Responsibility attitudes and interpretations are characteristic of obsessive compulsive disorder

Development and validation of the Compulsive Substance Use Questionnaire: Attending to substance use automaticity, craving, and continued use despite negative consequences

BACKGROUND

Compulsivity characterizes an important subtype of substance use disorders (SUDs), but there has been variability in how compulsive substance use is defined and measured. The current study was designed to (1) develop a new measure of substance use compulsivity, (2) validate this scale in a community sample of adults who drink alcohol, and (3) evaluate the association between this new measure of compulsivity and substance use severity. We hypothesize that compulsivity will be characterized by automaticity, craving and insensitivity to negative consequences, and greater substance use severity will be associated with higher levels of substance use compulsivity.

METHODS

A preliminary set of items were generated for the novel Compulsive Substance Use Questionnaire (CSUQ) to reflect three conceptual aspects of substance use compulsivity: automaticity, craving, and disregarding negative consequences. The study recruited a total of 253 adults who drink alcohol, with a range of severity. Participants answered online surveys on compulsivity, frequency of alcohol use, craving, and negative consequences of alcohol use.

RESULTS

We obtained a single-factor solution with 22 items that included 3 automaticity items, 10 craving items, and 9 disregarding negative consequences items. The resulting measure had excellent internal consistency (α = 0.96). The CSUQ was associated with substance use severity; specifically, greater compulsivity was associated with heavy alcohol use and higher frequency of negative consequences associated with alcohol use.

CONCLUSIONS

The current study supports the validity of a new measure of substance use compulsivity, composed of items that closely hew to the concept of substance use compulsivity. Future work investigating compulsivity in other substance use populations with varying levels of severity will further our understanding of compulsive substance use and SUD subtypes.

The clinical phenomenology of skin-picking disorder - Are there any obsessive-compulsive components?

BACKGROUND

Skin-picking disorder (SPD) is currently conceptualized as a condition related to obsessive-compulsive disorder (OCD). The present study investigated whether the emotional, cognitive, and somatic components of skin-picking episodes align with this conceptual framework.

METHOD

A total of 134 patients diagnosed with SPD (mean age = 32 years; 84 % female; average symptom duration: 16 years) underwent in-person clinical assessment. Patients were asked to describe what they experienced directly before, during, and after picking their skin.

RESULTS

Patients reported a very strong urge to manipulate their skin, particularly in situations characterized by emotional and/or bodily tension. No obsession-like phenomena preceded the skin-picking episodes. Skin manipulation had an immediately rewarding effect in the majority of patients or induced 'trance-like' states. After terminating a skin-picking episode, negative self-conscious emotions were dominant.

CONCLUSIONS

The interview findings do not align with the conceptualization of SPD as an OCD-related disorder. Patients reported no obsession-like symptoms, and their skin-picking behaviors did not serve harm prevention, which is characteristic of compulsions. Instead, the rewarding nature of skin-picking and its function in experiential avoidance suggests an addiction component to this behavior.

Mediation analyses of longitudinal data investigating temporal associations between inflated sense of responsibility, obsessive-compulsive symptoms, and anger suppression

OBJECTIVE

Cognitive theories emphasize the central role of anger and anger suppression in obsessive-compulsive disorder (OCD). According to these theories, anger suppression is seen as a consequence of OCD, whereas cognitive beliefs, such as an inflated sense of responsibility, are seen as antecedent factors. To extend the findings from cross-sectional studies, the current study investigated the temporal associations between OCD symptoms, an inflated sense of responsibility, and anger suppression. Consistent with cognitive considerations, we hypothesized that OCD symptoms mediate the association between feelings of responsibility and anger suppression. These associations were also explored in patients presenting particularly high checking-related symptoms. Further, the stability of effects beyond controlling for depressive symptoms and medication intake was explored.

METHODS

A total of N = 48 patients with OCD (50% female, M = 32.46 [SD = 10.63] years of age) completed measures on obsessive beliefs, OCD symptoms, and anger suppression at three assessment points: before and after a metacognitive intervention as well as at a follow-up 6 months later. Mediation models investigating symptom associations at these three timepoints were conducted. Exploratory analyses investigating these associations in individuals presenting high checking-related symptoms (n = 20) and testing the stability of effects beyond controlling for depressive symptoms and medication intake were conducted.

RESULTS

The sense of responsibility did not significantly predict the level of anger suppression. A temporal association between OCD symptoms (as assessed with the self-report measure) and anger suppression could be evidenced, which was stable beyond controlling for depressive symptoms and medication intake. Against the expectations based on cognitive theories, the sense of responsibility did not predict OCD symptoms. No mediating effect of OCD symptoms was found.

CONCLUSION

In line with cognitive viewpoints, the present study shows that higher OCD symptoms predict higher levels of anger suppression in a longitudinal design, thereby contributing to the suppression of anger. This effect seems to be independent from depressive symptoms and medication intake. The effect of sense of responsibility on OCD symptoms was less clear and could only be found in the subgroup of patients with OCD and checking-related symptoms, who generally presented higher levels of responsibility. Overall, this is the first study demonstrating temporal associations between OCD symptoms and anger suppression. Acknowledging that anger and anger suppression may be a consequence of OCD symptoms and may also affect aspects of psychotherapy, which can ultimately inform future adjustments to psychotherapeutic treatment.

Impact of Paternal Postpartum Depression on Maternal and Infant Health: A Narrative Review of the Literature

Postpartum depression (PPD) has been widely studied, assessed, and promptly intervened in new mothers. However, paternal postpartum depression gained attention not long ago. Postpartum depression in men could present over one year following the birth of the child, frequently presenting with symptoms like irritability, low mood, sleep disturbances, changes in appetite, fatigue, and loss of interest in everyday activities; amongst other symptoms of Major Depressive Disorder which may hinder them from taking care of themselves and the baby. Paternal PPD significantly impacts partner relationships causing maternal PPD, poor infant bonding, and therefore, affecting overall child development. The following narrative review is based on a literature search of articles published on paternal postnatal depression. The primary emphasis of this review has been to provide an overview of the current comprehension of paternal postpartum depression regarding prevalence, global incidence, and risk factors and to explore potential diagnostic tools for assessment and interventional strategies to treat this condition. Interestingly, pandemic-related stressors have been positively attributed to an increase in PPD prevalence post-pandemic. While more research is being conducted on this subject, research on the measurement characteristics of the diagnostic tools is highly recommended to implement well-defined criteria for early diagnosis of paternal PPD. The significant adverse consequences of PPD for not just the new mother, but also the infants, necessitate proper and timely diagnosis of PPD. Despite its severity, there have been no specific treatment modalities.

