Searching for Specificity Between Cognitive Vulnerabilities and Mood and Anxiety Symptoms

Using two large nonclinical samples (N = 725), relations between five targeted cognitive variables [intolerance of uncertainty, negative problem orientation, perfectionism/certainty, responsibility/threat estimation, and importance/control of thoughts] and mood [depression] and anxiety [social anxiety, generalized anxiety, and obsessive–compulsive] symptoms were examined. Analyses provided multiple levels of specificity, including zero-order correlations, partial correlations controlling for the effects of positive and negative affect, regression analyses, and hierarchical structural modeling. Results were that (a) intolerance of uncertainty showed relative specificity to anxiety versus depression symptoms and (b) negative problem orientation was common to mood and anxiety symptoms. Although certain analyses suggested that (c) perfectionism/certainty specifically predicted generalized anxiety and (d) both responsibility/threat estimation and importance/control of thoughts were unique predictors of obsessive–compulsive symptoms, these three cognitive variables inconsistently predicted symptom scores across the two studies. Conceptual and therapeutic implications are discussed.     

Written Exposure Therapy for Suicide in a Psychiatric Inpatient Unit: A Case Series

Patients with posttraumatic stress disorder (PTSD) are at an elevated risk of suicide. For patients hospitalized for suicide risk, psychosocial treatment and stabilization are routinely offered; however, the availability of evidence-based, manualized therapeutic interventions for PTSD is sparse. Typically, the short duration of hospitalization makes it difficult to accommodate evidence-based, trauma-focused treatments. This article presents the clinical course of four active-duty service members with PTSD who were hospitalized in a psychiatric inpatient unit for acute suicide risk and treated with Written Exposure Therapy for Suicide (WET-S). WET-S is a brief, five-session therapy based upon Written Exposure Therapy and augmented with Crisis Response Planning for Suicide Prevention. Both posttraumatic stress symptoms and suicidal ideation were reduced from pre- to posttreatment for three of the four patients treated. WET-S shows promise as a manualized therapeutic intervention that can be delivered on an inpatient psychiatric unit.     

Obsessional Beliefs and Symptoms of Obsessive–Compulsive Disorder in a Clinical Sample

The aim of the present study was to investigate the relationships among a broad range of obsessive–compulsive disorder (OCD) symptoms and obsessional beliefs in a clinical sample of OCD patients. Ninety-nine treatment-seeking adult OCD patients completed the Obsessive Beliefs Questionnaire and the Obsessive–Compulsive Inventory-Revised. Hierarchical regression analyses, controlling for comorbid symptoms, suggested that washing was predicted by responsibility/threat estimation beliefs. Checking/doubting was not predicted by any obsessional beliefs. Hoarding was predicted by perfectionism/certainty beliefs. Neutralizing was predicted by responsibility/threat estimation beliefs. Obsessing was predicted by importance/control of thoughts and perfectionism/certainty beliefs. Ordering was predicted by perfectionism/certainty beliefs. A principal components analysis of OCD symptom dimensions and accompanying beliefs yielded two components, accounting for 53% of the variance: one, which was labeled “Fear/Threat,” consisted of importance/control of thoughts, obsessing, responsibility/threat estimation, and washing. The second, which was labeled “Incompleteness/Not Just Right,” consisted of neutralizing, perfectionism/certainty, checking/doubting, and hoarding.     

Disgust and psychopathological symptoms in a nonclinical sample

There is little doubt that disgust sensitivity plays a role in the development of small animal phobias. However, it has been suggested that the basic emotion of disgust is implied in a broad range of psychopathological conditions. The present study examined the relationship between disgust sensitivity and symptoms of phobias (other than animal phobias), obsessive–compulsive disorder, depression, and eating disorder in a nonclinical sample. Undergraduate psychology students were asked to complete the Disgust Sensitivity Questionnaire, as well as measures of phobic (Fear Questionnaire), obsessive–compulsive (Maudsley Obsessive–Compulsive Inventory), depressive (Beck Depression Inventory), and eating disorder (Restraint Scale) symptomatology. Results showed that disgust sensitivity was only related to symptoms of agoraphobia and obsessive–compulsive disorder. The present findings cast doubts on the idea that disgust sensitivity is a central factor underlying a broad range of psychopathological conditions.     

