-116. [PMID: 32736761 DOI: 10.1016/b978-0-444-64239-4.00005-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
This chapter provides an overview of current research discoveries beginning to uncover the neurobiology of maternal mental illness. Results are described according to standard diagnostic categories (specifically, perinatal depression, perinatal anxiety and OCD, postpartum psychosis and bipolar disorder, and trauma and posttraumatic stress disorder), yet we aim to put this approach in context with the introduction of a classification model for psychiatric research, the research domain criteria, gaining traction in basic and clinical translational fields. We first review a new area of study, the neuroplasticity of the pregnant and postpartum brain, as work here has relevance for understanding the pathophysiology of mental disorders and may provide clues to changes in brain functioning that are related to compromised parenting in the context of postpartum depression. We next provide background information on neuroendocrine and immune changes during pregnancy and, to a lesser extent, the postpartum period, as alterations in these systems are significantly implicated in underlying neurobiology of mental illness for peripartum women. Our discussion of the major mental illnesses for pregnant and postpartum women includes neuroendocrine changes, neuroinflammation, and neurotransmitter alterations, as well as circuit dysfunction. Overall, remarkable progress has been made in identifying variations in neurobiology (and related systems) involved in maternal mental illness; yet, it is clear that, as classified with standard diagnostic systems, these are heterogeneous disorders and there is individual variability in the alterations in neurobiology for the same illness.
Collapse
Affiliation(s)
- Jamie Maguire
- Department of Neuroscience, Tufts University School of Medicine, Boston, MA, United States
| | - Clare McCormack
- Center for Science and Society, Columbia University, New York, NY, United States
| | - Anika Mitchell
- Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, NY, United States
| | - Catherine Monk
- Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York, NY, United States; Department of Psychiatry, Columbia University Irving Medical Center, New York, NY, United States; New York State Psychiatric Institute, New York, NY, United States.
| |
Collapse
|
35
|
|
36
|
Che Din N, Mohd Nawi L, Ghazali SE, Ahmad M, Ibrahim N, Said Z, Amit N, Subramaniam P. Preliminary Analysis of the Factor Structure, Reliability and Validity of an Obsessive-Compulsive Disorder Screening Tool for Use with Adults in Malaysia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:E4763. [PMID: 31795076 PMCID: PMC6927007 DOI: 10.3390/ijerph16234763] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Revised: 11/08/2019] [Accepted: 11/09/2019] [Indexed: 12/02/2022]
Abstract
This is a preliminary study to examine the factor structure, reliability, and validity of an obsessive-compulsive disorder (OCD) screening tool for use in the Malaysian setting. A total of 199 Malaysian adults were recruited for this study. After cleaning and normalizing the data, 190 samples were left to be analyzed. Principle component analysis using varimax rotation was then performed to examine various factors derived from psychometric tools commonly used to assess OCD patients. The screening tool exhibited three factors that fit the description of obsessions and compulsions from the Diagnostic and Statistical Manual of Mental Disorders-5th Edition (DSM 5), as well as other common symptoms that co-morbid with OCD. The labels given to the three factors were: Severity of Compulsions, Severity of Obsessions, and Symptoms of Depression and Anxiety. Reliability analysis showed high reliability with a Cronbach's alpha of 0.94, whereas convergent validity of the tool with the Yale Brown Obsessive-compulsive Scale-Self Report demonstrated good validity of r = 0.829. The three-factor model explained 68.91% of the total variance. Subsequent studies should focus on OCD factors that are culturally unique in the Malaysian context. Future research may also use online technology, which is cost-efficient and accessible, to further enhance the screening tool.