Beliefs, compulsive behavior and reduced confidence in control

OCD has been conceptualized as a disorder arising from dysfunctional beliefs, such as overestimating threats or pathological doubts. Yet, how these beliefs lead to compulsions and obsessions remains unclear. Here, we develop a computational model to examine the specific beliefs that trigger and sustain compulsive behavior in a simple symptom-provoking scenario. Our results demonstrate that a single belief disturbance-a lack of confidence in the effectiveness of one's preventive (harm-avoiding) actions-can trigger and maintain compulsions and is directly linked to compulsion severity. This distrust can further explain a number of seemingly unrelated phenomena in OCD, including the role of not-just-right feelings, the link to intolerance to uncertainty, perfectionism, and overestimation of threat, and deficits in reversal and state learning. Our simulations shed new light on which underlying beliefs drive compulsive behavior and highlight the important role of perceived ability to exert control for OCD.

Towards a neurocomputational account of social controllability: From models to mental health

Controllability, or the influence one has over their surroundings, is crucial for decision-making and mental health. Traditionally, controllability is operationalized in sensorimotor terms as one's ability to exercise their actions to achieve an intended outcome (also termed "agency"). However, recent social neuroscience research suggests that humans also assess if and how they can exert influence over other people (i.e., their actions, outcomes, beliefs) to achieve desired outcomes ("social controllability"). In this review, we will synthesize empirical findings and neurocomputational frameworks related to social controllability. We first introduce the concepts of contextual and perceived controllability and their respective relevance for decision-making. Then, we outline neurocomputational frameworks that can be used to model social controllability, with a focus on behavioral economic paradigms and reinforcement learning approaches. Finally, we discuss the implications of social controllability for computational psychiatry research, using delusion and obsession-compulsion as examples. Taken together, we propose that social controllability could be a key area of investigation in future social neuroscience and computational psychiatry research.

Safety, tolerability, and clinical and neural effects of single-dose psilocybin in obsessive-compulsive disorder: protocol for a randomized, double-blind, placebo-controlled, non-crossover trial

Background

Psilocybin may help treat obsessive-compulsive disorder (OCD). To date, only one open-label study of psilocybin for OCD exists, necessitating further investigation with a randomized controlled design. The neural correlates of psilocybin's effects on OCD have also not been studied.

Objectives

This first-of-its-kind trial aims to evaluate the feasibility, safety, and tolerability of psilocybin in the treatment of OCD, provide preliminary evidence on the effects of psilocybin on OCD symptoms, and elucidate neural mechanisms that may mediate psilocybin's effects on OCD.

Design

We use a randomized (1:1), double-blind, placebo-controlled, non-crossover design to examine the clinical and neural effects of either a single dose of oral psilocybin (0.25 mg/kg) or active placebo-control agent (250 mg of niacin) on OCD symptoms.

Methods and analysis

We are enrolling 30 adult participants at a single site in Connecticut, USA who have failed at least one trial of standard care treatment (medication/psychotherapy) for OCD. All participants will also receive unstructured, non-directive psychological support during visits. Aside from safety, primary outcomes include OCD symptoms over the past 24 h, assessed by the Acute Yale-Brown Obsessive-Compulsive Scale and Visual Analog Scale ratings. These are collected by blinded, independent raters at baseline and the primary endpoint of 48 h post-dosing. Total follow-up is 12 weeks post-dosing. Resting state neuroimaging data will be collected at baseline and primary endpoint. Participants randomized to placebo will be offered the chance to return for an open-label dose of 0.25 mg/kg.

Ethics statement

All participants will be required to provide written informed consent. The trial (protocol v. 5.2) was approved by the institutional review board (HIC #2000020355) and registered with ClinicalTrials.gov (NCT03356483).

Discussion

This study may represent an advance in our ability to treat refractory OCD, and pave the way for future studies of neurobiological mechanisms of OCD that may respond to psilocybin.

Responses to autobiographical memories involving being a victim or perpetrator of betrayal in people with OCD and community controls

Mental contamination in people with OCD has been linked to the perceived impact of being betrayed and betraying others. In this study, participants with OCD (N = 56) and community controls (N = 37) were randomised to an induction involving eliciting autobiographical memories of either being betrayed by someone they trusted or betraying someone that trusted them. The OCD group experienced greater increases in state mental contamination and anxiety than the control group, but no differences were observed between groups in urges to wash or drink. Both betrayal conditions elicited similar levels of mental contamination and anxiety. The results of this study suggest that people with OCD experience similar increases in mental contamination and anxiety not only when recalling memories of being a victim of betrayal but also when recalling being a perpetrator. People with OCD are therefore more sensitive to betrayal experiences than community controls. Clinical implications and implications for future research are discussed.

Attention allocation in OCD: A systematic review and meta-analysis of eye-tracking-based research

INTRODUCTION

Cognitive models of obsessive-compulsive disorder (OCD) implicate heightened attention allocation to stimuli related to one's obsessions in the disorder. Recently, to overcome several limitations of reaction time-based measures, eye-tracking methodology has been increasingly used in attentional research.

METHODS

A meta-analysis of studies examining attention allocation towards OCD-related vs. neutral stimuli, using eye-tracking methodology and a group-comparison design, was conducted conforming to Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. Separate meta-analyses were performed for attentional vigilance (both latency and location of first fixations) and maintenance (total dwell time and total fixation count, conjointly). Each meta-analysis was conducted twice - once including all studies (main analysis) and once only including studies using the free-viewing paradigm (secondary analysis).

RESULTS

The systematic search yielded a total of nine studies. Of those, eight provided the needed data to be included in the meta-analysis. No evidence emerged for vigilance via latency to first fixation. Vigilance reflected via first fixation location emerged in the main analysis, but not in the secondary one. Evidence for attentional maintenance was found only when analyzing free-viewing studies exclusively (the secondary analysis).

LIMITATIONS

To increase the accuracy of the research question, correlational studies were excluded, resulting in a small number of available studies.

CONCLUSIONS

OCD may be characterized by vigilance, but mainly in tasks entailing specific demands and/or goals. Conversely, attentional maintenance may be evident only when using tasks that pose no requirements or demands for participants.