Psychotherapy for Individuals with Autism Spectrum Disorders

Individuals with autism spectrum disorders (ASDs) present unique challenges for psychotherapists. Those with autism, Asperger’s Disorder and pervasive developmental disorder-not otherwise specified (PDD-NOS) show impairments in social communication and social relationships as well as unusual behavioral features that set them apart from peers. Further, individuals affected with autism spectrum disorders may experience anxiety, depression, obsessive–compulsive disorder and other psychiatric symptoms that can be distressing and, at times, disabling. At present, there is limited information regarding evidence-based approaches for addressing either core impairments of ASDs or associated conditions in a psychotherapy setting. Nevertheless, information about how persons with ASD experience their world and learn can provide clues about what interventions might be useful to assist them such that they can reach their fullest potential. From this standpoint, new or modified approaches to therapy can be tested and further refined to provide a more comprehensive understanding of the psychotherapeutic challenges and the most efficacious therapeutic approach to maximize functioning in this population.     

Recollections of parent–child relationships,attachment insecurity,and obsessive–compulsive beliefs

To adequately understand Obsessive Compulsive Disorder (OCD), it is important to understand the developmental origins of obsessive beliefs and corresponding compulsive acts. Prior work has shown that having cold, neglectful parents in childhood and/or insecure attachment styles are both linked to emotional disturbances. In this study, we explored the potential contributions of early parent–child relationships to attachment styles and the severity of obsessive–compulsive beliefs in adulthood. A sample of 397 college students completed online, self-report measures of retrospective parent–child relationships, adult attachment styles, and ongoing obsessive–compulsive symptoms. Analyses revealed that attachment anxiety partially mediated the association between parent–child relationships and obsessive beliefs; attachment avoidance failed to operate as a mediating mechanism. Our findings provide support for interpersonal approaches to obsessive–compulsive symptoms and disorder, with implications for the continuity of relationship dysfunction from childhood into adulthood.     

Neurofeedback Treatment of Depression and Anxiety

A robust body of research documents that there are biological predispositions that often exist for depression, anxiety, and obsessive–compulsive disorder. However, new research has shown that medication is only mildly more effective than placebo in the treatment of these problems. In treating these conditions, neurofeedback (EEG biofeedback) may offer an alternative to invasive treatments such as medication, ECT, and intense levels of transcrancial magnetic stimulation. This paper reviews the neurofeedback literature with these problems, finding particularly positive research support for the treatment of anxiety disorders. New findings on the neurofeedback treatment of depression are presented.     

Public and private self-consciousness as specific psychopathological features

Public self-consciousness (PUBSC) and private self-consciousness (PRISC) represent aspects of dispositional self-directed attention. The aim of the present study was to investigate whether four clinical groups, namely patients with a diagnosis of social phobia, panic disorder, obsessive–compulsive disorder or bulimia nervosa, and normal controls differentiated on the basis of their PUBSC and PRISC scores. Results indicated that both PUBSC and PRISC are extremely elevated in patients with social phobia. Patients with panic disorder and patients with obsessive–compulsive disorder score somewhere between social phobics and normal controls on PUBSC and PRISC scales. Bulimics had significantly higher PUBSC values than both controls and patients with panic disorder, but had lower values than social phobics. Compared to normal controls, bulimics showed no elevated PRISC scores. In addition, contrary to the other groups, PUBSC and PRISC seem to be unrelated in bulimics. Thus, PUBSC and PRISC appear to be specific psychopathological features for German females when comparing groups with different mental disorders and normal controls.     

Change in sleep symptoms across Cognitive Processing Therapy and Prolonged Exposure: A longitudinal perspective

Sleep disturbance is a core component in posttraumatic stress disorder (PTSD). Although cognitive-behavioral treatments for PTSD reduce the severity of sleep symptoms, they do not lead to complete remission. The present study examines the impact of Cognitive Processing Therapy (CPT) and Prolonged Exposure (PE) on subjective measures of sleep disturbance from treatment randomization through long-term follow-up (LTFU). Participants were 171 female rape victims with PTSD who were randomly assigned to CPT, PE, or Minimal Attention (MA). After 6-weeks, the MA group was randomized to CPT or PE. Sleep symptoms were assessed at baseline, post-MA, post-treatment, 3-months, 9-months and LTFU using the Pittsburgh Sleep Quality Index (PSQI) and nightmare and insomnia items from the Clinician Administered PTSD Scale. Change in sleep during MA, from pre- to post-treatment for CPT and PE, and from post-treatment through LTFU was assessed using piecewise hierarchical linear modeling with the intent-to-treat sample. Controlling for medication, sleep improved during CPT and PE compared to MA, and treatment gains were maintained through LTFU. CPT and PE were equally efficacious and improvements persist over LTFU, yet, neither produced remission of sleep disturbance. Overall, sleep symptoms do not remit and may warrant sleep-specific treatments.     

