Journal of Obsessive-Compulsive and Related Disorders最新文献

Trichotillomania (TTM) research lacks an ecologically valid phenomenological description despite increasing research efforts. Previous studies primarily rely on retrospective cross-sectional data, emphasizing the need for longitudinal high-frequency assessments to capture the variability of hair pulling.

The objective of this study was to describe hair pulling patterns and episode characteristics by means of ecological momentary assessment (EMA), and to compare those parameters between focused and automatic episodes.

Study procedures included an online screening, a diagnostic interview via telephone, a comprehensive self-report questionnaire and a 10-day EMA-protocol (7 EMAs/day).

Data from 61 individuals who met diagnostic criteria for TTM (age: M = 29.3, SD = 7.47; 92% female) were analyzed (3948 EMAs; 1217 episodes). Participants reported a mean number of 2.00 (SD = 2.31; range: 0–4.9) episodes per day. One third did not report any days without episodes. Hair pulling showed a relatively even distribution throughout the day. Most prominent triggers were tension and visual/tactile cues. The latter were more relevant in focused episodes, whereas “habit/routine” scored higher in automatic episodes.

The results suggest that hair pulling occurs not sporadic but is rather present in daily life. Using real-time data from a clinical sample, the study enhances our comprehension of the phenomenology of TTM which may ultimately advance TTM research.

Treatment for trichotillomania is notably limited, preventing suffering individuals from having access to treatment. To address this need, researchers have developed and tested asynchronous online interventions for adults with trichotillomania. A factor that may impact the efficacy of these programs is the use of phone check-ins (or similar coaching support) to improve treatment adherence in website treatment delivery. In the current study we evaluated the role of check-ins on treatment adherence and efficacy of a website delivering acceptance and commitment therapy-enhanced behavior therapy (A-EBT). A sample of 101 adults with trichotillomania were randomly assigned to an A-EBT web-based intervention with or without phone check-in support. Adherence to the web-based program was not significantly improved by check-ins and treatment outcomes did not vary by condition (with or without check-ins). However, adherence to the program across conditions, did predict treatment outcomes. The program was found to be effective at decreasing trichotillomania symptom severity and improving trichotillomania specific psychological inflexibility over time across check-in conditions. Our findings suggest that check-ins did not improve adherence to or efficacy of the program, thus supporting recent literature suggesting that check-ins do not necessarily improve program adherence.

Skin picking disorder is a chronic repetitive condition that impacts daily functioning and causes significant distress. Acceptance and commitment therapy (ACT) enhanced behavioral training (A-EBT) has shown promise in targeting skin picking symptoms but is not widely disseminated among providers. This study examines the efficacy and feasibility of an eight-week fully-automated online A-EBT program for skin picking disorder. Participants with skin picking disorder (N = 84) were randomized into either an online intervention (n = 43) or a waitlist control (n = 41). All participants completed self-report assessments at baseline, mid-, post-intervention, and 1-month follow-up. Analyses used multilevel linear modeling with the full intent-to-treat sample. Results demonstrated statistically stronger improvements from baseline to 1-month follow-up in the intervention condition compared to waitlist for skin picking symptoms (SMD = 0.90), skin picking-related psychological flexibility (SMD = −0.82), and well-being (SMD = −0.31), with no significant effects on distress. Treatment effects were maintained at one-month follow-up, with 29.0% of intervention participants meeting responder status, compared to 0.1% of waitlist participants. High usability and acceptability scores provide preliminary evidence of its feasibility as a fully automated intervention. These findings suggest an automated online A-EBT program may be an effective and scalable treatment for individuals with skin picking disorder.

Prevalence of obsessive-compulsive disorder (OCD) appears to be higher in sexual and gender minority (SGM) individuals compared to cisgender, heterosexual individuals. Although existing self-report measures for OCD (i.e., Yale Brown Obsessive Compulsive Scale Self-Report-II-Self Report [Y-BOCS-II-SR], Dimensional Obsessive Compulsive Scale [DOCS], and Obsessive Beliefs Questionnaire-Short Form [OBQ-SF]) have demonstrated strong psychometric properties in prior samples, these studies have not reported the proportion of SGM individuals in their samples. Thus, it remains unclear how these measures perform when used with SGM individuals. Accordingly, the psychometric properties of the Y-BOCS-II-SR, DOCS, and OBQ-SF were examined in a sample of 318 sexual minority (98.4%) and gender minority (33.8%) adults with self-reported OCD (Mage = 27.5 years; 87.4% female sex at birth; 93.4% white). Replicating prior research, these measures demonstrated consistent response patterns and strong factor structures and loadings, internal consistency, and convergent validity. Overall, these measures appear to be psychometrically sound when used with SGM individuals, and the few psychometric weaknesses found in the present study parallel those found in other samples, suggesting that they are not specific to use with SGM individuals. Findings support that the Y-BOCS-II- SR, DOCS, and OBQ- SF can be accurately used and interpreted in samples that are comprised of SGM individuals.

Hoarding is characterized by difficulties discarding, clutter, and excessive acquiring. Disruptions in interpersonal attachment and associated interpersonal difficulties have been implicated in the development and maintenance of hoarding; however, limited research has investigated the link between interpersonal functioning and hoarding. The current study examined the association between hoarding symptoms and multiple interpersonal factors in young adults during the COVID-19 pandemic. Participants (N = 137) completed an online survey in Spring 2020 which included measures of perceived social support, thwarted belongingness, depression, and hoarding symptoms, including difficulties discarding and acquiring. Participants also completed an ecological momentary assessment protocol where they provided daily ratings of connectedness. At a basic level, both difficulties discarding and acquiring symptoms were correlated with greater thwarted belongingness and lower social support. These associations remained significant even after controlling for depression, with the exception of the relationship between difficulty discarding and thwarted belongingness. Greater acquiring was also associated with greater variability in daily connectedness. This study is the first to demonstrate a unique relationship between hoarding symptoms and multiple interpersonal factors, controlling for depression. Our findings suggest that interpersonal functioning is a potential mechanism underlying hoarding. Clinically, addressing interpersonal difficulties may improve the efficacy of current treatments for hoarding disorder.