Collapse
Affiliation(s)
- Normah Che Din
- Health Psychology Program, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur 50300, Malaysia; (L.M.N.); (S.E.G.); (M.A.); (N.I.); (Z.S.); (N.A.); (P.S.)
| | | | | | | | | | | | | | | |
Collapse
|
37
|
Olatunji BO, Christian C, Brosof L, Tolin DF, Levinson CA. What is at the core of OCD? A network analysis of selected obsessive-compulsive symptoms and beliefs. J Affect Disord 2019; 257:45-54. [PMID: 31299404 DOI: 10.1016/j.jad.2019.06.064] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Revised: 05/01/2019] [Accepted: 06/30/2019] [Indexed: 01/20/2023]
Abstract
BACKGROUND Obsessive-compulsive disorder (OCD) is a heterogeneous condition that consists of distinct subtypes, and identification of its core symptoms may inform how to best conceptualize the heterogeneity. Accordingly, we used network analysis to evaluate which symptoms (and associations between symptoms) are most central to OCD symptoms and beliefs. METHODS Participants consisted of a combined sample of adults with a primary diagnosis of OCD (N = 150), those with other primary diagnoses (N = 114), and an unselected nonclinical sample (N = 310). Network analysis was used to identify the most central symptoms (nodes) and associations between symptoms (edges) assessed by the Obsessive-Compulsive Inventory-Revised and the Obsessional Beliefs Questionnaire-44. RESULTS The most central symptoms in the network were negative appraisals of intrusive thoughts (i.e., Having intrusive thoughts means I'm out of control). Some of the strongest associations between symptoms were also observed for those pertaining to intrusive thoughts and their negative appraisal. Furthermore, central symptoms in the network predicted depression and anxiety (over and above peripheral symptoms) among those with a primary diagnosis of OCD, but not the severity of OCD symptoms. LIMITATIONS The approach was exploratory rather than experimental and relied solely on self-report measures of OCD symptoms and beliefs. CONCLUSIONS Negative appraisals of intrusive thoughts were the most central symptoms in the OCD network, and they uniquely predict co-occurring symptoms of anxiety and depression, suggesting that these symptoms should be prioritized in theoretical and treatment models of OCD.
Collapse
Affiliation(s)
- Bunmi O Olatunji
- Department of Psychology, Vanderbilt University, 301 Wilson Hall, 111 21st Avenue South, Nashville, TN 37203, USA.
| | | | | | | | | |
Collapse
|
38
|
Wolmarans DW, Stein DJ, Harvey BH. A Psycho-Behavioral Perspective on Modelling Obsessive-Compulsive Disorder (OCD) in Animals: The Role of Context. Curr Med Chem 2019; 25:5662-5689. [PMID: 28545371 DOI: 10.2174/0929867324666170523125256] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2016] [Revised: 04/18/2017] [Accepted: 05/29/2017] [Indexed: 01/24/2023]
Abstract
Obsessive-compulsive disorder is a heterogeneous and debilitating condition, characterized by intrusive thoughts and compulsive repetition. Animal models of OCD are important tools that have the potential to contribute significantly to our understanding of the condition. Although there is consensus that pre-clinical models are valuable in elucidating the underlying neurobiology in psychiatric disorders, the current paper attempts to prompt ideas on how interpretation of animal behavior can be expanded upon to more effectively converge with the human disorder. Successful outcomes in psychopharmacology involve rational design and synthesis of novel compounds and their testing in well-designed animal models. As part of a special journal issue on OCD, this paper will 1) review the psychobehavioral aspects of OCD that are of importance on how the above ideas can be articulated, 2) briefly elaborate on general issues that are important for the development of animal models of OCD, with a particular focus on the role and importance of context, 3) propose why translational progress may often be less than ideal, 4) highlight some of the significant contributions afforded by animal models to advance understanding, and 5) conclude by identifying novel behavioral constructs for future investigations that may contribute to the face, predictive and construct validity of OCD animal models. We base these targets on an integrative approach to face and construct validity, and note that the issue of treatment-resistance in the clinical context should receive attention in current animal models of OCD.
