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Smits JAJ, Abramowitz JS, Arch JJ, Papini S, Anderson RA, Dixon LJ, Graham BM, Hofmann SG, Hoyer J, Huppert JD, Jacquart J, Johnson D, McEvoy PM, McKay D, Newby J, Otto MW, Pittig A, Rief W, Rosenfield D, Timpano KR, Wannemüller A. Improving Exposure Therapy: Rationale and Design of an International Consortium. Psychiatr Clin North Am 2024; 47:433-444. [PMID: 38724129 PMCID: PMC11082449 DOI: 10.1016/j.psc.2024.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/12/2024]
Abstract
The Exposure Therapy Consortium (ETC) was established to advance the science and practice of exposure therapy. To encourage participation from researchers and clinicians, this article describes the organizational structure and activities of the ETC. Initial research working group experiences and a proof-of-principle study underscore the potential of team science and larger-scale collaborative research in this area. Clinical working groups have begun to identify opportunities to enhance access to helpful resources for implementing exposure therapy effectively. This article discusses directions for expanding the consortium's activities and its impact on a global scale.
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Affiliation(s)
- Jasper A J Smits
- Department of Psychology, The University of Texas at Austin, 1 University Station, Mail Code A8000, Austin, TX 78712, USA.
| | - Jonathan S Abramowitz
- Department of Psychology, The University of North Carolina at Chapel Hill, Campus Box 3270, Chapel Hill, NC 27599, USA
| | - Joanna J Arch
- Department of Psychology and Neuroscience, University of Colorado Boulder, Boulder, CO, USA
| | - Santiago Papini
- Department of Psychology, University of Hawai'i at Mānoa, 2530 Dole Street, Sakamaki C400, Honolulu, HI 96822, USA
| | - Rebecca A Anderson
- School of Population Health and enAble Institute, Curtin University, Bentley, Western Australia, 6102 Australia
| | - Laura J Dixon
- Department of Psychology, University of Mississippi, P.O. Box 1848, University, MS 38677, USA
| | - Bronwyn M Graham
- School of Psychology, UNSW Sydney, New South Wales 2052 Australia
| | - Stefan G Hofmann
- Department of Psychology, University of Marburg, Marburg 35032, Germany
| | | | - Jonathan D Huppert
- Department of Psychology, The Hebrew University of Jerusalem, Mt. Scopus, Jerusalem, 91905 Israel
| | - Jolene Jacquart
- Department of Psychology, The University of Arizona, 1503 E. University Boulevard, Tucson, AZ 85721, USA
| | - David Johnson
- Department of Psychological & Brain Sciences, Texas A&M University, 4235 TAMU, College Station, TX 77843, USA
| | - Peter M McEvoy
- Centre for Clinical Interventions, Perth, Western Australia 6000, Australia
| | - Dean McKay
- Department of Psychology, Fordham University, 441 East Fordham Road, Bronx, NY 10458-5198, USA
| | - Jill Newby
- School of Psychology, UNSW Sydney at the Black Dog Institute, Hospital Road, Randwick, New South Wales 2031, Australia
| | - Michael W Otto
- Department of Psychological and Brain Sciences, Boston University, 64 Cummington Mall, Boston, MA 02215, USA
| | - Andre Pittig
- Translational Psychotherapy, Institute of Psychology, University of Goettingen, Germany
| | - Winfried Rief
- Department of Psychology, University of Marburg, 35032 Marburg, Germany
| | - David Rosenfield
- Department of Psychology, Southern Methodist University, 6425 Boaz Lane, Dallas TX 75205, USA
| | - Kiara R Timpano
- Department of Psychology, The University of Miami, 5665 Ponce de Leon Boulevard, Coral Gables, FL 33146, USA
| | - Andre Wannemüller
- Mental Health Research and Treatment Center, Ruhr University Bochum, Massenbergstr. 9-13, Bochum 44787, Germany
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Crowley JJ, Cappi C, Ochoa-Panaifo ME, Frederick RM, Kook M, Wiese AD, Rancourt D, Atkinson EG, Giusti-Rodriguez P, Anderberg JL, Abramowitz JS, Adorno VR, Aguirre C, Alves GS, Alves GS, Ancalade N, Arellano Espinosa AA, Arnold PD, Ayton DM, Barbosa IG, Castano LMB, Barrera CN, Berardo MC, Berrones D, Best JR, Bigdeli TB, Burton CL, Buxbaum JD, Callahan JL, Carneiro MCB, Cepeda SL, Chazelle E, Chire JM, Munoz MC, Quiroz PC, Cobite J, Comer JS, Costa DL, Crosbie J, Cruz VO, Dager G, Daza LF, de la Rosa-Gómez A, Del Río D, Delage FZ, Dreher CB, Fay L, Fazio T, Ferrão YA, Ferreira GM, Figueroa EG, Fontenelle LF, Forero DA, Fragoso DTH, Gadad BS, Garrison SR, González A, Gonzalez LD, González MA, Gonzalez-Barrios P, Goodman WK, Grice DE, Guintivano J, Guttfreund DG, Guzick AG, Halvorsen MW, Hovey JD, Huang H, Irreño-Sotomonte J, Janssen-Aguilar R, Jensen M, Jimenez Reynolds AZ, Lujambio JAJ, Khalfe N, Knutsen MA, Lack C, Lanzagorta N, Lima MO, Longhurst MO, Lozada Martinez DA, Luna ES, Marques AH, Martinez MS, de Los Angeles Matos M, Maye CE, McGuire JF, Menezes G, Minaya C, Miño T, Mithani SM, de Oca CM, Morales-Rivero A, Moreira-de-Oliveira ME, Morris OJ, Muñoz SI, Naqqash Z, Núñez Bracho AA, Núñez Bracho BE, Rojas MCO, Olavarria Castaman LA, Balmaceda TO, Ortega I, Patel DI, Patrick AK, Paz Y Mino M, Perales Orellana JL, Stumpf BP, Peregrina T, Duarte TP, Piacsek KL, Placencia M, Prieto MB, Quarantini LC, Quarantini-Alvim Y, Ramos RT, Ramos IC, Ramos VR, Ramsey KA, Ray EV, Richter MA, Riemann BC, Rivas JC, Rosario MC, Ruggero CJ, Ruiz-Chow AA, Ruiz-Velasco A, Sagarnaga MN, Sampaio AS, Saraiva LC, Schachar RJ, Schneider SC, Schweissing EJ, Seligman LD, Shavitt RG, Soileau KJ, Stewart SE, Storch SB, Strouphauer ER, Cuevas VT, Timpano KR, la Garza BTD, Vallejo-Silva A, Vargas-Medrano J, Vásquez MI, Martinez GV, Weinzimmer SA, Yanez MA, Zai G, Zapata-Restrepo LM, Zappa LM, Zepeda-Burgos RM, Zoghbi AW, Miguel EC, Rodriguez CI, Martinez Mallen MC, Moya PR, Borda T, Moyano MB, Mattheisen M, Pereira S, Lázaro-Muñoz G, Martinez-Gonzalez KG, Pato MT, Nicolini H, Storch EA. Latin American Trans-ancestry INitiative for OCD genomics (LATINO): Study protocol. Am J Med Genet B Neuropsychiatr Genet 2024; 195:e32962. [PMID: 37946624 PMCID: PMC11076176 DOI: 10.1002/ajmg.b.32962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 09/26/2023] [Accepted: 10/06/2023] [Indexed: 11/12/2023]
Abstract
Obsessive-compulsive disorder (OCD) is a debilitating psychiatric disorder. Worldwide, its prevalence is ~2% and its etiology is mostly unknown. Identifying biological factors contributing to OCD will elucidate underlying mechanisms and might contribute to improved treatment outcomes. Genomic studies of OCD are beginning to reveal long-sought risk loci, but >95% of the cases currently in analysis are of homogenous European ancestry. If not addressed, this Eurocentric bias will result in OCD genomic findings being more accurate for individuals of European ancestry than other ancestries, thereby contributing to health disparities in potential future applications of genomics. In this study protocol paper, we describe the Latin American Trans-ancestry INitiative for OCD genomics (LATINO, https://www.latinostudy.org). LATINO is a new network of investigators from across Latin America, the United States, and Canada who have begun to collect DNA and clinical data from 5000 richly phenotyped OCD cases of Latin American ancestry in a culturally sensitive and ethical manner. In this project, we will utilize trans-ancestry genomic analyses to accelerate the identification of OCD risk loci, fine-map putative causal variants, and improve the performance of polygenic risk scores in diverse populations. We will also capitalize on rich clinical data to examine the genetics of treatment response, biologically plausible OCD subtypes, and symptom dimensions. Additionally, LATINO will help elucidate the diversity of the clinical presentations of OCD across cultures through various trainings developed and offered in collaboration with Latin American investigators. We believe this study will advance the important goal of global mental health discovery and equity.
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Affiliation(s)
- James J Crowley
- Department of Genetics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Carolina Cappi
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Departamento de Psiquiatria, Universidade de São Paulo, São Paulo, São Paulo, Brazil
| | | | - Renee M Frederick
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas, USA
| | - Minjee Kook
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas, USA
| | - Andrew D Wiese
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas, USA
| | - Diana Rancourt
- Department of Psychology, University of South Florida, Tampa, Florida, USA
| | - Elizabeth G Atkinson
- Department of Molecular and Human Genetics, Baylor College of Medicine, Houston, Texas, USA
| | - Paola Giusti-Rodriguez
- Department of Psychiatry, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Jacey L Anderberg
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas, USA
| | - Jonathan S Abramowitz
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Victor R Adorno
- Hospital Psiquiátrico de Asunción, Direccion General, Asuncion, Central, Paraguay
| | - Cinthia Aguirre
- Departamento de Psiquiatría, Hospital Psiquiátrico de Asunción, Asuncion, Central, Paraguay
| | - Gilberto S Alves
- Hospital Nina Rodrigues/Universidade Federal do Maranhão (UFMA), Sao Luis do Maranhao, Maranhao, Brazil
| | - Gustavo S Alves
- Hospital Universitário Professor Edgard Santos, Serviço de Psiquiatria, Laboratório de Neuropsicofarmacologia-LANP, Universidade Federal da Bahia, Salvador, Bahia, Brazil
- Faculdade de Medicina da Bahia, Universidade Federal da Bahia, Pós-Graduação em Medicina e Saúde, Salvador, Bahia, Brazil
| | - NaEshia Ancalade
- Department of Genetics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | | | - Paul D Arnold
- The Mathison Centre for Mental Health Research & Education, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| | - Daphne M Ayton
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas, USA
| | - Izabela G Barbosa
- Departamento de Saúde Mental da Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | | | | | - María Celeste Berardo
- Centro Interdisciplinario de Tourette, TOC, TDAH y Trastornos Asociados (CITA), Buenos Aires, Buenos Aires, Argentina
| | - Dayan Berrones
- Department of Psychology, Rice University, Houston, Texas, USA
| | - John R Best
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
| | - Tim B Bigdeli
- Department of Psychiatry and Behavioral Sciences, SUNY Downstate Health Sciences University, Brooklyn, New York, USA
- VA New York Harbor Healthcare System, Brooklyn, New York, USA
| | - Christie L Burton
- Department of Neurosciences and Mental Health, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Joseph D Buxbaum
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | | | - Maria Cecília B Carneiro
- Departamento de Psiquiatria e Medicina Legal, Universidade Federal do Paraná, Curitiba, Parana, Brazil
| | - Sandra L Cepeda
- Department of Psychology, University of Miami, Coral Gables, Florida, USA
| | - Evelyn Chazelle
- Centro Interdisciplinario de Tourette, TOC, TDAH y Trastornos Asociados (CITA), Buenos Aires, Buenos Aires, Argentina
| | - Jessica M Chire
- Instituto Nacional de Salud Mental "Honorio Delgado-Hideyo Noguchi", Dirección de Niños y Adolescentes Lima, Lima, Peru
| | | | | | - Journa Cobite
- Department of Counseling Psychology, University of Houston, Houston, Texas, USA
| | - Jonathan S Comer
- Department of Psychology, Florida International University, Miami, Florida, USA
| | - Daniel L Costa
- Departamento de Psiquiatria, Universidade de São Paulo, São Paulo, São Paulo, Brazil
| | - Jennifer Crosbie
- Department of Neurosciences and Mental Health, Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Victor O Cruz
- Instituto Nacional de Salud Mental "Honorio Delgado-Hideyo Noguchi", Oficina Ejecutiva de Investigación, Lima, Lima, Peru
- School of Medicine, Universidad San Martin de Porres, Lima, Lima, Peru
| | - Guillermo Dager
- Corporación Universitaria Rafael Nuñez, Cartagena, Bolivar, Colombia
| | - Luisa F Daza
- Hospital Psiquiátrico Universitario Del Valle, Cali, Valle del Cauca, Colombia
| | - Anabel de la Rosa-Gómez
- Facultad de Estudios Superiores Iztacala, Tlalnepantla de Baz, Universidad Nacional Autónoma de México, Ciudad de Mexico, Mexico
| | | | - Fernanda Z Delage
- Departamento de Medicina Forense e Psiquiatria, Universidade Federal do Paraná, Curitiba, Parana, Brazil
| | - Carolina B Dreher
- Departamento de Psiquiatria, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
- Departamento de Psiquiatria, Clínica Médica, Porto Alegre, Rio Grande do Sul, Brazil
| | - Lucila Fay
- Centro Interdisciplinario de Tourette, TOC, TDAH y Trastornos Asociados (CITA), Buenos Aires, Buenos Aires, Argentina
| | - Tomas Fazio
- Centro Interdisciplinario de Tourette, TOC, TDAH y Trastornos Asociados (CITA), Buenos Aires, Buenos Aires, Argentina
| | - Ygor A Ferrão
- Departamento de Psiquiatria, Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil
| | - Gabriela M Ferreira
- Departamento de Medicina Forense e Psiquiatria, Universidade Federal do Paraná, Curitiba, Parana, Brazil
- Hospital de Clínicas da Universidade Federal do Paraná, Curitiba, Parana, Brazil
| | - Edith G Figueroa
- Departamento de Psiquiatría de Adultos, Instituto Nacional de Salud Mental "Honorio Delgado-Hideyo Noguchi", Lima, Lima, Peru
| | - Leonardo F Fontenelle
- Departamento de Psiquiatria e Medicina Legal, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Rio de Janeiro, Brazil
- Departamento de Psiquiatria, Instituto D'Or de Pesquisa e Ensino, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Diego A Forero
- Fundación Universitaria del Área Andina, Escuela de Salud y Ciencias del Deporte, Bogota, Bogota, Colombia
| | - Daniele T H Fragoso
- Departamento de Medicina Forense e Psiquiatria, Universidade Federal do Paraná, Curitiba, Parana, Brazil
| | - Bharathi S Gadad
- Department of Psychiatry, Texas Tech University Health Sciences Center El Paso, El Paso, Texas, USA
| | | | | | - Laura D Gonzalez
- Centro Interdisciplinario de Tourette, TOC, TDAH y Trastornos Asociados (CITA), Buenos Aires, Buenos Aires, Argentina
| | - Marco A González
- Facultad de Estudios Superiores Iztacala, Tlalnepantla de Baz, Universidad Nacional Autónoma de México, Ciudad de Mexico, Mexico
| | - Polaris Gonzalez-Barrios
- Departamento de Psiquiatría, Universidad de Puerto Rico, San Juan, Puerto Rico, USA
- Universidad de Puerto Rico Campus de Ciências Médicas, San Juan, Puerto Rico, USA
| | - Wayne K Goodman
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas, USA
| | - Dorothy E Grice
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Jerry Guintivano
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | | | - Andrew G Guzick
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas, USA
| | - Matthew W Halvorsen
- Department of Genetics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Joseph D Hovey
- Department of Psychological Science, The University of Texas Rio Grande Valley, Edinburg, Texas, USA
| | - Hailiang Huang
- Broad Institute of MIT and Harvard, Stanley Center for Psychiatric Research, Cambridge, Massachusetts, USA
| | - Jonathan Irreño-Sotomonte
- Center for Mental Health-Cersame, School of Medicine and Health Sciences, Universidad del Rosario, Bogota, District of Colombia, Colombia
| | - Reinhard Janssen-Aguilar
- Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suarez, Subdirección de Psiquiatría, Ciudad de México, Ciudad de Mexico, Mexico
| | - Matias Jensen
- Centro de Neurociencias, Universidad de Valparaíso, Valparaiso, Chile
| | | | | | - Nasim Khalfe
- Baylor College of Medicine, School of Medicine, Houston, Texas, USA
| | - Madison A Knutsen
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas, USA