What is underneath all that stuff? A Q-methodological exploration of profiles of beliefs and vulnerabilities in hoarding disorder

BACKGROUND

Hoarding disorder (HD) can be understood through the cognitive behavioural model in the context of vulnerability factors (for example, personality traits, co-morbidities, traumatic life events) and beliefs about possessions (for example, identity, emotional attachment, memory, utility). Less is known about the strength of these hypothesised beliefs, or how they interact within the hoarding population, with researchers suggesting that specifying beliefs would improve treatment outcomes.

AIM

The current study explored beliefs in HD, utilising Q-methodology to explore both categories of beliefs and the interactions between these. Moreover, Q-methodology allowed for comparison of the individuals endorsing specific categories of beliefs.

METHOD

A comprehensive list of beliefs about possessions was developed. Thirty-two adults with clinically significant levels of HD completed a Q-sort task, alongside measures of proposed vulnerabilities, including co-morbidity, trauma and attachment style.

RESULTS

Q-factor analysis produced four profiles consisting of groups of participants who endorsed the same beliefs and had shared characteristics: (1) 'Expression of identity', (2) 'Responsibility and morality', (3) 'Stability and predictability', and (4) 'Objects as emotional and meaningful beings'.

DISCUSSION

The profiles were distinguished by different categories of beliefs and co-morbid symptoms, suggesting that more targeted assessment tools and interventions would be beneficial to account for this heterogeneity within the clinical population. In particular, beliefs about identity and self-concept formed the largest profile, and beliefs about stability and predictability introduce a novel category of beliefs.

Cognitive Beliefs Across the Symptom Dimensions of Pediatric Obsessive-Compulsive Disorder: Type of Symptom Matters

The cognitive model of obsessive-compulsive disorder (OCD) posits that dysfunctional cognitive beliefs are crucial to the onset and maintenance of OCD; however, the relationship between these cognitive beliefs and the heterogeneity of OCD symptoms in children and adolescents remains unknown. We examined how the major belief domains of the cognitive model (inflated responsibility/threat estimation, perfectionism/intolerance of uncertainty, importance/control of thoughts) and dysfunctional metacognitions were related to OCD symptoms across the following dimensions: doubting/checking, obsessing, hoarding, washing, ordering, and neutralization. Self-report ratings from 137 treatment-seeking youth with OCD were analyzed. When cognitive beliefs and symptom dimensions were analyzed in tandem, inflated responsibility/threat estimation and dysfunctional metacognitions were uniquely related to doubting/checking, obsessing, and hoarding and perfectionism/intolerance of uncertainty to ordering. Cognitive beliefs explained a large proportion of variation in doubting/checking (61%) and obsessing (46%), but much less so in ordering (15%), hoarding (14%), neutralization (8%), and washing (3%). Similar relations between cognitive beliefs and symptom dimensions were present in children and adolescents. Cognitive beliefs appear to be relevant for pediatric OCD related to harm, responsibility, and checking, but they do not map clearly onto contamination and symmetry-related symptoms. Implications for OCD etiology and treatment are discussed.

Minding our Minds: Obsessive-Compulsiveness, Psychiatry, and Psychology

Obsessive-compulsive features are commonly found in high-achieving people including psychiatrists, psychologists, and scientists. These traits have a substantial but unrecognized cultural influence on psychiatric and psychological science and practice. This article reviews obsessive-compulsive mechanisms and discusses the ways they both promote and impede psychiatric and psychological science and practice. It examines them in relation to two of the dominant psychiatric and psychological paradigms of our era, the Diagnostic and Statistical Manual (DSM), and Cognitive-Behavioral Therapy. Finally, the article suggests that better awareness of our collective obsessive-compulsive tendencies can facilitate a cultural shift toward a broader, more useful science of mind and brain, as well as therapies informed by more comprehensive scientific understanding.

Risking Everything in Obsessive-Compulsive Disorder: An Analogue Decision-Making Study

An experiment examined decision-making processes among nonclinical participants with low or high levels of OCD symptomatology (N = 303). To better simulate the decision environments that are most likely to be problematic for clients with OCD, we employed decision tasks that incorporated "black swan" options that have a very low probability but involve substantial loss. When faced with a choice between a safer option that involved no risk of loss or a riskier alternative with a very low probability of substantial loss, most participants chose the safer option regardless of OCD symptom level. However, when faced with choices between options that had similar expected values to the previous choices, but where each option had some low risk of a substantial loss, there was a significant shift towards riskier decisions. These effects were stronger when the task involved a contamination based, health-relevant decision task as compared to one with financial outcomes. The results suggest that both low and high symptom OC participants approach decisions involving risk-free options and decisions involving risky alternatives in qualitatively different ways. There was some evidence that measures of impulsivity were better predictors of the shift to risky decision making than OCD symptomatology.

Socioeconomic Status and Individual Personal Responsibility Beliefs Towards Food Access

Despite worldwide attention given to food access, very little progress has been made under the current model. Recognizing that individual engagement is likely based on individual experiences and perceptions, this research study investigated whether or not a correlation exists between one's socioeconomic status (SES) and perceived personal responsibility for food access. Discussion of results and implications provide fresh insight into the ongoing global debate surrounding food access. Outcomes also provide insight into willing and able participants and point to least-cost solutions which may be better suited to implement and initiate change. Results indicate that the issue of food access is more complex than simply lobbying for better decision-making among individuals and populations, highlighting the importance of unit of analysis considerations.

Forgiveness in the Modulation of Responsibility in a Sample of Italian Adolescents with a Tendency towards Conduct or Obsessive-Compulsive Problems

Although obsessive–compulsive disorder (OCD) and the conduct disorders (CD) express a contrasting symptomatology, they could represent different answers to a common matrix about morality. In the literature, some theoretical models describe people with OCD as individuals who experience high levels of responsibility and guilt. On the other hand, adolescents with a CD are described as if they do not feel guilty at all or consider anti-social purposes as more important than existing moral purposes. The aims of this study were to investigate the role of forgiveness in responsibility and guilt levels and to test whether this putative relation was influenced by tendencies towards obsessive–compulsive problems (OCP) or conduct problems (CP). In total, 231 adolescents aged between 16 and 18 years were self-assessed using a Youth Self-Report, Child Responsibility Attitudes Questionnaire, Heartland Forgiveness Scale, and Test Of Self-Conscious Affect. The results show that self-forgiveness predicted responsibility levels, while guilt was predicted by self-forgiveness and situation-forgiveness. Moreover, mediation analyses revealed that the effects of OCP on responsibility and guilt were mediated by self-forgiveness and situation-forgiveness. Regarding CP, no mediated effects were found. In conclusion, lower proneness to forgive increases responsibility and guilt, and this is particularly evident in subjects with higher levels of OCP.

