Advances in the Cognitive Behavioural Treatment of Obsessive Compulsive Disorder

The aim of this paper is to highlight key advances in the cognitive-behavioural treatment of obsessive compulsive disorder over the course of Professor Lars Göran Öst's illustrious career. The paper will focus on three specific areas of interest: the treatment of obsessions, compulsive checking, and the fear of contamination. It will also highlight recent advances concerning the broader need to ensure that treatment is acceptable. An increase in acceptability could result in improvements in completion rates so that more patients benefit from the recent improvements in the science and therapy for this disabling disorder.     

Addressing Barriers to Change in the Treatment of Childhood Obsessive Compulsive Disorder

Although considerable evidence supports the use of cognitive behavior therapy (CBT) for the treatment of childhood obsessive compulsive disorder, large numbers of youth fail to respond and clinical remission is often elusive. Poor family functioning frequently is implicated as an obstacle for youth undergoing CBT, with features such as symptom accommodation, family conflict, and blame known to attenuate outcomes. These features are common in child and adolescent obsessive compulsive disorder (OCD) and they may pose particular challenges for exposure-based treatments. Nonetheless, interventions that focus specifically on family functioning have, to date, been limited. This paper reviews the literature on family features associated with childhood OCD and discusses their links to treatment outcome. It then describes the development of a brief family intervention tailored to address the needs of highly distressed families of youth with OCD in the service of improving individual child CBT outcomes. Preliminary pilot data are presented and clinical implications are discussed.     

Satiation Therapy and Exposure Response Prevention in the Treatment of Obsessive Compulsive Disorder

The purpose of present study was to test the comparative effectiveness of Satiation Therapy and Exposure Response Prevention techniques in the treatment of obsessive–compulsive disordered patients. Sixty self-referred male outpatient cases were investigated within a randomized controlled trial. Patients were allocated to Satiation Therapy, Exposure Response Prevention or wait-list control groups. Obsessive–compulsive symptoms were measured by the Yale-Brown Obsessive Compulsive Scale at baseline, post-treatment, and 3 and 6 month follow-ups. The therapeutic groups had more significant improvement than the control group. In addition, there was not a significant difference between therapeutic groups on post-treatment and follow-up assessments which showed that Satiation Therapy and Exposure Response Prevention were similarly effective in reducing obsessive–compulsive symptoms. Analyses revealed that therapeutic groups had improved significantly while the control group had continued unchanged. Finally, the present investigation supported both Satiation Therapy and Exposure Response Prevention in the treatment of obsessive–compulsive disorder.     

Worry and Rumination in Generalized Anxiety Disorder and Obsessive Compulsive Disorder

Ample work has already been conducted on worry and rumination as negative thought processes involved in the etiology of most of the anxiety and mood related disorders. However, minimal effort has been exerted to investigate whether one type of negative thought process can make way for another type of negative thought process, and if so, how it subsequently results in experiencing a host of symptoms reflective of one or the other type of psychological distress. Therefore, the present study was taken up to investigate whether rumination mediates the relationship between worry and generalized anxiety disorder (GAD), and between worry and obsessive compulsive disorder (OCD) in two clinical groups. Self-report questionnaires tapping worry, rumination, generalized anxiety disorder (GAD), and obsessive compulsive disorder (OCD) were administered to a clinical sample of 60 patients aged 30–40. Worry, rumination, generalized anxiety disorder (GAD), and obsessive compulsive disorder (OCD) correlated substantially with each other, however, rumination did not mediate the relationship between worry and generalized anxiety disorder (GAD) and between worry and obsessive compulsive disorder (OCD). We also analyzed differences of outcome variables within two clinical groups. These results showed that worry and rumination were significantly different between GAD and OCD groups.     

Phenomenology of Early Childhood Onset Obsessive Compulsive Disorder

This paper describes the phenomenological features of early childhood onset obsessive compulsive disorder (OCD; defined as children meeting DSM-IV criteria for OCD with age of onset <8 years). Fifty-eight children (ages 4–8) were included in the sample. OCD and comorbid diagnoses were determined by structured interview, and OCD severity was measured using the Children’s Yale-Brown Obsessive Compulsive Scale (CY-BOCS). Mean age of OCD onset was almost five, and mean age of presentation was between 6 and 7. Mean symptom severity was in the moderately severe range. Comorbidity and family history of OCD were common. Contamination and aggressive/catastrophic obsessions and washing and checking compulsions were endorsed most frequently. Results indicate that early childhood onset OCD may have a lower boy to girl ratio and lower rates of depressive disorders, but may be similar to later childhood onset OCD in terms of OCD symptom presentation and severity.     