- Department of Psychology, Augustana College, Rock Island, Illinois, USA
| | - Caleb Lack
- Department of Psychology, University of Central Oklahoma, Edmond, Oklahoma, USA
| | - Nuria Lanzagorta
- Departamento de Investigación Clínica, Grupo Médico Carracci, Ciudad de México, Ciudad de Mexico, Mexico
| | - Monicke O Lima
- Departamento de Psiquiatria, Universidade de São Paulo, São Paulo, São Paulo, Brazil
| | - Melanie O Longhurst
- Department of Psychiatry, Texas Tech University Health Sciences Center El Paso, El Paso, Texas, USA
| | | | - Elba S Luna
- Instituto Nacional de Salud Mental "Honorio Delgado-Hideyo Noguchi", Oficina Ejecutiva de Investigación, Lima, Lima, Peru
| | - Andrea H Marques
- National Institute of Mental Heatlh (NIMH), Bethesda, Maryland, USA
| | - Molly S Martinez
- DFW OCD Treatment Specialists, Richardson, Texas, USA
- Specialists in OCD and Anxiety Recovery (SOAR), Richardson, Texas, USA
| | - Maria de Los Angeles Matos
- Centro Interdisciplinario de Tourette, TOC, TDAH y Trastornos Asociados (CITA), Buenos Aires, Buenos Aires, Argentina
| | - Caitlyn E Maye
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas, USA
| | - Joseph F McGuire
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Gabriela Menezes
- Programa de Ansiedade, Obsessões e Compulsões, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Charlene Minaya
- Department of Psychology, Fordham University, New York, New York, USA
| | - Tomás Miño
- Centro de Neurociencias, Universidad de Valparaíso, Valparaiso, Chile
| | - Sara M Mithani
- School of Nursing, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
| | | | | | - Maria E Moreira-de-Oliveira
- Programa de Ansiedade, Obsessões e Compulsões, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Olivia J Morris
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas, USA
| | - Sandra I Muñoz
- Facultad de Estudios Superiores Iztacala, Tlalnepantla de Baz, Universidad Nacional Autónoma de México, Ciudad de Mexico, Mexico
| | - Zainab Naqqash
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
| | | | | | | | | | - Trinidad Olivos Balmaceda
- Centro Interdisciplinario de Neurociencia de Valparaíso, Universidad de Valparaíso, Valparaiso, Valparaiso, Chile
| | - Iliana Ortega
- The Mathison Centre for Mental Health Research & Education, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| | - Darpan I Patel
- School of Nursing, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
| | - Ainsley K Patrick
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Mariel Paz Y Mino
- Clínica de Salud Mental USFQ, Universidad San Francisco de Quito, Quito, Pichincha, Ecuador
- Universidad San Francisco de Quito, Quito, Pichincha, Ecuador
| | - Jose L Perales Orellana
- Universidad Tegnológica Privada de Santa Cruz (UTEPSA), Santa Cruz de la Sierra, Andres Ibañez, Bolivia
| | - Bárbara Perdigão Stumpf
- Departamento de Saúde Mental da Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | | | | | | | - Maritza Placencia
- Departamento Académico de Ciencias Dinámicas, Universidad Nacional Mayor de San Marcos, Lima, Lima, Peru
| | - María Belén Prieto
- Centro Interdisciplinario de Tourette, TOC, TDAH y Trastornos Asociados (CITA), Buenos Aires, Buenos Aires, Argentina
| | - Lucas C Quarantini
- Hospital Universitário Professor Edgard Santos, Serviço de Psiquiatria, Laboratório de Neuropsicofarmacologia-LANP, Universidade Federal da Bahia, Salvador, Bahia, Brazil
- Departamento de Neurociências e Saúde Mental, Faculdade de Medicina da Bahia, Universidade Federal da Bahia, Salvador, Bahia, Brazil
| | - Yana Quarantini-Alvim
- Hospital Universitário Professor Edgard Santos, Serviço de Psiquiatria, Laboratório de Neuropsicofarmacologia-LANP, Universidade Federal da Bahia, Salvador, Bahia, Brazil
- Faculdade Santa Casa, Faculdade de Psicologia, Salvador, Bahia, Brazil
| | - Renato T Ramos
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
- Department of Psychiatry, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Iaroslava C Ramos
- Department of Psychiatry, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Department of Psychiatry, Frederick Thompson Anxiety Disorders Centre, Toronto, Ontario, Canada
| | - Vanessa R Ramos
- Departamento de Psiquiatria, Universidade de São Paulo, São Paulo, São Paulo, Brazil
| | - Kesley A Ramsey
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Elise V Ray
- Department of Genetics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Margaret A Richter
- Department of Psychiatry, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | | | - Juan C Rivas
- Hospital Psiquiátrico Universitario Del Valle, Cali, Valle del Cauca, Colombia
- Departamento de Psiquiatría, Universidad del Valle, Cali, Valle del Cauca, Colombia
- Departamento de Psiquiatria, Universidad ICESI, Cali, Valle del Cauca, Colombia
- Departamento de Psiquiatria, Fundación Valle del Lili, Cali, Valle del Cauca, Colombia
| | - Maria C Rosario
- Departamento de Psiquiatria da, Universidade Federal de São Paulo (UNIFESP), Sao Paulo, Sao Paulo, Brazil
| | - Camilo J Ruggero
- Department of Psychology, University of North Texas, Denton, Texas, USA
| | | | - Alejandra Ruiz-Velasco
- Department of Psychiatry, Texas Tech University Health Sciences Center El Paso, El Paso, Texas, USA
| | - Melisa N Sagarnaga
- Facultad de Psicología, Universidad de Buenos Aires, Buenos Aires, Buenos Aires, Argentina
| | - Aline S Sampaio
- Hospital Universitário Professor Edgard Santos, Serviço de Psiquiatria, Laboratório de Neuropsicofarmacologia-LANP, Universidade Federal da Bahia, Salvador, Bahia, Brazil
- Faculdade de Medicina da Bahia, Universidade Federal da Bahia, Pós-Graduação em Medicina e Saúde, Salvador, Bahia, Brazil
- Departamento de Neurociências e Saúde Mental, Faculdade de Medicina da Bahia, Universidade Federal da Bahia, Salvador, Bahia, Brazil
| | - Leonardo C Saraiva
- Departamento de Psiquiatria, Universidade de São Paulo, São Paulo, São Paulo, Brazil
| | - Russell J Schachar
- Department of Neurosciences and Mental Health, Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Sophie C Schneider
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas, USA
| | - Ethan J Schweissing
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas, USA
| | - Laura D Seligman
- Department of Psychological Science, The University of Texas Rio Grande Valley, Edinburg, Texas, USA
| | - Roseli G Shavitt
- Departamento de Psiquiatria, Universidade de São Paulo, São Paulo, São Paulo, Brazil
| | - Keaton J Soileau
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas, USA
| | - S Evelyn Stewart
- Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada
- BC Mental Health and Substance Use Services, Vancouver, British Columbia, Canada
- BC Children's Hospital Research Institute, Vancouver, British Columbia, Canada
| | - Shaina B Storch
- Washington University in St. Louis, St. Louis, Missouri, USA
| | | | - Vissente Tapia Cuevas
- Centro Interdisciplinario de Neurociencia de Valparaíso, Universidad de Valparaíso, Valparaiso, Valparaiso, Chile
| | - Kiara R Timpano
- Department of Psychology, University of Miami, Coral Gables, Florida, USA
| | | | - Alexie Vallejo-Silva
- Center for Mental Health-Cersame, School of Medicine and Health Sciences, Universidad del Rosario, Bogota, District of Colombia, Colombia
| | - Javier Vargas-Medrano
- Department of Psychiatry, Texas Tech University Health Sciences Center El Paso, El Paso, Texas, USA
| | - María I Vásquez
- Hospital Nacional Arzobispo Loayza, Servicio de Salud Mental, Lima, Lima, Peru
| | - Guadalupe Vidal Martinez
- Department of Psychiatry, Texas Tech University Health Sciences Center El Paso, El Paso, Texas, USA
| | - Saira A Weinzimmer
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas, USA
| | - Mauricio A Yanez
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas, USA
| | - Gwyneth Zai
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Department of Molecular Brain Sciences, Centre for Addiction and Mental Health, Neurogenetics Section, Toronto, Ontario, Canada
| | - Lina M Zapata-Restrepo
- Departamento de Psiquiatria, Fundación Valle del Lili, Cali, Valle del Cauca, Colombia
- Facultad de Ciencias de la Salud, Universidad ICESI, Cali, Valle, Colombia
- Department of Neurology, Global Brain Health Institute-University of California San Francisco, San Francisco, California, USA
| | - Luz M Zappa
- Centro Interdisciplinario de Tourette, TOC, TDAH y Trastornos Asociados (CITA), Buenos Aires, Buenos Aires, Argentina
- Departamento de Salud Mental, Hospital de Niños Ricardo Gutierrez, Buenos Aires, Buenos Aires, Argentina
- Hospital Universitario Austral, Materno Infantil, Buenos Aires, Buenos Aires, Argentina
| | - Raquel M Zepeda-Burgos
- Centro de Investigación en Ciencias y Humanidades, Universidad Dr. José Matías Delgado, Santa Tecla, La Libertad, El Salvador
| | - Anthony W Zoghbi
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas, USA
- Department of Psychiatry, New York State Psychiatric Institute, New York, New York, USA
| | - Euripedes C Miguel
- Departamento de Psiquiatria, Universidade de São Paulo, São Paulo, São Paulo, Brazil
| | - Carolyn I Rodriguez
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California, USA
- Department of Psychiatry, Temerty Faculty of Medicine, Veterans Affairs Palo Alto Health Care System, Palo Alto, California, USA
| | | | - Pablo R Moya
- Universidad de Valparaíso, Instituto de Fisiología Valparaiso, Valparaiso, Chile
- Centro Interdisciplinario de Neurociencia de Valparaiso (CINV), Valparaiso, Chile
| | - Tania Borda
- Instituto Realize, Buenos Aires, Buenos Aires, Argentina
- Facultad de Psicología, Universidad Catolica Argentina, Buenos Aires, Buenos Aires, Argentina
| | - María Beatriz Moyano
- Centro Interdisciplinario de Tourette, TOC, TDAH y Trastornos Asociados (CITA), Buenos Aires, Buenos Aires, Argentina
- Asociación de Psiquiatras Argentinos (APSA), Buenos Aires, Buenos Aires, Argentina
- Asociación de Psiquiatras Argentinos (APSA), Presidente del Capítulo de Investigacion en Psiquiatria, Buenos Aires, Buenos Aires, Argentina
| | - Manuel Mattheisen
- Department of Community Health and Epidemiology & Faculty of Computer Science, Dalhousie University, Halifax, Nova Scotia, Canada
- LMU Munich, Institute of Psychiatric Phenomics and Genomics (IPPG), Munich, Germany
| | - Stacey Pereira
- Baylor College of Medicine, Center for Medical Ethics and Health Policy, Houston, Texas, USA
| | - Gabriel Lázaro-Muñoz
- Center for Bioethics, Harvard University School of Medicine, Boston, Massachusetts, USA
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts, USA
| | | | - Michele T Pato
- Department of Psychiatry, Rutgers University-Robert Wood Johnson Medical School, Piscataway, New Jersey, USA
| | - Humberto Nicolini
- Departamento de Psiquiatría, Ciudad de México, Grupo Médico Carracci, Ciudad de Mexico, Mexico
- Laboratorio de Genómica de Enfermedades Psiquiátricas y Neurodegenerativas, Ciudad de México, Instituto Nacional de Medicina Genómica, Ciudad de Mexico, Mexico
| | - Eric A Storch
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas, USA
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3
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Pinciotti CM, Van Kirk N, Horvath G, Storch EA, Mancebo MC, Abramowitz JS, Fontenelle LF, Goodman WK, Riemann BC, Cervin M. Co-occurring PTSD in intensive OCD treatment: Impact on treatment trajectory vs. response. J Affect Disord 2024; 353:109-116. [PMID: 38452939 DOI: 10.1016/j.jad.2024.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Revised: 02/21/2024] [Accepted: 03/04/2024] [Indexed: 03/09/2024]
Abstract
BACKGROUND Obsessive-compulsive disorder (OCD) and co-occurring posttraumatic stress disorder (PTSD) is associated with more severe and chronic OCD. However, findings regarding treatment effectiveness of cognitive behavioral treatment (CBT) with exposure and response prevention (ERP) with this comorbidity are mixed. Research aimed at understanding the precise barriers to OCD treatment effectiveness for individuals with co-occurring PTSD may help elucidate unique treatment needs. METHODS The current study used linear regression and latent growth curve analysis comparing treatment response and trajectory from patients with OCD (n = 3083, 94.2 %) and OCD + PTSD (n = 191, 5.2 %) who received CBT with ERP in two major intensive OCD treatment programs. RESULTS Although patients with OCD + PTSD evidenced similar trajectories of overall severity change, patients at one site required nearly 11 additional treatment days to achieve comparable reduction in OCD severity. Further, at the dimensional level, those with OCD + PTSD had poorer treatment response for unacceptable thoughts and symmetry symptoms. The moderate effect for unacceptable thoughts, indicating the widest gap in treatment response, suggests these symptoms may be particularly relevant to PTSD. LIMITATIONS Findings are limited by a naturalistic treatment sample with variation in treatment provision. CONCLUSIONS Findings emphasize caution in using a one-size-fits-all approach for patients with co-occurring OCD + PTSD within intensive OCD treatment programs, as broadly defined outcomes (e.g., reduction in overall severity) may not translate to reduction in the nuanced symptom dimensions likely to intersect with trauma. Unacceptable thoughts and symmetry symptoms, when co-occurring with PTSD, may require a trauma-focused treatment approach within intensive OCD treatment.
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Affiliation(s)
- Caitlin M Pinciotti
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA.
| | - Nathaniel Van Kirk
- OCD Institute, Office of Clinical Assessment and Research (OCAR), McLean Hospital/Harvard Medical School, Belmont, MA, USA
| | - Gregor Horvath
- Department of Biostatistics, School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Eric A Storch
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
| | - Maria C Mancebo
- Department of Psychiatry & Human Behavior, Alpert Medical School, Brown University, Providence, RI, USA
| | - Jonathan S Abramowitz
- Department of Psychology & Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Leonardo F Fontenelle
- Department of Psychiatry, School of Clinical Sciences, Monash University, Clayton, Victoria, Australia; Obsessive, Compulsive, and Anxiety Spectrum Research Program, Institute of Psychiatry, Federal University of Rio de Janeiro (UFRJ), D'Or Institute for Research and Education (IDOR), Rio de Janeiro, Brazil
| | - Wayne K Goodman
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
| | | | - Matti Cervin
- Department of Clinical Sciences, Lund, Lund University, Lund, Sweden
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4
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Tolin DF, McKay D, Olatunji BO, Abramowitz JS, Otto MW. On the importance of identifying mechanisms and active ingredients of psychological treatments. Behav Res Ther 2023; 170:104425. [PMID: 37913558 PMCID: PMC11034847 DOI: 10.1016/j.brat.2023.104425] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 10/17/2023] [Accepted: 10/23/2023] [Indexed: 11/03/2023]
Abstract
This commentary addresses the thought-provoking article by Lorenzo-Luaces (in press). We review areas of both agreement and disagreement with the author's points, noting that readers should not infer that research into active ingredients and mechanisms is pointless. We conclude with a call for more research into the mechanisms of therapeutic change and the active ingredients of therapeutic interventions, with the aim of disseminating treatments that are both effective and efficient.
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Affiliation(s)
- David F Tolin
- The Institute of Living, Yale University School of Medicine, United States.