Neurocognitive Performance in Children with ADHD and OCD

Attention-deficit/hyperactivity Disorder (ADHD) and obsessive–compulsive disorder (OCD) have both been linked to dysfunction in the cortico-striato-thalamo-cortical circuitry (CSTCC). However, the exact nature of neurocognitive deficits remains to be investigated in both disorders. We applied two neuropsychological tasks that tap into different functions associated with the CSTCC, namely a serial reaction time (SRT) task, developed to assess implicit sequence learning, and a delay aversion (DA) task in order to assess abnormal motivational processes. The performance data of boys with ADHD (n = 20), OCD (n = 20) and healthy controls (n = 25), all aged 10–18 years, were compared. Subjects with ADHD less frequently chose the larger, more delayed reward compared to those with OCD and controls, while subjects with OCD showed impaired implicit learning. In contrast, the ADHD group was unimpaired in their implicit learning behavior and the OCD group was not characterized by a DA style. Within the OCD-group, severity of obsessions was associated with implicit learning deficits and impulsive symptoms with DA in the ADHD-group. This double dissociation highlights the distinct cognitive dysfunctions associated with ADHD and OCD and might possibly point to different neural abnormalities in both disorders.     

The Attention Training Technique as an Attempt to Decrease Intrusive Thoughts in Obsessive–Compulsive Disorder (OCD): From Cognitive Theory to Practice and Back

The attention training technique (ATT) is a cognitive treatment method that is aimed at ameliorating intrusive thoughts in anxiety disorders. To the best of our knowledge, no randomized controlled study has yet been conducted on individuals with obsessive–compulsive disorder (OCD). For the present study, we recruited 80 participants with OCD over the internet and allocated them to an experimental (ATT implemented as bibliotherapy) or a wait-list condition. Assessments were made at baseline and four weeks later. Groups performed similar at both time points on the self-report version of the Yale-Brown Obsessive Compulsive Scale (Y-BOCS) and the Obsessive Compulsive Inventory-revised (OCI-R). The present study speaks against the effectiveness of ATT as a stand-alone bibliotherapeutical approach for OCD. From our data and increasing evidence that OCD patients do not suffer from severe attention or executive deficits we consider an approach targeting attentional biases for certain OCD-related events more useful than a generic (i.e., OCD-unspecific) cognitive remediation approach.     

Behavioral Inhibition and Attentional Control in Adolescents: Robust Relationships with Anxiety and Depression

Behavioral inhibition (BI) has been associated with the development of internalizing disorders in children and adolescents. It has further been shown that attentional control (AC) is negatively associated with internalizing problems. The combination of high BI and low AC may particularly lead to elevated symptomatology of internalizing behavior. This study broadens existing knowledge by investigating the additive and interacting effects of BI and AC on the various DSM-IV based internalizing dimensions. A sample of non-clinical adolescents (N = 1806, age M = 13.6 years), completed the Behavioral Inhibition System/Behavioral Activation System Scales (BIS/BAS), the attentional control subscale of the Adult Temperament Questionnaire (ATQ) and the Revised Child Anxiety and Depression Scale (RCADS). As expected, BI was positively, and AC was negatively related to internalizing dimensions, with stronger associations of BI than of AC with anxiety symptoms, and a stronger association of AC than of BI with depressive symptoms. AC moderated the association between BI and all measured internalizing dimensions (i.e., symptoms of generalized anxiety disorder, social phobia, separation anxiety disorder, panic disorder, obsessive–compulsive disorder, and major depressive disorder). Since high AC may reduce the impact of high BI on the generation of internalizing symptoms, an intervention focused on changing AC may have potential for prevention and treatment of internalizing disorders.     

The Relation of Severity and Comorbidity to Treatment Outcome with Cognitive Behavioral Therapy for Childhood Anxiety Disorders

The present study investigated the impact of comorbidity over and above the impact of symptom severity on treatment outcome of Cognitive Behavioral Therapy for children with anxiety disorders. Children (aged 8–12, n = 124) diagnosed with an anxiety disorder were treated with a short-term CBT protocol. Severity was assessed with a composite measure of parent-reported behavior problems. Two approaches to comorbidity were examined; “total comorbidity” which differentiated anxiety disordered children with (n = 69) or without (n = 55) a co-occurring disorder and “non-anxiety comorbidity’ which differentiated anxious children with (n = 22) or without a non-anxiety comorbid disorder (n = 102). Treatment outcome was assessed in terms of Recovery, represented by post-treatment diagnostic status, and Reliable Change, a score reflecting changes in pre- to post-treatment symptom levels. Severity contributed to the prediction of (no) Recovery and (more) Reliable Change in parent-reported internalizing and externalizing symptoms and self-reported depressive symptoms. Total and non-anxiety comorbidity added to the prediction of diagnostic recovery. Non-anxiety comorbidity added to the prediction of Reliable Change in parent reported measures by acting as a suppressor variable. Non-anxiety comorbidity operated as a strong predictor that explained all of the variance associated with severity for self-reported depressive symptoms. The results support the need for further research on mechanisms by which treatment gains in children with higher symptom severity and non-anxiety comorbidity can be achieved.     