Knowledge and competency standards for specialized cognitive behavior therapy for adult obsessive-compulsive disorder

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.

Mistakes that matter: An event-related potential study on obsessive-compulsive symptoms and social performance monitoring in different responsibility contexts

Mistakes that affect others often are linked to increased feelings of responsibility and guilt. This especially holds for individuals high in obsessive-compulsive symptoms (OCS), who are characterized by inflated feelings of responsibility and a fear of causing harm to others. This event-related potential study investigated individual differences in OCS in social performance monitoring with a focus on the role of responsibility for other’s harm and the error-related negativity (ERN). Healthy volunteers low (N = 27) or high (N = 24) in OCS performed a Flanker task in the presence of a gender-matched peer in three conditions. Mistakes could either have negative monetary consequences for 1) oneself, 2) the other, or 3) no one. Results showed enhanced ERNs for mistakes that harmed others instead of the self for individuals high in OCS, whereas individuals low in OCS showed decreased amplitudes specifically for mistakes affecting no one versus oneself. Amplitudes of the error positivity but not the ERN also were larger in the high OCS group. These findings indicate that high OCS are associated with enhanced performance monitoring in a social responsibility context, when mistakes harm others instead of the self, and demonstrate the importance of integrating the social context in performance monitoring research as a way to shed more light on obsessive-compulsive symptomatology.

Obsessive-compulsive symptoms and reactions to the COVID-19 pandemic

We aimed to investigate OCD symptoms and responsibility beliefs in relation to coronavirus-related anxiety and adaptive and maladaptive behaviors at two different time points. We tested age as a moderator of the relationship between responsibility and outcomes. 159 participants completed the initial online assessment, whereas 56 completed the second assessment, six months later. OCD symptoms significantly predicted coronavirus-related anxiety, adaptive and maladaptive behaviors. Responsibility beliefs predicted the above-mentioned outcomes, but no longer when controlling for OCD symptoms and age did not moderate these relationships. OCD symptoms may represent both protective and vulnerability factors during the coronavirus pandemic.

Sensitivity to being betrayed and betraying others in obsessive compulsive disorder and depression

OBJECTIVES

Mental contamination (MC) describes subjective internal feelings of 'dirtiness', which are experienced in the absence of direct physical contact/contaminants. There is evidence of a link between MC in obsessive compulsive disorder (OCD) and the experience of past betrayals. However, it has also been noted that 'perpetrators' also experience MC. We aimed to replicate the previous finding of specificity of OCD for sensitivity to being betrayed by comparing with those suffering from depression, and to extend this by evaluating whether people with high MC OCD are also relatively more sensitive to the idea that they might betray others compared to those with low levels of MC OCD.

DESIGN

A cross-sectional, between-groups design was used.

METHOD

Four groups, high MC OCD (N = 60), low MC OCD (N = 61), depression (N = 28), and non-clinical controls (N = 46) completed online questionnaires. Participants were recruited through the National Health Service (NHS) and social media.

RESULTS

Relative to all groups, the high MC OCD group had significantly higher scores both for betrayal sensitivity and sensitivity to betraying others. The depression group showed similar levels to low MC OCD in betrayal sensitivity but were significantly lower (and comparable to non-clinical controls) in sensitivity to betraying others.

CONCLUSIONS

Betrayal sensitivity occurs trans-diagnostically. There may be a specific link between the development of OCD and the perception of betraying others, perhaps linked to the trauma of being betrayed making those so affected more likely to worry about their own responsibility for betraying others.

PRACTITIONER POINTS

Clinicians should, across diagnoses, attend to sensitivity to being betrayed and the experiences which may have led to this. Current treatments for MC OCD recommend working with historical experiences of 'betrayal'. This study suggests that people with OCD also have an increased sensitivity to the idea of being a 'perpetrator' of betrayal linked to high responsibility beliefs. Specifically for OCD, it is possible that the experience of previously being betrayed results in increased current sensitivity to being responsible for being a 'betrayer'. It may, therefore, also be useful for therapists to consider if patients with MC OCD are concerned about potentially betraying others and to consider this within the formulation. The focus of clinical work could be to redefine these difficulties by reappraising beliefs regarding experience of betrayal and the likelihood of betraying others. Elevated levels of betrayal sensitivity were found in people with depression, and this may need to be considered in treatment approaches.

Evaluation of mechanism of change in transdiagnostic cognitive behaviour therapy using single case experimental design

BACKGROUND AND OBJECTIVES

Transdiagnostic mechanisms of change (txMOC) specific to cognitive behaviour therapy are poorly understood. Salkovskis (1996) proposed one such mechanism in terms of the shift towards an alternative, less negative view of their problems or cognitive flexibility. This hypothesis has been described as involving a shift in beliefs, from "theory A″ to "theory B". The objective of this research was to evaluate this hypothesis.

METHODS

Effectiveness of a novel txCBT and temporal changes in process and symptom measures were evaluated using a non-concurrent multiple baseline design and Tau-U calculations with thirteen participants (five with obsessive-compulsive disorder, two with panic disorder with agoraphobia and six with major depressive disorder). As a secondary analysis authors calculated Kendall's - Tau correlation between process and symptom measures, performed the Wilcoxon signed-rank test to assess treatment modules effect on negative thought and calculated Reliable change index (RCI).

RESULTS

The txCBT was clearly effective for eight participants. The results varied dependent on the stimuli evaluated as negative or threatening. Level and trend of the ratings of belief in theory A followed the level and trend of symptom measures to a greater extent than the (inverse) level and trend of belief in theory B.

LIMITATIONS

Only thirteen participants were recruited and evaluated.

CONCLUSIONS

The results are consistent with the view that effective treatment may involve a txMOC characterized by the ability to shift from a relatively fixed negative view of their experience to a less negative psychologically focused alternative.