Collapse
Affiliation(s)
- De Wet Wolmarans
- Division of Pharmacology, Center of Excellence for Pharmaceutical Sciences, Faculty of Health Sciences, North West-University, Potchefstroom, South Africa
| | - Dan J Stein
- MRC Unit on Risk and Resilience in Mental Disorders, University of Cape Town, Cape Town, South Africa.,Department of Psychiatry and Mental Health, MRC Unit on Risk and Resilience in Mental Disorders, University of Cape Town, Cape Town, South Africa
| | - Brian H Harvey
- Division of Pharmacology, Center of Excellence for Pharmaceutical Sciences, Faculty of Health Sciences, North West-University, Potchefstroom, South Africa.,MRC Unit on Risk and Resilience in Mental Disorders, University of Cape Town, Cape Town, South Africa
| |
Collapse
|
39
|
Buchholz JL, Blakey SM, Abramowitz JS, Leonard RC, Riemann BC. Predictors of concurrent depressive symptoms in patients with obsessive-compulsive disorder. Psychiatry Res 2019; 279:267-271. [PMID: 30955863 DOI: 10.1016/j.psychres.2019.03.052] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2018] [Revised: 03/29/2019] [Accepted: 03/30/2019] [Indexed: 01/22/2023]
Abstract
Many patients with obsessive-compulsive disorder (OCD) exhibit concurrent depressive symptoms, which are associated with negative psychological outcomes. Yet little research has focused on identifying factors that predict depressive symptoms in OCD. The current study examined three transdiagnostic constructs-anxiety sensitivity (AS), intolerance of uncertainty (IU), and worry-as predictors of depressive symptom severity in a sample of treatment-seeking adults with a primary diagnosis of OCD (N = 93). Strong, positive associations between depressive symptoms and measures of AS, IU, and worry were detected, and AS and worry (but not IU) remained significant unique predictors of depression after controlling for the severity of OCD symptoms. The conceptual and clinical implications of these findings, as well as study limitations and future directions, are discussed.
Collapse
Affiliation(s)
- Jennifer L Buchholz
- Department of Psychology & Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599-3270, USA.
| | - Shannon M Blakey
- Department of Psychology & Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599-3270, USA
| | - Jonathan S Abramowitz
- Department of Psychology & Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599-3270, USA
| | | | | |
Collapse
|
40
|
Siwiec SG, Riemann BC, Lee HJ. Predictors of acute outcomes for intensive residential treatment of obsessive-compulsive disorder. Clin Psychol Psychother 2019; 26:661-672. [PMID: 31273851 DOI: 10.1002/cpp.2389] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2018] [Revised: 06/20/2019] [Accepted: 06/25/2019] [Indexed: 11/09/2022]
Abstract
For those who suffer with chronic and disruptive obsessive-compulsive disorder (OCD), who have not been sufficiently helped by outpatient treatments or medications, intensive residential treatment (IRT) is often the next best treatment option. To date, research of the predictors of treatment outcome in IRT for OCD are mixed and sometimes contradictory. Additionally, although comorbidity is common for patients in this setting, the inclusion of comorbidity as a potential predictor of outcome has been mostly lacking in research to date. The current study aimed to address these issues by utilizing optimal indices of treatment outcomes, while incorporating comorbidity into our analyses, in order to identify the predictors of treatment outcomes in the IRT for OCD setting. To this end, we analysed outcome data from 379 patients receiving IRT for OCD at the Rogers Memorial OCD Center between August 2012, and December 2017. Results indicated that the most important predictor of treatment outcome was obsession severity at admission. Specifically, higher obsession severity at admission predicted poorer treatment outcomes at discharge. Clinical implications and suggestions for future research were discussed in the manuscript.
