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Krause S, Radomsky AS. 'Things that shouldn't be': a qualitative investigation of violation-related appraisals in individuals with OCD and/or trauma histories. Behav Cogn Psychother 2024; 52:463-477. [PMID: 38679952 DOI: 10.1017/s1352465824000201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/01/2024]
Abstract
BACKGROUND Cognitive models of mental contamination (i.e. feelings of internal dirtiness without contact with a contaminant) propose that these feelings arise when individuals misappraise a violation. However, an operational definition of 'violation' and identification of specific violation misappraisals is limited. AIMS This study's aim was to elaborate on cognitive models using qualitative data from those with lived experience to fill these gaps. METHOD Twenty participants with a diagnosis of obsessive-compulsive disorder and/or a trauma history took part in a semi-structured interview about violation. Grounded theory was used to analyse interview transcripts. DISCUSSION Three categories emerged, each with several themes - qualities of violation, violation-related appraisals, and violation-related behaviours. Different violation-related appraisals were associated with different emotions and urges. Specific self-focused appraisal sub-themes (i.e. permanence of consequences; self-worth; responsibility, self-blame and regret) were most closely related to emotions tied to mental contamination. These findings support and expand upon existing cognitive models of mental contamination, identifying key violation-related appraisals and differentiating between mental contamination-related appraisals and those related to other emotional sequelae. Future quantitative and experimental research can evaluate the potential of these appraisals as intervention targets.
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Affiliation(s)
- Sandra Krause
- Concordia University, Department of Psychology, Montreal, Quebec, Canada
| | - Adam S Radomsky
- Concordia University, Department of Psychology, Montreal, Quebec, Canada
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2
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Krause S, Radomsky AS. Development and psychometric evaluation of the Violation Appraisal Measure (VAM). Cogn Behav Ther 2024:1-22. [PMID: 39206950 DOI: 10.1080/16506073.2024.2395823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2024] [Accepted: 08/14/2024] [Indexed: 09/04/2024]
Abstract
Mental contamination refers to feelings of dirtiness and/or urges to wash that arise without direct contact with a contaminant. Cognitive models propose that this results from "serious, negative misappraisals of perceived violations". However, the specific violation misappraisals most relevant to mental contamination have yet to be established empirically, in part due to the lack of a comprehensive validated inventory of violation appraisals. Therefore, this study's aim was to develop and validate such a measure. Items for the new Violation Appraisal Measure (VAM) were developed from qualitative interviews, theoretical models, and previous empirical work. An Exploratory Factor Analysis was conducted in a sample of (n = 300) undergraduate participants, which revealed a four-factor structure: Responsibility/Self-Blame, Permanence, Mistrust, and Self-Worth. The VAM showed excellent internal consistency (α = 0.90), good convergent (r = .50 to .64) and adequate divergent (r = -.01 to .46) validity and was predictive of mental contamination symptoms over and above existing related appraisal measures, Δ F(1,289) = 29.35, p < .001, Δ R2 = 0.06. A Confirmatory Factor Analysis in a second sample of (n = 300) undergraduate students confirmed strong model fit for the four-factor structure of the VAM. The development of the VAM is an important contribution to the search for empirically based cognitive mechanisms in mental contamination and other violation-related sequelae.
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Affiliation(s)
- Sandra Krause
- Department of Psychology, Concordia University, Montreal, Quebec, Canada
| | - Adam S Radomsky
- Department of Psychology, Concordia University, Montreal, Quebec, Canada
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Miccoli M, Poli A. Randomized trial on the effects of an EMDR intervention on traumatic and obsessive symptoms during the COVID-19 quarantine: a psychometric study. Front Psychiatry 2024; 15:1369216. [PMID: 38988736 PMCID: PMC11233768 DOI: 10.3389/fpsyt.2024.1369216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Accepted: 05/22/2024] [Indexed: 07/12/2024] Open
Abstract
Introduction It has been suggested that the COVID-19 pandemic was a potentially traumatic occurrence that may have induced generalized anxiety and discomfort, particularly in susceptible populations like individuals with mental illnesses. The therapeutic approach known as eye movement desensitization and reprocessing (EMDR) has been shown to be successful in helping patients process traumatic events and restore wellbeing. Nevertheless, little is known about the precise processes through which EMDR fosters symptom recovery. Methods In order to disentangle these issues, we conducted a randomized controlled trial (ClinicalTrials.gov Identifier NCT06110702) with 107 participants who were selected from university hospitals as a sample of investigation. Random assignments were applied to the participants in order to assign them to the experimental and control groups. The experimental group, but not the control group, underwent an 8-week EMDR intervention. Body perception, disgust, and emotions of guilt and shame, as well as mental contamination and posttraumatic and obsessive-compulsive symptoms, were investigated before and after the EMDR intervention. Results The EMDR intervention was able to improve all of the variables investigated. Path analysis showed that body perception was able to predict both disgust and emotions of guilt and shame. Disgust was able to predict both mental contamination and obsessive-compulsive symptoms, while guilt and shame were able to predict post-traumatic symptoms. Conclusions EMDR is an effective therapy for the treatment of post-traumatic and obsessive symptoms that acts through the promotion of improvement of the emotions of guilt/shame and disgust, respectively. Implications for clinical practice are examined. Clinical trial registration https://www.clinicaltrials.gov, identifier NCT06110702.