Scrupulosity and Obsessive Compulsive Disorder: The Cognitive Perspective in Islamic Sources

A moral/religious subtype of obsessive compulsive disorder has been termed as scrupulosity by mental health professionals. Since ultimate feared consequence in scrupulous individuals is religious or moral in nature, it also presents interesting and difficult issue for religious authorities. This article focuses on various aspects of scrupulosity that have until now been poorly conceptualized in Islamic world and provides a conceptual cognitive framework and analysis of scrupulosity according to Islamic sources.     

Elucidating the Relation of Hoarding to Obsessive Compulsive Disorder and Impulse Control Disorders

Hoarding has historically been conceptualized as a symptom of Obsessive Compulsive Disorder (OCD); however, data demonstrate important differences between hoarding and OC symptoms (for discussion, see Grisham et al. Anxiety Disorders, 19, 767‑779. 2005). Hoarding has also been observed in disorders besides OCD, including specific Impulse Control Disorders (ICDs; e.g., kleptomania, trichotillomania, pathological gambling, compulsive buying). Therefore, the current study tested the hypothesis that hoarding would be as strongly related to symptoms of ICDs as it is to OCD and that these relationships would be medium to strong in magnitude. Results from an undergraduate sample showed hoarding behaviors were strongly related to symptoms of OCD, moderately related to symptoms of compulsive buying, and more modestly related to symptoms of pathological gambling, trichotillomania, and kleptomania. Finally, findings suggest indecisiveness may be a particularly important underlying feature in hoarding behaviors. These results support the consideration of hoarding outside the confines of OCD.

Development and Validation of a Child Version of the Obsessive Compulsive Inventory

Surprisingly, only 3 self-report measures that directly assess pediatric obsessive-compulsive disorder (OCD) have been developed. In addition, these scales have typically been developed in small samples and fail to provide a quick assessment of symptoms across multiple domains. Therefore, the current paper presents initial psychometric data for a quick assessment of pediatric OCD across multiple symptom domains, a child version of the Obsessive Compulsive Inventory (the OCI-CV). Data from a sample of over 100 youth ages 7 to 17 with a primary DSM-IV diagnosis of OCD support the use of the 21-item OCI-CV. Results support the use of the OCI-CV as a general index of OCD symptom severity and in 6 symptom domains parallel to those assessed by the revised adult version of the scale (OCI-R). The OCI-CV showed strong retest reliability after approximately 1.5 weeks in a subsample of 64 participants and was significantly correlated with clinician-rated OCD symptom severity and parent and child reports of dysfunction related to OCD. Significantly stronger correlations with self-reported anxiety than with depressive symptoms provide initial support for the divergent validity of the measure. Finally, preliminary data with 88 treatment completers suggest that the OCI-CV is sensitive to change.     

Examining the Experience of Undergoing Group Cognitive Behavioral Therapy for Obsessive Compulsive Disorder: An Interpretative Phenomenological Analysis

This study used interpretative phenomenological analysis (IPA) to explore the lived experiences of five individuals diagnosed with obsessive-compulsive disorder (OCD) who underwent a group cognitive behavioral therapy (CBT) intervention program to address their symptoms. Two master themes were identified: experiences and processes of change and reflections on change. For all participants, the degree of group cohesion or connectedness they established with group members emerged as highly important in facilitating therapeutic progress. A number of technical elements of cognitive behavioral therapy (CBT) were also notable therapeutic factors, including questioning/rationalizing maladaptive interpretations about intrusions. However, the commonality of non-specific group processes as key features for subsequent therapeutic change prompts the need for further research in dynamics within CBT group interventions for OCD.     

A dimensional analysis of the Yale-Brown Obsessive Compulsive Scale.

A principal axis factor analysis with a Promax rotation was performed on the Yale-Brown Obsessive Compulsive Scale. Although the scale has separate obsession and compulsion indices, only one factor was extracted. The psychometric implications of this finding are discussed.     

Yale-Brown Obsessive Compulsive Scale: Psychometric Properties of the Self-Report Version in a Student Sample

The aim of the present study was to investigate the psychometric properties of an Icelandic translation of the self-report version of the Yale-Brown Obsessive Compulsive Scale (Y-BOCS-SR). The Y-BOCS-SR was administered to a sample of 427 Icelandic university students along with another measure of OCD symptoms (OCI-R) and measures of general anxiety and worry (GAD-Q-IV and PSWQ). The internal consistency of the Y-BOCS-SR total severity score and its obsession and compulsion subscales was very good. Confirmatory factor analysis supported the original two- factor structure of the severity dimensions but a three-factor model with obsession, compulsion and resistance/control factors fitted the data equally well. Five factors described best the latent structure of the symptom dimensions. Support was found for the convergent and divergent validity of the Y-BOCS-SR. The results indicate that the Y-BOCS-SR is a reliable and valid instrument for assessing the severity of obsessions and compulsions in a student population.     