Dialectical behavior therapy adapted for suicidal adolescents

We report a quasi-experimental investigation of an adaptation of Dialectical Behavior Therapy (DBT) with a group of suicidal adolescents with borderline personality features. The DBT group (n = 29) received 12 weeks of twice weekly therapy consisting of individual therapy and a multifamily skills training group. The treatment as usual (TAU) group (n = 82) received 12 weeks of twice weekly supportive-psychodynamic individual therapy plus weekly family therapy. Despite more severe pre-treatment symptomatology in the DBT group, at post-treatment this group had significantly fewer psychiatric hospitalizations during treatment, and a significantly higher rate of treatment completion than the TAU group. There were no significant differences in the number of suicide attempts made during treatment. Examining pre-post change within the DBT group, there were significant reductions in suicidal ideation, general psychiatric symptoms, and symptoms of borderline personality. DBT appears to be a promising treatment for suicidal adolescents with borderline personality characteristics.     

Twenty-five Years of Research on Childhood Anxiety Disorders: Publication Trends Between 1982 and 2006 and a Selective Review of the Literature

We examined trends in publications on childhood anxiety disorders over the past 25 years. A PsycINFO search was carried out to find relevant research articles published between 1982 and 2006. Results indicated a gradual and significant rise in the frequency of publications on childhood anxiety disorders during the past 25 years, and this increase was particularly strong for post-traumatic stress disorder, obsessive–compulsive disorder, social phobia, and multiple anxiety disorders. Most studies concerned the phenomenology of childhood anxiety disorders (i.e., >50%). Considerable less research has been conducted on the etiology, intervention, and assessment of these disorders in youths. Nevertheless, the conclusion seems warranted that the research on childhood anxiety disorders has made significant advancements during the past decades. This notion is supported by a selective review of the literature, which highlights important developments in this field of study.     

Cognitive intrusions in a non-clinical population. I. Response style, subjective experience, and appraisal

The present study identified distinctive response styles to unpleasant cognitive intrusions to further understanding of intrusive phenomena similar to those observed in obsessive-compulsive disorder and other anxiety disorders. Response styles were studied among 125 university students who completed a questionnaire describing and evaluating seven cognitive intrusions and inventories of depressive, anxious, and compulsive symptoms. Almost all subjects (99%) reported intrusions and 92% included effortful strategies in response to intrusions in their repertoire. Large differences were observed in the dominant strategy used. Three distinctive dominant response styles were identified including no effortful response (26%) and two effortful styles, attentive thinking (34%), and escape/avoidance (40%). The two groups using effortful strategies were more anxious and reported more difficulty removing intrusions. The group using escape/avoidance strategies reported more sadness, worry, guilt, and disapproval than subjects reporting no effortful response. The attentive thinking group reported more varied forms and more frequently triggered intrusions then the no effortful response group. Within subject analyses support the group comparisons and showed that intrusions eliciting escape/avoidance strategies were evaluated more disapprovingly than thoughts eliciting attentive thinking. The results are discussed in terms of Salkovskis' (Behavior Research and Therapy, 27, 677–682, 1985) formulation of obsessive-compulsive disorder and Borkovec's (Journal of Consulting and Clinical Psychology, 23, 481–482, 1985) and Barlow's (Anxiety and its disorders: The nature and treatment of anxiety and panic, 1988) discussions of worry and generalized anxiety.     

A Psychometric Evaluation of the Thought Control Ability Questionnaire (TCAQ) and the Prediction of Cognitive Control

Study 1 evaluated the psychometric properties of the English version of the Thought Control Ability Questionnaire (TCAQ; Luciano et al. 2005), an index of perceived control over intrusive cognitions. Confirmatory factor analysis in a sample of 720 University students revealed a clear uni-dimensional structure (after removal of items 5, 7, 8, 14, and 25) with high internal consistency (α = .87, 95% CI = [.86, .88]) and test-retest reliability after a six month interval (r = .68). Correlational analyses supported an inverse relationship with measures of depression, anxiety, maladaptive cognitive control strategies, and obsessive–compulsive symptomatology. Study 2 tested the ability of the TCAQ to predict successful cognitive control during an experimental suppression protocol. Results demonstrated that weak thought control ability was predictive of the frequency and associated levels of distress of a target thought while under instruction to suppress. Additionally, weak perceived thought control ability was predictive of increased efforts to suppress the target material. Collectively, results suggest that thought control ability is a measurable individual difference variable and that the TCAQ is a reliable index of perceived cognitive control.     