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Affiliation(s)
- Mario Miccoli
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Andrea Poli
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
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Khosravani V, Samimi Ardestani SM, Wong SF, Moulding R, Aardema F, Sharifibastan F, Aminaee M. Cross-sectional direct and indirect relationships between the corrupted feared self and obsessive-compulsive symptoms in a clinical sample: The role of mental contamination. BRITISH JOURNAL OF CLINICAL PSYCHOLOGY 2023; 62:800-815. [PMID: 37715987 DOI: 10.1111/bjc.12440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 08/27/2023] [Accepted: 08/29/2023] [Indexed: 09/18/2023]
Abstract
OBJECTIVES There is a significant relationship between a general feared self and contact contamination concerns in obsessive-compulsive disorder (OCD), especially when the influence of mental contamination is considered a part of this relationship. However, these associations have not been explored in a clinical OCD sample when using each dimension of the multidimensional conceptualization of the feared self as the predictor (i.e., the corrupted, culpable, and malformed feared selves). METHODS We tested these associations using a cross-sectional design. Specifically, a sample of patients diagnosed with OCD (N = 417) completed a series of self-report measures of OCD symptoms and its related constructs. We also explored these associations with unacceptable thoughts as the outcome, rather than contamination concerns, due to unacceptable thoughts having evidenced strong associations with the feared self and mental contamination. RESULTS After controlling for relevant cognitive (i.e., obsessive beliefs) and affective (i.e., depressive symptoms) constructs and comorbidity, the corrupted feared self was found to have a direct link, along with an indirect link through mental contamination, with symptoms of contact contamination and unacceptable thoughts. CONCLUSIONS The fear of being corrupted may be associated with feelings of contamination in the absence of direct contact with a contaminant, which may then predict OCD symptoms of repugnant obsessional thoughts and contact contamination concerns. The corrupted feared self and mental contamination should therefore be targeted in treatments for repugnant obsessions and contamination-related OCD.
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Affiliation(s)
- Vahid Khosravani
- Behavioral Sciences Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Seyed Mehdi Samimi Ardestani
- Department of Psychiatry, Behavioral Sciences Research Center, Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Shiu Fung Wong
- Department of Psychological Sciences, Swinburne University of Technology, Melbourne, Victoria, Australia
| | - Richard Moulding
- The Faculty of Psychology, Counselling and Psychotherapy, The Cairnmillar Institute, Hawthorn East, Australia
| | - Frederick Aardema
- Department of Psychiatry and Addictology, Montreal Mental Health University Institute Research Center, University of Montreal, Montreal, Quebec, Canada
| | - Farangis Sharifibastan
- Behavioral Sciences Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Department of Psychosocial Science, University of Bergen, Bergen, Norway
| | - Mohammad Aminaee
- Department of Clinical Psychology, Faculty of Education and Psychology, Shiraz University, Shiraz, Iran
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5
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Ferrão JVB, do Rosário MC, Fontenelle LF, Ferrão YA. Prevalence and psychopathology features of mental rituals in patients with obsessive-compulsive disorder: A descriptive exploratory study of 1001 patients. Clin Psychol Psychother 2023; 30:1520-1533. [PMID: 37554049 DOI: 10.1002/cpp.2890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Revised: 07/04/2023] [Accepted: 07/17/2023] [Indexed: 08/10/2023]
Abstract
INTRODUCTION Mental rituals (MR) are compulsions with no overt behavioural or motoric signs. It is presently unclear whether MR found in obsessive-compulsive disorder are associated with a distinctive clinical profile. OBJECTIVES The main objectives of this paper were to assess the prevalence and psychopathological correlates of mental rituals in a large sample of OCD patients. METHODS This exploratory case-control study compared 519 patients with versus 447 without MR in terms of sociodemographics, presence and severity of obsessive-compulsive symptoms, psychiatric comorbidities, sensory phenomena, suicidality, and insight. RESULTS Current MR were found in 51.8%, while lifetime MR were found in 55.4% of the sample. The multiple logistic regression model determined that the most relevant clinical factors independently associated with current MR in OCD patients were the absence of any sensory phenomena and the presence of lifetime suicide ideation. CONCLUSION Due to its relation to OCD clinical aspects, MR are a frequent feature among OCD patients. It also seems to be associated with a range of features that are probably relevant for treatment, especially sensory phenomena and suicidality.