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5
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Pinciotti CM, Bulkes NZ, Bailey BE, Storch EA, Abramowitz JS, Fontenelle LF, Riemann BC. Common rituals in obsessive-compulsive disorder and implications for treatment: A mixed-methods study. Psychol Assess 2023; 35:763-777. [PMID: 37470990 PMCID: PMC10527485 DOI: 10.1037/pas0001254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/21/2023]
Abstract
Obsessive-compulsive disorder (OCD) is characterized by engagement in rituals that serve to obtain certainty and prevent feared outcomes. Exposure and response prevention is most effective when rituals are resisted, yet existing self-report measures of OCD limit identification of the full range of possible rituals, and little is known about how rituals might cluster together and predict worsened severity and poorer treatment outcomes. In a retrospective sample of 641 adult patients who received intensive OCD treatment, the present study used a mixed-methods approach to (a) identify and validate treatment provider-identified rituals using the Yale-Brown Obsessive-Compulsive Scale, (b) identify clustering patterns of rituals, and (c) examine the impact of these clusters on severity and treatment outcomes. Sixty-two discrete rituals clustered into eight higher order ritual clusters: avoidance, reassurance, checking, cleaning/handwashing, just right, rumination, self-assurance, and all other rituals. At admission, reassurance predicted greater intolerance of uncertainty (IU) and rumination predicted less OCD severity. Only one ritual cluster-just right-predicted treatment outcomes; patients with just right rituals had worse IU at discharge and significantly longer length of treatment (average 7.0 days longer). Clinical observation can identify more nuanced and individualized rituals than self-report assessment alone. Patients presenting with just right rituals may benefit less from treatment focused on harm avoidance and habituation; instead, treatment should be tailored to the idiosyncrasies of incompleteness and not just the right experiences. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
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Affiliation(s)
| | | | | | - Eric A Storch
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine
| | - Jonathan S Abramowitz
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill
| | - Leonardo F Fontenelle
- Obsessive, Compulsive, and Anxiety Spectrum Research Program, Institute of Psychiatry, Federal University of Rio de Janeiro
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6
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Buchholz JL, Abramowitz JS, Hellberg SN, Ojalehto HJ, Twohig M. Different Psychological Processes in Traditional and ACT-Enhanced ERP for Obsessive-Compulsive Disorder. J Cogn Psychother 2023; 37:239-251. [PMID: 37463698 DOI: 10.1891/jcp-2021-0004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/20/2023]
Abstract
Background: Acceptance and commitment therapy (ACT) has been shown to promote willingness to experience intrusive thoughts among individuals with obsessive-compulsive disorder (OCD). Exposure with response prevention (ERP) delivered from an ACT framework (i.e., ACT+ERP) may facilitate changes in how patients relate to their unwanted internal experiences.Aims: Accordingly, the present study aimed to examine the effect of ACT+ERP on appraisals of intrusive thoughts, relative to standard ERP.Methods: Forty-eight adults who received 16 treatment sessions as part of a randomized controlled trial comparing standard ERP to ACT+ERP completed the Interpretation of Intrusions Inventory (III) at pre-treatment, post-treatment, and follow-up.Results: Results showed a significant main effect of time for all III subscales, suggesting that appraisals of intrusive thoughts shift over the course of treatment. The effect of the condition × time interaction, however, differed between the III subscales. Specifically, a significant interaction emerged for the control of thoughts subscale, such that individuals who received ACT+ERP experienced greater reductions in beliefs about the need to control thoughts. The interaction term was not significant for importance of thoughts or responsibility subscales.Conclusions: Findings suggest that augmenting ERP with ACT enhances change in beliefs about the need to control thoughts, but not in beliefs about responsibility and the importance of thoughts. Clinical implications and future research directions will be discussed.
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Affiliation(s)
| | | | | | - Heidi J Ojalehto
- University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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7
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Hellberg SN, DuBois C, Myers NS, Rodriguez C, Butcher M, Ojalehto HJ, Riemann B, Abramowitz JS. The contribution of guilt sensitivity in the prediction of obsessive-compulsive disorder symptom dimensions: Replication and extension. J Anxiety Disord 2023; 97:102728. [PMID: 37236070 DOI: 10.1016/j.janxdis.2023.102728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 02/05/2023] [Accepted: 05/17/2023] [Indexed: 05/28/2023]
Abstract
BACKGROUND Obsessive-compulsive disorder (OCD) is associated with particular cognitive processes, such as beliefs about the importance of intrusive thoughts. The present study examined the explanatory power of guilt sensitivity to OCD symptom dimensions after controlling for well-established cognitive predictors. METHODS 164 patients with OCD completed self-reported measures of OCD and depressive symptoms, obsessive beliefs, and guilt sensitivity. Bivariate correlations were examined, and latent profile analysis (LPA) was used to generate groups based on symptom severity scores. Differences in guilt sensitivity were examined across latent profiles. RESULTS Guilt sensitivity was most strongly associated with unacceptable thoughts and responsibility for harm OCD symptoms, and moderately with symmetry. After controlling for depression and obsessive beliefs, guilt sensitivity added explanatory power to the prediction of unacceptable thoughts. LPA identified 3 profiles; profile-based subgroups significantly differed from one another in terms of guilt sensitivity, depression, and obsessive beliefs. CONCLUSIONS Guilt sensitivity is relevant to various OCD symptom dimensions. Above and beyond depression and obsessive beliefs, guilt sensitivity contributed to the explanation of repugnant obsessions. Theory, research, and treatment implications are discussed.
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Affiliation(s)
| | - Chase DuBois
- University of North Carolina at Chapel Hill, United States
| | | | | | - Megan Butcher
- University of North Carolina at Chapel Hill, United States
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8
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Crowley JJ, Cappi C, Ochoa-Panaifo ME, Frederick RM, Kook M, Wiese AD, Rancourt D, Atkinson EG, Giusti-Rodriguez P, Anderberg JL, Abramowitz JS, Adorno VR, Aguirre C, Alves GS, Alves GS, Ancalade N, Espinosa AAA, Arnold PD, Ayton DM, Barbosa IG, Castano LMB, Barrera CN, Prieto MB, Berardo MC, Berrones D, Best JR, Bigdeli TB, Burton CL, Callahan JL, Carneiro MCB, Cepeda SL, Chazelle E, Chire JM, Munoz MC, Quiroz PC, Cobite J, Comer JS, Costa DL, Crosbie J, Cruz VO, Dager G, Daza LF, de la Rosa-Gómez A, Del Río D, Delage FZ, Dreher CB, Fay L, Fazio T, Ferrão YA, Ferreira GM, Figueroa EG, Fontenelle LF, Forero DA, Fragoso DT, Gadad BS, Garrison SR, González A, Gonzalez LD, González MA, Gonzalez-Barrios P, Goodman W, Guintivano J, Guttfreund DG, Guzick AG, Halvorsen MW, Hovey JD, Janssen-Aguilar R, Jensen M, Reynolds AZJ, Lujambio JAJ, Khalfe N, Knutsen MA, Lack C, Lanzagorta N, Lima MO, Longhurst MO, Martinez DAL, Luna ES, Marques AH, Martinez M, de Los Angeles Matos M, Maye CE, McGuire JF, Menezes G, Minaya C, Miño T, Mithani SM, de Oca CM, Morales-Rivero A, Moreira-de-Oliveira ME, Morris OJ, Muñoz SI, Naqqash Z, Bracho AAN, Bracho BEN, Rojas MCO, Castaman LAO, Ortega I, Patel DI, Patrick AK, Mino MPY, Orellana JLP, Stumpf BP, Peregrina T, Duarte TP, Piacsek KL, Placencia M, Quarantini LC, Quarantini-Alvim Y, Ramos RT, Ramos IC, Ramos VR, Ramsey KA, Ray EV, Richter MA, Riemann BC, Rivas JC, Rosario MC, Ruggero CJ, Ruiz-Chow AA, Ruiz-Velasco A, Sampaio AS, Saraiva LC, Schachar RJ, Schneider SC, Schweissing EJ, Seligman LD, Shavitt RG, Soileau KJ, Stewart SE, Storch SB, Strouphauer ER, Timpano KR, Treviño-de la Garza B, Vargas-Medrano J, Vásquez MI, Martinez GV, Weinzimmer SA, Yanez MA, Zai G, Zapata-Restrepo LM, Zappa LM, Zepeda-Burgos RM, Zoghbi AW, Miguel EC, Rodriguez CI, Mallen MCM, Moya PR, Borda T, Moyano MB, Mattheisen M, Pereira S, Lázaro-Muñoz G, Martinez-Gonzalez KG, Pato MT, Nicolini H, Storch EA. Latin American Trans-ancestry INitiative for OCD genomics (LATINO): Study Protocol. medRxiv 2023:2023.02.23.23286373. [PMID: 37131804 PMCID: PMC10153323 DOI: 10.1101/2023.02.23.23286373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
Obsessive-compulsive disorder (OCD) is a debilitating psychiatric disorder. Worldwide, its prevalence is ~2% and its etiology is mostly unknown. Identifying biological factors contributing to OCD will elucidate underlying mechanisms and might contribute to improved treatment outcomes. Genomic studies of OCD are beginning to reveal long-sought risk loci, but >95% of the cases currently in analysis are of homogenous European ancestry. If not addressed, this Eurocentric bias will result in OCD genomic findings being more accurate for individuals of European ancestry than other ancestries, thereby contributing to health disparities in potential future applications of genomics. In this study protocol paper, we describe the Latin American Trans-ancestry INitiative for OCD genomics (LATINO, www.latinostudy.org). LATINO is a new network of investigators from across Latin America, the United States, and Canada who have begun to collect DNA and clinical data from 5,000 richly-phenotyped OCD cases of Latin American ancestry in a culturally sensitive and ethical manner. In this project, we will utilize trans-ancestry genomic analyses to accelerate the identification of OCD risk loci, fine-map putative causal variants, and improve the performance of polygenic risk scores in diverse populations. We will also capitalize on rich clinical data to examine the genetics of treatment response, biologically plausible OCD subtypes, and symptom dimensions. Additionally, LATINO will help elucidate the diversity of the clinical presentations of OCD across cultures through various trainings developed and offered in collaboration with Latin American investigators. We believe this study will advance the important goal of global mental health discovery and equity.
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Affiliation(s)
- James J Crowley
- University of North Carolina at Chapel Hill, Department of Genetics, Chapel Hill, North Carolina, United States of America
- University of North Carolina at Chapel Hill, Department of Psychiatry, Chapel Hill, North Carolina, United States of America
| | - Carolina Cappi
- Icahn School of Medicine at Mount Sinai, Department of Psychiatry, New York City, New York, United States of America
- Universidade de São Paulo, Departamento de Psiquiatria, São Paulo, São Paulo, Brasil
| | | | - Renee M Frederick
- Baylor College of Medicine, Department of Psychiatry and Behavioral Sciences, Houston, Texas, United States of America
| | - Minjee Kook
- Baylor College of Medicine, Department of Psychiatry and Behavioral Sciences, Houston, Texas, United States of America
| | - Andrew D Wiese
- Baylor College of Medicine, Department of Psychiatry and Behavioral Sciences, Houston, Texas, United States of America
| | - Diana Rancourt
- University of South Florida, Department of Psychology, Tampa, Florida, United States of America
| | - Elizabeth G Atkinson
- Baylor College of Medicine, Department of Molecular and Human Genetics, Houston, Texas, United States of America
| | - Paola Giusti-Rodriguez
- University of Florida College of Medicine, Department of Psychiatry, Gainesville, Florida, United States of America
| | - Jacey L Anderberg
- Baylor College of Medicine, Department of Psychiatry and Behavioral Sciences, Houston, Texas, United States of America
| | - Jonathan S Abramowitz
- University of North Carolina at Chapel Hill, Department of Psychology and Neuroscience, Chapel Hill, North Carolina, United States of America
| | - Victor R Adorno
- Hospital Psiquiátrico de Asunción, Direccion General, Asunción, Central, Paraguay
| | - Cinthia Aguirre
- Hospital Psiquiátrico de Asunción, Departamento de Psiquiatría, Asunción, Central, Paraguay
| | - Gustavo S Alves
- Universidade Federal da Bahia, Hospital Universitário Professor Edgard Santos, Serviço de Psiquiatria, Laboratório de Neuropsicofarmacologia - LANP, Salvador, Bahia, Brasil
- Universidade Federal da Bahia, Pós-Graduação em Medicina e Saúde, Faculdade de Medicina da Bahia, Salvador, Bahia, Brasil
| | - Gilberto S Alves
- Hospital Nina Rodrigues/Universidade Federal do Maranhão (UFMA), Sao Luis do Maranhão, Maranhão, Brasil
| | - NaEshia Ancalade
- University of North Carolina at Chapel Hill, Department of Genetics, Chapel Hill, North Carolina, United States of America
| | | | - Paul D Arnold
- University of Calgary, The Mathison Centre for Mental Health Research & Education, Hotchkiss Brain Institute, Calgary, Alberta, Canada
| | - Daphne M Ayton
- Baylor College of Medicine, Department of Psychiatry and Behavioral Sciences, Houston, Texas, United States of America
| | - Izabela G Barbosa
- Universidade Federal de Minas Gerais, Departamento de Saúde Mental da Faculdade de Medicina, Belo Horizonte, Minas Gerais, Brasil
| | | | | | - María Belén Prieto
- Centro Interdisciplinario de Tourette, TOC, TDAH y Trastornos Asociados (CITA), Buenos Aires, Buenos Aires, Argentina
| | - María Celeste Berardo
- Centro Interdisciplinario de Tourette, TOC, TDAH y Trastornos Asociados (CITA), Buenos Aires, Buenos Aires, Argentina
| | - Dayan Berrones
- Rice University, Department of Psychology, Houston, Texas, United States of America
| | - John R Best
- University of British Columbia, Department of Psychiatry, Vancouver, British Columbia, Canada
| | - Tim B Bigdeli
- SUNY Downstate Health Sciences University, Department of Psychiatry and Behavioral Sciences, Brooklyn, New York, United States of America
- VA New York Harbor Healthcare System, Brooklyn, New York, United States of America
| | - Christie L Burton
- Hospital for Sick Children, Department of Neurosciences and Mental Health, Toronto, Ontario, Canada
| | - Jennifer L Callahan
- University of North Texas, Department of Psychology, Denton, Texas, United States of America
| | - Maria Cecília B Carneiro
- Universidade Federal do Paraná, Departamento de Psiquiatria e Medicina Legal, Curitiba, Paraná, Brasil
| | - Sandra L Cepeda
- University of Miami, Department of Psychology, Coral Gables, Florida, United States of America
| | - Evelyn Chazelle
- Centro Interdisciplinario de Tourette, TOC, TDAH y Trastornos Asociados (CITA), Buenos Aires, Buenos Aires, Argentina
| | - Jessica M Chire
- Instituto Nacional de Salud Mental ""Honorio Delgado-Hideyo Noguchi"", Dirección de Niños y Adolescentes, Lima, Lima, Perú
| | | | | | - Journa Cobite
- University of Houston, Department of Counseling Psychology, Houston, Texas, United States of America
| | - Jonathan S Comer
- Florida International University, Department of Psychology, Miami, Florida, United States of America
| | - Daniel L Costa
- Universidade de São Paulo, Departamento de Psiquiatria, São Paulo, São Paulo, Brasil
| | - Jennifer Crosbie
- Hospital for Sick Children, Department of Neurosciences and Mental Health, Toronto, Ontario, Canada
- University of Toronto, Department of Psychiatry, Toronto, Ontario, Canada
| | - Victor O Cruz
- Instituto Nacional de Salud Mental ""Honorio Delgado-Hideyo Noguchi"", Oficina Ejecutiva de Investigación, Lima, Lima, Perú
- Universidad San Martin de Porres, School of Medicine, Lima, Lima, Perú
| | - Guillermo Dager
- Corporación Universitaria Rafael Nuñez, Cartagena, Bolivar, Colombia
| | - Luisa F Daza
- Hospital Psiquiátrico Universitario Del Valle, Cali, Valle del Cauca, Colombia
| | - Anabel de la Rosa-Gómez
- Universidad Nacional Autónoma de México, Facultad de Estudios Superiores Iztacala, Tlalnepantla de Baz, Ciudad de México, México
| | | | - Fernanda Z Delage
- Universidade Federal do Paraná, Departamento de Medicina Forense e Psiquiatria, Curitiba, Paraná, Brasil
| | - Carolina B Dreher
- Universidade Federal do Rio Grande do Sul, Departamento de Psiquiatria, Porto Alegre, Rio Grande do Sul, Brasil
- Universidade Federal de Ciências da Saúde de Porto Alegre, Departamento de Psiquiatria - Clínica Médica, Porto Alegre, Rio Grande do Sul, Brasil
| | - Lucila Fay
- Centro Interdisciplinario de Tourette, TOC, TDAH y Trastornos Asociados (CITA), Buenos Aires, Buenos Aires, Argentina
| | - Tomas Fazio
- Centro Interdisciplinario de Tourette, TOC, TDAH y Trastornos Asociados (CITA), Buenos Aires, Buenos Aires, Argentina
| | - Ygor A Ferrão
- Universidade Federal do Paraná de Porto Alegre, Departamento de Psiquiatria, Porto Alegre, Rio Grande do Sul, Brasil
| | - Gabriela M Ferreira
- Universidade Federal do Paraná, Departamento de Medicina Forense e Psiquiatria, Curitiba, Paraná, Brasil
- Hospital de Clínicas da Universidade Federal do Paraná, Curitiba, Parana, Brasil
| | - Edith G Figueroa
- Instituto Nacional de Salud Mental ""Honorio Delgado-Hideyo Noguchi"", Departamento de Psiquiatría de Adultos, Lima, Lima, Perú
