Journal of Obsessive-Compulsive and Related Disorders最新文献

Attachment theory suggests that hoarding is an attempt at compensating for unmet relatedness needs. We therefore expect high loneliness levels in hoarding disorder (HD). While previous studies have shown a positive association between hoarding and loneliness in non-clinical samples, few studies have examined loneliness levels in clinical HD samples. In Study 1, we examined loneliness in a treatment-seeking HD sample (n = 39). Results showed that 87.2% of HD sufferers reported high loneliness levels, which was significantly higher than loneliness rates in community samples. Loneliness was positively associated with hoarding severity even after controlling for depression. In Study 2, we examined loneliness in MTurk workers with clinical levels of hoarding (high hoarding [HH] group; n = 305) compared to MTurk workers with low hoarding symptoms (LH group; n = 775). Results showed high loneliness levels in 77.7% of participants in the HH group compared to 36.8% in the LH group. Differences remained significant for HH vs LH groups matched on depression. The positive association between loneliness and hoarding was also significant even after controlling for age, gender, marital status, and depression. Our results underscore the importance of assessing and addressing loneliness in the HD treatment.

Hoarding disorder (HD) is characterized by distress and difficulty letting go of possessions, leading to clutter that congests living spaces and interferes with daily activities. HD is common, with an estimated overall pooled prevalence of 2.5% of the general population. Because it is a relatively newly defined disorder, there are questions and controversies regarding its diagnosis and treatment that warrant exploration. In this manuscript, we clarify diagnostic boundaries between HD and related neuropsychiatric conditions, and consider how both shared and unique features of HD may inform strategies for treatment. We additionally discuss specific manifestations of hoarding behavior (e.g., animal hoarding); review motivations, beliefs, and characteristics that may contribute to hoarding behaviors; examine available evidence regarding the efficacy of different treatment modalities; highlight the challenges of engaging individuals who do not want care; and suggest a potential explanatory model for insight impairment in HD.

Cognitive behavioral therapy adapted for autistic youth with anxiety and/or OCD has a strong evidence base, but few have access. A 12-week family-based, Internet-delivered cognitive behavioral therapy (iCBT) program for 7-15 year-old autistic youth with anxiety and/or OCD was developed as a potential method to address this problem. Quantitative and qualitative feedback from stakeholders (parents, youth, clinicians) was gathered on an initial draft of content before conducting a pilot trial. This feedback suggested high quality, engagement, usability, and informativeness of the material. Suggestions were incorporated into the treatment program that was tested in a pilot trial. Eight families were randomized to the iCBT program with either 1) weekly email support or 2) weekly email support plus biweekly telehealth check-ins, and seven of these families completed pre- and post-treatment assessments. An average reduction of 39% in anxiety severity scores was found, with six of the seven being classified as responders. Preliminary evidence suggests that family-based iCBT is an acceptable and promising treatment for autistic youth with anxiety and/or obsessive-compulsive disorders that should be further modified and tested in future work.

The past four decades have yielded a robust body of evidence supporting the efficacy and effectiveness of cognitive-behavioral therapy (CBT) as a gold-standard treatment for obsessive-compulsive disorder (OCD) across the lifespan. Exposure and response prevention (E/RP) has been identified as a key component of this approach. Despite robust research support for CBT with E/RP, several myths and misconceptions continue to proliferate in both research and practice settings. Such myths and misconceptions are concerning, as they lack empirical basis, may hinder widespread dissemination and implementation of CBT for OCD, and run contrary to the practice of evidence-based psychological medicine. Focusing on the importance of promoting evidence-based practice and generative clinical science, the present review article synthesizes relevant research within the field of treatments for OCD to address the following myths/misconceptions: (a) uncertainty exists concerning the evidence base supporting CBT for OCD, (b) E/RP attrition and dropout rates are unacceptably high due to excessive risk and perceived patient intolerability, and (c) alternative treatments for OCD need to be expeditiously developed due to major limitations of E/RP. Recommendations for future research and clinical dissemination and implementation to further advance a generative clinical science of OCD treatment are discussed.