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Affiliation(s)
- João Vítor Bueno Ferrão
- Medical School, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, Brazil
| | - Maria Conceição do Rosário
- Brazilian Consortium for Research on Obsessive-Compulsive Spectrum Disorders (C-TOC), Unidade de Psiquiatria da Infância e Adolescência (UPIA), Escola Paulista de Medicina, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
| | - Leonardo F Fontenelle
- Brazilian Consortium for Research on Obsessive-Compulsive Spectrum Disorders (C-TOC), Departamento de Psiquiatria e Medicina Legal da Faculdade de Medicina da Universidade Federal do Rio de Janeiro (UFRJ) e da Faculdade de Medicina da Universidade Federal Fluminense (UFF), Instituto DOr de Pesquisa e Ensino (IDOR), Rio de Janeiro, Brazil
| | - Ygor Arzeno Ferrão
- Brazilian Consortium for Research on Obsessive-Compulsive Spectrum Disorders (C-TOC), Clinical Neurosciences, Medical School, Programa de Pós- Graduação em Ciências da Saúde, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, Brazil
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6
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Millar JFA, Coughtrey AE, Healy A, Whittal M, Shafran R. The current status of mental contamination in obsessive compulsive disorder: A systematic review. J Behav Ther Exp Psychiatry 2023; 80:101745. [PMID: 37247969 DOI: 10.1016/j.jbtep.2022.101745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 04/07/2022] [Accepted: 04/23/2022] [Indexed: 05/31/2023]
Abstract
BACKGROUND AND OBJECTIVES Over the past 25 years Mental Contamination (MC) has become recognised as a distinct construct, particularly in relation to Obsessive Compulsive Disorder (OCD). MC is defined as feelings of contamination, often located internally, that arise in the absence of contact with a contaminant, with the source proposed to be human. Despite considerable interest from researchers and clinicians, there has not been a systematic review on the relationship between MC and OCD. Therefore, a systematic review was conducted to summarise and synthesise the current status of phenomenological and experimental evidence, mechanisms, assessment, measurement, and treatment of MC in OCD (PROSPERO: CRD42021223119). METHODS All study designs were eligible provided the focus of the study was on MC and the implications of the study were linked to OCD. We searched PsychINFO, Embase, Medline, Ethos, ProQuest, conference abstracts and trial registries between 1990 and 2021. The Mixed Methods Appraisal tool was used to assess methodological quality of included studies. RESULTS We found 58 reports with a total of 67 studies that met criteria for inclusion in the review. Twenty-three of these studies used clinical samples, 28 were experimental, 12 focused on phenomenology and 8 addressed treatment. The quality of the studies was variable. LIMITATIONS Grey literature was not included, thus there may be further unpublished MC studies that have not been included in the review. CONCLUSIONS Based on the findings, mental contamination is a robust clinical construct within OCD that has important implications for understanding and treating the disorder.
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Affiliation(s)
| | | | | | - Maureen Whittal
- Vancouver CBT Centre and University of British Columbia, Canada
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Remission of treatment-resistant obsessive-compulsive disorder with 600 milligrams of fluvoxamine daily: a case report. Int Clin Psychopharmacol 2023:00004850-990000000-00046. [PMID: 36752695 DOI: 10.1097/yic.0000000000000458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
First-line drugs for obsessive-compulsive disorder (OCD) pharmacotherapy are selective serotonin reuptake inhibitors (SSRI). The medication must be continued for at least 12 weeks at an effective dosage to find the most effective SSRI. For treatment, the drug dose should be titrated to the highest tolerated dose. The manufacturer's recommended maximum dose of fluvoxamine is 300 mg per day. We reported remission after about 1 month of 600 mg (high dose) fluvoxamine, which was tolerated by a patient with OCD. The patient continued at this dose for 3 months and remained in remission.
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Rast C, Woronko S, Jessup SC, Olatunji BO. Treatment of disgust in specific emotional disorders. Bull Menninger Clin 2023; 87:5-30. [PMID: 37871191 DOI: 10.1521/bumc.2023.87.suppa.5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2023]
Abstract
Although conditioning approaches have highlighted potential characteristics of disgust in anxiety disorders, obsessive-compulsive disorder (OCD), and posttraumatic stress disorder (PTSD), these findings have yet to be translated into evidence-based treatments. Examination of the literature suggests various indicators of disgust that predict treatment outcome in these disorders. However, mechanisms remain unclear because studies examining disgust during the course of treatment are limited. Increasingly, the field has moved toward experimental investigation of strategies that reduce disgust. While cognitive reappraisal and imagery techniques appear promising, such techniques have yet to be examined as anxiety disorder treatments in large-scale randomized clinical trials. The literature also points to novel approaches to treating disgust, ranging from an inhibitory-informed approach to exposure therapy to transcranial direct current stimulation. However, the development of novel treatment approaches will require more rigorous experimental psychopathology approaches that can further elucidate processes that contribute to the etiology and/or maintenance of disorders of disgust.
