Journal of Obsessive-Compulsive and Related Disorders最新文献

This study aimed to extend the cognitive-behavioral model of Body Dysmorphic Disorder (BDD) by exploring the role of insecure attachment and self-ambivalence on the relationship between two specific cognitive factors, namely appearance orientation (seeing the self as an aesthetic object) and appearance evaluation (negative appraisal of internal body image), on levels of BDD severity. A convenience sample of 304 Australian residents (72.4% females) completed online self-report measures; 53% reported clinical or subclinical levels of BDD. Attachment anxiety and self-ambivalence were both associated with BDD severity, as were both cognitive factors. The direct effect of attachment anxiety was no longer significant after controlling for self-ambivalence, appearance orientation and evaluation. However, significant specific indirect effects were found suggesting that individuals who report greater levels of insecure attachment and self-ambivalence exhibit greater appearance orientation and negative appearance evaluation which, in turn, results in higher levels of BDD. The indirect effect through self-ambivalence was strongest suggesting a central role of self in the relationship between attachment anxiety and BDD severity. The current research demonstrates the importance of attachment anxiety and self-ambivalence in the context of BDD and implicates their potential role in treatment; however, further clinical studies are needed.

Emerging evidence suggests that rescripting intrusive mental imagery may reduce OCD symptoms. We tested whether a similar process could be adapted to an online experimental format. Amazon mTurk workers high in OCD traits (n = 198) were asked to identify OCD-related imagery of the future. They were then randomised to one of three audio-guided imagery conditions: rescripting, exposure, or a distracting control. We found that self-appraisals improved across all three conditions. Participants in the rescripting condition also reported greater reductions in aversive emotions, the vividness of their imagery, and their urge to neutralise the imagery, compared to those in the exposure condition. Results from the control condition were consistent with distraction. These experimental findings suggest that imagery rescripting in a standardised audio-guided format may facilitate emotional processing. Suggestions to improve on methodological limitations are discussed.

Background

Traumatic life events are common among individuals with hoarding disorder (HD), though rates of posttraumatic stress disorder are no higher than in other groups. HD symptoms typically begin to appear in mid-childhood, and early life stress (ELS) is a known associated feature of negative mental health outcomes. The specifics of this relationship are still unclear.

Methods

We obtained Early Life Stress Questionnaire (ELSQ) responses from 35 participants with HD, 22 participants with obsessive-compulsive disorder (OCD), and 23 non-clinical control participants. We combined these quantitative data with qualitative interviews exploring what role ELS experiences play in HD.

Results

Per the ELSQ, individuals with HD reported significantly more ELS events than the non-clinical control participants. In qualitative interviews, HD participants described the ELS events that were most impactful in shaping their relationship to material possessions; these events tended to be long in duration and elicited feelings of scarcity of emotional support. Participants described relying on possessions in place of relationships and viewed possessions as potential sources of connection to peers.

Conclusions

Our qualitative and quantitative results build on the cognitive behavioral model of HD, emphasizing early experiences of prolonged stress or scarcity of emotional support as a key contributing vulnerability factor. Specific differences are consistent with earlier research that people with HD experience absence of early warmth. They further suggest that screening for ELS experiences is important when working with individuals with HD, and that HD treatments may benefit from increased focus on social and emotional connection building.

Relationship Obsessive–Compulsive Disorder (ROCD) is considered a clinical variant of obsessive–compulsive disorder (OCD) in which obsessions may be focused on the relationship itself (relationship-centered ROCD [RC-ROCD]), or on the partner's perceived flaws (partner-focused ROCD [PF-ROCD]). Despite the growing interest in ROCD, not much is known regarding contextual, cognitive, and personality determinants of the symptoms. Using multiple regression analysis, we investigated results of an online survey administered to 164 healthy participants, assessing fear of guilt, RC- and PF-ROCD symptoms, and narcissistic and paranoic personality traits. Results showed the significant effects of fear of guilt and relationship duration on both ROCD subtypes. Narcissism was found to predict PF-ROCD only, and effects of paranoia were found to predict RC-ROCD only, providing possible support for differential diagnoses. We discuss influence mechanisms. Taken together, these results offer a valuable source of knowledge in approaching the assessment of and intervention for ROCD as well as sexual dysfunction.

Treatment access for those with trichotillomania is limited by several issues including professionals’ lack of knowledge of the disorder, proximity to providers, and financial constraints. Acceptance-enhanced behavioral therapy (AEBT) has been implemented in groups and using telehealth to reach a larger population. However, these methods still require therapist time and incur notable costs. This study aimed to address the gap in trichotillomania treatment accessibility by examining the feasibility and efficacy of a self-guided, web-based AEBT treatment for adults with trichotillomania across the United States. Participants completed an eight-module asynchronous program over eight weeks. The effects of the website were tested with 81 adults with trichotillomania randomized into a treatment and waitlist condition. Results demonstrated statistically stronger decreases in the treatment condition over the waitlist condition across outcomes including trichotillomania symptoms severity, trichotillomania-related psychological flexibility, well-being, total distress, depression, and stress. Treatment effects were maintained at one month follow-up. Anxiety did not significantly decrease between conditions, but a significant decrease was found across time. Of participants in the treatment condition, 52.8% (vs 15% for waitlist) met treatment responder status from pre-to post-treatment and 30.5% (vs 10% for waitlist) met responder status from pre-treatment to follow-up. Implications of these preliminary findings are discussed.

