Family Accommodation in Intensive/Residential Treatment for Adults With OCD: A Cross-Lagged Panel Analysis

Many adults with OCD experience residual symptoms following CBT, with or without medication. A potential target for enhancing treatment effectiveness is family accommodation (FA). This study examined (1) possible sociodemographic and clinical correlates of FA in adults presenting for intensive/residential treatment, and (2) temporal relationships between FA and OCD symptom severity during acute treatment and follow-up phases. Adult patients (N = 315) completed baseline measures of FA and OCD symptom severity at admission to IRT. Follow-up data were collected from a subset of participants (n = 111) at discharge, 1-month, and 6-month follow-up. Cross-lagged panel analysis showed that changes in OCD symptom severity from admission to discharge predicted changes in FA from discharge to 1-month follow-up. Increases in FA from discharge to 1-month follow-up predicted increases in OCD symptom severity from 1-month to 6-month follow-up. Female patients reported greater baseline FA from their family members than did males, and there were no significant differences in FA by relationship type or marital status. Contamination, Responsibility for Harm, and Symmetry/Incompleteness symptoms were each found to uniquely predict FA at admission. Results from this study provide support for the temporal precedence of FA reduction in OCD symptom improvement as adults transition home following residential treatment.

Multi-method assessment of suicidal thoughts and behaviors among patients in treatment for OCD and related disorders

Obsessive-compulsive and related disorders (OCRDs) are associated with increased risk of suicidal thoughts and behaviors (STBs), yet research characterizing suicidality in OCRDs remains limited. A major challenge in assessing STBs is the reliance on explicit self-report. This study utilized multi-method assessment to examine changes in both implicit and explicit STBs in 31 adults receiving partial/residential treatment for OCRDs. Assessments were administered at admission and weekly during treatment. Approximately three-quarters of participants reported lifetime suicidal thoughts, with 16 % reporting a prior suicide attempt. OCD severity was significantly correlated with lifetime suicidal thoughts, and was significantly higher for those with lifetime suicidal thoughts and prior attempts compared to those without. Implicit biases towards death were not associated with OCD severity, and did not predict explicitly endorsed STBs. This is the first study to measure both explicit and implicit STBs in adults with OCRDs. Limitations included small sample size and lack of racial/ethnic diversity. Given the majority had recent suicidal thoughts and one in six had a prior attempt, we emphasize the importance of STB assessment in OCD treatment settings.

Feasibility and Acceptability of Cognitive Bias Modification for Interpretation as an Adjunctive Treatment for OCD and Related Disorders: A Pilot Randomized Controlled Trial

Cognitive models implicate interpretation bias in the development and maintenance of obsessive compulsive and related disorders (OCRDs), and research supports Cognitive Bias Modification for Interpretation (CBM-I) in targeting this mechanism. However, prior studies in OCRDs have been limited to nonclinical populations, adolescents, and adults in a laboratory setting. This study evaluated the feasibility and acceptability of CBM-I as an adjunctive intervention during intensive/residential treatment (IRT) for adults with OCRDs. We modified a lab-based CBM-I training for adults seeking IRT for OCRDs, and conducted a feasibility trial (N = 4) and subsequent pilot RCT; participants (N = 31) were randomized to receive CBM-I or psychoeducation. Benchmarks were met for feasibility, acceptability, and target engagement. From pre- to post-intervention, the CBM-I group showed a large effect for change in interpretation bias (d = .90), whereas this effect was trivial (d = .06) for psychoeducation. This was the first study to evaluate CBM-I in naturalistic treatment for adults seeking IRT for OCRDs. Findings support the feasibility and acceptability of CBM-I in this novel sample and setting. A larger scale RCT is needed to determine whether CBM-I can enhance OCRD treatment response.

Higher order compulsivity versus grooming dimensions as treatment targets for the DSM-5 obsessive-compulsive and related disorders

BACKGROUND

Transdiagnostic definitions of obsessive-compulsive and related disorders (OCRDs) may represent useful treatment targets. The current study sought to characterize higher order dimensions underpinning the OCRDs in the Diagnostic and Statistical Manual of Mental Disorders-Fifth Edition, and examine their course during treatment.

METHODS

Adult patients (N = 407) completed measures of OCRDs, depression, and worry before and after intensive/residential treatment for OCRDs. Structural equation modeling was used to examine the comorbidity structure and temporal course of the symptoms.

RESULTS

Covariation of the symptoms was best represented by three dimensions: distress (depression and worry), compulsivity (obsessive-compulsive disorder, hoarding, and body dysmorphia), and grooming (hair pulling and skin picking). Latent change score modeling revealed significant reduction in the means of all three dimensions across treatment (Cohen's ds = -1.04, -0.62, and -0.23 for distress, compulsivity, and grooming, respectively). There was a strong correlation between change in compulsivity and grooming (r = .67) and change in compulsivity and distress (r = .80), but a small correlation between change in grooming and distress (r = .35).

CONCLUSIONS

The results indicate that OCRDs are underpinned by higher order compulsivity and grooming dimensions that differ in their association with distress. The results further suggest that the two dimensions may reflect promising intervention targets suitable for transdiagnostic treatment protocols.

Delayed Bedtimes Are Associated With More Severe Obsessive-Compulsive Symptoms in Intensive Residential Treatment

Delays in behavioral and biological circadian rhythms (e.g., sleep timing, melatonin secretion) are found more frequently in individuals with severe and treatment-resistant obsessive-compulsive disorder (OCD). In recent years, it has been documented that these delays in behavioral and biological circadian rhythms are associated with more severe OCD symptoms and poorer response to some OCD treatments. This study examined self-reported sleep behaviors in individuals taking part in an intensive treatment for OCD and the relations between these and OCD symptoms (both at admission to and discharge from the treatment program). Replicating previous findings in less severe populations, delayed sleep phases were relatively common in this group and later bedtimes were associated with more severe OCD symptoms at admission. Sleep onset latency and sleep duration were not associated with OCD symptom severity at admission. Later bedtimes were not associated with self-reported depression or worry symptom severity. There was no evidence of sleep behaviors affecting change in OCD symptoms from admission to discharge from treatment-however, later bedtimes at admission were associated with more severe OCD symptoms at admission and discharge from treatment. There was no evidence of sleep onset latency or sleep duration having a similar predictive effect. More severe OCD symptoms at admission were also associated with later bedtimes at admission and discharge from treatment. These bidirectional predictive relations between late bedtimes and OCD symptoms were of small effect size but support the potential value of evaluating sleep timing in individuals with severe and/or treatment-resistant OCD.