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Affiliation(s)
- Catherine Rast
- Department of Psychology at Vanderbilt University. Catherine Rast and Sarah Woronko are research assistants, Sarah Jessup is a graduate assistant, and Bunmi Olatunji is a professor
| | - Sarah Woronko
- Department of Psychology at Vanderbilt University. Catherine Rast and Sarah Woronko are research assistants, Sarah Jessup is a graduate assistant, and Bunmi Olatunji is a professor
| | - Sarah C Jessup
- Department of Psychology at Vanderbilt University. Catherine Rast and Sarah Woronko are research assistants, Sarah Jessup is a graduate assistant, and Bunmi Olatunji is a professor
| | - Bunmi O Olatunji
- Department of Psychology at Vanderbilt University. Catherine Rast and Sarah Woronko are research assistants, Sarah Jessup is a graduate assistant, and Bunmi Olatunji is a professor
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Badour CL, Tipsword JM, Jones AC, McCann JP, Fenlon EE, Brake CA, Alvarran S, Hood CO, Adams TG. Obsessive-Compulsive Symptoms and Daily Experiences of Posttraumatic Stress and Mental Contamination Following Sexual Trauma. J Obsessive Compuls Relat Disord 2023; 36:100767. [PMID: 37900357 PMCID: PMC10601737 DOI: 10.1016/j.jocrd.2022.100767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Although cross-sectional research highlights similarities between symptoms of obsessive-compulsive disorder (OCD) and posttraumatic stress disorder (PTSD) among individuals exposed to sexual trauma, little is known about how these disorders relate over time. The goal of the present study was to examine whether 1) OCD symptoms prospectively predicted daily symptoms of PTSD, and 2) OCD and PTSD symptoms prospectively predicted daily experiences of sexual trauma-related mental contamination (i.e., dirtiness in the absence of a physical pollutant). Forty-one women with a sexual trauma history completed baseline measures of OCD and PTSD, as well as twice-daily assessments of PTSD symptoms and mental contamination over a two-week period. Total OCD symptoms and the unacceptable thoughts dimension significantly predicted daily PTSD symptoms after accounting for other OCD dimensions. Only total OCD symptoms significantly predicted daily mental contamination when examined together with total PTSD symptoms. No individual PTSD or OCD clusters/dimensions significantly predicted daily mental contamination when examined simultaneously. Findings from this study highlight the nuanced associations among OCD symptoms, PTSD symptoms, and experiences of mental contamination. Future research is needed to further understand the development of PTSD, OCD, and mental contamination over time to inform targets for intervention.
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Affiliation(s)
- Christal L. Badour
- Department of Psychology, University of Kentucky, Lexington, Kentucky, USA
| | - Jordyn M. Tipsword
- Department of Psychology, University of Kentucky, Lexington, Kentucky, USA
| | - Alyssa C. Jones
- Southeast Mental Illness Research, Education, and Clinical Centers, Ralph H. Johnson VA Medical Center, Charleston, South Carolina, USA
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Jesse P. McCann
- Department of Psychology, University of Kentucky, Lexington, Kentucky, USA
| | - Emily E. Fenlon
- Department of Psychology, University of Kentucky, Lexington, Kentucky, USA
| | - C. Alex Brake
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School, Brown University, Providence, Rhode Island, USA
| | - Sophia Alvarran
- College of Social Work, University of Kentucky, Lexington, Kentucky, USA
| | - Caitlyn O. Hood
- Department of Psychiatry, University of Kentucky, Lexington, Kentucky, USA
| | - Thomas G. Adams
- Department of Psychology, University of Kentucky, Lexington, Kentucky, USA
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Teunisse AK, Pembroke L, O’Gradey‐Lee M, Sy M, Rapee RM, Wuthrich VM, Creswell C, Hudson JL. A scoping review investigating the use of exposure for the treatment and targeted prevention of anxiety and related disorders in young people. JCPP ADVANCES 2022; 2:e12080. [PMID: 37431458 PMCID: PMC10242975 DOI: 10.1002/jcv2.12080] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Accepted: 04/01/2022] [Indexed: 07/29/2023] Open
Abstract
Background Cognitive Behavioural Therapy (CBT) is the gold standard intervention for anxiety and related mental health disorders among young people; however, the efficacy of individual elements of CBT (e.g., exposure to feared stimuli) have received little scrutiny. Aims This scoping review, informed by three stakeholder groups and a scientific advisory group, aimed to identify the nature and extent of the available research literature on the efficacy of exposure to feared stimuli, moderators of effectiveness in young people aged 14-24 years. Method Three international stakeholder groups composed of clinicians (N = 8), parents/carers (N = 5) and youth with lived experience of anxiety (N = 7) provided input into study design and results. Using the PRISMA extension for scoping reviews, a search of MEDLINE/Ovid, PsycINFO, PubMed, CINAHL, SCOPUS, EMBASE, ERIC, and Health Collection (informit) was conducted using terms related to anxiety, ages 14-24, and exposure. Results From 3508 unique abstracts, 64 papers were included for the review. While there was evidence for the efficacy of exposure as a treatment for youth anxiety disorders, fundamental gaps in knowledge of exposure in this age group were identified. Most studies examined post-traumatic stress disorder, obsessive-compulsive disorder, and specific phobias with no randomised clinical trials uniquely evaluating exposure for the treatment of DSM-5 anxiety disorders. Exposure was typically delivered accompanied by other anxiety management techniques. A multitude of optimisation strategies have been tested, yet only one of these effects (timing relative to sleep) showed preliminary evidence of replication. Conclusions A systematic and theoretically driven program of research investigating the efficacy of exposure in young people and factors that moderate its efficacy, along with methods to overcome barriers for delivery, is urgently needed.
