Journal of Obsessive-Compulsive and Related Disorders最新文献

Although the possible link between betrayal and mental contamination (MC) in the context of Obsessive-Compulsive Disorder (OCD) has been the focus of important and innovative theoretical work, the actual findings appear somewhat contradictory. The present narrative systematic review aimed pull together and synthesise research focussed on the relationship between betrayal and MC in OCD and whether the current empirical literature indicates whether or not betrayal could be implicated in the experience of MC in OCD. Experimental and exploratory research studies of both quantitative and qualitative nature were included if they examined factors associated with MC and betrayal in OCD. Ovid and Open Athens databases including PsycINFO, Pubmed, Medline and Google Scholar were searched in May 2023. Quality and risk of bias was assessed using the Mixed Methods Appraisal Tool (MMAT). A total of 16 studies were included in the review (three qualitative, seven experimental, three quantitative non-randomised, two quantitative descriptive and two mixed methods studies). Overall, the current evidence provides some support for a connection between betrayal, MC and OCD in clinical samples with the evidence being more mixed in analogue samples. Strengths, limitations, implications and future directions are discussed.

A smartwatch that automatically detects compulsive actions could help to address the shortcomings of current treatment options for obsessive-compulsive disorder (OCD). We first present our overall research approach to investigate the effectiveness of using a smartwatch as a supplement to cognitive-behavioral therapy (CBT). Second, in a usefulness survey, 82 individuals diagnosed with OCD and 54 therapists answered questions about the degree of usefulness of different aspects of a smartwatch as an adjunct to CBT. Third, in a laboratory study, 23 participants were trained to wash their hands like individuals with OCD (enacted compulsive hand washing) and then asked to clean a cup, to brush their teeth, and to peel a carrot (confounding activities), while wearing a smartwatch. Results of the survey show that the large majority of therapists (94.1%–98.1%) and individuals with OCD (86.5%–93.9%) considered all relevant aspects of a smartwatch that is used as an adjunct to CBT as at least moderately useful. Enacted compulsive hand washing could be discriminated from confounding activities with high sensitivity (0.84) and acceptable specificity (0.79) using a deep learning model. Overall, our findings encouraged us to continue with our research and to test the smartwatch in individuals with compulsive hand washing.

Patients with obsessive compulsive disorder (OCD) present as risk-averse and avoidant of feared stimuli, yet the literature examining risk aversion in OCD is conflicting. One possible explanation is that patients may exhibit aversion only on ambiguous tasks where the likelihood of possible outcomes is unknown. To test this idea, the current study assigned 30 patients with OCD versus 30 non-psychiatric controls (NPC) to conditions of known versus unknown risk (i.e., probabilities) on the Beads Task. Importantly, the task involved real financial stakes. We also examined self-reported intolerance of uncertainty (IU) as a mechanism. Results revealed a significant risk information × group interaction for certainty about the decision. Specifically, while NPCs felt significantly less certain on the unknown risk (versus known risk) task, the OCD group felt uncertain regardless of risk information. Results also revealed a significant main effect of group for distress after deciding, such that the OCD group was more distressed across all task versions compared to NPCs. Elevated trait IU was associated with higher task-related distress. Results indicate that even when patients with OCD are given information about likelihoods, they still feel uncertain and experience distress. Findings have clinical implications for addressing risk aversion and ambiguity/uncertainty in treatment.

Despite growing interest in ecological momentary assessment (EMA) in psychopathology and clinical observation of day-to-day fluctuations in obsessive-compulsive disorder (OCD) symptoms, there is not a standardized EMA measure of such symptoms that can guide systematic research. In the absence of such a measure, prior EMA research in OCD has utilized heterogeneous approaches to sampling momentary and daily OCD symptoms, which limits the ability to compare results between studies. The present study sought to examine the psychometric properties of a daily OCD symptom (d-OCS) measure that assesses common OCD symptom themes (e.g., contamination, checking, intrusive thoughts) in a sample of adults with OCD (n = 20), psychiatric controls (n = 27), and healthy controls (n = 27). Participants completed the d-OCS 3 times per day for 1 week. The d-OCS distinguished those with OCD from psychiatric controls and healthy controls. The d-OCS demonstrated good internal consistency, adequate test-retest reliability, and good convergent validity. These findings offer initial psychometric support for the use of the d-OCS in EMA research examining day-to-day fluctuations in symptoms of OCD. Additional investigation is needed to examine the discriminant validity of the d-OCS and generalize these findings to more diverse samples.

Approximately 10–20% of children with obsessive-compulsive disorder (OCD) have treatment-resistant presentations, and there is likely interest in developing interventions for this patient group, which may include deep brain stimulation (DBS). The World Society for Stereotactic and Functional Neurosurgery has argued that at least two successful randomized controlled trials should be available before DBS treatment for a psychiatric disorder is considered “established.” The FDA approved DBS for adults with treatment-resistant OCD under a humanitarian device exemption (HDE) in 2009, which requires that a device be used to manage or treat a condition impacting 8000 or fewer patients annually in the United States. DBS is currently offered to children ages 7 and older with treatment-resistant dystonia under an HDE. Ethical and empirical work are needed to evaluate whether and under what conditions it might be appropriate to offer DBS for treatment-resistant childhood OCD. To address this gap, we report qualitative data from semi-structured interviews with 25 clinicians with expertise in this area. First, we report clinician perspectives on acceptable levels of evidence to offer DBS in this patient population. Second, we describe their perspectives on institutional policies or protocols that might be needed to effectively provide care for this patient population.