Collapse
Affiliation(s)
- Stephan G Siwiec
- Department of Psychology, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin, USA
| | | | - Han-Joo Lee
- Department of Psychology, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin, USA
| |
Collapse
|
41
|
Fink J, Exner C. Does Transcranial Direct Current Stimulation (tDCS) Improve Disgust Regulation Through Imagery Rescripting? Front Hum Neurosci 2019; 13:192. [PMID: 31275125 PMCID: PMC6593270 DOI: 10.3389/fnhum.2019.00192] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Accepted: 05/23/2019] [Indexed: 11/13/2022] Open
Abstract
The first pilot studies have shown the potential of imagery rescripting (ImR) for reducing contamination-related pathological disgust, although the effects were rather small. The aim of the present study is to investigate whether the effects of ImR in reducing disgust can be further increased by transcranial direct current stimulation (tDCS). tDCS is a non-invasive method of brain stimulation that has been successfully used multiple times to support emotion-regulation strategies. In the present study, disgust was induced via images related to individualized sources of disgust. Fifty-eight healthy volunteers took part in two parallel experiments. The two groups were matched by age, highest educational level and gender, and were tested under two emotion-regulation conditions, namely an ImR condition and a control condition. Participants performed three trials on the first day and three trials on the second day. Across both days they performed three trials under each of the two emotion-regulation conditions in a randomized order. On one day active stimulation was applied, while on the other day participants were sham stimulated. The combination of emotion-regulation and stimulation condition was balanced across subjects. The only difference between the two groups was the localization of tDCS stimulation: one group was stimulated over the dorsolateral prefrontal cortex and the other group was stimulated over the visual cortex (VC). This experimental manipulation was implemented to gain further insights into the underlying neuropsychological mechanisms of imagery. ImR was conducted via a previously-recorded audio file. The results confirm the effect of ImR on the reduction of disgust. However, with the present experimental design we were not able to show that supplementary tDCS of the VC or the dorsolateral prefrontal cortex lead to improvement.
Collapse
Affiliation(s)
- Jakob Fink
- Department of Clinical Psychology and Psychotherapy, University of Leipzig, Leipzig, Germany
| | - Cornelia Exner
- Department of Clinical Psychology and Psychotherapy, University of Leipzig, Leipzig, Germany
| |
Collapse
|
42
|
Say Öcal D, Özdel K, Şafak Y, Kekilli Karnaz Y, Kısa C. A comparison of symptom dimensions for obsessive compulsive disorder and obsessive compulsive-related disorders. PLoS One 2019; 14:e0218955. [PMID: 31276509 PMCID: PMC6611656 DOI: 10.1371/journal.pone.0218955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2018] [Accepted: 06/12/2019] [Indexed: 11/19/2022] Open
Abstract
Objective In this study, it is aimed to determine obsessive compulsive-related disorders (OCRDs) comorbidity among the patients with obsessive compulsive disorder (OCD) and compare patients with OCD with or without comorbid OCRDs in terms of the severity of their OCD symptoms, symptom dimensions, and comorbidity with other axis I disorders. Methods The study included 90 patients diagnosed as having OCD according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR). The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) diagnostic criteria for OCRDs were used to determine the presence of OCRDs. In order to determine the symptom dimensions and severity of these individuals’ OCD symptoms, we administered the Dimensional Obsessive Compulsive Scale (DOCS) and The Yale-Brown Obsessive Compulsive Scale (Y-BOCS). Results In our study, 20% of the patients with OCD simultaneously met the criteria for at least one OCRD, we also found that a significantly greater proportion of this group were men. None of the mentioned disorders was associated with any symptom dimensions we evaluated using DOCS. In addition, no differences were found in the severity of OCD symptoms and comorbid axis I disorders between the group with comorbid OCRDs and the group without comorbid OCRDs. Discussion There was no significant relationship between the symptom dimensions of OCD and OCRDs. It is found that OCRD comorbidity does not increase the severity of OCD symptoms and the prevalence of an axis I diagnosis.