A longstanding assumption suggests that college student cohorts are not representative of clinical cohorts as students are perceived as ‘high functioning’ which may limit generalizability. Yet little research has compared the profile of DSM disorders among students to those reported in community or treatment-seeking samples, particularly in the context of obsessive-compulsive disorder (OCD). To address this gap in the literature, we compared the profile of DSM OCD in college students, to treatment-seeking and community OCD samples, and student subsamples with other DSM disorders, or with no diagnosis. 529 students from two US and one Belgian university were screened using semi-structured interviews and completed self-report questionnaires. 36 students met DSM criteria for OCD. Comparison with non-OCD diagnoses (n = 183), and non-clinical student controls (n = 311) yielded expected differences on symptomatic OCD measures and comorbidity profiles. Comparisons with published OCD samples yielded a similar profile. Therefore, OCD in students is similar to OCD in clinical samples, with minor differences. We conclude that when appropriately screened, students are a viable population for the study of OCD. This may enhance research into OCD, allowing researchers without access to clinical cohorts to contribute to the field.

Contamination fears and disgust are maintaining factors for a range of mental illnesses. To date, there are relatively few evidence-based therapeutic strategies for directly modifying disgust although several studies have demonstrated that both cognitive and imagery strategies can be helpful in changing pathological disgust. Cognitive restructuring and imagery modification (CRIM) is a promising contamination and disgust-specific strategy that has been successfully used in the area of trauma-related disorders. An online study was conducted to investigate whether 102 participants with different levels of obsessive-compulsive symptoms would benefit from using CRIM for reducing disgust and contamination fear compared to a control intervention. Although the results showed no superiority of CRIM over the control intervention, this pre-post study design provides a good basis for a thorough discussion of the methodological difficulties in studying online interventions, especially those with a focus on obsessive-compulsive disorder (OCD). In addition, the implications for examining the effectiveness of strategies such as CRIM in an online environment are outlined.

The Yale-Brown Obsessive-Compulsive Scale Modified for Body Dysmorphic Disorder (BDD-YBOCS) is a clinician-administered interview to assess symptom severity in individuals with a BDD diagnosis. It has been translated into German and disseminated into research and practice. However, the psychometric properties of the German version have not been thoroughly evaluated. Therefore, we investigated its psychometric properties, factor structure and provided normative data. Our study included a large pooled sample comprising 350 outpatients with a BDD diagnosis (mean age = 30.35 years, SD = 10.15; gender: 70.6% female, 28.9% male, 0.6% unspecified). Psychometric data supported a good internal consistency of the BDD-YBOCS total score (α = 0.81, ω = 0.86) and an excellent interrater-reliability (ICC = 0.96). The BDD-YBOCS correlated moderately with other measures of BDD symptom severity. Confirmatory factor analysis favored a two-factor structure representing obsessions versus compulsions over a one-factor structure, with the quality of the proposed two-factor structure still being poor. Normative data indicated that BDD-YBOCS scores between 21 and 34 can be considered as typical range in an outpatient sample with a wide range of BDD symptom severity. In conclusion, the German BDD-YBOCS is a brief and psychometrically supported clinician-rated instrument for the measurement of BDD severity.

Cognitive Bias Modification–Interpretation (CBM-I) training has been put forward as a promising new intervention for youth with psychopathology. A recent Randomised Controlled Trial (RCT) showed that an online CBM-I training designed to reduce dysfunctional interpretations in youth with Obsessive Compulsive Disorder (OCD) had therapeutic benefits on OCD symptoms. In addition, there are practical benefits as the online and automated nature of the training allows for 24/7 accessibility, is cheap and an easy to implement intervention. There is, however, significant variability in CBM-I training effects on symptoms. By conducting secondary analyses of the online CBM-I RCT, we aimed to examine whether baseline OCD severity, interpretation bias, and degree of autism symptoms are related to training effectiveness. In the RCT, 36 children with OCD (8–18 years) followed 12-sessions CBM-I training. Bayesian analyses showed no evidence for any of the three predictors being associated with CBM-I effects on OCD symptoms. These results offer no answer to the question for whom CBM-I training works best. However, there is also no evidence that CBM-I might work less well for these subgroups. Future research with larger samples is necessary to test the robustness of these findings.

Background

Various barriers contribute to low treatment rates in Body Dysmorphic Disorder (BDD). While internet-based intervention is considered a low-threshold option and shows efficacy, studies report acceptance deficits. We first tested predictors of the Unified Theory of Acceptance and Use of Technology for acceptance and secondly evaluated an acceptance-facilitating intervention for an internet-based self-esteem training addressed to individuals with BDD symptoms.

Method

We randomly assigned 110 participants with distinct BDD symptoms to a 6-min animated whiteboard video (n = 50) or a waiting control group (n = 60) before offering them internet-based training.

Results

Acceptance was good before the intervention (87% with moderate/high scores). Performance expectancy, social influence and slightly effort expectancy predicted baseline acceptance (R² = 0.70). The acceptance-facilitating intervention led to greater improvements of performance expectancy and facilitating conditions compared to the control group. Higher self-reported acceptance was associated with training uptake and higher adherence.

Discussion

In particular, performance expectancy, but also social influence seemed to be valid predictors of acceptance of web-based BDD treatment. The results suggest that a specifically designed, brief video improves acceptance-facilitating factors. Subject to review, the potential benefit of an acceptance-facilitating intervention may be to enhance treatment rates in BDD.