| | - Leonardo F Fontenelle
- Universidade Federal do Rio de Janeiro, Departamento de Psiquiatria e Medicina Legal, Rio de Janeiro, Rio de Janeiro, Brasil
- Instituto D'Or de Pesquisa e Ensino, Departamento de Psiquiatria, Rio de Janeiro, Rio de Janeiro, Brasil
| | - Diego A Forero
- Fundación Universitaria del Área Andina, Escuela de Salud y Ciencias del Deporte, Bogotá, Bogotá, Colombia
| | - Daniele Th Fragoso
- Universidade Federal do Paraná, Departamento de Medicina Forense e Psiquiatria, Curitiba, Paraná, Brasil
| | - Bharathi S Gadad
- Texas Tech University Health Sciences Center El Paso, Department of Psychiatry, El Paso, Texas, United States of America
| | - Sheldon R Garrison
- Rogers Behavioral Health, Oconomowoc, Wisconsin, United States of America
| | | | - Laura D Gonzalez
- Centro Interdisciplinario de Tourette, TOC, TDAH y Trastornos Asociados (CITA), Buenos Aires, Buenos Aires, Argentina
| | - Marco A González
- Universidad Nacional Autónoma de México, Facultad de Estudios Superiores Iztacala, Tlalnepantla de Baz, Ciudad de México, México
| | - Polaris Gonzalez-Barrios
- Universidad de Puerto Rico, Departamento de Psiquiatría, San Juan, Puerto Rico, Los Estados Unidos
- Universidad de Puerto Rico Campus de Ciências Médicas, San Juan, Puerto Rico, Los Estados Unidos
| | - Wayne Goodman
- Baylor College of Medicine, Department of Psychiatry and Behavioral Sciences, Houston, Texas, United States of America
| | - Jerry Guintivano
- University of North Carolina at Chapel Hill, Department of Psychiatry, Chapel Hill, North Carolina, United States of America
| | | | - Andrew G Guzick
- Baylor College of Medicine, Department of Psychiatry and Behavioral Sciences, Houston, Texas, United States of America
| | - Matthew W Halvorsen
- University of North Carolina at Chapel Hill, Department of Genetics, Chapel Hill, North Carolina, United States of America
| | - Joseph D Hovey
- The University of Texas Rio Grande Valley, Department of Psychological Science, Edinburg, Texas, United States of America
| | - Reinhard Janssen-Aguilar
- Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suarez, Subdirección de Psiquiatría, Ciudad de México, Ciudad de México, México
| | - Matias Jensen
- Universidad de Valparaíso, Centro de Neurociencias, Valparaíso, Valparaíso, Chile
| | - Alexandra Z Jimenez Reynolds
- Baylor College of Medicine, Department of Psychiatry and Behavioral Sciences, Houston, Texas, United States of America
| | | | - Nasim Khalfe
- Baylor College of Medicine, School of Medicine, Houston, Texas, United States of America
| | - Madison A Knutsen
- Augustana College, Department of Psychology, Rock Island, Illinois, United States of America
- Baylor College of Medicine, Department of Psychiatry and Behavioral Sciences, Houston, Texas, United States of America
| | - Caleb Lack
- University of Central Oklahoma, Department of Psychology, Edmond, Oklahoma, United States of America
| | - Nuria Lanzagorta
- Grupo Médico Carracci, Departamento de Investigación Clínica, Ciudad de México, Ciudad de México, México
| | - Monicke O Lima
- Universidade de São Paulo, Departamento de Psiquiatria, São Paulo, São Paulo, Brasil
| | - Melanie O Longhurst
- Texas Tech University Health Sciences Center El Paso, Department of Psychiatry, El Paso, Texas, United States of America
| | | | - Elba S Luna
- Instituto Nacional de Salud Mental ""Honorio Delgado-Hideyo Noguchi"", Oficina Ejecutiva de Investigación, Lima, Lima, Perú
| | - Andrea H Marques
- National Institute of Mental Heatlh (NIMH), Bethesda, Maryland, United States of America
| | - Molly Martinez
- DFW OCD Treatment Specialists, Richardson, Texas, United States of America
- Specialists in OCD and Anxiety Recovery (SOAR), Richardson, Texas, United States of America
| | - Maria de Los Angeles Matos
- Centro Interdisciplinario de Tourette, TOC, TDAH y Trastornos Asociados (CITA), Buenos Aires, Buenos Aires, Argentina
| | - Caitlyn E Maye
- Baylor College of Medicine, Department of Psychiatry and Behavioral Sciences, Houston, Texas, United States of America
| | - Joseph F McGuire
- Johns Hopkins University School of Medicine, Department of Psychiatry and Behavioral Sciences, Baltimore, Maryland, United States of America
| | - Gabriela Menezes
- Universidade Federal do Rio de Janeiro, Programa de Ansiedade, Obsessões e Compulsões, Rio de Janeiro, Rio de Janeiro, Brasil
| | - Charlene Minaya
- Fordham University, Department of Psychology, New York City, New York, United States of America
| | - Tomás Miño
- Universidad de Valparaíso, Centro de Neurociencias, Valparaíso, Valparaíso, Chile
| | - Sara M Mithani
- University of Texas Health Science Center at San Antonio, School of Nursing, San Antonio, Texas, United States of America
| | | | | | - Maria E Moreira-de-Oliveira
- Universidade Federal do Rio de Janeiro, Programa de Ansiedade, Obsessões e Compulsões, Rio de Janeiro, Rio de Janeiro, Brasil
| | - Olivia J Morris
- Baylor College of Medicine, Department of Psychiatry and Behavioral Sciences, Houston, Texas, United States of America
| | - Sandra I Muñoz
- Universidad Nacional Autónoma de México, Facultad de Estudios Superiores Iztacala, Tlalnepantla de Baz, Ciudad de México, México
| | - Zainab Naqqash
- University of British Columbia, Department of Psychiatry, Vancouver, British Columbia, Canada
| | | | | | | | | | - Iliana Ortega
- University of Calgary, The Mathison Centre for Mental Health Research & Education, Hotchkiss Brain Institute, Calgary, Alberta, Canada
| | - Darpan I Patel
- University of Texas Health Science Center at San Antonio, School of Nursing, San Antonio, Texas, United States of America
| | - Ainsley K Patrick
- Johns Hopkins University School of Medicine, Department of Psychiatry and Behavioral Sciences, Baltimore, Maryland, United States of America
| | - Mariel Paz Y Mino
- Universidad San Francisco de Quito, Clínica de Salud Mental USFQ, Quito, Pichincha, Ecuador
- Universidad San Francisco de Quito, Quito, Pichincha, Ecuador
| | - Jose L Perales Orellana
- Universidad Tegnológica Privada de Santa Cruz (UTEPSA), Santa Cruz de la Sierra, Andres Ibañez, Bolivia
| | - Bárbara Perdigão Stumpf
- Universidade Federal de Minas Gerais, Departamento de Saúde Mental da Faculdade de Medicina, Belo Horizonte, Minas Gerais, Brasil
| | | | | | - Kelly L Piacsek
- Rogers Behavioral Health, Oconomowoc, Wisconsin, United States of America
| | - Maritza Placencia
- Universidad Nacional Mayor de San Marcos, Departamento Académico de Ciencias Dinámicas, Lima, Lima, Perú
| | - Lucas C Quarantini
- Universidade Federal da Bahia, Departamento de Neurociências e Saúde Mental, Faculdade de Medicina da Bahia, Salvador, Bahia, Brasil
- Universidade Federal da Bahia, Hospital Universitário Professor Edgard Santos, Serviço de Psiquiatria, Laboratório de Neuropsicofarmacologia - LANP, Salvador, Bahia, Brasil
| | - Yana Quarantini-Alvim
- Universidade Federal da Bahia, Hospital Universitário Professor Edgard Santos, Serviço de Psiquiatria, Laboratório de Neuropsicofarmacologia - LANP, Salvador, Bahia, Brasil
- Faculdade Santa Casa, Faculdade de Psicologia, Salvador, Bahia, Brasil
| | - Renato T Ramos
- Sunnybrook Health Sciences Centre, Department of Psychiatry, Toronto, Ontario, Canada
- University of Toronto, Department of Psychiatry, Toronto, Ontario, Canada
| | - Iaroslava C Ramos
- Sunnybrook Health Sciences Centre, Department of Psychiatry, Toronto, Ontario, Canada
- Frederick Thompson Anxiety Disorders Centre, Department of Psychiatry, Toronto, Ontario, Canada
| | - Vanessa R Ramos
- Universidade de São Paulo, Departamento de Psiquiatria, São Paulo, São Paulo, Brasil
| | - Kesley A Ramsey
- Johns Hopkins University School of Medicine, Department of Psychiatry and Behavioral Sciences, Baltimore, Maryland, United States of America
| | - Elise V Ray
- University of North Carolina at Chapel Hill, Department of Genetics, Chapel Hill, North Carolina, United States of America
| | - Margaret A Richter
- Sunnybrook Health Sciences Centre, Department of Psychiatry, Toronto, Ontario, Canada
- University of Toronto, Department of Psychiatry, Temerty Faculty of Medicine, Toronto, Ontario, Canada
| | - Bradley C Riemann
- Rogers Behavioral Health, Oconomowoc, Wisconsin, United States of America
| | - Juan C Rivas
- Hospital Psiquiátrico Universitario Del Valle, Cali, Valle del Cauca, Colombia
- Universidad del Valle, Departamento de Psiquiatría, Cali, Valle del Cauca, Colombia
- Universidad ICESI, Departamento de Psiquiatria, Cali, Valle del Cauca, Colombia
- Fundación Valle del Lili, Departamento de Psiquiatria, Cali, Valle del Cauca, Colombia
| | - Maria C Rosario
- Departamento de Psiquiatria da Universidade Federal de São Paulo (UNIFESP), São Paulo, São Paulo, Brasil
| | - Camilo J Ruggero
- University of North Texas, Department of Psychology, Denton, Texas, United States of America
| | | | - Alejandra Ruiz-Velasco
- Texas Tech University Health Sciences Center El Paso, Department of Psychiatry, El Paso, Texas, United States of America
| | - Aline S Sampaio
- Universidade Federal da Bahia, Departamento de Neurociências e Saúde Mental, Faculdade de Medicina da Bahia, Salvador, Bahia, Brasil
- Universidade Federal da Bahia, Pós-Graduação em Medicina e Saúde, Faculdade de Medicina da Bahia, Salvador, Bahia, Brasil
- Universidade Federal da Bahia, Hospital Universitário Professor Edgard Santos, Serviço de Psiquiatria, Laboratório de Neuropsicofarmacologia - LANP, Salvador, Bahia, Brasil
| | - Leonardo C Saraiva
- Universidade de São Paulo, Departamento de Psiquiatria, São Paulo, São Paulo, Brasil
| | - Russell J Schachar
- Hospital for Sick Children, Department of Neurosciences and Mental Health, Toronto, Ontario, Canada
- University of Toronto, Department of Psychiatry, Toronto, Ontario, Canada
| | - Sophie C Schneider
- Baylor College of Medicine, Department of Psychiatry and Behavioral Sciences, Houston, Texas, United States of America
| | - Ethan J Schweissing
- Baylor College of Medicine, Department of Psychiatry and Behavioral Sciences, Houston, Texas, United States of America
| | - Laura D Seligman
- The University of Texas Rio Grande Valley, Department of Psychological Science, Edinburg, Texas, United States of America
| | - Roseli G Shavitt
- Universidade de São Paulo, Departamento de Psiquiatria, São Paulo, São Paulo, Brasil
| | - Keaton J Soileau
- Baylor College of Medicine, Department of Psychiatry and Behavioral Sciences, Houston, Texas, United States of America
| | - S Evelyn Stewart
- University of British Columbia, Department of Psychiatry, Vancouver, British Columbia, Canada
- BC Mental Health and Substance Use Services, Vancouver, British Columbia, Canada
- BC Children's Hospital Research Institute, Vancouver, British Columbia, Canada
| | - Shaina B Storch
- Washington University in St. Louis, St. Louis, Missouri, United States of America
| | - Emily R Strouphauer
- Baylor College of Medicine, School of Medicine, Houston, Texas, United States of America
| | - Kiara R Timpano
- University of Miami, Department of Psychology, Coral Gables, Florida, United States of America
| | | | - Javier Vargas-Medrano
- Texas Tech University Health Sciences Center El Paso, Department of Psychiatry, El Paso, Texas, United States of America
| | - María I Vásquez
- Hospital Nacional Arzobispo Loayza, Servicio de Salud Mental, Lima, Lima, Perú
| | - Guadalupe Vidal Martinez
- Texas Tech University Health Sciences Center El Paso, Department of Psychiatry, El Paso, Texas, United States of America
| | - Saira A Weinzimmer
- Baylor College of Medicine, Department of Psychiatry and Behavioral Sciences, Houston, Texas, United States of America
| | - Mauricio A Yanez
- Baylor College of Medicine, Department of Psychiatry and Behavioral Sciences, Houston, Texas, United States of America
| | - Gwyneth Zai
- Centre for Addiction and Mental Health, Neurogenetics Section, Molecular Brain Sciences Department, Toronto, Ontario, Canada
- University of Toronto, Department of Psychiatry, Temerty Faculty of Medicine, Toronto, Ontario, Canada
| | - Lina M Zapata-Restrepo
- Fundación Valle del Lili, Departamento de Psiquiatria, Cali, Valle, Colombia
- Universidad ICESI, Facultad de Ciencias de la Salud, Cali, Valle, Colombia
- Global Brain Health Institute - University of California San Francisco, Department of Neurology, San Francisco, California, United States of America
| | - Luz M Zappa
- Centro Interdisciplinario de Tourette, TOC, TDAH y Trastornos Asociados (CITA), Buenos Aires, Buenos Aires, Argentina
- Hospital de Niños Ricardo Gutierrez, Departamento de Salud Mental, Buenos Aires, Buenos Aires, Argentina
- Hospital Universitario Austral, Materno Infantil, Buenos Aires, Buenos Aires, Argentina
| | - Raquel M Zepeda-Burgos
- Universidad Dr. José Matías Delgado, Centro de Investigación en Ciencias y Humanidades, Santa Tecla, La Libertad, El Salvador
| | - Anthony W Zoghbi
- Baylor College of Medicine, Department of Psychiatry and Behavioral Sciences, Houston, Texas, United States of America
- New York State Psychiatric Institute, Department of Psychiatry, New York City, New York, United States of America
| | - Euripedes C Miguel
- Universidade de São Paulo, Departamento de Psiquiatria, São Paulo, São Paulo, Brasil
| | - Carolyn I Rodriguez
- Stanford University School of Medicine, Department of Psychiatry and Behavioral Sciences, Stanford, California, United States of America
- Veterans Affairs Palo Alto Health Care System, Department of Psychiatry, Temerty Faculty of Medicine, Palo Alto, California, United States of America
| | | | - Pablo R Moya
- Universidad de Valparaíso, Instituto de Fisiología, Valparaíso, Valparaíso, Chile
- Centro Interdisciplinario de Neurociencia de Valparaiso (CINV), Valparaíso, Valparaíso, Chile
| | - Tania Borda
- Instituto Realize, Buenos Aires, Buenos Aires, Argentina
- Universidad Catolica Argentina, Facultad de Psicologia, Buenos Aires, Buenos Aires, Argentina
| | - María Beatriz Moyano
- Centro Interdisciplinario de Tourette, TOC, TDAH y Trastornos Asociados (CITA), Buenos Aires, Buenos Aires, Argentina
- Asociacion de Psiquiatras Argentinos (APSA), Buenos Aires, Buenos Aires, Argentina
- Asociacion de Psiquiatras Argentinos (APSA), Presidente del Capitulo de Investigacion en Psiquiatria, Buenos Aires, Buenos Aires, Argentina
| | - Manuel Mattheisen
- Dalhousie University, Department of Community Health and Epidemiology & Faculty of Computer Science, Halifax, Nova Scotia, Canada
- LMU Munich, Institute of Psychiatric Phenomics and Genomics (IPPG), Munich, Germany
| | - Stacey Pereira
- Baylor College of Medicine, Center for Medical Ethics and Health Policy, Houston, Texas, United States of America
| | - Gabriel Lázaro-Muñoz
- Harvard University School of Medicine, Center for Bioethics, Boston, Massachusetts, United States of America
- Massachusetts General Hospital, Department of Psychiatry, Boston, Massachusetts, United States of America
| | | | - Michele T Pato
- Rutgers University- Robert Wood Johnson Medical School, Department of Psychiatry, Piscataway, New Jersey, United States of America
| | - Humberto Nicolini
- Grupo Médico Carracci, Departamento de Psiquiatría, Ciudad de México, Ciudad de México, México
- Instituto Nacional de Medicina Genómica, Laboratorio de Genómica de Enfermedades Psiquiátricas y Neurodegenerativas, Ciudad de México, Ciudad de México, México
| | - Eric A Storch
- Baylor College of Medicine, Department of Psychiatry and Behavioral Sciences, Houston, Texas, United States of America
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9
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Hellberg SN, Abramowitz JS, Ojalehto HJ, Butcher MW, Buchholz JL, Riemann BC. Co-occurring depression and obsessive-compulsive disorder: A dimensional network approach. J Affect Disord 2022; 317:417-426. [PMID: 36055534 DOI: 10.1016/j.jad.2022.08.101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2021] [Revised: 05/26/2022] [Accepted: 08/26/2022] [Indexed: 10/31/2022]
Abstract
BACKGROUND Depressive and obsessive-compulsive (OCD) symptoms often co-occur and a number of possible explanations for this co-occurrence have been explored, including shared biological and psychosocial risk factors. Network approaches have offered a novel hypothesis for the link between depression and OCD: functional inter-relationships across the symptoms of these conditions. The few network studies in this area have relied largely on item, rather than process-level constructs, and have not examined relationships dimensionally. METHODS Network analytic methods were applied to data from 463 treatment-seeking adults with OCD. Patients completed self-report measures of OCD and depression. Factor analysis was used to derive processes (i.e., nodes) to include in the network. Networks were computed, and centrality, bridge, and stability statistics examined. RESULTS Networks showed positive relations among specific OCD and depressive symptoms. Obsessions (particularly repugnant thoughts), negative affectivity, and cognitive-somatic changes (e.g., difficulty concentrating) were central to the network. Unique relations were observed between symmetry OCD symptoms and cognitive-somatic changes. No direct link between harm-related OCD symptoms and depression was observed. CONCLUSIONS Our results bring together prior findings, suggesting that both negative affective and psychomotor changes are important to consider in examining the relationship between OCD and depression. Increased consideration of heterogeneity in the content of OCD symptoms is key to improving clinical conceptualizations, particularly when considering the co-occurrence of OCD with other disorders.