Collapse
Affiliation(s)
- Derya Say Öcal
- Department of Psychiatry, Kecioren Training and Research Hospital, Ankara, Turkey
- * E-mail:
| | - Kadir Özdel
- Department of Psychiatry, Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey
| | - Yasir Şafak
- Department of Psychiatry, Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey
| | | | - Cebrail Kısa
- Department of Psychology, İstanbul Aydın University, İstanbul, Turkey
| |
Collapse
|
43
|
Mulhall K, O’Connor J, Timulakova K. Managing the monster in the mind: a psychoanalytically informed qualitative study exploring the experiences of people diagnosed with obsessive-compulsive disorder. PSYCHOANALYTIC PSYCHOTHERAPY 2019. [DOI: 10.1080/02668734.2019.1614087] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- K. Mulhall
- School of Psychology, Trinity College, Dublin, Ireland
| | - J. O’Connor
- School of Psychology, Trinity College, Dublin, Ireland
| | - K. Timulakova
- Psychology Department, Strand House, Dublin 3, Ireland
| |
Collapse
|
44
|
Buchholz JL, Abramowitz JS, Blakey SM, Reuman L, Twohig MP. Sudden Gains: How Important Are They During Exposure and Response Prevention for Obsessive-Compulsive Disorder? Behav Ther 2019; 50:672-681. [PMID: 31030882 DOI: 10.1016/j.beth.2018.10.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Revised: 10/09/2018] [Accepted: 10/09/2018] [Indexed: 01/27/2023]
Abstract
Symptom reduction over the course of cognitive-behavioral therapy is not always distributed evenly across sessions. Some individuals experience a sudden gain, defined as a large, rapid, and stable decrease in symptoms during treatment. Although research documents a link between sudden gains and treatment for depression and anxiety, findings in the context of obsessive-compulsive disorder (OCD) treatment are mixed. The present study investigated the relationship between sudden gains and treatment outcome in 44 adults with OCD and addressed limitations of previous studies by measuring OCD symptoms dimensionally and comparing individuals who experience sudden gains to those who experience gradual gains of similar magnitude. Sudden gains were observed among 27% of participants, with highest rates among individuals with primary contamination symptoms. Participants who experienced a sudden gain had greater OCD symptom reductions at posttreatment (but not at follow-up), and this difference did not persist after controlling for gain magnitude. Thus, the importance of sudden gains during OCD treatment may be limited. Findings are discussed in light of inhibitory learning models of cognitive-behavioral therapy.
Collapse
|
45
|
Ozcanli F, Ceulemans E, Hermans D, Claes L, Mesquita B. Obsessions Across Two Cultures: A Comparison of Belgian and Turkish Non-clinical Samples. Front Psychol 2019; 10:657. [PMID: 30971988 PMCID: PMC6443853 DOI: 10.3389/fpsyg.2019.00657] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Accepted: 03/08/2019] [Indexed: 11/13/2022] Open
Abstract
There is a growing interest in the role of culture in Obsessive-Compulsive Disorder, yet cultural studies to date have suffered from methodological limitations and lack a clear theoretical framework. In the current study, we adopted a rigorous methodological approach, and a clear cultural psychological framework. We compared the structure and frequency of obsessions in non-clinical samples (N = 706) from Belgium, a Western culture, and Turkey, a non-Western cultural context. Obsessions were measured by a newly compiled instrument that included a broad range of obsessions. Cross-cultural equivalence of the structure of obsessions was assessed both in the pooled data, and in each culture separately. At an abstract level, we found a two-factor structure that was cross-culturally invariant, and that fit both cultures equally well. These two types of obsessions each corresponded with a different model of agency. Compared to the Turkish sample, the Belgian sample reported more obsessions that can be understood from a disjoint (independent) model of agency as frequently found in Western cultures, whereas the Turkish sample, compared to their Belgian counterparts, reported more obsessions that can be tied to a conjoint (shared) model of agency as frequently found in non-Western cultural contexts. Differences in the prevalent types of obsessions were systematic and interpretable, therefore. In addition to the cross-culturally equivalent two-factor structure, we found culture-specific factor solutions; these solutions point to cultural differences in the experience of obsessions that have yet to be fully understood. In the Discussion, we outline future directions of the research on culture and obsessions.