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Affiliation(s)
- Alessandra K. Teunisse
- Centre for Emotional HealthSchool of Psychological SciencesMacquarie University, Macquarie ParkNew South WalesAustralia
| | - Lorna Pembroke
- Centre for Emotional HealthSchool of Psychological SciencesMacquarie University, Macquarie ParkNew South WalesAustralia
| | - Maddison O’Gradey‐Lee
- Centre for Emotional HealthSchool of Psychological SciencesMacquarie University, Macquarie ParkNew South WalesAustralia
- Black Dog InstituteUniversity of New South WalesRandwickNew South WalesAustralia
| | - Megan Sy
- Centre for Emotional HealthSchool of Psychological SciencesMacquarie University, Macquarie ParkNew South WalesAustralia
| | - Ronald M. Rapee
- Centre for Emotional HealthSchool of Psychological SciencesMacquarie University, Macquarie ParkNew South WalesAustralia
| | - Viviana M. Wuthrich
- Centre for Emotional HealthSchool of Psychological SciencesMacquarie University, Macquarie ParkNew South WalesAustralia
| | - Cathy Creswell
- Department of Experimental Psychology and Department of PsychiatryUniversity of OxfordOxfordUK
| | - Jennifer L. Hudson
- Centre for Emotional HealthSchool of Psychological SciencesMacquarie University, Macquarie ParkNew South WalesAustralia
- Black Dog InstituteUniversity of New South WalesRandwickNew South WalesAustralia
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11
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Sookman D, Phillips KA, Anholt GE, Bhar S, Bream V, Challacombe FL, Coughtrey A, Craske MG, Foa E, Gagné JP, Huppert JD, Jacobi D, Lovell K, McLean CP, Neziroglu F, Pedley R, Perrin S, Pinto A, Pollard CA, Radomsky AS, Riemann BC, Shafran R, Simos G, Söchting I, Summerfeldt LJ, Szymanski J, Treanor M, Van Noppen B, van Oppen P, Whittal M, Williams MT, Williams T, Yadin E, Veale D. Knowledge and competency standards for specialized cognitive behavior therapy for adult obsessive-compulsive disorder. Psychiatry Res 2021; 303:113752. [PMID: 34273818 DOI: 10.1016/j.psychres.2021.113752] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Accepted: 01/21/2021] [Indexed: 12/19/2022]
Abstract
Obsessive-Compulsive Disorder (OCD) is a leading cause of disability world-wide (World Health Organization, 2008). Treatment of OCD is a specialized field whose aim is recovery from illness for as many patients as possible. The evidence-based psychotherapeutic treatment for OCD is specialized cognitive behavior therapy (CBT, NICE, 2005, Koran and Simpson, 2013). However, these treatments are not accessible to many sufferers around the world. Currently available guidelines for care are deemed to be essential but insufficient because of highly variable clinician knowledge and competencies specific to OCD. The phase two mandate of the 14 nation International OCD Accreditation Task Force (ATF) created by the Canadian Institute for Obsessive Compulsive Disorders is development of knowledge and competency standards for specialized treatments for OCD through the lifespan deemed by experts to be foundational to transformative change in this field. This paper presents knowledge and competency standards for specialized CBT for adult OCD developed to inform, advance, and offer a model for clinical practice and training for OCD. During upcoming ATF phases three and four criteria and processes for training in specialized treatments for OCD through the lifespan for certification (individuals) and accreditation (sites) will be developed based on the ATF standards.
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Affiliation(s)
- Debbie Sookman
- Department of Psychology, McGill University Health Center, 1025 Pine Ave W, Montreal, Quebec, H3A 1A1, Canada; Department of Psychiatry, McGill University, 845 Sherbrooke St W, Montreal, Quebec, H3A 0G4, Canada.
| | - Katharine A Phillips
- Department of Psychiatry, Weill Cornell Medicine, 1300 York Ave, New York, NY 10065, United States.
| | - Gideon E Anholt
- Department of Psychology, Marcus Family Campus, Ben-Gurion University of the Negev, Beer Sheva, P.O.B. 653 Beer-Sheva, 8410501, Israel.
| | - Sunil Bhar
- Department of Psychological Sciences, Faculty of Health, Arts and Design, Swinburne University of Technology, 1 John St, Hawthorn, Victoria, 3122, Australia.
| | - Victoria Bream
- Oxford Health Specialist Psychological Interventions Clinic and Oxford Cognitive Therapy Centre, Warneford Hospital, Oxford, OX3 7JX, United Kingdom.
| | - Fiona L Challacombe
- Institute of Psychiatry, Psychology and Neuroscience, Kings College London, De Crespigny Park, London, SE5 8AF, United Kingdom.
| | - Anna Coughtrey
- Great Ormond Street Hospital for Children, London WC1N 3JH, United Kingdom; UCL Great Ormond Street Institute of Child Health, 30 Guilford St, Holborn, London, WC1N 1EH, United Kingdom.
| | - Michelle G Craske
- Anxiety and Depression Research Center, Depression Grant Challenge, Innovative Treatment Network, Staglin Family Music Center for Behavioral and Brain Health, UCLA Department of Psychology and Department of Psychiatry and Biobehavioral Sciences, Box 951563, 1285 Franz Hall, Los Angeles, CA, United States.
| | - Edna Foa
- Center for the Treatment and Study of Anxiety, University of Pennsylvania Perelman SOM, 3535 Market Street, Philadelphia, PA 19104, United States.
| | - Jean-Philippe Gagné
- Department of Psychology, Concordia University, 7141 Sherbrooke St, West, Montreal, Quebec H4B 1R6, Canada.
| | - Jonathan D Huppert
- Department of Psychology, The Hebrew University of Jerusalem, Mt. Scopus, Jerusalem, 91905, Israel.
| | - David Jacobi
- Rogers Behavioral Health, 34700 Valley Road, Oconomowoc, WI, 53066, United States.