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Affiliation(s)
- Samantha N Hellberg
- Department of Psychology & Neuroscience, University of North Carolina, Chapel Hill, USA.
| | - Jonathan S Abramowitz
- Department of Psychology & Neuroscience, University of North Carolina, Chapel Hill, USA
| | - Heidi J Ojalehto
- Department of Psychology & Neuroscience, University of North Carolina, Chapel Hill, USA
| | - Megan W Butcher
- Department of Psychology & Neuroscience, University of North Carolina, Chapel Hill, USA
| | - Jennifer L Buchholz
- Department of Psychology & Neuroscience, University of North Carolina, Chapel Hill, USA
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10
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Abramovitch A, Abramowitz JS, McKay D, Cham H, Anderson KS, Farrell LJ, Geller DA, Hanna GL, Mathieu S, McGuire JF, Rosenberg DR, Stewart SE, Storch EA, Wilhelm S. An ultra-brief screening scale for pediatric obsessive-compulsive disorder: The OCI-CV-5. J Affect Disord 2022; 312:208-216. [PMID: 35697331 PMCID: PMC9286779 DOI: 10.1016/j.jad.2022.06.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 05/30/2022] [Accepted: 06/08/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND Obsessive-compulsive disorder (OCD) is an often disabling and chronic condition that is normally assessed using diagnostic interviews or lengthy self-report questionnaires. This makes routine screening in general health settings impractical, and as a result OCD is often under-(or mis-)recognized. The present study reports on the development of an ultra-brief version of the Obsessive-Compulsive Inventory-Child Version (OCI-CV) which may be administered routinely as a screener for pediatric OCD. METHOD A total of 489 youth diagnosed with OCD, 259 non-clinical controls, and 299 youth with other disorders completed the OCI-CV and other indices of psychopathology. Using item analyses, we extracted five items and examined the measure's factor structure, sensitivity and specificity, and convergent and discriminant validity. RESULTS We extracted five items that assess different dimensions of OCD (washing, checking, ordering, obsessing, neutralizing/counting), termed the OCI-CV-5. Results revealed that the measure possesses good to excellent psychometric properties, and a cutoff off (≥2) yielded optimal sensitivity and specificity. LIMITATIONS Participants were predominantly White. In addition, more research is needed to examine the OCI-CV-5's test-retest reliability and sensitivity to treatment. CONCLUSIONS The OCI-CV-5 shows promise as an ultra-brief self-report screener for identifying OCD in youth when in-depth assessment is unfeasible.
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Affiliation(s)
- Amitai Abramovitch
- Department of Psychology, Texas State University, San Marcos, TX, USA; Department of Psychiatry, Massachusetts General Hospital Boston, MA, USA.
| | - Jonathan S Abramowitz
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Dean McKay
- Department of Psychology Fordham University, Bronx, NY, USA
| | - Heining Cham
- Department of Psychology Fordham University, Bronx, NY, USA
| | | | - Lara J Farrell
- School of Applied Psychology, Griffith University, Gold Coast, Australia
| | - Daniel A Geller
- Department of Psychiatry, Massachusetts General Hospital Boston, MA, USA; Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Gregory L Hanna
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA
| | - Sharna Mathieu
- School of Applied Psychology, Griffith University, Gold Coast, Australia
| | - Joseph F McGuire
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University, Baltimore, MD, USA
| | - David R Rosenberg
- Department of Psychiatry and Behavioral Neurosciences, Wayne State University, Detroit, MI, USA
| | - S Evelyn Stewart
- University of British Columbia/British Columbia Children's Hospital, British Columbia Mental Health and Substance Use Services Research Institute, Vancouver, Canada
| | - Eric A Storch
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
| | - Sabine Wilhelm
- Department of Psychiatry, Massachusetts General Hospital Boston, MA, USA; Department of Psychiatry, Harvard Medical School, Boston, MA, USA
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11
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Abramowitz JS. OCD and Comorbid Depression: Assessment, Conceptualization, and Cognitive-Behavioral Treatment. J Cogn Psychother 2022:JCP-2021-0003.R1. [PMID: 35379766 DOI: 10.1891/jcp-2021-0003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Many individuals with obsessive-compulsive disorder (OCD) also meet criteria for additional diagnoses. Among the most common co-occurring diagnoses are mood disorders-especially depression. This article focuses on the comorbidity between OCD and major depression. After discussing nature of OCD and depression, the rates and clinical impact of depression on OCD, the conceptualization, assessment, and treatment of OCD when it appears along with depression is covered in detail. The derivation and implementation of a cognitive-behavioral treatment program specifically for depressed OCD patients is described and illustrated using a case example.
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Affiliation(s)
- Jonathan S Abramowitz
- Department of Psychology and Neuroscience University of North Carolina at Chapel Hill
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12
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Ong CW, Petersen JM, Terry CL, Krafft J, Barney JL, Abramowitz JS, Twohig MP. The “How” of exposures: Examining the relationship between exposure parameters and outcomes in obsessive-compulsive disorder. Journal of Contextual Behavioral Science 2022. [DOI: 10.1016/j.jcbs.2022.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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14
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Reuman L, Abramowitz JS. GIV CARE: A Group Intervention to Reduce Accommodation Among Relatives of Individuals With Fear-Based Disorders. Cogn Behav Pract 2021; 28:336-349. [PMID: 34690481 DOI: 10.1016/j.cbpra.2020.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Fear-based disorders (FBDs) occur in an interpersonal context as relatives (e.g., partners, parents) often accommodate symptoms. Symptom accommodation, which is ubiquitous and reinforces FBD behavior, is associated with increased FBD symptom severity and interferes with treatment. Accordingly, reducing accommodation represents a crucial aim for intervention. We describe a brief, manualized group intervention to decrease symptom accommodation and caregiver burden among cohabitating relatives of individuals with FBDs. The intervention is the first to date that (a) jointly includes parents and partners to target symptom accommodation, and (b) uses a transdiagnostic group treatment approach. We also provide preliminary empirical support for this group-based intervention among adult relatives (N = 20) that participated in the five weekly intervention sessions and completed assessments at baseline, posttreatment, and 1-month follow-up (1MFU). Preliminary results suggest that the group intervention is feasible and acceptable. Completers (n = 18) exhibited significant reductions in symptom accommodation and self-reported burden between baseline and 1MFU. The discussion identifies study limitations and future directions.
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15
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Ojalehto HJ, Abramowitz JS, Hellberg SN, Butcher MW, Buchholz JL. Predicting COVID-19-related anxiety: The role of obsessive-compulsive symptom dimensions, anxiety sensitivity, and body vigilance. J Anxiety Disord 2021; 83:102460. [PMID: 34352520 PMCID: PMC8318675 DOI: 10.1016/j.janxdis.2021.102460] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 06/02/2021] [Accepted: 07/27/2021] [Indexed: 01/18/2023]
Abstract
The novel coronavirus disease (COVID-19), first detected in December of 2019 and declared a global pandemic in March of 2020, continues to pose a serious threat to public health and safety worldwide. Many individuals report anxiety in response to this threat, and at high levels, such anxiety can result in adverse mental health outcomes and maladaptive behavioral responses that have consequences for the health of communities more broadly. Predictors of excessive anxiety in response to COVID-19 are understudied. Accordingly, the present study examined psychological factors that predict more intense COVID-19-related anxiety. 438 community members completed measures assessing COVID-19-related anxiety as well as psychological variables hypothesized to predict anxious responding to the threat of COVID-19. As expected, obsessive-compulsive symptoms related to contamination, the fear of arousal-related body sensations (i.e., anxiety sensitivity), and body vigilance each predicted more severe anxiety related to the pandemic. Obsessive-compulsive symptoms related to responsibility for causing harm also emerged as a predictor. Study limitations and implications are discussed.
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Affiliation(s)
| | - Jonathan S. Abramowitz
- Corresponding author at: Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Campus Box 3270 (Davie Hall), Chapel Hill, NC 27599, United States
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16
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Frohlich F, Riddle J, Abramowitz JS. Transcranial alternating current stimulation for the treatment of obsessive-compulsive disorder? Brain Stimul 2021; 14:1048-1050. [PMID: 34192553 PMCID: PMC9337719 DOI: 10.1016/j.brs.2021.06.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 06/24/2021] [Indexed: 11/30/2022] Open
Affiliation(s)
- Flavio Frohlich
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; Carolina Center for Neurostimulation, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; Department of Neurology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; Department of Cell Biology and Physiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; Department of Biomedical Engineering, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; Neuroscience Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
| | - Justin Riddle
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; Carolina Center for Neurostimulation, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Jonathan S Abramowitz
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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17
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Pinciotti CM, Riemann BC, Abramowitz JS. Intolerance of uncertainty and obsessive-compulsive disorder dimensions. J Anxiety Disord 2021; 81:102417. [PMID: 33991818 DOI: 10.1016/j.janxdis.2021.102417] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 04/23/2021] [Accepted: 05/04/2021] [Indexed: 01/23/2023]
Abstract
Intolerance of uncertainty (IU), which can include prospective (i.e., desire for predictability) and inhibitory (i.e., uncertainty paralysis) IU, is widely understood to be a central underlying component of obsessive-compulsive disorder (OCD). IU has several treatment implications, yet research on the differences in IU underlying OCD dimensions is limited and does not account for covarying effects of overlapping symptoms, shared variance in IU, demographic variables, and comorbid psychiatric conditions like generalized anxiety disorder (GAD) and posttraumatic stress disorder (PTSD). A sample of 974 patients with diagnosed OCD enrolled in residential, partial hospitalization, and intensive outpatient treatment programs for OCD and anxiety completed self-report measures of OCD symptoms and IU at admission. Structural equation modeling included prospective. inhibitory IU, and common IU and covariates (i.e., race, ethnicity, level of care, and comorbid GAD and PTSD) as predictors of four common OCD dimensions found that contamination and unacceptable thoughts symptoms evidenced a unique relationship with IU. Specifically, whereas a common IU factor predicted all four OCD symptom dimensions, inhibitory IU uniquely predicted contamination and unacceptable thoughts symptoms over and above covarying effects. Individuals with contamination and unacceptable thoughts symptoms may be more likely to feel "paralyzed" by uncertainty due to overreliance on overt immediate rituals, outright avoidance, rumination, or difficulties with emotion regulation, and may benefit from additional psychoeducation, problem-solving, and accountability. Broadly, individuals with OCD may benefit from explicit discussions about IU-related expectancies and disconfirmation of fears.
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Affiliation(s)
| | - Bradley C Riemann
- Rogers Behavioral Health, 34700 Valley Rd., Oconomowoc, WI, 53066, USA
| | - Jonathan S Abramowitz
- Department of Psychology and Neuroscience, University of North Carolina-Chapel Hill, 235 E. Cameron Ave, Chapel Hill, NC, 27514, USA
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18
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Reuman L, Thompson-Hollands J, Abramowitz JS. Better Together: A Review and Recommendations to Optimize Research on Family Involvement in CBT for Anxiety and Related Disorders. Behav Ther 2021; 52:594-606. [PMID: 33990236 PMCID: PMC8124087 DOI: 10.1016/j.beth.2020.07.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 07/25/2020] [Accepted: 07/29/2020] [Indexed: 11/20/2022]
Abstract
Anxiety and related disorders (ARDs) occur in an interpersonal context. Individuals with ARDs respond well to individual cognitive behavioral therapy (CBT); however, there is room for improvement. As such, family members may be included to "enhance" treatment outcomes, yet findings from studies examining family involvement in CBT for ARDs are equivocal. The present paper (a) identifies methodological considerations for explaining inconsistent outcomes among CBT for ARDs with family involvement, and (b) reviews factors that affect outcomes of CBT for ARDs with family involvement including levels of involvement in treatment (e.g., number, duration, and spacing of sessions) and characteristics of who is involved in treatment (e.g., family member cognitions and cultural factors). Limitations of the literature and recommendations for future research are discussed. Researchers should focus on conducting studies that can test not whether but for whom and how family involvement can contribute to improved outcomes above and beyond individual CBT for ARDs.
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Affiliation(s)
- Lillian Reuman
- University of North Carolina at Chapel Hill; Boston University School of Medicine; National Center for PTSD at VA Boston Healthcare System.
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19
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Abramovitch A, Abramowitz JS, McKay D. The OCI-12: A syndromally valid modification of the obsessive-compulsive inventory-revised. Psychiatry Res 2021; 298:113808. [PMID: 33647706 DOI: 10.1016/j.psychres.2021.113808] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2020] [Accepted: 02/11/2021] [Indexed: 12/12/2022]
Abstract
The 18-item Obsessive-Compulsive Inventory-Revised (OCI-R) is a widely used self-report measure of Obsessive-Compulsive Disorder (OCD) symptoms, yet its factor structure does not converge with contemporary dimensional models of OCD symptoms. In addition to assessing the four core OCD dimensions, the OCI-R includes hoarding and neutralizing factors. However, since its publication, hoarding has been designated as a separate disorder, and there are concerns about the neutralizing factor's reliability and validity. The aim of this study was to evaluate a syndromally valid modification of the OCI-R. Adult samples of individuals diagnosed with OCD (n = 1087), anxiety related disorders (n = 1306), and unselected community volunteers (n = 423) completed the OCI-R and measures of anxiety and mood. Analyses excluded the 3 OCI-R hoarding items and suggested the removal of the 3 neutralizing items. Internal consistency, sensitivity and specificity to OCD clinical status, test-retest reliability, sensitivity to treatment, and convergent and discriminant validity were evaluated for the resultant 12-item scale (termed the OCI-12). The OCI-12 evidenced good to excellent psychometric properties. Clinical norms, severity benchmarks, and a clinical cutoff score were computed. In conclusion, the OCI-12 represents a syndromally valid update of the OCI-R with comparable psychometric properties and superior sensitivity and specificity.
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Affiliation(s)
- Amitai Abramovitch
- Department of Psychology, Texas State University, San Marcos, TX, United States.
| | - Jonathan S Abramowitz
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States.
| | - Dean McKay
- Department of Psychology Fordham University, Bronx, NY, United States.