Brooding and Reflection as Subtypes of Rumination: Evidence from Confirmatory Factor Analysis in Nonclinical Samples using the Dutch Ruminative Response Scale

Previous research has shown that depressive rumination is an important vulnerability factor for experiencing depressive symptoms. The most widely used measure to assess depressive rumination is the Ruminative Response Scale (RRS). According to Treynor et al. (Cognitive Therapy and Research 27:247–259, 2003), the RRS contains two subscales, reflecting two different rumination subcomponents: brooding and reflection. The present study examined the psychometric properties of the RRS in two samples (N = 432 and N = 407). Based on a confirmatory factor analysis (CFA), results confirmed that a two-dimensional model with brooding and reflection factors provided an adequate fit to the data. Reliability, convergent and discriminant validity of the rumination subcomponents were appropriate. Furthermore, brooding but not reflection predicted depressive symptoms prospectively, even when accounting for concurrent depressive feelings. The results provide the first confirmatory factor-analytical support for the widely assumed two-factor model of the RRS and add to the accumulating body of evidence supporting the multidimensional nature of depressive rumination.     

Change in metacognitions predicts outcome in obsessive–compulsive disorder patients undergoing treatment with exposure and response prevention

Wells' (Wells, A. (1997). Cognitive therapy of anxiety disorders: a practice manual and conceptual guide. Chichester, UK: Wiley) metacognitive model of obsessive–compulsive disorder (OCD) predicts that metacognitions must change in order for psychological treatment to be effective. The aim of this study was to explore: (1) if metacognitions change in patients undergoing exposure treatment for OCD; (2) to determine the extent to which cognitive and metacognitive change predicts symptom improvement and recovery. The sample consisted of 83 outpatients with a diagnosis of OCD who completed exposure and response prevention treatment. The Yale–Brown Obsessive–Compulsive Scale (Y-BOCS), the Metacognitions Questionnaire (MCQ-30) and the Obsessive Beliefs Questionnaire (OBQ-44) were administered before treatment, after treatment, and at 12-month follow-up. Treatment resulted in significant changes in symptoms, metacognition score, responsibility and perfectionism. Regression analysis using post-treatment Y-BOCS as the dependent variable indicated that when the overlap between predictors was controlled for, only changes in metacognition were significant. Changes in metacognitions explained 22% of the variance in symptoms at post-treatment when controlling for pre-treatment symptoms and changes in mood. A further regression revealed that two MCQ-30 subscales made individual contributions. The patients had significantly higher scores compared to community controls on the MCQ-30. Patients who achieved clinical significant change had lower scores on the MCQ-30 compared to patients who did not change. The results did not change significantly from post-treatment to follow-up assessment. These findings provide further support for the importance of metacognitions in treating OCD.     

Internet-based self-help treatment for panic disorder: a randomized controlled trial comparing mandatory versus optional complementary psychological support

Panic disorder (PD) is one of the most common psychiatric disorders. Web-based self-help treatments for PD have had promising results. These online treatments seem to have larger effect sizes (ESs) when professional support is added. However, the amount of support or how it should be administered is not yet clear. The aim of this trial was to study two ways of administering psychological support provided by phone as a part of Internet-based self-help treatment for PD based on cognitive behavioral therapy. Seventy-seven participants diagnosed with PD were randomly assigned to one of three experimental conditions: a waiting list control group; a treatment group with non-scheduled psychological support; or a treatment group with scheduled psychological support. PD symptoms of participants who received treatment improved significantly compared to the control group (mean ES d = 1.18, p < .05). In addition, there were statistically and clinically significant differences between treatment groups (Mean difference = ?3.20, p = .005, 95% CI [?5.62, ?.79]). The scheduled group showed a larger ES, a lower dropout rate, and better adherence to treatment than the non-scheduled group. Scheduled support seems to be indicated for patients who seek Web-based treatment for PD, and their symptoms of panic, anxiety, and depression improve at post-treatment and six-month follow-up. In contrast, when support depends on patient demand, they receive less support and so, the therapeutic effect is poorer.