| | - Karina Lovell
- Division of Nursing, Midwifery and Social Work, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Oxford Rd, Manchester, M13 9PL, United Kingdom; Manchester Academic Health Science Centre, Greater Manchester Mental Health NHS Foundation Trust, Manchester, M13 9PL, United Kingdom.
| | - Carmen P McLean
- National Center for PTSD, Dissemination and Training Division, VA Palo Alto Healthcare System, 795 Willow Road, Menlo Park, CA, 94025, United States; Department of Psychiatry and Behavioral Sciences, Stanford University, 450 Serra Mall, Stanford, CA, 94305, United States.
| | - Fugen Neziroglu
- Bio-Behavioral Institute, 935 Northern Boulevard, Suite 102, Great Neck, NY, 11021, United States.
| | - Rebecca Pedley
- Division of Nursing, Midwifery and Social Work, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, M13 9PL, United Kingdom.
| | - Sean Perrin
- Department of Psychology, Lund University, Box 213, 22100, Lund, Sweden.
| | - Anthony Pinto
- Zucker School of Medicine at Hofstra/Northwell, Zucker Hillside Hospital - Northwell Health, 265-16 74th Avenue, Glen Oaks, NY, 11004, United States.
| | - C Alec Pollard
- Center for OCD and Anxiety-Related Disorders, Saint Louis Behavioral Medicine Institute, 1129 Macklind Ave, St. Louis, MO, 63110, United States; Department of Family and Community Medicine, Saint Louis University School of Medicine, Saint Louis, MO, 63110, United States.
| | - Adam S Radomsky
- Department of Psychology, Concordia University, 7141 Sherbrooke St, West, Montreal, Quebec H4B 1R6, Canada.
| | - Bradley C Riemann
- 34700 Valley Road, Rogers Behavioral Health, Oconomowoc, WI, 53066, United States.
| | - Roz Shafran
- Population, Policy and Practice Research and Teaching Department, UCL Great Ormond Street Hospital Institute of Child Health, Holborn, London, WC1N 1EH, United Kingdom.
| | - Gregoris Simos
- Department of Educational and Social Policy, University of Macedonia, 156 Egnatia Street, 54636 Thessaloniki, Greece.
| | - Ingrid Söchting
- Departments of Psychology, University of British Columbia, 2136 West Mall, Vancouver, British Columbia, V6T 1Z4, Canada.
| | - Laura J Summerfeldt
- Department of Psychology, Trent University, 1600 West Bank Drive, Peterborough, K9L 0G2 Ontario, Canada.
| | - Jeff Szymanski
- International OCD Foundation, 18 Tremont Street, #308, Boston MA, 02108, United States.
| | - Michael Treanor
- Anxiety and Depression Research Center, University of California, Los Angeles, Box 951563, 1285 Franz Hall, Los Angeles, CA, United States.
| | - Barbara Van Noppen
- Clinical Psychiatry and Behavioral Sciences, OCD Southern California, 2514 Jamacha Road Ste, 502-35 El Cajon, CA, 92019, United States; Department of Psychiatry and Behavioral Sciences, Keck School of Medicine, University of Southern California, 2250 Alcazar Street, Suite 2200, Los Angeles, CA, 90033, United States.
| | - Patricia van Oppen
- Department of Psychiatry, Amsterdam UMC, location VUmc, Netherlands; Amsterdam Public Health Research Institute - Mental Health, Netherlands; GGZ inGeest Specialized Mental Health Care, Netherlands.
| | - Maureen Whittal
- Vancouver CBT Centre, 302-1765 W8th Avenue, Vancouver, British Columbia, V6J5C6, Canada; Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada.
| | - Monnica T Williams
- School of Psychology, University of Ottawa, 136 Jean-Jacques Lussier Pvt, Ottawa, K1N 6N5, Ontario, Canada.
| | - Timothy Williams
- Department of Psychology, University of Reading, PO Box 217, Reading, Berkshire, RG6 6AH, United Kingdom.
| | - Elna Yadin
- Department of Psychiatry, University of Pennsylvania, 3535 Market Street, 2nd Floor, Philadelphia, PA 19104, United States.
| | - David Veale
- South London and the Maudsley NHS Foundation Trust & King's College London, Denmark Hill, London, SE5 8 AZ, United Kingdom.
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12
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Clauss K, Bardeen JR. The interactive effect of mental contamination and cognitive fusion on anxiety. J Clin Psychol 2021; 78:517-525. [PMID: 34269414 DOI: 10.1002/jclp.23224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 06/08/2021] [Accepted: 06/30/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVES Mental contamination and cognitive fusion have been identified as risk factors for anxiety. The purpose of this study was to examine the moderating effect of cognitive fusion on the relationship between mental contamination and anxiety. METHOD Participants (N = 504 community adults), recruited via Amazon's Mechanical Turk (MTurk), completed measures of mental contamination, cognitive fusion, and anxiety. RESULTS Results from a regression analysis showed that the interaction between mental contamination and cognitive fusion predicted anxiety (β = 0.15, p < 0.001). Simple slopes analysis revealed a positive association between mental contamination and anxiety that was significant at higher (β = 0.25, p < 0.001), but not lower (β = 0.01, p = 0.88), levels of cognitive fusion. CONCLUSION The development of risk profiles that incorporate mental contamination and cognitive fusion may be beneficial for early identification of individuals at high risk for anxiety.