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20
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Gruber J, Prinstein MJ, Clark LA, Rottenberg J, Abramowitz JS, Albano AM, Aldao A, Borelli JL, Chung T, Davila J, Forbes EE, Gee DG, Hall GCN, Hallion LS, Hinshaw SP, Hofmann SG, Hollon SD, Joormann J, Kazdin AE, Klein DN, La Greca AM, Levenson RW, MacDonald AW, McKay D, McLaughlin KA, Mendle J, Miller AB, Neblett EW, Nock M, Olatunji BO, Persons JB, Rozek DC, Schleider JL, Slavich GM, Teachman BA, Vine V, Weinstock LM. Mental health and clinical psychological science in the time of COVID-19: Challenges, opportunities, and a call to action. Am Psychol 2021; 76:409-426. [PMID: 32772538 PMCID: PMC7873160 DOI: 10.1037/amp0000707] [Citation(s) in RCA: 265] [Impact Index Per Article: 88.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
COVID-19 presents significant social, economic, and medical challenges. Because COVID-19 has already begun to precipitate huge increases in mental health problems, clinical psychological science must assert a leadership role in guiding a national response to this secondary crisis. In this article, COVID-19 is conceptualized as a unique, compounding, multidimensional stressor that will create a vast need for intervention and necessitate new paradigms for mental health service delivery and training. Urgent challenge areas across developmental periods are discussed, followed by a review of psychological symptoms that likely will increase in prevalence and require innovative solutions in both science and practice. Implications for new research directions, clinical approaches, and policy issues are discussed to highlight the opportunities for clinical psychological science to emerge as an updated, contemporary field capable of addressing the burden of mental illness and distress in the wake of COVID-19 and beyond. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
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Affiliation(s)
- June Gruber
- Department of Psychology and Neuroscience, University of Colorado Boulder
| | - Mitchell J Prinstein
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill
| | | | | | - Jonathan S Abramowitz
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill
| | | | | | - Jessica L Borelli
- Department of Psychological Science, University of California, Irvine
| | - Tammy Chung
- Institute for Health, Healthcare Policy and Aging Research, Rutgers, The State University of New Jersey
| | | | | | | | | | | | | | - Stefan G Hofmann
- Department of Psychological and Brain Sciences, Boston University
| | | | | | | | | | | | | | | | - Dean McKay
- Department of Psychology, Fordham University
| | | | - Jane Mendle
- Department of Human Development, Cornell University
| | - Adam Bryant Miller
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill
| | | | | | | | | | | | | | - George M Slavich
- Cousins Center for Psychoneuroimmunology, University of California, Los Angeles
| | | | - Vera Vine
- Department of Psychiatry, University of Pittsburgh
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21
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Gruber J, Prinstein MJ, Clark LA, Rottenberg J, Abramowitz JS, Albano AM, Aldao A, Borelli JL, Chung T, Davila J, Forbes EE, Gee DG, Hall GCN, Hallion LS, Hinshaw SP, Hofmann SG, Hollon SD, Joormann J, Kazdin AE, Klein DN, La Greca AM, Levenson RW, MacDonald AW, McKay D, McLaughlin KA, Mendle J, Miller AB, Neblett EW, Nock M, Olatunji BO, Persons JB, Rozek DC, Schleider JL, Slavich GM, Teachman BA, Vine V, Weinstock LM. Mental health and clinical psychological science in the time of COVID-19: Challenges, opportunities, and a call to action. Am Psychol 2021; 76:409-426. [PMID: 32772538 DOI: 10.31234/osf.io/desg9] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
COVID-19 presents significant social, economic, and medical challenges. Because COVID-19 has already begun to precipitate huge increases in mental health problems, clinical psychological science must assert a leadership role in guiding a national response to this secondary crisis. In this article, COVID-19 is conceptualized as a unique, compounding, multidimensional stressor that will create a vast need for intervention and necessitate new paradigms for mental health service delivery and training. Urgent challenge areas across developmental periods are discussed, followed by a review of psychological symptoms that likely will increase in prevalence and require innovative solutions in both science and practice. Implications for new research directions, clinical approaches, and policy issues are discussed to highlight the opportunities for clinical psychological science to emerge as an updated, contemporary field capable of addressing the burden of mental illness and distress in the wake of COVID-19 and beyond. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
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Affiliation(s)
- June Gruber
- Department of Psychology and Neuroscience, University of Colorado Boulder
| | - Mitchell J Prinstein
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill
| | | | | | - Jonathan S Abramowitz
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill
| | | | | | - Jessica L Borelli
- Department of Psychological Science, University of California, Irvine
| | - Tammy Chung
- Institute for Health, Healthcare Policy and Aging Research, Rutgers, The State University of New Jersey
| | | | | | | | | | | | | | - Stefan G Hofmann
- Department of Psychological and Brain Sciences, Boston University
| | | | | | | | | | | | | | | | - Dean McKay
- Department of Psychology, Fordham University
| | | | - Jane Mendle
- Department of Human Development, Cornell University
| | - Adam Bryant Miller
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill
| | | | | | | | | | | | | | - George M Slavich
- Cousins Center for Psychoneuroimmunology, University of California, Los Angeles
| | | | - Vera Vine
- Department of Psychiatry, University of Pittsburgh
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22
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Ojalehto HJ, Hellberg SN, Butcher MW, Buchholz JL, Timpano KR, Abramowitz JS. Experiential avoidance and the misinterpretation of intrusions as prospective predictors of postpartum obsessive-compulsive symptoms in first-time parents. Journal of Contextual Behavioral Science 2021. [DOI: 10.1016/j.jcbs.2021.04.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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23
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McKay D, Abramowitz JS, Storch EA. Mechanisms of harmful treatments for obsessive–compulsive disorder. Clinical Psychology: Science and Practice 2021. [DOI: 10.1111/cpsp.12337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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24
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Abstract
Anxiety sensitivity (AS), the fear of anxiety-related physiological sensations, is a predictor of posttraumatic stress symptoms (PTSS) following a traumatic event, yet there is limited research on the relationship between AS and PTSS among sexual assault survivors. The present study was designed to test the hypothesis that AS would emerge as a statistical predictor of PTSS dimensions among community members and undergraduate students endorsing lifetime exposure to sexual trauma. Adults endorsing a history of sexual assault (N = 52) completed an online battery, including self-report measures of AS, general distress, dysfunctional trauma-related beliefs (i.e., posttraumatic cognitions), and PTSS. Although AS was associated with PTSS dimensions at the bivariate level (rs ranged .68-82), AS did not emerge as a significant unique predictor of PTSS dimensions in linear regression analyses after controlling for general distress and posttraumatic cognitions. In fact, general distress was the only significant statistical predictor of PTSS total and dimension scores (ps < 01). Study implications, limitations, and future directions are discussed.
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Affiliation(s)
- Sarah C Jessup
- Graduate Student, Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill.,Vanderbilt University, Nashville, Tennessee
| | - Shannon M Blakey
- Postdoctoral fellow, Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill
| | - Jonathan S Abramowitz
- Professor of psychology, Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill
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25
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Kvale G, Hansen B, Hagen K, Abramowitz JS, Børtveit T, Craske MG, Franklin ME, Haseth S, Himle JA, Hystad S, Kristensen UB, Launes G, Lund A, Solem S, Öst LG. Effect of D-Cycloserine on the Effect of Concentrated Exposure and Response Prevention in Difficult-to-Treat Obsessive-Compulsive Disorder: A Randomized Clinical Trial. JAMA Netw Open 2020; 3:e2013249. [PMID: 32789516 PMCID: PMC7426745 DOI: 10.1001/jamanetworkopen.2020.13249] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
IMPORTANCE Evidence is lacking for viable treatment options for patients with difficult-to-treat obsessive-compulsive disorder (OCD). It has been suggested that D-cycloserine (DCS) could potentiate the effect of exposure and response prevention (ERP) treatment, but the hypothesis has not been tested among patients with difficult-to-treat OCD. OBJECTIVE To evaluate whether DCS potentiates the effect of concentrated ERP among patients with difficult-to-treat OCD. DESIGN, SETTING, AND PARTICIPANTS The study was a randomized placebo-controlled triple-masked study with a 12-month follow-up. Participants were adult outpatients with difficult-to-treat OCD. A total of 220 potential participants were referred, of whom 36 did not meet inclusion criteria and 21 declined to participate. Patients had either relapsed after (n = 100) or not responded to (n = 63) previous ERP treatment. A total of 9 specialized OCD teams within the public health care system in Norway participated, giving national coverage. An expert team of therapists from the coordinating site delivered treatment. Inclusion of patients started in January 2016 and ended in August 2017. Data analysis was conducted February to September 2019. INTERVENTIONS All patients received individual, concentrated ERP treatment delivered during 4 consecutive days in a group setting (the Bergen 4-day treatment format) combined with 100 mg DCS, 250 mg DCS, or placebo. MAIN OUTCOMES AND MEASURES Change in symptoms of OCD and change in diagnostic status. Secondary outcomes measures included self-reported symptoms of OCD, anxiety, depression, and quality of life. RESULTS The total sample of 163 patients had a mean (SD) age of 34.5 (10.9) years, and most were women (117 [71.8%]). They had experienced OCD for a mean (SD) of 16.2 (10.2) years. A total of 65 patients (39.9%) were randomized to receive 100 mg DCS, 67 (41.1%) to 250 mg of DCS, and 31 (19.0%) to placebo. Overall, 91 (56.5%) achieved remission at posttreatment, while 70 (47.9%) did so at the 12-month follow-up. There was no significant difference in remission rates among groups. There was a significant reduction in symptoms at 12 months, and within-group effect sizes ranged from 3.01 (95% CI, 2.38-3.63) for the group receiving 250 mg DCS to 3.49 (95% CI, 2.78-4.18) for the group receiving 100 mg DCS (all P < .001). However, there was no significant effect of treatment group compared with placebo in obsessive-compulsive symptoms (250 mg group at posttreatment: d = 0.33; 95% CI, -0.10 to 0.76; 100 mg group at posttreatment: d = 0.36; 95% CI, -0.08 to 0.79), symptoms of depression and anxiety (eg, Patient Health Questionnaire-9 score among 250 mg group at 12-month follow-up: d = 0.30; 95% CI, -0.17 to 0.76; Generalized Anxiety Disorder-7 score among 100 mg group at 12-month follow-up: d = 0.27; 95% CI, -0.19 to 0.73), and well-being (250 mg group: d = 0.10; 95% CI, -0.42 to 0.63; 100 mg group: d = 0.34; 95% CI, -0.19 to 0.86). No serious adverse effects were reported. CONCLUSIONS AND RELEVANCE In this study, DCS did not potentiate ERP treatment effect, but concentrated ERP treatment was associated with improvement. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT02656342.
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Affiliation(s)
- Gerd Kvale
- Bergen Center for Brain Plasticity, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Psychology, University of Bergen, Bergen, Norway
| | - Bjarne Hansen
- Bergen Center for Brain Plasticity, Haukeland University Hospital, Bergen, Norway
- Center for Crisis Psychology, University of Bergen, Bergen, Norway
| | - Kristen Hagen
- Bergen Center for Brain Plasticity, Haukeland University Hospital, Bergen, Norway
- Department of Psychiatry, Molde Hospital, Molde, Norway
| | | | - Tore Børtveit
- Bergen Center for Brain Plasticity, Haukeland University Hospital, Bergen, Norway
| | | | - Martin E. Franklin
- Rogers Memorial Hospital, Oconomowoc, Wisconsin
- Department of Psychology, University of Pennsylvania, Philadelphia
| | - Svein Haseth
- Nidaros Outpatient Psychiatric Unit, St. Olavs Hospital, Trondheim, Norway
| | - Joseph A. Himle
- School of Social Work, Department of Psychiatry, University of Michigan, Ann Arbor
| | - Sigurd Hystad
- Department for Psychosocial Science, University of Bergen, Bergen, Norway
| | | | - Gunvor Launes
- Solvang Outpatient Psychiatric Unit, Sørlandet Hospital, Kristiansand, Norway
| | - Anders Lund
- Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine, Section for Psychiatry, Faculty of Medicine and Dentistry, University of Bergen, Bergen, Norway
| | - Stian Solem
- Bergen Center for Brain Plasticity, Haukeland University Hospital, Bergen, Norway
- Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway
| | - Lars-Göran Öst
- Bergen Center for Brain Plasticity, Haukeland University Hospital, Bergen, Norway
- Department of Psychology, Stockholm University, Stockholm, Sweden
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26
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van der Veld WM, Duppen L, Hendriks GJ, Abramowitz JS, Kampman M. Psychometric Properties of the Dutch Dimensional Obsessive-Compulsive Scale (DOCS). European Journal of Psychological Assessment 2020. [DOI: 10.1027/1015-5759/a000600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Abstract. The Dimensional Obsessive-Compulsive Scale (DOCS) is a self-report questionnaire aimed to measure the severity of obsessive-compulsive symptoms on four thematically different symptom dimensions (contamination, responsibility for harm, unacceptable thoughts, and symmetry and completeness). The DOCS was developed in the US in response to the insufficiency of existing OCD measures. The 20-item scale is used in research and clinical settings. We translated the DOCS into Dutch and examined the psychometric properties in a clinical sample. In addition, we further examined the US version of DOCS with respect to measurement invariance between patient and non-patients and also between the US and the Dutch version of the DOCS. The analyses showed that the Dutch version is a valid and reliable version of the DOCS. Measurement invariance tests indicated that patient scores can be validly compared with non-patient scores. Therefore, the DOCS is a good instrument to monitor the development of OCD, for example, during treatment. The same result was found for the US DOCS and the Dutch DOCS, hence US scores and Dutch scores can be validly compared. With these two studies we have extended our knowledge of the DOCS, beyond the common psychometric properties.
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Affiliation(s)
| | - Lotte Duppen
- Behavioural Science Institute, Radboud University, Nijmegen, The Netherlands
- Pro Persona, Centre of Expertise for Anxiety, OCD, and PTSD, Nijmegen, The Netherlands
| | - Gert-Jan Hendriks
- Behavioural Science Institute, Radboud University, Nijmegen, The Netherlands
- Pro Persona, Centre of Expertise for Anxiety, OCD, and PTSD, Nijmegen, The Netherlands
- Department of Psychiatry, Radboud University Medical Centre, Nijmegen, The Netherlands
| | | | - Mirjam Kampman
- Behavioural Science Institute, Radboud University, Nijmegen, The Netherlands
- Pro Persona, Centre of Expertise for Anxiety, OCD, and PTSD, Nijmegen, The Netherlands
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27
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Storch EA, Peris TS, De Nadai A, Piacentini J, Bloch M, Cervin M, McGuire J, Farrell LJ, McCracken JT, McKay D, Riemann BC, Wagner AP, Franklin M, Schneider SC, Walkup JT, Williams L, Abramowitz JS, Stewart SE, Fitzgerald KD, Goodman WK. Little Doubt That CBT Works for Pediatric OCD. J Am Acad Child Adolesc Psychiatry 2020; 59:785-787. [PMID: 32618273 DOI: 10.1016/j.jaac.2020.01.026] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Revised: 12/27/2019] [Accepted: 04/24/2020] [Indexed: 12/19/2022]
Abstract
We write with great concern in response to the recent systematic review and meta-analysis of cognitive-behavioral therapy (CBT) in pediatric obsessive-compulsive disorder (OCD) by Uhre et al.1 Although the authors' results consistently support the clinical efficacy of CBT for pediatric OCD, we expect that, much like ourselves, readers will be confused by the discordant and inappropriate conclusions that they put forward. These conclusions stem from the authors' application and interpretation of their particular qualitative methods, which could lead important stakeholders (eg, parents, patients, clinicians, and payers) to wrongly discount clear evidence for what is known to be the best evidence-based therapy for pediatric OCD.
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Affiliation(s)
| | - Tara S Peris
- Jane and Terry Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles
| | | | - John Piacentini
- Jane and Terry Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles
| | - Michael Bloch
- Yale University College of Medicine, New Haven, Connecticut
| | | | | | - Lara J Farrell
- School of Applied Psychology, Griffith University, Gold Coast Campus, Queensland, Australia
| | - James T McCracken
- Jane and Terry Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles
| | | | | | | | | | | | - John T Walkup
- Lurie Children's Hospital of Chicago and Northwestern Feinberg School of Medicine, Chicago, Illinois
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28
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Fontenelle LF, Oldenhof E, Eduarda Moreira-de-Oliveira M, Abramowitz JS, Antony MM, Cath D, Carter A, Dougherty D, Ferrão YA, Figee M, Harrison BJ, Hoexter M, Soo Kwon J, Küelz A, Lazaro L, Lochner C, Marazziti D, Mataix-Cols D, McKay D, Miguel EC, Morein-Zamir S, Moritz S, Nestadt G, O'Connor K, Pallanti S, Purdon C, Rauch S, Richter P, Rotge JY, Shavitt RG, Soriano-Mas C, Starcevic V, Stein DJ, Steketee G, Storch EA, Taylor S, van den Heuvel OA, Veale D, Woods DW, Verdejo-Garcia A, Yücel M. A transdiagnostic perspective of constructs underlying obsessive-compulsive and related disorders: An international Delphi consensus study. Aust N Z J Psychiatry 2020; 54:719-731. [PMID: 32364439 DOI: 10.1177/0004867420912327] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
BACKGROUND The Research Domain Criteria seeks to bridge knowledge from neuroscience with clinical practice by promoting research into valid neurocognitive phenotypes and dimensions, irrespective of symptoms and diagnoses as currently conceptualized. While the Research Domain Criteria offers a vision of future research and practice, its 39 functional constructs need refinement to better target new phenotyping efforts. This study aimed to determine which Research Domain Criteria constructs are most relevant to understanding obsessive-compulsive and related disorders, based on a consensus between experts in the field of obsessive-compulsive and related disorders. METHODS Based on a modified Delphi method, 46 experts were recruited from Australia, Africa, Asia, Europe and the Americas. Over three rounds, experts had the opportunity to review their opinion in light of feedback from the previous round, which included how their response compared to other experts and a summary of comments given. RESULTS Thirty-four experts completed round one, of whom 28 (82%) completed round two and 24 (71%) completed round three. At the final round, four constructs were endorsed by ⩾75% of experts as 'primary constructs' and therefore central to understanding obsessive-compulsive and related disorders. Of these constructs, one came from the Positive Valence System (Habit), two from the Cognitive Control System (Response Selection/Inhibition and Performance Monitoring) and the final construct was an additional item suggested by experts (Compulsivity). CONCLUSION This study identified four Research Domain Criteria constructs that, according to experts, cut across different obsessive-compulsive and related disorders. These constructs represent key areas for future investigation, and may have potential implications for clinical practice in terms of diagnostic processes and therapeutic management of obsessive-compulsive and related disorders.