Narrative Review of COVID-19 Impact on Obsessive-Compulsive Disorder in Child, Adolescent and Adult Clinical Populations

Background: The COVID-19 pandemic and quarantine had a significant impact on mental health which resulted in an increase of anxiety and depression in adult, child and adolescent clinical populations. Less is known about the potential effect of pandemic on obsessive-compulsive disorder (OCD) so there is a lack of review work to illustrate the impact of the COVID-19 pandemic on OCD. Purpose: The main objective is to review all the empirical contributions published after March 2020 that dealt with the impact of the COVID-19 pandemic on OCD in adults, children and adolescents, investigating the state-of-the-art literature concerning the impact on OCD and detailing limitations. Methods: The literature search was conducted using PsycINFO, PsycARTICLES, MEDLINE, Scopus, Web of Science, PubMed, and Google Scholar. This review analyzed all studies from January 2020 to 8 January 2021, focusing on clinical populations of children, adolescents, and adults with OCD. Results: A total of 102 articles were screened, resulting in the identification of 64 full-text articles to be further scrutinized. Upon closer examination, there was consensus that 39 articles met the study inclusion criteria and 14 of these were selected for study. Analysis of the results revealed that COVID-19 had an impact on OCD in both adults and young people and seems to have caused exacerbation of symptoms, especially of the contamination/washing subtypes. Eight studies in adult samples showed an increase in the severity of obsessive-compulsive symptoms; two studies underlined a minimal impact of COVID-19 on OCD patients and one study showed a slight improvement in symptoms. Two out of three studies on children and adolescents showed an exacerbation of OCD and a worsening even in the presence of an ongoing treatment. Conclusions: The studies reviewed are few. There are more studies on adult OCD than on children and adolescents. The results are controversial: few studies examined OCD subtypes; in most studies the typology of treatment was not clear and the samples covered a wide age range; a large number of studies did not use the same monitoring period or quantitative measures, both of which make it difficult to compare or rely on the results.

Shared and unique neural mechanisms underlying pediatric trichotillomania and obsessive compulsive disorder

BACKGROUND

Little is known about the neural underpinnings of pediatric trichotillomania (TTM). We examined error-related negativity (ERN)-amplitude and theta-EEG power differences among youth with TTM, OCD, and healthy controls (HC).

METHODS

Forty channel EEG was recorded from 63 pediatric participants (22 with TTM, 22 with OCD, and 19 HC) during the Eriksen Flanker Task. EEG data from inhibitory control were used to derive estimates of ERN amplitude and event-related spectral power associated with motor inhibition.

RESULTS

TTM and HC were similar in brain activity patterns in frontal and central regions and TTM and OCD were similar in the parietal region. Frontal ERN-amplitude was significantly larger in OCD relative to TTM and HC, who did not differ from each other. The TTM group had higher theta power compared to OCD in frontal and central regions, and higher theta than both comparison groups in right motor cortex and superior parietal regions. Within TTM, flanker task performance was correlated with EEG activity in frontal, central, and motor cortices whereas global functioning and impairment were associated with EEG power in bilateral motor and parietal cortices.

CONCLUSIONS

Findings are discussed in terms of shared and unique neural mechanisms in TTM and OCD and treatment implications.

An Observational Study of OCD Patients Treated With Cognitive Behavioral Therapy During the COVID-19 Pandemic

Background and Objectives: While the consequences of the COVID-19 pandemic for general mental health and the increase in anxiety and depression are clear, less is known about the potential effect of the pandemic on OCD. The purpose of this study is to collect new data to monitor the symptomatic status of patients with OCD during the period of emergency due to COVID-19 and to make a comparison between two psychodiagnostic evaluations. Methods: Eleven OCD patients and their psychotherapists were recruited. All patients had a specific psychodiagnostic assessment for OCD (SCL-90; OCI-R; Y-BOCS self-report) performed between December 2019 and January 2020 (t0), and undertook cognitive behavioral therapy (CBT) and exposure and prevention of response protocol (ERP) before the lockdown. The psychodiagnostic assessment carried out at t0 was re-administered (t1) to all patients, together with a set of qualitative questions collected through an online survey. The respective therapists were asked to document the status of the therapy and the monitoring of symptoms through use of a semi-structured interview (Y-BOCS) and a qualitative interview. Non-parametric analyses were conducted. Results: Patients reported a significant decrease in OCD symptoms. Data analysis showed a decrease in the scores across t0 and at t1 on the Y-BOCS (SR) total self-report, and on OCD symptoms' severity assessed by means of the OCI-r and SCL-90 r OC subscale, for 11 participants. Relating to the measures detected by psychotherapists, marginally significant improvements and lower scores were found in the Y-BOCS (I). An improvement in symptoms was noticed by 90.9% of the clinical sample; this was confirmed by 45.4% of the therapists, who claimed moderate progress in their patients. Conclusions: The data collected through standardized measurements at two different times, albeit relative to a small sample, assume relevance from a clinical point of view. In the literature, some studies document the worsening of OCD. However, in many studies, the type of treatment, the detection time, and the intervention period are not well-specified. These results confirm the effectiveness of CBT/ERP as an elective treatment for OCD through a specific intervention procedure.

Using supervised machine learning on neuropsychological data to distinguish OCD patients with and without sensory phenomena from healthy controls

OBJECTIVES

While theoretical models link obsessive-compulsive disorder (OCD) with executive function deficits, empirical findings from the neuropsychological literature remain mixed. These inconsistencies are likely exacerbated by the challenge of high-dimensional data (i.e., many variables per subject), which is common across neuropsychological paradigms and necessitates analytical advances. More unique to OCD is the heterogeneity of symptom presentations, each of which may relate to distinct neuropsychological features. While researchers have traditionally attempted to account for this heterogeneity using a symptom-based approach, an alternative involves focusing on underlying symptom motivations. Although the most studied symptom motivation involves fear of harmful events, 60-70% of patients also experience sensory phenomena, consisting of uncomfortable sensations or perceptions that drive compulsions. Sensory phenomena have received limited attention in the neuropsychological literature, despite evidence that symptoms motivated by these experiences may relate to distinct cognitive processes.

METHODS

Here, we used a supervised machine learning approach to characterize neuropsychological processes in OCD, accounting for sensory phenomena.