Gender and/or sex differences in the prevalence of hoarding disorder have been well documented, yet there remains a striking lack of understanding as to potential reasons. Critically no study to date has examined whether gender differences may stem from underlying biases in hoarding assessment instruments. The current study used item response theory to evaluate the Saving Inventory-Revised (SI-R; Frost et al., 1994), to determine if there might be differential item functioning (DIF) between men and women across the three core features of hoarding. We first examined responses in a sample of individuals with clinically significant hoarding symptoms (N = 255), and then replicated our findings in a non-selected community sample (N = 719). There was evidence of modest DIF, which affected only a handful of items in each SI-R subscale. In the clinical sample, women scored significantly higher on the clutter and acquisition latent continuum, whereas there was no gender difference for difficulties discarding. In contrast, there were no gender differences in any of the subscales for the community sample. Findings indicate that while there are likely gender differences in the manifestation and associated features of hoarding, those gender differences are not the result of measurement artifacts in the SI-R.

Consistent with the inhibitory retrieval approach, one proposed modification to improve the effectiveness of exposure-based interventions is to maximize variability by not proceeding linearly up an exposure hierarchy. Accordingly, the present study compares hierarchical and variable exposure interventions for contamination-fearful individuals and examines the role of uncertainty to predict intervention outcomes. Participants (N = 73) were randomly assigned to complete a single-session exposure intervention using a standard hierarchy or a variable exposure intervention in which hierarchy items were randomly presented. Participants completed a behavioral approach task (BAT) at baseline and two follow-up visits over a two-week period. Both interventions resulted in a significant decrease in anxiety and disgust as well as more BAT steps completed but did not differ from one another. However, individuals in the variable exposure condition reported less variability in uncertainty during exposure compared to those in the standard condition, d = .78. Furthermore, lower levels of variability in uncertainty predicted greater reductions in anxiety and disgust post-intervention. Consistent with previous studies, variable exposure did not convey additional benefit over standard, hierarchical exposure. The experience of uncertainty during exposure is an important yet understudied process that warrants additional investigation.

Background

Emerging research has suggested that hoarding may be associated with reduced social cognition, specifically reduced theory of mind and hostility biases, which may contribute to the social difficulties observed in this population. The primary aim of this study was to evaluate the feasibility and acceptability of Social Cognition and Interaction Training (SCIT) in a sample of individuals with Hoarding Disorder (HD) and assess its potential as an adjunct to CBT. We secondarily examined changes in loneliness and hoarding symptoms.

Methods

Twelve individuals, with a primary diagnosis of HD, completed a 12-week SCIT program and one booster session. Participants were assessed at pre-treatment, mid-treatment, post-treatment, and one-month follow-up on measures of theory of mind, attributional style, hoarding symptom severity, and loneliness.

Results

From pre-to post-treatment, participants had an improvement in theory of mind for sarcastic remarks and a reduction in hostility bias, hoarding symptoms, and loneliness. Retention was also good as all participants completed treatment.

Conclusion

These preliminary results suggest that SCIT is a promising treatment to improving social cognition for hoarding disorder and may improve interpersonal difficulties such as loneliness. We propose that SCIT may represent a potential adjunct targeting social factors to improve the efficacy of CBT.

Background

Few patients receive cognitive behavioral therapy, the gold-standard for body dysmorphic disorder (CBT-BDD). Smartphones can make evidence-based interventions, like CBT-BDD, more accessible and scalable. A key question is: how do patients view it? Low credibility and expectancy would likely translate to low uptake and engagement outside of research settings, diminishing the impact. Thus, it is important to understand patients’ beliefs about digital CBT-BDD.

Methods

We compared credibility and expectancy in a coach-guided app-based CBT-BDD trial (N = 75) to a previous in-person CBT-BDD trial (N = 55). We further examined the relationship of perceptions of digital CBT-BDD to baseline clinical and demographic factors and dropout.

Results

Credibility did not differ between the in-person (M = 19.3) and digital (M = 18.3) trials, p = .24. Expectancy for improvement was moderately higher for in-person (M = 58.4) than digital (M = 48.3) treatment, p = .005. In the digital trial, no demographic variables were associated with credibility or expectancy. Better BDD-related insight and past non-CBT BDD therapy were associated with greater expectancy. Credibility was associated with lower likelihood of dropout.

Discussion

Digital CBT-BDD was regarded as similarly credible to in-person CBT-BDD but with lower expectancy. Tailored expectancy-enhancing strategies could strengthen this novel approach, particularly among those with poorer insight and without prior BDD treatment.