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Affiliation(s)
- Leonardo F Fontenelle
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Melbourne, VIC, Australia.,D'Or Institute for Research and Education, D'Or São Luiz Network, Rio de Janeiro, Brazil.,Obsessive, Compulsive, and Anxiety Spectrum Research Program, Institute of Psychiatry, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Erin Oldenhof
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Melbourne, VIC, Australia
| | - Maria Eduarda Moreira-de-Oliveira
- D'Or Institute for Research and Education, D'Or São Luiz Network, Rio de Janeiro, Brazil.,Obsessive, Compulsive, and Anxiety Spectrum Research Program, Institute of Psychiatry, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Jonathan S Abramowitz
- Department of Psychology and Neuroscience, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Martin M Antony
- Department of Psychology, Ryerson University, Toronto, ON, Canada
| | - Danielle Cath
- RGOc and Department of Psychiatry, Rijksuniversity Groningen, UMC Groningen, Groningen, The Netherlands.,Department of Specialized Trainings, Mental Health Services Drenthe, Assen, The Netherlands
| | - Adrian Carter
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Melbourne, VIC, Australia
| | - Darin Dougherty
- Division of Neurotherapeutics, Massachusetts General Hospital, Boston, MA, USA.,Obsessive-Compulsive Disorder Institute, McLean Hospital, Belmont, MA, USA.,Obsessive-Compulsive and Related Disorders Program, Massachusetts General Hospital, Boston, MA, USA.,Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Ygor A Ferrão
- Department of Psychiatry, Federal University of Health Sciences of Porto Alegre (UFCSPA), Porto Alegre, Brazil
| | - Martijn Figee
- Department of Psychiatry, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, The Netherlands.,Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York City, NY, USA
| | - Ben J Harrison
- Melbourne Neuropsychiatry Centre, Department of Psychiatry, The University of Melbourne, Melbourne, VIC, Australia
| | - Marcelo Hoexter
- Department of Psychiatry, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Jun Soo Kwon
- Department of Psychiatry, College of Medicine, Seoul National University, Seoul, Korea
| | - Anne Küelz
- Department of Psychiatry and Psychotherapy, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Luísa Lazaro
- Department of Child and Adolescent Psychiatry and Psychology, Hospital Clinic of Barcelona, IDIBAPS, CIBERSAM, University of Barcelona, Barcelona, Spain
| | - Christine Lochner
- SU/UCT MRC Unit on Risk and Resilience in Mental Disorders, Department of Psychiatry, Stellenbosch University, Stellenbosch, South Africa
| | - Donatella Marazziti
- Dipartimento di Medicina Clinica e Sperimentale, Section of Psychiatry, University of Pisa, Pisa, Italy
| | - David Mataix-Cols
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Dean McKay
- Department of Psychology, Fordham University, Bronx, NY, USA
| | - Euripedes C Miguel
- Department of Psychiatry, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Sharon Morein-Zamir
- School of Psychology and Sports Science, Anglia Ruskin University, Cambridge, UK
| | - Steffen Moritz
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Gerald Nestadt
- Department of Psychiatry and Behavioral Sciences, School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Kieron O'Connor
- Research Center of the Montreal University Institute of Mental Health, University of Montreal, Montreal, QC, Canada
| | - Stefano Pallanti
- Department of Psychiatry and Behavioral Sciences, Stanford University Medical Center, Stanford, CA, USA.,Institute of Neuroscience, University of Florence, Florence, Italy
| | - Christine Purdon
- Department of Psychology, University of Waterloo, Waterloo, ON, Canada
| | - Scott Rauch
- Obsessive-Compulsive Disorder Institute, McLean Hospital, Belmont, MA, USA.,Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Peggy Richter
- Anxiety Disorders Centre, Sunnybrook Health Care Sciences, Toronto, Canada and Department of Psychiatry, University of Toronto, Toronto, Canada
| | - Jean-Yves Rotge
- Inserm U 1127, CNRS UMR 7225, Department of Psychiatry, Institut du Cerveau et de la Moelle, ICM-A-IHU, Sorbonne Université, AP-HP, Paris, France
| | - Roseli G Shavitt
- Department of Psychiatry, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Carles Soriano-Mas
- Department of Psychiatry and Department of Psychobiology and Methodology of Health Sciences, Bellvitge Biomedical Research Institute-IDIBELL, Mental Health Networking Biomedical Research Centre (CIBERSAM) and Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Vladan Starcevic
- Department of Psychiatry, Nepean Hospital, Faculty of Medicine and Health, Sydney Medical School, Nepean Clinical School, The University of Sydney, Sydney, NSW, Australia
| | - Dan J Stein
- Department of Psychiatry and MRC Unit on Risk & Resilience in Mental Disorders, University of Cape Town, Cape Town, South Africa
| | - Gail Steketee
- School of Social Work, Boston University, Boston, USA
| | - Eric A Storch
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TC, USA
| | - Steven Taylor
- Department of Psychiatry, The University of British Columbia, Vancouver, BC, Canada
| | - Odile A van den Heuvel
- Department of Psychiatry and Department of Anatomy & Neurosciences, Amsterdam Neuroscience, Amsterdam UMC, Vrije Universiteit, Amsterdam, The Netherlands.,Bergen Center for Brain Plasticity, Haukeland University Hospital, Bergen, Norway
| | - David Veale
- South London and Maudsley NHS Foundation Trust, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Douglas W Woods
- Department of Psychological and Brain Sciences, Texas A&M University, College Station, TX, USA.,Department of Psychology, Marquette University, Milwaukee, WI, USA
| | - Antonio Verdejo-Garcia
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Melbourne, VIC, Australia
| | - Murat Yücel
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Melbourne, VIC, Australia
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Ojalehto HJ, Abramowitz JS, Hellberg SN, Buchholz JL, Twohig MP. Adherence to exposure and response prevention as a predictor of improvement in obsessive-compulsive symptom dimensions. J Anxiety Disord 2020; 72:102210. [PMID: 32208231 DOI: 10.1016/j.janxdis.2020.102210] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Accepted: 03/05/2020] [Indexed: 11/18/2022]
Abstract
Exposure and response prevention (ERP) is an effective treatment for obsessive compulsive disorder (OCD); yet, improvement rates vary and it is therefore important to examine potential predictors of outcome. The present study examined adherence with ERP homework as a predictor of (a) treatment response across OCD symptom dimensions and (b) reductions in psychological factors implicated in the maintenance of OCD. Fifty adults with OCD received manualized twice-weekly ERP as part of a treatment trial. Results indicated that treatment was effective for all OCD symptom dimensions and that greater adherence with ERP homework predicted post-treatment (but not follow-up) improvements in OCD symptoms pertaining to responsibility for harm, unacceptable obsessional thoughts, and symmetry. Adherence did not predict outcomes for contamination symptoms, however. Adherence also predicted improvement in psychological maintenance factors such as obsessive beliefs and experiential avoidance. Implications of the findings include the importance of emphasizing adherence to homework instructions, as well as the importance of considering OCD symptoms dimensionally as opposed to globally in examining predictors of treatment response.
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Buchholz JL, Abramowitz JS. The therapeutic alliance in exposure therapy for anxiety-related disorders: A critical review. J Anxiety Disord 2020; 70:102194. [PMID: 32007734 DOI: 10.1016/j.janxdis.2020.102194] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Revised: 01/15/2020] [Accepted: 01/16/2020] [Indexed: 11/29/2022]
Abstract
The therapeutic alliance has been the subject of a great deal of psychotherapy research, and evidence from numerous empirical studies suggests that a strong patient-therapist relationship predicts favorable treatment outcomes. Despite the consistency of the alliance outcome relationship across treatment modalities and diagnoses, little attention has been given to this potential prognostic indicator in exposure therapy for anxiety-related disorders. Given that exposure therapy requires patients to engage in challenging and distressing activities (e.g., confrontation with feared stimuli), a strong alliance between patient and therapist is conceptually relevant to treatment. Relatively few published exposure therapy trials have included the therapeutic alliance as a process variable, and no single review summarizes findings from this body of literature. Accordingly, the purpose of this review is to provide an overview and synthesis of existing research on the alliance-outcome relationship in exposure therapy. Methodological and conceptual considerations will be discussed, and future research priorities will be identified.
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31
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Hellberg SN, Buchholz JL, Twohig MP, Abramowitz JS. Not just thinking, but believing: Obsessive beliefs and domains of cognitive fusion in the prediction of OCD symptom dimensions. Clin Psychol Psychother 2019; 27:69-78. [PMID: 31657499 DOI: 10.1002/cpp.2409] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Revised: 09/17/2019] [Accepted: 10/17/2019] [Indexed: 11/08/2022]
Abstract
Cognitive fusion (CF) involves the tendency to "buy in" to thoughts and feelings and consists of three empirically established domains: somatic concerns, emotion regulation, and negative evaluation. CF is hypothesized to play a role in obsessive-compulsive disorder (OCD). The present study examined how well the CF domains, relative to traditional cognitive-behavioural constructs (i.e., obsessive beliefs such as inflated responsibility), predict OCD symptoms. Fifty-two treatment-seeking adults with OCD completed self-report measures of CF, obsessive beliefs, OCD symptoms, and general distress. Domains of CF were differentially associated with the responsibility for harm, symmetry, and unacceptable thoughts of OCD dimensions; yet after accounting for obsessive beliefs, only the negative evaluation domain of CF significantly predicted symmetry OCD symptoms. Obsessive beliefs significantly predicted all OCD dimensions except for contamination. These findings provide additional support for existing cognitive-behavioural models of OCD across symptom dimensions, with the exception of contamination symptoms, and suggest that the believability of thoughts and feelings about negative evaluation adds to the explanation of symmetry symptoms. Conceptual and treatment implications, study limitations, and future directions are discussed.
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Affiliation(s)
- Samantha N Hellberg
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Jennifer L Buchholz
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | | | - Jonathan S Abramowitz
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
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Jacoby RJ, Abramowitz JS, Blakey SM, Reuman L. Is the hierarchy necessary? Gradual versus variable exposure intensity in the treatment of unacceptable obsessional thoughts. J Behav Ther Exp Psychiatry 2019; 64:54-63. [PMID: 30851653 DOI: 10.1016/j.jbtep.2019.02.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Revised: 01/24/2019] [Accepted: 02/20/2019] [Indexed: 11/29/2022]
Abstract
Although research suggests that introducing varying levels of fear during exposure enhances outcomes for some anxiety-related problems, this has not been examined in the context of obsessions. The current preliminary study tested the hypothesis that introducing variability in exposure intensity would improve long-term outcomes relative to traditional gradual (hierarchical) exposure METHODS: Adults (N = 40) with a moderately distressing unacceptable obsessional thought were randomly assigned in parallel to four twice-weekly sessions of: (a) gradual exposure (EXP-G; n = 19) emphasizing hierarchical exposure completion, or (b) variable exposure (EXP-V; n = 21) emphasizing variability in exposure intensity RESULTS: There were no significant differences in pre to post changes between groups using self-report, interview, or behavioral outcomes (as evaluated by an independent assessor blind to treatment condition). Group comparisons at 3-month follow-up did not reach statistical significance but were moderate in magnitude. Specifically, as measured by clinical interview (the Yale-Brown Obsessive-Compulsive Scale; primary outcome) and self-report, individuals in the EXP-G group maintained gains at 3-month follow-up, while the EXP-V group continued to improve. Treatment expectancies and satisfaction were comparable for both groups. Five participants withdrew from the EXP-G condition, and none withdrew from the EXP-V condition. In contrast to previous studies, variability in subjective and physiological fear during exposure did not predict outcomes LIMITATIONS: The study employed an analogue sample with moderate unacceptable obsessions, and results should be replicated in clinical samples CONCLUSIONS: Variable exposure warrants future study to understand the mechanisms, moderators, and implications of this novel approach.
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Affiliation(s)
- Ryan J Jacoby
- University of North Carolina at Chapel Hill, Davie Hall, Campus Box 3270, Chapel Hill, NC, 27599, United States; Massachusetts General Hospital / Harvard Medical School, 185 Cambridge St, Boston, MA, 02114, United States.
| | - Jonathan S Abramowitz
- University of North Carolina at Chapel Hill, Davie Hall, Campus Box 3270, Chapel Hill, NC, 27599, United States.
| | - Shannon M Blakey
- University of North Carolina at Chapel Hill, Davie Hall, Campus Box 3270, Chapel Hill, NC, 27599, United States.
| | - Lillian Reuman
- University of North Carolina at Chapel Hill, Davie Hall, Campus Box 3270, Chapel Hill, NC, 27599, United States.
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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] [What about the content of this article? (0)] [Affiliation(s)] [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.
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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
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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] [What about the content of this article? (0)] [Affiliation(s)] [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.
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Blakey SM, Abramowitz JS. Dropping Safety Aids and Maximizing Retrieval Cues: Two Keys to Optimizing Inhibitory Learning During Exposure Therapy. Cognitive and Behavioral Practice 2019. [DOI: 10.1016/j.cbpra.2018.03.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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36
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Blakey SM, Abramowitz JS, Buchholz JL, Jessup SC, Jacoby RJ, Reuman L, Pentel KZ. A randomized controlled trial of the judicious use of safety behaviors during exposure therapy. Behav Res Ther 2019; 112:28-35. [DOI: 10.1016/j.brat.2018.11.010] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Revised: 10/30/2018] [Accepted: 11/19/2018] [Indexed: 10/27/2022]
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37
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Ong ML, Reuman L, Youngstrom EA, Abramowitz JS. Discriminative Validity of the Dimensional Obsessive-Compulsive Scale for Separating Obsessive-Compulsive Disorder From Anxiety Disorders. Assessment 2018; 27:810-821. [PMID: 30043619 DOI: 10.1177/1073191118791039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective: We investigated the diagnostic efficiency and clinical utility of the Dimensional Obsessive-Compulsive Scale (DOCS) and subscales for distinguishing obsessive-compulsive disorder (OCD) from anxiety disorders (ADs). Method: A total of 369 participants (167 male, Mage = 29.61 years) diagnosed with DSM-IV OCD or AD, recruited from specialty clinics across the United States, completed clinical interviews and self-report questionnaires, including the DOCS. Receiver operating characteristic analyses and diagnostic likelihood ratios (DiLRs) determined discriminative validity and provided clinical utility. Logistic regressions tested for incremental validity in the DOCS-total scale and subscales in predicting OCD status. Results: The DOCS-total scale and Contamination subscale performed best in differentiating between OCD and AD diagnosis (DOCS-total: Area under curve [AUC] = .75, p < .001; Contamination: AUC = .70, p < .001) as compared with the other subscales. At high scores (DOCS-total: 28+, Contamination: 6+), Contamination was more effective than the DOCS-total in differentiating OCD from ADs, with high scores in Contamination quadrupling OCD odds and DOCS-total by about threefold (Contamination DiLR+ = 4.04, DOCS-total DiLR+ = 2.82). At low scores (DOCS-total: 0-9, Contamination: 0-2), the converse was true, with low scores in Contamination cutting OCD odds by half and DOCS-total by one fifths (Contamination DiLR- = 0.52, DOCS-total DiLR- = 0.23). Conclusion: At high scores, the Contamination subscale is the most helpful subscale to differentiate OCD and ADs. For low scores, the DOCS-total scale performs the best among the scales.
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Affiliation(s)
- Mian-Li Ong
- University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Lillian Reuman
- University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Reuman L, Buchholz J, Abramowitz JS. Obsessive beliefs, experiential avoidance, and cognitive fusion as predictors of obsessive-compulsive disorder symptom dimensions. Journal of Contextual Behavioral Science 2018. [DOI: 10.1016/j.jcbs.2018.06.001] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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39
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Twohig MP, Abramowitz JS, Smith BM, Fabricant LE, Jacoby RJ, Morrison KL, Bluett EJ, Reuman L, Blakey SM, Ledermann T. Adding acceptance and commitment therapy to exposure and response prevention for obsessive-compulsive disorder: A randomized controlled trial. Behav Res Ther 2018; 108:1-9. [PMID: 29966992 DOI: 10.1016/j.brat.2018.06.005] [Citation(s) in RCA: 63] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Revised: 05/31/2018] [Accepted: 06/21/2018] [Indexed: 01/17/2023]
Abstract
The objective of this study was to test whether treatment acceptability, exposure engagement, and completion rates could be increased by integrating acceptance and commitment therapy (ACT) with traditional exposure and response prevention (ERP). 58 adults (68% female) diagnosed with obsessive-compulsive disorder (OCD; M age = 27, 80% white) engaged in a multisite randomized controlled trial of 16 individual twice-weekly sessions of either ERP or ACT + ERP. Assessors unaware of treatment condition administered assessments of OCD, depression, psychological flexibility, and obsessional beliefs at pretreatment, posttreatment, and six-month follow-up. Treatment acceptability, credibility/expectancy, and exposure engagement were also assessed. Exposure engagement was high in both conditions and there were no significant differences in exposure engagement, treatment acceptability, or dropout rates between ACT + ERP and ERP. OCD symptoms, depression, psychological inflexibility, and obsessional beliefs decreased significantly at posttreatment and were maintained at follow-up in both conditions. No between-group differences in outcome were observed using intent to treat and predicted data from multilevel modeling. ACT + ERP and ERP were both highly effective treatments for OCD, and no differences were found in outcomes, processes of change, acceptability, or exposure engagement.