RESULTS

Compared to logistic regression and other algorithms, random forest best differentiated healthy controls (n = 59; balanced accuracy = .70), patients with sensory phenomena (n = 29; balanced accuracy = .59), and patients without sensory phenomena (n = 46; balanced accuracy = .62). Decision-making best distinguished between groups based on sensory phenomena, and among the patient subsample, those without sensory phenomena uniquely displayed greater risk sensitivity compared to healthy controls (d = .07, p = .008).

CONCLUSIONS

Results suggest that different cognitive profiles may characterize patients motivated by distinct drives. The superior performance and generalizability of the newer algorithms highlights the utility of considering multiple analytic approaches when faced with complex data.

PRACTITIONER POINTS

Practitioners should be aware that sensory phenomena are common experiences among patients with OCD. OCD patients with sensory phenomena may be distinguished from those without based on neuropsychological processes.

Thought-Action Fusion as Predictors of Obsessive-Compulsive Symptom Dimensions

OBJECTIVE

There have been several studies investigating the relationships between dysfunctional beliefs and obsessive-compulsive (OC) symptoms in obsessive-compulsive disorder (OCD). However, studies about the relationships between dysfunctional beliefs, especially thought-action fusion (TAF), and OC symptom dimensions have been scarce. Therefore, this study examined to what extent and how TAF subcomponents account for unique variability in four OC symptom dimensions.

METHODS

Sixty-five patients with OCD and 45 healthy controls aged between 18 and 30 years completed measures for OC symptom dimensions, OC symptoms, and dysfunctional beliefs such as TAF, trait-guilt, and inflated responsibility.

RESULTS

Three facets of TAF were exclusively associated with two symptom domains, namely, responsibility for harm and unacceptable thoughts, and explained the additional but small amount of variance to predict these two domains. In particular, the likelihood-others TAF positively predicted the unacceptable thoughts domain, whereas the likelihood-self TAF negatively predicted the aforementioned domain. For OC symptoms measured by the OC Inventory, no TAF components predicted the corresponding obsessing and mental neutralizing symptoms.

CONCLUSION

This study provides supporting evidence that the three TAF subcomponents may be differently associated with certain OC symptom dimensions, and a dimensional approach may complement typical symptom-oriented OC measures.

Common Symptom Presentations in Individuals With Probable Comorbid Obsessive-Compulsive Disorder and Posttraumatic Stress Disorder

Obsessive-compulsive disorder (OCD) and posttraumatic stress disorder (PTSD) are heterogeneous disorders that share common underlying factors, etiology, and symptoms. A small body of literature suggests common OCD symptom presentations may exist for this comorbid group, yet common comorbid PTSD symptom presentations remain unknown. The current study examined common symptom presentations in individuals with probable comorbid OCD + PTSD compared with those with a sole presentation of probable OCD or PTSD, controlling for overlapping symptoms, using a sample of 133 undergraduates. Individuals who exceeded cutoffs for probable OCD + PTSD endorse more severe OCD symptoms overall but report similar levels of PTSD symptoms compared with the respective diagnostic groups. Logistic regressions found that symptom domains present similarly overall in a comorbid presentation compared with the respective diagnostic groups, yet some OCD symptom domains were significantly more severe in the comorbid group compared with individuals with probable PTSD. Explanations for the unique contributions of symptoms are discussed, and clinical recommendations for addressing these domains are provided.

When Beliefs Face Reality: An Integrative Review of Belief Updating in Mental Health and Illness

Belief updating is a relatively nascent field of research that examines how people adjust their beliefs in light of new evidence. So far, belief updating has been investigated in partly unrelated lines of research from different psychological disciplines. In this article, we aim to integrate these disparate lines of research. After presenting some prominent theoretical frameworks and experimental designs that have been used for the study of belief updating, we review how healthy people and people with mental disorders update their beliefs after receiving new information that supports or challenges their views. Available evidence suggests that both healthy people and people with particular mental disorders are prone to certain biases when updating their beliefs, although the nature of the respective biases varies considerably and depends on several factors. Anomalies in belief updating are discussed in terms of both new insights into the psychopathology of various mental disorders and societal implications, such as irreconcilable political and societal controversies due to the failure to take information into account that disconfirms one’s own view. We conclude by proposing a novel integrative model of belief updating and derive directions for future research.

Personality Beliefs in Obsessive-Compulsive Disorder: How Are They Related to Symptom Severity?

OBJECTIVE

The comorbidity of obsessive-compulsive disorder (OCD) and personality disorders (PDs) is frequent but there are conflicting findings about which PDs are the most common. This study aimed to investigate the personality beliefs that exist on a more pathological level among OCD patients, to explore the association between personality beliefs and OCD severity, and to clarify the mediator effect of depression in this relationship.

METHODS

202 OCD patients and 76 healthy controls with similar sociodemographic features were included in the study. The Personality Belief Questionnaire-Short Form was administered to both groups. The Yale-Brown Obsessions and Compulsions Scale, Beck Depression Inventory, and the Beck Anxiety Inventory were administered only to the clinical sample.

RESULTS

The dependent, histrionic, paranoid, borderline, and avoidant personality subscale scores were significantly higher in the OCD group than in the control group. There was an association only between OCD severity and narcissistic personality beliefs, also depression mediated the relationship between narcissistic personality and OCD severity.

CONCLUSION

Some personality beliefs at a pathological level are more common among OCD patients. Personality beliefs, as well as depression, should be routinely assessed, as they may affect OCD severity, help-seeking behavior, and response to treatment.

The role of reassurance seeking in obsessive compulsive disorder: the associations between reassurance seeking, dysfunctional beliefs, negative emotions, and obsessive- compulsive symptoms

BACKGROUND

This study investigates the association of reassurance seeking with obsessive compulsive (OC) symptoms, dysfunctional beliefs, and negative emotions.

METHODS

Reassurance Seeking Questionnaire, Obsessive-Compulsive Inventory, Obsessive Beliefs Questionnaire, Trait Anger Expression Inventory, and Guilt Inventory were applied to 53 obsessive compulsive disorder (OCD) patients and 591 non-clinical participants.

RESULTS

The results showed that the severity of the OC symptoms significantly predicted the carefulness of OCD patients during reassurance seeking, indicating increased carefulness during reassurance seeking as the severity of OC symptoms increased. Moreover, feelings of guilt increased with increasing intensity of reassurance seeking. In addition, carefulness during reassurance seeking significantly predicted the level of anxiety. Responsibility/threat estimation, perfectionism/need for certainty, and importance/control of thoughts significantly predicted the OC symptoms. Moreover, the dysfunctional beliefs directly associated with an increased need to seek reassurance from different sources and seek reassurance more carefully. In terms of mediational effect, the results revealed that the individuals who had distorted beliefs were more likely to have OC symptoms and, in turn, the OC symptoms increased carefulness during reassurance seeking. The analysis of the model test revealed mostly similar results to those obtained for the clinical sample.