Collapse
Affiliation(s)
- Fulya Ozcanli
- Center for Social and Cultural Psychology, Faculty of Psychology and Educational Sciences, KU Leuven, Leuven, Belgium
| | - Eva Ceulemans
- Research Group of Quantitative Psychology and Individual Differences, Faculty of Psychology and Educational Sciences, KU Leuven, Leuven, Belgium
| | - Dirk Hermans
- Centre for the Psychology of Learning and Experimental Psychopathology, Faculty of Psychology and Educational Sciences, KU Leuven, Leuven, Belgium
| | - Laurence Claes
- Research Group of Clinical Psychology, Faculty of Psychology and Educational Sciences, KU Leuven, Leuven, Belgium.,Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Batja Mesquita
- Center for Social and Cultural Psychology, Faculty of Psychology and Educational Sciences, KU Leuven, Leuven, Belgium
| |
Collapse
|
46
|
Palmer AM, Schlauch RC, Darkes J. Treatment of Violent and Sexual Obsessions Using Exposure and Response Prevention During a Concurrent Depressive Episode. Clin Case Stud 2019. [DOI: 10.1177/1534650119838628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Obsessive-compulsive disorder (OCD) frequently co-occurs during a major depressive episode (i.e., Major depressive disorder, MDD). Concurrent depressive episodes may present additional challenges and barriers in OCD treatment; therefore, clinicians should address both symptom domains simultaneously. The present case study illustrates an example of an individual presenting with OCD symptoms falling under aggressive and sexual domains. The treatment utilized was exposure and response prevention (ERP), which is empirically supported to address OCD symptoms. Additional treatment elements, such as behavioral activation, building self-concept through mastery, and emotional processing were incorporated to specifically address depression symptoms, which enhanced the efficacy of ERP. The current case presentation provides evidence that the utilized combination of treatment modalities is feasible to implement and may effectively reduce OCD symptoms during a depressive episode.
Collapse
Affiliation(s)
- Amanda M. Palmer
- University of South Florida, Tampa, FL, USA
- Moffitt Cancer Center, Tampa, FL, USA
| | | | | |
Collapse
|
47
|
Falkenstein MJ, Nota JA, Krompinger JW, Schreck M, Garner LE, Potluri S, Van Kirk N, Ponzini G, Tifft E, Brennan BP, Mathes B, Cattie J, Crosby JM, Elias JA. Empirically-derived response trajectories of intensive residential treatment in obsessive-compulsive disorder: A growth mixture modeling approach. J Affect Disord 2019; 245:827-833. [PMID: 30699866 PMCID: PMC9632647 DOI: 10.1016/j.jad.2018.11.075] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Revised: 11/01/2018] [Accepted: 11/11/2018] [Indexed: 10/27/2022]
Abstract
BACKGROUND This study investigated distinct trajectories of treatment response in a naturalistic intensive/residential treatment (IRT) program for adults with severe obsessive-compulsive disorder (OCD). We hypothesized that: (1) distinct trajectories would emerge and (2) demographic variables, psychiatric comorbidity, OCD symptom subtype, level of insight, previous exposure and response prevention (ERP) treatment, and quality of life, would differentially predict assignment to these trajectories. METHODS Participants included 305 individuals with primary OCD admitted for IRT. RESULTS Two trajectories emerged over the course of the first eight weeks of treatment, with the vast majority of participants demonstrating treatment response. The first trajectory (96%, n = 292) showed a negative, linear treatment response (a.k.a. "linear responders") and more severe OCD symptoms at admission. The second trajectory (4%, n = 13) had less severe OCD symptoms at admission and did not exhibit a significant overall change in symptoms over the course of treatment. More specifically, this second trajectory or "u-shaped responders" show a non-significant linear response through week four of treatment, followed by slightly increased symptoms in week five. Assignment to these classes was not differentially predicted by hypothesized predictor variables. LIMITATIONS Our final model had inconsistent fit indices and small class prevalance of the u-shaped responder group; therefore, model selection was based on both fit indices and substantive meaning. CONCLUSIONS This study emprically derived two distinct trajectories of OCD symptom severity over the course of IRT. These findings have the potential to refine IRT for patients with severe OCD, and to potentially guide future investigation into the optimal delivery of ERP treatment for OCD generally.