Introduction

Doubt and decision-making difficulties are very common in obsessive-compulsive disorder (OCD). In the present study, we focused on a particular feature of decision-making in OCD – increased information-seeking. Based on the Seeking Proxies for Internal States and the Intolerance for Uncertainty theoretical frameworks, we hypothesized that OCD symptoms will be positively associated with information-seeking, even for neutral perceptual decisions.

Method

Fifty-eight UK participants were recruited via Prolific. They performed a perceptual decision-making task and completed questionnaires assessing OCD and associated variables. The perceptual task entailed locating the exact mid-point of a brightness continuum of a specific hue. Upon request, participants could obtain objective hints (purported responses of other participants), although hints incurred time-out penalties.

Results

Consistent with our hypothesis, OCD symptom levels predicted how many hints participants requested, even after controlling for anxiety and depression symptoms. Additionally, OCD symptoms were partially related to indecisiveness in the task.

Discussion

Our findings suggest that obsessive-compulsive tendencies are related to indecisiveness and to seeking external information even in a neutral context. Moreover, OCD tendencies were related to finding external information desirable enough to justify mildly aversive penalties. This need for clarity and objectivity might account for the development of compulsions despite personal costs.

Exposure and response prevention (EX/RP) can be delivered as monotherapy or to augment serotonin reuptake inhibitors (SRIs). While both options are considered effective OCD treatments, responses are heterogenous. Substantial work has investigated EX/RP predictors to account for this variability, with mixed findings. Little research has studied whether EX/RP predictors may differ in medicated versus non-medicated samples (i.e., medication status as a moderator). We pooled data from two clinical trials conducted concurrently in the same specialty OCD clinic. One enrolled patients who were on stable SRI doses (EX/RP as SRI augmentation, n = 58) while the other enrolled non-medicated patients (EX/RP monotherapy, n = 38). Both trials used the same manualized EX/RP protocol and blinded independent evaluators. LASSO regression derived predictors and moderators of outcome. Improvement did not significantly differ between the EX/RP alone group and the SRI + EX/RP group. In both groups, higher baseline OCD severity and worse quality of life predicted poorer outcome. OCPD traits moderated results: Patients with more severe OCPD traits had better outcomes from EX/RP monotherapy than those receiving EX/RP with SRIs. Patient adherence to EX/RP homework mediated the associations between the baseline variables and outcome. The effect of OCPD traits on outcome warrants future study to improve care.

Background

Hoarding disorder causes significant impairment, but existing treatments have notable barriers to access and do not target several psychological processes that may contribute to hoarding. Therefore, this study evaluated an acceptance and commitment therapy (ACT) self-help website for hoarding with minimal coaching in a randomized waitlist-controlled trial to evaluate initial feasibility and efficacy.

Methods

Participants were 73 U.S.-based adults with clinically significant hoarding symptoms. The website comprised 16 self-help sessions to be completed over 8 weeks. Measures were taken at baseline, posttreatment, and 1-month follow-up.

Results

Multilevel models indicated that the ACT condition improved significantly more than waitlist on hoarding symptom severity (the primary outcome; β = 0.74, Holm-corrected p = .01) as well as secondary outcomes (e.g., functional impairment, well-being, and progress toward personal values, Holm-corrected ps < .05). Rates of reliable (34.61%) and clinically significant (11.54%) change at posttreatment were limited, with no significant differences between groups. Responses indicated that this intervention was acceptable, credible, and easy to use, although adherence could be further improved.

Conclusions

Overall, results suggest that an ACT self-help program for hoarding can be acceptable and efficacious. Limitations include a predominantly White and female sample and the lack of an active control condition.

Misophonia is an often chronic condition characterized by strong, unpleasant emotional reactions when exposed to specific auditory or visual triggers. While not currently defined within existing classification systems, and not clearly fitting within the framework of extant psychiatric conditions, misophonia has historically been studied most frequently within the context of obsessive-compulsive and related disorders. Internalizing and externalizing psychiatric symptoms are common in misophonia, but specific factors that confer risk for these symptoms remain unknown. The present cross-sectional study examined whether sensory sensitivity and cognitive emotion regulation facets are associated with co-occurring internalizing and externalizing symptoms in 102 youth with misophonia aged 8–17 years (N_females = 69). Participants completed self-report assessments of misophonia severity, sensory sensitivity, cognitive emotion regulation, and emotional-behavioral functioning. In the final model, controlling for all variables, multiple linear regression analyses revealed that sensory sensitivity and age were significant predictors of internalizing symptoms, while sensory sensitivity and the other-blame cognitive emotion regulation facet were significant predictors of externalizing symptoms. Further, findings demonstrated that the positive reappraisal cognitive emotion regulation facet moderated the effect of misophonia severity on internalizing symptoms. Results highlight a strong, consistent relation between sensory sensitivities (beyond sound sensitivity) and psychiatric symptoms in misophonic youth. Further research is necessary to determine mechanisms and clinical variables impacting internalizing and externalizing symptoms within youth with misophonia.