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Affiliation(s)
- Kate Clauss
- Department of Psychological Sciences, Auburn University, Auburn, Alabama, USA
| | - Joseph R Bardeen
- Department of Psychological Sciences, Auburn University, Auburn, Alabama, USA
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13
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García-Batista ZE, Guerra-Peña K, Alsina-Jurnet I, Cano-Vindel A, Cantisano-Guzmán LM, Nazir-Ferreiras A, Moretti LS, Medrano LA, Garrido LE. Design and Validation of Augmented Reality Stimuli for the Treatment of Cleaning Obsessive-Compulsive Disorder. Front Psychol 2021; 12:618874. [PMID: 34135802 PMCID: PMC8201081 DOI: 10.3389/fpsyg.2021.618874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2020] [Accepted: 04/01/2021] [Indexed: 11/13/2022] Open
Abstract
Fear to contamination is an easy-to-provoke, intense, hard-to-control, and extraordinarily persistent fear. A worsening of preexisting psychiatric disorders was observed during the COVID-19 (coronavirus disease 2019) outbreak, and several studies suggest that those with obsessive-compulsive disorder (OCD) may be more affected than any other group of people. In the face of worsening OCD symptoms, there is a need for mental health professionals to provide the support needed not only to treat patients who still report symptoms, but also to improve relapse prevention. In this line, it is recommended to improve alternative strategies such as online consultations and digital psychiatry. The aim of this study is to develop augmented reality (AR) stimuli that are clinically relevant for patients with cleaning OCD and assess their efficiency to obtain emotionally significant responses. Four AR stimuli were developed: a plastic bag full of garbage, a piece of bread with mold, a dirty sports shoe, and a piece of rotten meat. All stimuli were shown to a clinical group (17 patients with cleaning OCD) and a control group (11 patients without OCD). Relevant results were the design of the AR stimuli. These stimuli were validated with the statistical difference in perceived anxiety in the meat stimuli between the clinical and control groups. Nevertheless, when looking at effect sizes, all stimuli present effect sizes from small (plastic bag) to large (meat), with both shoe and bread between small and medium effect sizes. These results are a valuable support for the clinical use of these AR stimuli in the treatment of cleaning OCD.
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Affiliation(s)
- Zoilo Emilio García-Batista
- Escuela de Psicología, Pontificia Universidad Católica Madre y Maestra, Santiago de los Caballeros, Dominican Republic
| | - Kiero Guerra-Peña
- Escuela de Psicología, Pontificia Universidad Católica Madre y Maestra, Santiago de los Caballeros, Dominican Republic
| | - Ivan Alsina-Jurnet
- Departamento de Personalidad, Evaluación y Tratamientos Psicológicos, Facultad de Psicología, Universidad de Vic-Universitat Central de Catalunya (UVIC-UCC), Barcelona, Spain
| | - Antonio Cano-Vindel
- Departamento de Psicología Básica, Facultad de Psicología, Universidad Complutense de Madrid, Spain
| | | | - Asha Nazir-Ferreiras
- Escuela de Psicología, Pontificia Universidad Católica Madre y Maestra, Santiago de los Caballeros, Dominican Republic
| | - Luciana Sofía Moretti
- Escuela de Psicología, Pontificia Universidad Católica Madre y Maestra, Santiago de los Caballeros, Dominican Republic.,Facultad de Psicología, Universidad Siglo 21, Argentina
| | - Leonardo Adrián Medrano
- Escuela de Psicología, Pontificia Universidad Católica Madre y Maestra, Santiago de los Caballeros, Dominican Republic.,Facultad de Psicología, Universidad Siglo 21, Argentina
| | - Luis Eduardo Garrido
- Escuela de Psicología, Pontificia Universidad Católica Madre y Maestra, Santiago de los Caballeros, Dominican Republic
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14
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Palombini E, Richardson J, McAllister E, Veale D, Thomson AB. When self-harm is about preventing harm: emergency management of obsessive-compulsive disorder and associated self-harm. BJPsych Bull 2021; 45:109-114. [PMID: 33762047 PMCID: PMC8111969 DOI: 10.1192/bjb.2020.70] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Mental health staff may have limited exposure to emergencies associated with obsessive-compulsive disorder (OCD) during postgraduate training. The first time they encounter a person in the midst of severe obsessions, or one who has compulsively self-harmed in response to such obsessions, might be when working on call covering the emergency department. This educational article presents the lived experience of one of the authors as a clinical scenario. The scenario is then used to illustrate the severity of disability and the rates of self-harm and suicide-related mortality caused by OCD. The recognition and assessment of OCD is described, along with what helps in emergency situations. Written informed consent was obtained for the publication of clinical details.