Collapse
Affiliation(s)
| | | | | | - Meghan Schreck
- McLean Hospital/Harvard Medical School, Belmont, MA, United States.
| | | | - Sriramya Potluri
- McLean Hospital/Harvard Medical School, Belmont, MA, United States.
| | | | | | - Eric Tifft
- McLean Hospital/Harvard Medical School, Belmont, MA, United States.
| | | | - Brittany Mathes
- McLean Hospital/Harvard Medical School, Belmont, MA, United States.
| | - Jordan Cattie
- McLean Hospital/Harvard Medical School, Belmont, MA, United States.
| | | | | |
Collapse
|
48
|
Raines AM, Franklin CL, Carroll MN. Obsessive-Compulsive Symptom Dimensions and Insomnia: Associations Among a Treatment-Seeking Veteran Sample. J Cogn Psychother 2019; 33:46-57. [PMID: 32746421 DOI: 10.1891/0889-8391.33.1.46] [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
Sleep disturbances are a prevalent and pernicious correlate of most emotional disorders. A growing body of literature has recently found evidence for an association between sleep disturbances and obsessive-compulsive disorder (OCD). Though informative, this link has yet to be explored in a veteran population. Further, the degree to which this relationship is accounted for by relevant third variables is limited. The current study investigated the relationship between self-reported insomnia and OCD symptoms after controlling for probable depression and posttraumatic stress disorder (PTSD) using an unselected sample of veterans (N = 57). Most of the sample reported clinically significant OCD (61%) and insomnia symptoms (58%). Results revealed associations between insomnia and OCD unacceptable thoughts/neutralizing compulsions, but not contamination obsessions/washing compulsions, responsibility for harm obsessions/checking compulsions, or symmetry obsessions/ordering compulsions. Findings highlight the need for more research on OCD and sleep problems and clinical work focused on sleep for patients reporting increased OCD symptoms, particularly veterans.
Collapse
Affiliation(s)
- Amanda M Raines
- South Central Mental Illness Research, Education and Clinical Center (MIRECC), New Orleans, Louisiana.,Southeast Louisiana Veterans Health Care System, New Orleans, Louisiana.,Department of Psychiatry and Behavioral Sciences, Tulane University School of Medicine, New Orleans, Louisiana
| | - C Laurel Franklin
- South Central Mental Illness Research, Education and Clinical Center (MIRECC), New Orleans, Louisiana.,Southeast Louisiana Veterans Health Care System, New Orleans, Louisiana.,Department of Psychiatry and Behavioral Sciences, Tulane University School of Medicine, New Orleans, Louisiana
| | - Michele N Carroll
- Southeast Louisiana Veterans Health Care System, New Orleans, Louisiana
| |
Collapse
|
49
|
Brown C, Shahab R, Collins K, Fleysher L, Goodman WK, Burdick KE, Stern ER. Functional neural mechanisms of sensory phenomena in obsessive-compulsive disorder. J Psychiatr Res 2019; 109:68-75. [PMID: 30508745 PMCID: PMC6347462 DOI: 10.1016/j.jpsychires.2018.11.018] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2018] [Revised: 11/02/2018] [Accepted: 11/20/2018] [Indexed: 11/24/2022]
Abstract
Sensory phenomena (SP) are aversive or uncomfortable sensations that accompany and/or drive repetitive behaviors in obsessive-compulsive disorder (OCD). Although SP are associated with significant distress and may respond less well to standard treatments than harm-related obsessions, little is known about their underlying neurobiology. The present study used functional magnetic resonance imaging (fMRI) to measure brain functioning related to severity of SP during a "body-focused" videos task designed to elicit activation in sensorimotor brain regions. Regression analysis examined the relationship between severity of SP and activation during task using permutation analysis, cluster-level corrected for multiple comparisons (family-wise error rate p < 0.05). The distribution of SP severity was not significantly different from normal, with both high- and low-severity scores represented in the OCD sample. Severity of SP was not correlated with other clinical symptoms in OCD including general anxiety, depression, or harm avoidance. When viewing body-focused videos, patients with greater severity of SP showed increased activity in the mid-posterior insula, a relationship that remained significant when controlling for other clinical symptoms, medication status, and comorbidities. At uncorrected thresholds, SP severity was also positively related to somatosensory, mid orbitofrontal, and lateral prefrontal cortical activity. These data suggest that SP in OCD are dissociable from other symptoms in the disorder and related to hyperactivation of the insula. Future work examining neural mechanisms of SP across different disorders (tics, trichotillomania) as well as with other imaging modalities will be needed to further understand the neurobiology of these impairing symptoms.