CONCLUSIONS

The findings revealed a close relationship between OC symptoms and reassurance-seeking behaviors.

Screening dysfunktionaler Überzeugungen bei Zwangsstörungen

Hintergrund

Dysfunktionale Überzeugungen und Bewertungen von Zwangsgedanken sind ausschlaggebend für die Entstehung und Aufrechterhaltung von Zwangsstörungen. Die reliable und valide Erfassung dieser Überzeugungen mithilfe von Screeningverfahren ist für die kognitiv-verhaltenstherapeutische Behandlung relevant.

Fragestellung

Ziel der Arbeit war die Erstellung eines Scoping review bezüglich der aktuellen Screeninginstrumenten zur Erfassung der 6 von der Obsessive Compulsive Cognitions Working Group (OCCWG) vorgeschlagenen Domänen bei Zwangsstörungen. Die Verfahren wurden systematisch nach ihrer psychometrischen Güte bewertet und in ihren Eigenschaften verglichen.

Material und Methoden

Die Literatursuche erfolgte in den Datenbanken Web of Science Core Collection, Google Scholar und PubMed. Eingeschlossen wurden deutsch- und englischsprachige Verfahren für Erwachsene (≥18 Jahre).

Ergebnisse

Es konnten 56 Studien zur Überprüfung der psychometrischen Eigenschaften von 16 Fragebogen eingeschlossen werden. Die Fragebogen erfassten alle Domänen dysfunktionaler Überzeugungen. Außerdem lagen 4 domänenübergreifende Verfahren vor, und 9 der Fragebogen waren deutschsprachig. Die Mehrzahl der Screeningverfahren wies adäquate bis gute psychometrische Werte auf. Die methodische Qualität der Studien war heterogen; methodische und statistische Verfahren nahmen über die Jahre an Komplexität zu.

Schlussfolgerung

Weiterer Forschungsbedarf besteht v. a. in der Untersuchung der Störungsspezifität und Änderungssensitivität von Screeningverfahren an klinischen Stichproben.

Extended formulation in cognitive behavioural therapy for OCD: a single case experimental design

The demanding nature of exposure work that forms an essential component of exposure and response prevention (ERP) for obsessive compulsive disorder (OCD) is for some patients intolerable and leads to disengagement. The addition of cognitive therapy to ERP (CBT) with a focus on developing a shared understanding of how OCD works may aid engagement. This paper reports a case study of an individual who had not responded to two previous courses of ERP due to engagement difficulties with the treatment rationale. This study aimed to establish if CBT for OCD, incorporating an extended period of assessment and longitudinal formulation, would: (1) aid in engagement with the treatment rationale and therapy and (2) lead to an improvement in OCD symptoms, general functioning and mood. An A–B single case experimental design was used. Standardised measures were collected at weekly intervals over 15 sessions of CBT, in conjunction with pre–post idiographic behavioural measures. The extended formulation was successful in helping the individual to develop a less threatening understanding of how OCD works, enabling her to engage in therapy. This led to a reduction in the duration of the overt compulsions in her behavioural measures although on the standardised measures there was no change in self-reported OCD symptoms. The patient’s covert rituals and underlying responsibility and control beliefs largely remained intact, thus maintaining her OCD and requiring further intervention. There was a significant improvement in social functioning and consequently the patient reported being able to regain a sense of some control in her life.

Key learning aims

(1)

Enhanced error-related brain activations for mistakes that harm others: ERP evidence from a novel social performance-monitoring paradigm

Our mistakes often have negative consequences for ourselves, but may also harm the people around us. Continuous monitoring of our performance is therefore crucial for both our own and others' well-being. Here, we investigated how modulations in responsibility for other's harm affects electrophysiological correlates of performance-monitoring, viz. the error-related negativity (ERN) and error positivity (Pe). Healthy participants (N = 27) performed a novel social performance-monitoring paradigm in two responsibility contexts. Mistakes made in the harmful context resulted in a negative consequence for a co-actor, i.e., hearing a loud aversive sound, while errors in the non-harmful context were followed by a soft non-aversive sound. Although participants themselves did not receive auditory feedback in either context, they did experience harmful mistakes as more distressing and reported higher effort to perform well in the harmful context. ERN amplitudes were enhanced for harmful compared to non-harmful mistakes. Pe amplitudes were unaffected. The present study shows that performing in a potentially harmful social context amplifies early automatic performance-monitoring processes and increases the impact of the resulting harmful mistakes. These outcomes not only further our theoretical knowledge of social performance monitoring, but also demonstrate a novel and useful paradigm to investigate aberrant responsibility attitudes in various clinical populations.

Modelling OCD: a test of the inflated responsibility model

BACKGROUND

The Salkovskis (1999) model of obsessive compulsive disorder (OCD), which emphasizes the role of inflated responsibility, has proven highly influential in both the understanding and treatment of OCD.

AIMS

This study aimed to empirically test several core processes of this model.

METHOD

The individual components of the model were measured using multiple indicators in a sample of undergraduate students (n = 170), and confirmatory factor analyses were used to ascertain the most reliable, valid and theoretically consistent latent variables. Structural equation modelling was used to test proposed relations between latent constructs in the model.

RESULTS

The inflated responsibility model was a good fit for the data in the present sample. As predicted by the model, misinterpretations of intrusive thoughts as indicating personal responsibility fully mediated the relationships between responsibility beliefs and counterproductive safety strategies, neutralizing actions and mood changes.

CONCLUSIONS

The Salkovksis (1999) inflated responsibility model of OCD is empirically supported in the present sample of undergraduate students, lending support to the proposed mechanisms in the model and supporting prior evidence.