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Affiliation(s)
| | | | | | - David Veale
- South London and Maudsley NHS Foundation Trust, UK.,King's College London, UK
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15
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Thomson AB, McAllister E, Veale D. Frequent attendance with self-harm: what might you be missing? Emerg Med J 2020; 37:331-344. [PMID: 32487706 DOI: 10.1136/emermed-2019-208974] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/02/2019] [Indexed: 11/03/2022]
Affiliation(s)
- Alex B Thomson
- Department of Psychological Medicine, Northwick Park Hospital, Central and North West London NHS Foundation Trust, Harrow, Middlesex, UK
| | | | - David Veale
- Centre for Anxiety Disorders and Trauma, South London and Maudsley NHS Foundation Trust, London, UK.,Institute of Psychiatry Psychology and Neuroscience, King's College London, London, UK
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16
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Mathes BM, Day TN, Wilver NL, Redden SA, Cougle JR. Indices of change in exposure and response prevention for contamination-based OCD. Behav Res Ther 2020; 133:103707. [PMID: 32758679 DOI: 10.1016/j.brat.2020.103707] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Revised: 06/04/2020] [Accepted: 07/29/2020] [Indexed: 01/29/2023]
Abstract
Few studies have examined indices of change in treatment for obsessive compulsive disorder (OCD). The current study evaluated within- and between-session trajectories of fear, disgust, and urge to wash in exposure and response prevention (ERP) for contamination-based OCD and tested whether change in these indices were associated with treatment outcomes. Forty-one participants (75.6% female) engaged in three sessions of ERP for contamination OCD. Participants provided ratings of fear, disgust, and urge to wash during each session, and contamination symptoms were assessed at pre- and post-treatment and two-week follow-up. Fear, disgust, and urge to wash all significantly decreased both within and between sessions. Both fear and disgust declined significantly faster than urge to wash within session, though declines in fear and disgust did not significantly differ from each other. Within-session changes in fear were significantly associated with reduced symptoms at post-treatment, whereas within-session changes in disgust were associated with symptoms at two-week follow-up. The current study highlights the roles of fear and disgust in the context of ERP as unique indicators of treatment outcome for contamination-based OCD. Only within-session fear was uniquely associated with treatment outcome at post, while within-session disgust predicted outcome at follow-up. Theoretical and clinical implications are discussed.
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Affiliation(s)
- Brittany M Mathes
- Florida State University, 1107 West Call Street, Tallahassee, FL, 32304, USA
| | - Taylor N Day
- Florida State University, 1107 West Call Street, Tallahassee, FL, 32304, USA
| | - Natalie L Wilver
- Florida State University, 1107 West Call Street, Tallahassee, FL, 32304, USA
| | - Sarah A Redden
- Florida State University, 1107 West Call Street, Tallahassee, FL, 32304, USA
| | - Jesse R Cougle
- Florida State University, 1107 West Call Street, Tallahassee, FL, 32304, USA.
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17
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18
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Bouvard M, Fournet N, Denis A, Achachi O, Purdon C. A study of the Repeated Actions Diary in patients suffering from obsessive compulsive disorder. Clin Psychol Psychother 2020; 27:228-238. [PMID: 31881103 DOI: 10.1002/cpp.2422] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Revised: 12/04/2019] [Accepted: 12/09/2019] [Indexed: 11/10/2022]
Abstract
The structured Repeated Action Diary (RAD) collects in vivo data on compulsions and their various characteristics. Certain compulsions (i.e., those ending because the patient feels certain that it is safe to stop) are then compared with uncertain compulsions. The compulsion profile in patients with obsessive compulsive disorder (OCD) was assessed by using the RAD. Thirty-two patients from two sources participated in the study. Before pooling the two subgroups, we checked that they did not differ significantly with regard to demographic and clinical variables. Patients reported several categories of compulsion. The most frequently reported compulsions were washing and checking. In a given person, checking compulsions (in contrast to washing compulsions) were often produced by several different obsessions. Almost all the patients reported repeating the compulsions because of a need to feel sure. There were far more "certain" compulsions than "uncertain" compulsions. The number of repetitions was significantly lower for certain compulsions than for uncertain compulsions. The person felt greater relief from guilt and responsibility and a greater decrease in discomfort at the end of a compulsive episode for certain compulsions than for uncertain compulsions. In conclusion, the need to ritualize (prompted by uncertainty, i.e., potential danger) might explain the maintenance (or posttreatment recurrence) of OCD in many patients. The need for certainty in the completion of a compulsion may be worth considering as a therapeutic tool. The development of an approach based on the need for certainty might help to improve treatment outcomes.
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Affiliation(s)
- Martine Bouvard
- Psychology and neurocognition laboratory, Univ. Grenoble Alpes, Univ. Savoie Mont Blanc, CNRS, LPNC, Grenoble, France.,Department of psychology, Savoie Mont Blanc University Psychology Centre, Chambéry, France
| | - Nathalie Fournet
- Psychology and neurocognition laboratory, Univ. Grenoble Alpes, Univ. Savoie Mont Blanc, CNRS, LPNC, Grenoble, France.,Department of psychology, Savoie Mont Blanc University Psychology Centre, Chambéry, France
| | - Anne Denis
- Department of psychology, Savoie Mont Blanc University Psychology Centre, Chambéry, France.,LIP/PC2S, Univ. Grenoble Alpes, Univ. Savoie Mont Blanc, LIP/PC2S, Grenoble, France
| | - Ouafae Achachi
- Psychology and neurocognition laboratory, Univ. Grenoble Alpes, Univ. Savoie Mont Blanc, CNRS, LPNC, Grenoble, France.,Hospital, Clinea (Lyon Lumière), Meyzieu, France
| | - Christine Purdon
- Department of Psychology, University of Waterloo, Waterloo, Ontario, Canada
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