Half of parents to infants and toddlers experience unwanted intrusive thoughts (UITs) about intentionally harming their child. For some, this can lead to impaired parental self-efficacy, elevated parental stress, and symptoms of depression. Many do not disclose their thoughts due to shame. Our research group has developed a self-guided online cognitive intervention for parents with distressing UITs of intentional child-related harm. A previous randomized pilot trial (N = 43) showed that the intervention was more effective than waitlist in reducing distress related to UITs. It also improved parental self-efficacy. This study is an qualitative investigation of the participants’ experiences with the intervention. We conducted semi-structured interviews with 8 participants. A thematic analysis revealed two overarching themes: (1) Changed perception of the unwanted intrusive thoughts and (2) Different paths to recovery. The parents reported that the intervention taught skills to approach their UITs in a more flexible way, which had positive effects on well-being and parenting. The flexibility and anonymity of the online format was highlighted as positive. Some would have liked additional therapist support and better adaptations to a smartphone format. The findings provide additional qualitative data how an online self-guided intervention can help parents who struggle with UITs.

Background

Insomnia symptoms are prevalent among patients with obsessive-compulsive disorder (OCD). This study involved secondary analyses from a previous randomized controlled trial testing if d-Cycloserine (DCS) augmented the effects of the Bergen 4-day treatment (B4DT) for OCD. In this study, the effects of the B4DT on sleep difficulties in a sample of difficult-to-treat OCD were explored.

Methods

The three groups received B4DT with either a placebo, 100 mg, or 250 mg of DCS. Patients (N = 163) had either not responded or relapsed after previous exposure-based treatment for OCD.

Results

The results showed a small, but robust treatment effect on insomnia symptoms (d = 0.37), maintained at 3-month follow-up (d = 0.38), and 12-month follow-up (d = 0.23). No significant differences between the groups receiving DCS or placebo were found. Insomnia did not affect OCD-treatment outcome.

Discussion

This study showed that OCD treatment is associated with some improvement in insomnia symptoms. Comorbid insomnia and DCS did not moderate treatment outcome. Patients with OCD and comorbid insomnia should be considered for specific insomnia treatment.

Exposure with response prevention (E/RP) within cognitive behavior therapy (CBT) is recognized as a critical therapeutic element that drives clinical improvement in the behavioral treatment of obsessive-compulsive disorder (OCD). However, many clinicians encounter a number of barriers when implementing E/RP for patients with OCD, negatively impacting patient outcomes. To understand and better address these challenges, we conducted a survey with 228 clinicians to capture the experiences of mental health providers that use E/RP to treat patients with OCD, and identify challenges they may experience when implementing this form of evidence-based care. We found that the majority of clinicians sampled endorsed facing barriers in implementing E/RP for patients with OCD. Additionally, we found that specific OCD symptom domains were identified by clinicians as difficult to complete exposures for within and between treatment sessions. Ultimately, this investigation identifies some of the challenges faced by clinicians using E/RP to treat patients with OCD, and offers several future research directions to pave the way toward addressing these barriers and improving treatment outcomes.

Extended reality (XR) technologies including virtual and augmented reality are seeing increasing research interest in the field of mental health. Obsessive compulsive disorder (OCD) is a condition that remains difficult to assess and treat despite the availability of effective therapies. This systematic review synthesises the current knowledge regarding the use and effectiveness of XR in the assessment, treatment, and study of OCD. The protocol for this review was registered on PROSPERO (ID: CRD42021248021). Searches of six databases were conducted. The xReality framework was used to define which technologies would be included as XR. Studies that recruited analogue samples as well as clinical OCD populations were included. A narrative synthesis of the findings was planned. There was consistent evidence for the use of virtual reality as a tool for symptom provocation in people with contamination-related OCD, as part of exposure and response prevention. Significant heterogeneity exists between study designs found in both symptom provocation and treatment outcome studies. This review has important implications about the narrow focus of research in this area thus far, highlighting the need for further study of different uses of XR in providing positive treatment outcomes across a broader range of OCD symptoms.

Sexual minority (e.g., gay, lesbian, bisexual) people are 9 times more likely than heterosexual people to be diagnosed with OCD. Cognitive models of OCD posit that obsessive beliefs drive clinical OCD symptoms, however, obsessive beliefs have yet to be examined based on sexual orientation. Due to prior research identifying that sexual minority people are more likely to be diagnosed or treated for OCD and present with unique symptom profiles, elucidating underlying beliefs may partially explain why these disparities persist. Participants (N = 505) completed the Obsessive Beliefs Questionnaire-44 (OBQ-44) upon admission to a partial hospital/residential treatment program for OCD. The three largest sexual orientation groups were bisexual/pansexual (n = 46), gay/lesbian (n = 34), and heterosexual (n = 425). To examine differences, the OBQ-44's subdomains (perfectionism/certainty, responsibility for harm/threat, and importance/control of thoughts) were compared by sexual orientation. Results highlighted that perfectionism/certainty and harm/threat were significantly higher for bi+ compared to heterosexual participants, but not compared to gay/lesbian people, or between heterosexual and gay/lesbian people. This paper adds to a growing body of literature suggesting that the experience of bi+ individuals is different, and future research should identify the role of bi+ discrimination in the development of these core beliefs.