A study on treatment sensitivity of ecological momentary assessment in obsessive-compulsive disorder

As part of a larger clinical trial, this ecological momentary assessment (EMA) study pursued the main goal of demonstrating that the EMA method is sensitive to treatment effects of detached mindfulness and cognitive restructuring for obsessive-compulsive disorder (OCD). A second goal was to provide a descriptive analysis of OCD symptoms and influencing factors in participants' everyday lives. Thirty-nine participants were included in the final analyses. EMA sampling involved a smartphone and comprised 4 days with 10 random prompts per day both before (Pre-Treatment EMA) and after the completion of a 2-week clinical intervention of either detached mindfulness or cognitive restructuring (Post-Treatment EMA) that participants had been randomly allocated to. The EMA questionnaire included items on the frequency of obsessions, subjective burden due to obsessions, perceived current stress, emotions, and on the frequency of compulsions and other dysfunctional behaviors. Descriptive Pre-Treatment EMA results highlight the importance of compulsions and emotional states of tension/discomfort in OCD. Pre-Post comparisons showed a significant reduction of avoidance behavior, obsessions, and burden due to obsessions, with a nonsignificant trend also indicating a reduction of compulsions. There was no pre to post effect concerning emotions. This study adds to the existing research on OCD symptoms and offers further evidence in confirmation of established theoretical models of OCD. Also, our results can be taken as evidence for treatment sensitivity of the EMA method in OCD. Further research is needed to replicate, broaden, and generalize our results.

Imagery rescripting as an adjunct clinical intervention for obsessive compulsive disorder

Novel adjunct psychological techniques are needed for the large number of patients with OCD who remain symptomatic despite the effective implementation of standard evidence-based treatments. The aim of this study was to examine the efficacy of imagery rescripting (ImRs), an established technique for the treatment of traumatic stress, as a treatment for OCD symptoms that were not responsive to standard exposure and response prevention (ERP). Thirteen patients completed a baseline assessment followed by a control intervention that involved discussion of an aversive memory linked with the onset of OCD symptoms. Treatment then involved provision of 1-6 ImRs sessions; ImRs continued until patients achieved a 35% reduction in symptoms, as measured using the Y-BOCS one week after each treatment. Patients were followed up one and three months after the treatment completion. Twelve out of thirteen patients achieved ≥35% improvement in Y-BOCS. Of these patients, six required only a single ImRs session, while the remaining six patients required 2-5 ImRs sessions to achieve a clinically significant change. Lower baseline Y-BOCS predicted improvement after a single treatment session. ImRs may be a useful adjunct for treatment-resistant OCD associated with past aversive experiences, especially when symptomatology remains within the mild-moderate range after standard ERP.

Inflated sense of responsibility, explanatory style and the cognitive model of social anxiety disorder: a brief report of a case control study

We sought to investigate situation-specific inflated sense of responsibility and explanatory style in social anxiety disorder (SAD) according to the cognitive model. Participants aged 17–68 years (mean = 31.9, SD = 11.1) included waiting list patients referred to a primary care mental health service for cognitive behavioural therapy for SAD (n = 18) and non-anxious control participants (n = 65). A battery of psychometric measures, including a bespoke measure of responsibility beliefs, was used. Compared with controls, participants with SAD were more likely to demonstrate an inflated sense of responsibility (p ≤ 0.001), and to adopt a negative explanatory style specific to social interaction (p ≤ 0.01). Inflated sense of responsibility was found to correlate with SAD symptomatology (r = 0.47, p ≤ 0.05), and with increased usage of safety behaviours (r = 0.47, p ≤ 0.05). Caseness (β = 1.45, p ≤ 0.01) and stability of causal attribution (β = 0.25, p ≤ 0.001) were found to predict inflated responsibility in our sample. To our knowledge this study represents the first attempt to investigate inflated responsibility within the context of SAD. Our results support the notion of inflated responsibility as a feature of SAD.

Key learning aims

(1)

The Cognitive Profile of Persons with Obsessive Compulsive Disorder with and without Autism Spectrum Disorder

INTRODUCTION

Autistic Spectrum Disorder (ASD) is often comorbid with Obsessive Compulsive Disorder (OCD). But to what extent can obsessional symptoms in individuals with ASD be considered "genuinely" comorbid OCD - or are there other mechanisms that are related to ASD? Which mechanisms in OCD with and without ASD share common features? People with ASD have a cognitive profile characterized by "mindblindness"; the antecedent is often referred to in terms of not knowing how to perform or behave and this is the cause of discomfort. This raises the question whether individuals with ASD and comorbid OCD share the same cognitive elements of responsibility interpretation and the same fear of causing harm as individuals who merely have OCD.

OBJECTIVE

The aim of the present study is therefore to evaluate the extent of responsibility interpretation in individuals with OCD alone compared with people experiencing OCD in the context of ASD.

METHODS

Two instruments, the Responsibility Attitude Scale (RAS) and the Responsibility Interpretations Questionnaire (RIQ), were administered to three groups of participants: (i) individuals diagnosed with OCD (n = 32); (ii) individuals with ASD and OCD (n = 19); and (iii) non-clinical control participants (n = 23).

RESULTS

Results indicate significant differences in all measures of responsibility belief (interpretation of obsession and assumption of responsibility) between the OCD-only group and the two other groups.

CONCLUSION

The conclusion is that OCD in people with ASD is not as "genuine" as in people with only OCD, according to cognitive behavioral theory of OCD.

Father's and mother's beliefs about children's anxiety

BACKGROUND

Previous research has focused on parenting styles and parental behaviors associated with children's anxiety. Parental beliefs about their child's anxiety have scarcely been studied, in spite of their probable influence in parents seeking help. The present study intended to fil that gap, by exploring what parents think about their children's anxiety and whether these cognitions are related or not to their use of professional help.

METHOD

In-depth semistructured interviews were conducted with 48 parents (50% fathers) of children (9-12 years old) with anxiety problems. Theoretical thematic analysis was performed on the transcripts.

RESULTS

Three dimensions were derived from the analysis, concerning (a) the causes of child's anxiety, (b) the impact of anxiety in the child's functioning, and (c) the evolution of anxiety. Most parents perceived the child's anxiety as a permanent condition, attributing it to external and parental factors and considering that the anxiety problems have a negative impact on the child's well-being. Plus, parents who had previously sought professional help for the child's emotional problems tended to believe that anxiety could improve with child's or parents' efforts and with professional guidance, contrarily to those who had not. Implications for research and clinical practice are discussed.

CONCLUSION

The present study highlighted important parental beliefs about their children's anxiety that might influence their attitudes and decisions (e.g., seek for professional help). Other parental cognitions should be investigated in order to understand parenting in the context of childhood anxiety.