Psychometric properties of the Obsessive Compulsive Inventory-Revised among Icelandic college students

In the present study, the psychometric properties of the Obsessive Compulsive Inventory-Revised (OCI-R) (Foa, et al., 2002) were investigated. The OCI-R was administered to a total of 816 Icelandic college students. The Maudsley Obsessive Compulsive Inventory (MOCI) and the Penn State Worry Questionnaire (PSWQ) were administered to a subsample of 304 students, and the PI-WSUR (Padua Inventory Washington State University Revision), the PSWQ and the Multidimensional Perfectionism Scale (MPS) to another subsample of 212 students. Also, 89 students filled in the OCI-R twice with two weeks in between. The factor structure of the instrument was replicated in a confirmatory factor analysis. Cronbach's alpha and test-retest reliabilities of the OCI-R total scale and all subscales were satisfactory. Further, the OCI-R total score showed a significantly higher correlation with the PI-WSUR and the MOCI than with the PSWQ or the MPS. Finally, conceptually similar scales of the OCI-R and the MOCI as well as the PI-WSUR showed higher inter-correlations than the correlations that were observed between conceptually more distinct scales. It is concluded that the Icelandic version of the OCI-R has strong psychometric properties in a student population.     

Use of formal and informal evaluation in institutional strengthening: The case of a village hydro project in Sri Lanka

Evaluation is an important management tool used by managers and beneficiaries of development projects. However, until recently, only the managers and external agencies evaluated project benefits, and there was little interaction with the beneficiaries. This approach to evaluation ignores the locally available evaluation capacity that could be harnessed not only for meaningful evaluation, but also for rational decision-making at the project level. This article, using some experience from a Village Hydro Project in Sri Lanka, demonstrates the value and relevance of using local capacity in project evaluations. When local capacity is combined with external formal evaluation exercises, not only does the evaluation become more enlightened and participatory, but more importantly, the beneficiaries become partners in development. The article argues that such local capacity could start as an informal evaluation system that could gradually be transformed into a formal evaluation system.     

斯里兰卡民族冲突的根源

斯里兰卡独立后,僧伽罗、泰米尔两大民族之间冲突不断发生.两大民族的冲突起源于英国殖民统治时期,佛教革命和一元制体制的建立是其宗教及文化根源,政府政策方针的变化则是其政治原因.     

Near-Death Experiences in a Multi-religious Hospital Population in Sri Lanka

Near-death experiences (NDEs) are a wide range of experiences that occur in association with impending death. There are no published studies on NDEs in general hospital populations, and studies have been mainly conducted on critically ill patients. We assessed the prevalence of NDEs and its associations in a multi-religious population in a general hospital in Sri Lanka. A randomised sample of patients admitted to the Colombo North Teaching Hospital was assessed using the Greyson NDE scale and clinical assessment. Out of total 826 participants, NDEs were described by 3%. Compared to the NDE-negative participants, the NDE-positive group had a significantly higher mean for age and a ratio of men. Women reported deeper NDEs. Patients of theistic religions (Christianity, Islam and Hinduism) reported significantly more NDEs compared to patients from the non-theistic religious group (Buddhism). NDE-positive patient group had significantly higher reporting of a feeling ‘that they are about to die’, the presence of loss of consciousness and a higher percentage of internal medical patients. This is the first time that NDEs are assessed in a general hospital population and NDEs being reported from Sri Lanka. We also note for the first time that persons with theistic religious beliefs reported more NDEs than those with non-theistic religious beliefs. Medical professionals need to be aware of these phenomena to be able to give an empathic hearing to patients who have NDE.     

The contemporary lay meditation movement and lay gurus in Sri Lanka

This article examines the lay meditation movement occurring in contemporary Buddhism in Sri Lanka. The lay meditation movement represents a different perspective from the nationalistic Sinhala Buddhism that has dominated the discourse in the wake of the intractable ethnic conflict in the country. The lay meditation movement reflects the contemporary ferment in Buddhist discourse among the laity. One of the key themes in this movement is the privileging of experience because it gives the lay groups authority to challenge contemporary orthodoxy and it has empowered a new class of spiritual leaders, the lay gurus. Paraphrasing Stirrat, we can say that these lay gurus are leading the lay meditation movement towards ‘a series of different interpretations of what it means’ to be a Buddhist today. In its overall effect the lay meditation movement not only reconstructs what it means to be a Buddhist today but also points in the direction of establishing new forms of sectarianism that could be considered to be ‘new religious movements’ under the umbrella of Buddhism.