Collapse
Affiliation(s)
- Carina Brown
- Department of Psychiatry, New York University School of Medicine, New York, NY, USA; Nathan Kline Institute for Psychiatric Research, Orangeburg, NY, USA
| | - Rebbia Shahab
- Department of Psychiatry, New York University School of Medicine, New York, NY, USA; Nathan Kline Institute for Psychiatric Research, Orangeburg, NY, USA
| | - Katherine Collins
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Lazar Fleysher
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Wayne K Goodman
- Department of Psychiatry, Baylor College of Medicine, Houston, TX, USA
| | | | - Emily R Stern
- Department of Psychiatry, New York University School of Medicine, New York, NY, USA; Nathan Kline Institute for Psychiatric Research, Orangeburg, NY, USA.
| |
Collapse
|
50
|
McGuire JF, Tan PZ, Piacentini J. Symptom Dimension Response in Children and Adolescents with Obsessive-Compulsive Disorder. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY 2019; 48:529-538. [PMID: 30644767 DOI: 10.1080/15374416.2018.1540009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
This report examined the nature of obsessive-compulsive disorder (OCD) symptoms nominated for treatment and investigate improvement in OCD symptom dimensions. Youth with OCD (N = 71) participated in a clinical trial that compared exposure-based cognitive behavior therapy (CBT) to psychoeducation plus relaxation training (PRT). Participants completed a baseline assessment to characterize OCD severity. Next, parents and youth collaboratively developed an OCD symptom treatment hierarchy. Afterward, these symptoms were independently reassessed at each session by youth and parents. After 12 sessions, a posttreatment assessment was completed by independent evaluators. A greater incidence of baseline aggressive/checking symptoms predicted a positive CBT treatment response. For parent ratings of youth distress, CBT outperformed PRT across symptom dimensions, but hoarding symptoms exhibited a slower rate of improvement relative to other dimensions across treatments. For youth distress ratings, CBT outperformed PRT across most symptom dimensions. Although symmetry/ordering symptoms exhibited a slower rate of improvement relative to other dimensions across treatments, post hoc tests found no difference in the average distress rating for symmetry/ordering symptoms between treatment groups. Finally, across symptom dimensions, parents reported a linear reduction in youth distress, whereas youth experienced a nonlinear reduction in distress that diminished over treatment. Exposure-based CBT is beneficial for OCD symptoms and remains the principle treatment for pediatric OCD. However, as symmetry/ordering symptoms exhibited improvement from CBT and PRT, there is some shared treatment mechanisms that improves these symptoms. Finally, as youth perceive diminishing distress reduction over time, clinicians are encouraged to employ appropriate reinforcement strategies in treatment.
Collapse
Affiliation(s)
- Joseph F McGuire
- a Division of Child and Adolescent Psychiatry , Johns Hopkins University School of Medicine.,b Semel Institute for Neuroscience and Human Behavior, Department of Psychiatry , University of California
| | - Patricia Z Tan
- b Semel Institute for Neuroscience and Human Behavior, Department of Psychiatry , University of California
| | - John Piacentini
- b Semel Institute for Neuroscience and Human Behavior, Department of Psychiatry , University of California
| |
Collapse
|