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Abramowitz JS, Blakey SM, Reuman L, Buchholz JL. New Directions in the Cognitive-Behavioral Treatment of OCD: Theory, Research, and Practice. Behav Ther 2018; 49:311-322. [PMID: 29704962 DOI: 10.1016/j.beth.2017.09.002] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2017] [Revised: 09/02/2017] [Accepted: 09/04/2017] [Indexed: 01/01/2023]
Abstract
The beneficial effects of cognitive-behavioral interventions (particularly exposure and response prevention) for OCD are among the most consistent research findings in the mental health literature. Nevertheless, even after an adequate trial, many individuals experience residual symptoms, and others never receive adequate treatment due to limited access. These and other issues have prompted clinicians and researchers to search for ways to improve the conceptual and practical aspects of existing treatment approaches, as well as look for augmentation strategies. In the present article, we review a number of recent developments and new directions in the psychological treatment of OCD, including (a) the application of inhibitory learning approaches to exposure therapy, (b) the development of acceptance-based approaches, (c) involvement of caregivers (partners and parents) in treatment, (d) pharmacological cognitive enhancement of exposure therapy, and (e) the use of technology to disseminate effective treatment. We focus on both the conceptual/scientific and practical aspects of these topics so that clinicians and researchers alike can assess their relative merits and disadvantages.
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41
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Blakey SM, Abramowitz JS. Interoceptive Exposure: An Overlooked Modality in the Cognitive-Behavioral Treatment of OCD. Cognitive and Behavioral Practice 2018. [DOI: 10.1016/j.cbpra.2017.01.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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42
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Abramowitz JS. Presidential Address: Are the Obsessive-Compulsive Related Disorders Related to Obsessive-Compulsive Disorder? A Critical Look at DSM-5's New Category. Behav Ther 2018; 49:1-11. [PMID: 29405915 DOI: 10.1016/j.beth.2017.06.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Revised: 06/08/2017] [Accepted: 06/08/2017] [Indexed: 12/18/2022]
Abstract
The 5th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM) includes a new class of obsessive-compulsive and related disorders (OCRDs) that includes obsessive-compulsive disorder (OCD) and a handful of other putatively related conditions. Although this new category promises to raise awareness of underrecognized and understudied problems, the empirical validity and practical utility of this new DSM category is questionable. This article critically examines the arguments underlying the new OCRD class, illuminates a number of problems with this class, and then discusses implications for clinicians and researchers.
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Blakey SM, Abramowitz JS, Reuman L, Leonard RC, Riemann BC. Anxiety sensitivity as a predictor of outcome in the treatment of obsessive-compulsive disorder. J Behav Ther Exp Psychiatry 2017; 57:113-117. [PMID: 28505489 DOI: 10.1016/j.jbtep.2017.05.003] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2016] [Revised: 02/20/2017] [Accepted: 05/02/2017] [Indexed: 11/19/2022]
Abstract
BACKGROUND AND OBJECTIVES To address the fact that not all individuals who receive cognitive-behavioral therapy (CBT) for obsessive-compulsive disorder (OCD) exhibit complete symptom reduction, research has examined factors that predict outcome; however, no studies have examined anxiety sensitivity (AS) as a predictor of outcome of CBT for OCD. AS refers to the fear of anxious arousal that results from mistaken beliefs about the dangerousness of anxiety-related body sensations. It is important to understand whether AS influences OCD treatment outcome, considering that (a) some obsessions directly relate to AS, and (b) OCD patients with high AS may be reluctant to engage in anxiety-provoking components of CBT for OCD. METHODS Patients (N = 187) with a primary diagnosis of OCD who received residential CBT for OCD participated in this study, which involved completing a self-report battery at pre- and post-treatment. RESULTS Results supported study hypotheses, in that (a) baseline AS positively correlated with baseline OCD severity, and (b) greater baseline AS prospectively predicted higher posttreatment OCD symptom severity even after controlling for pretreatment OCD and depression severity. LIMITATIONS The study was limited by its use of an older measure of AS, reliance on self-report measures, and nonstandardized treatment across participants. CONCLUSIONS Findings highlight the importance of AS in the nature and treatment of OCD. Clinical implications and future directions are discussed.
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Affiliation(s)
- Shannon M Blakey
- University of North Carolina at Chapel Hill, Chapel Hill, NC, United States.
| | | | - Lillian Reuman
- University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
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Abstract
The threat of a United States (U.S.) Zika virus pandemic during 2015-2016 was associated with public anxiety. Such threats represent opportunities to examine hypotheses about health anxiety. The present study investigated psychological predictors of Zika-related anxiety during the 2015-2016 outbreak. U.S. adults (N = 216) completed a battery of measures assessing Zika-related anxiety as well as psychological variables hypothesized to predict anxious responding to the threat of a domestic Zika outbreak. Contrary to hypotheses, regression analyses indicated that only contamination severity overestimates and greater Zika knowledge significantly predicted Zika-related anxiety. Study limitations and clinical implications are discussed.
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Affiliation(s)
- Shannon M Blakey
- Department of Psychology and Neuroscience, The University of North Carolina at Chapel Hill, CB # 3270, Davie Hall, Chapel Hill, NC, 27599, USA.
| | - Jonathan S Abramowitz
- Department of Psychology and Neuroscience, The University of North Carolina at Chapel Hill, CB # 3270, Davie Hall, Chapel Hill, NC, 27599, USA
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45
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Reuman L, Jacoby RJ, Blakey SM, Riemann BC, Leonard RC, Abramowitz JS. Predictors of illness anxiety symptoms in patients with obsessive compulsive disorder. Psychiatry Res 2017; 256:417-422. [PMID: 28697487 DOI: 10.1016/j.psychres.2017.07.012] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Revised: 06/01/2017] [Accepted: 07/04/2017] [Indexed: 10/19/2022]
Abstract
Illness anxiety and OCD symptoms appear to overlap in their presentation as well as in other conceptually important ways (e.g., dysfunctional cognitions). Little research, however, has directly examined these putative relationships. The present study examined the extent to which illness anxiety symptoms were associated with OCD symptom dimensions and relevant cognitive factors in a large treatment-seeking sample of patients with OCD. Patients completed a battery of self-report measures of OCD and health anxiety symptoms and related cognitive biases. Results from regression analyses indicated that illness anxiety symptoms were associated with harm obsessions and checking rituals, as well as with the tendency to overestimate threat and responsibility for harm. Illness anxiety was not associated with perfectionism. Conceptual and clinical implications of these findings are discussed.
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Affiliation(s)
- Lillian Reuman
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Ryan J Jacoby
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - Shannon M Blakey
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | | | | | - Jonathan S Abramowitz
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
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Eilertsen T, Hansen B, Kvale G, Abramowitz JS, Holm SEH, Solem S. The Dimensional Obsessive-Compulsive Scale: Development and Validation of a Short Form (DOCS-SF). Front Psychol 2017; 8:1503. [PMID: 28928693 PMCID: PMC5591872 DOI: 10.3389/fpsyg.2017.01503] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Accepted: 08/18/2017] [Indexed: 11/13/2022] Open
Abstract
Accurately and reliably measuring the presence and severity of Obsessive-Compulsive Disorder (OCD) symptoms is essential for both routine clinical work and research. The current study investigated psychometric properties of the dimensional obsessive-compulsive scale-short form (DOCS-SF). DOCS-SF was developed and validated in Norwegian. DOCS-SF contains a checklist with four symptom categories and five severity items scored on a zero to eight scale yielding a total score of 0–40. Data were collected from adults with a current diagnosis of OCD (n = 204) and a community comparison group (n = 211). The results provided evidence of internal consistency and convergent validity, although evidence for discriminant validity was mixed. Evidence was also found for diagnostic sensitivity and specificity, and treatment sensitivity. The analyses suggested a cut-off score of 16. In summary, the data obtained proved similar to studies published on the original dimensional obsessive-compulsive scale. There is strong evidence for the reliability and validity of the DOCS-SF for assessing OCD symptoms in individuals with this condition and in non-clinical individuals.
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Affiliation(s)
- Thomas Eilertsen
- OCD-Team, Haukeland University HospitalBergen, Norway.,Department of Clinical Psychology, University of BergenBergen, Norway
| | - Bjarne Hansen
- OCD-Team, Haukeland University HospitalBergen, Norway.,Department of Clinical Psychology, University of BergenBergen, Norway
| | - Gerd Kvale
- OCD-Team, Haukeland University HospitalBergen, Norway
| | - Jonathan S Abramowitz
- Department of Psychology and Neuroscience, University of North Carolina at Chapel HillChapel Hill, NC, United States
| | - Silje E H Holm
- OCD-Team, Haukeland University HospitalBergen, Norway.,Department of Clinical Psychology, University of BergenBergen, Norway
| | - Stian Solem
- Department of Psychology, Norwegian University of Science and TechnologyTrondheim, Norway
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Blakey SM, Reuman L, Buchholz JL, Abramowitz JS. Experiential avoidance and dysfunctional beliefs in the prediction of body image disturbance in a nonclinical sample of women. Body Image 2017; 22:72-77. [PMID: 28667898 DOI: 10.1016/j.bodyim.2017.06.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Revised: 06/07/2017] [Accepted: 06/13/2017] [Indexed: 12/01/2022]
Abstract
Body image disturbance (BID) refers to persistent dissatisfaction, distress, and dysfunction related to some aspect(s) of one's physical appearance. Cognitive models of BID highlight the importance of dysfunctional beliefs in maintaining BID. Relational Frame Theory (RFT), in contrast, posits that psychological distress is sustained by the unwillingness to experience aversive internal experiences (i.e., experiential avoidance [EA]). The present study tested the hypothesis that both dysfunctional beliefs and EA uniquely predict BID even after accounting for general distress. A nonclinical female sample (N=100) completed measures of general distress, dysfunctional beliefs about appearance, EA, and BID in addition to providing in vivo anxiety ratings after looking at their most dissatisfactory facial feature in a vanity mirror. Linear regression analyses showed that dysfunctional beliefs, but not EA, accounted for significant unique variance in BID outcomes. Implications for understanding, assessing, and treating clinically significant BID are discussed.
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Affiliation(s)
- Shannon M Blakey
- University of North Carolina at Chapel Hill, 235 E. Cameron Ave, Davie Hall (CB 3270), Chapel Hill, NC 27599-3270, United States.
| | - Lillian Reuman
- University of North Carolina at Chapel Hill, 235 E. Cameron Ave, Davie Hall (CB 3270), Chapel Hill, NC 27599-3270, United States.
| | - Jennifer L Buchholz
- University of North Carolina at Chapel Hill, 235 E. Cameron Ave, Davie Hall (CB 3270), Chapel Hill, NC 27599-3270, United States.
| | - Jonathan S Abramowitz
- University of North Carolina at Chapel Hill, 235 E. Cameron Ave, Davie Hall (CB 3270), Chapel Hill, NC 27599-3270, United States.
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Abramovitch A, Anholt G, Raveh-Gottfried S, Hamo N, Abramowitz JS. Meta-Analysis of Intelligence Quotient (IQ) in Obsessive-Compulsive Disorder. Neuropsychol Rev 2017; 28:111-120. [PMID: 28864868 DOI: 10.1007/s11065-017-9358-0] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2017] [Accepted: 08/14/2017] [Indexed: 11/28/2022]
Abstract
Obsessive compulsive disorder (OCD) is associated with a moderate degree of underperformance on cognitive tests, including deficient processing speed. However, despite little research focusing on Intelligence Quotient (IQ) in OCD, it has long been speculated that the disorder is associated with elevated intellectual capacity. The present meta-analytic study was, therefore, conducted to quantitatively summarize the literature on IQ in OCD systematically. We identified 98 studies containing IQ data among individuals with OCD and non-psychiatric comparison groups, and computed 108 effect sizes for Verbal IQ (VIQ, n = 55), Performance IQ (PIQ, n = 13), and Full Scale IQ (FSIQ, n = 40). Across studies, small effect sizes were found for FSIQ and VIQ, and a moderate effect size for PIQ, exemplifying reduced IQ in OCD. However, mean IQ scores across OCD samples were in the normative range. Moderator analyses revealed no significant moderating effect across clinical and demographic indices. We conclude that, although lower than controls, OCD is associated with normative FSIQ and VIQ, and relatively lowered PIQ. These results are discussed in light of neuropsychological research in OCD, and particularly the putative impact of reduced processing speed in this population. Recommendations for utilization of IQ tests in OCD, and directions for future studies are offered.
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Affiliation(s)
- Amitai Abramovitch
- Department of Psychology, Texas State University, San Marcos, TX, 78666, USA.
| | - Gideon Anholt
- Department of Psychology, Ben Gurion University, Beer Sheva, Israel
| | | | - Naama Hamo
- Department of Psychology, Ruppin Academic Center, Emek Hefer, Israel
| | - Jonathan S Abramowitz
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Affiliation(s)
- Dean McKay
- From the Department of Psychology, Fordham University, Bronx, N.Y.; the Department of Psychology, Texas State University, San Marcos; the Department of Psychology, University of North Carolina at Chapel Hill; and Illawarra Anxiety Clinic, New South Wales, Australia
| | - Amitai Abramovitch
- From the Department of Psychology, Fordham University, Bronx, N.Y.; the Department of Psychology, Texas State University, San Marcos; the Department of Psychology, University of North Carolina at Chapel Hill; and Illawarra Anxiety Clinic, New South Wales, Australia
| | - Jonathan S Abramowitz
- From the Department of Psychology, Fordham University, Bronx, N.Y.; the Department of Psychology, Texas State University, San Marcos; the Department of Psychology, University of North Carolina at Chapel Hill; and Illawarra Anxiety Clinic, New South Wales, Australia
| | - Brett Deacon
- From the Department of Psychology, Fordham University, Bronx, N.Y.; the Department of Psychology, Texas State University, San Marcos; the Department of Psychology, University of North Carolina at Chapel Hill; and Illawarra Anxiety Clinic, New South Wales, Australia
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50
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Fischer MS, Baucom DH, Baucom BR, Abramowitz JS, Kirby JS, Bulik CM. Disorder-specific patterns of emotion coregulation in couples: Comparing obsessive compulsive disorder and anorexia nervosa. J Fam Psychol 2017; 31:304-315. [PMID: 27748615 PMCID: PMC5378591 DOI: 10.1037/fam0000251] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
Impaired emotion regulation and maladaptive strategies to manage distress are central to psychopathology, including obsessive-compulsive disorder (OCD) and anorexia nervosa (AN). Emotion regulation can be fostered or thwarted by romantic partners, and the tendency to rely on interpersonally oriented emotion regulation may vary by disorder. This study examined coregulation as a form of interpersonal emotion regulation in OCD and AN. We hypothesized that OCD is associated with exaggerated and AN with diminished coregulation, and that OCD patients have greater overall levels of emotional arousal than AN patients. Greater symptom severity was expected to exacerbate these opposing tendencies. Vocally encoded emotional arousal was measured during couple conversations in 34 AN patients, 18 OCD patients, and their partners. Two indicators of coregulation (covariation and coupling) were analyzed using cross-lagged actor-partner interdependence and coupled linear oscillator models. As hypothesized, OCD was associated with greater overall emotional arousal than AN. Symptom severity was not associated with emotional arousal or coregulation. Covariation differed in the opposite direction of the hypothesis; there was no difference in coupling. AN patients exhibited consistent coregulation, indicating high reactivity to partners' emotional arousal which may contribute to interpersonal avoidance. OCD couples showed limited predictability of patients' arousal over time, while partners were affected by the patients' emotional arousal; thus, symptom accommodation may in part be partners' attempts at managing their own distress along with the patients'. A better understanding of interpersonal emotion regulation in OCD and AN can inform treatment by targeting interaction patterns that may maintain symptoms. (PsycINFO Database Record
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Affiliation(s)
- Melanie S Fischer
- Department of Psychology and Neuroscience, University of North Carolina
| | - Donald H Baucom
- Department of Psychology and Neuroscience, University of North Carolina
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