Danger ideation reduction therapy for obsessive-compulsive checking: preliminary findings

Danger Ideation Reduction Therapy (DIRT) is a cognitive treatment package developed in the mid-1990s to treat obsessive-compulsive (OC) washing. DIRT is solely directed at decreasing threat expectancies and does not involve direct or indirect exposure. The effectiveness of the DIRT package for OC washers has been examined, and to date a number of publications, including two randomised controlled trials, support its efficacy. Recently, the DIRT package was modified to treat people with the OC checking subtype. In the current study, three adult OC checkers received DIRT in 12 to 14 individual 1-hr sessions conducted by a clinical psychologist. At posttreatment, substantial and clinically significant reductions in scores on a range of standardized outcome measures of obsessive-compulsive disorder symptom severity were apparent for all three participants. Crucially, these improvements were maintained at 4-month follow-up. Although further research is clearly warranted, these preliminary findings suggest that DIRT for checkers may prove as effective as DIRT for OC washers.     

Danger Ideation Reduction Therapy for Obsessive–Compulsive Checking: Preliminary Findings

Danger Ideation Reduction Therapy (DIRT) is a cognitive treatment package developed in the mid-1990s to treat obsessive–compulsive (OC) washing. DIRT is solely directed at decreasing threat expectancies and does not involve direct or indirect exposure. The effectiveness of the DIRT package for OC washers has been examined, and to date a number of publications, including two randomised controlled trials, support its efficacy. Recently, the DIRT package was modified to treat people with the OC checking subtype. In the current study, three adult OC checkers received DIRT in 12 to 14 individual 1-hr sessions conducted by a clinical psychologist. At posttreatment, substantial and clinically significant reductions in scores on a range of standardized outcome measures of obsessive–compulsive disorder symptom severity were apparent for all three participants. Crucially, these improvements were maintained at 4-month follow-up. Although further research is clearly warranted, these preliminary findings suggest that DIRT for checkers may prove as effective as DIRT for OC washers.     

The Vancouver Obsessional Compulsive Inventory (VOCI)

The original Maudsley Obsessional Compulsive Inventory (MOCI) has been widely used and is considered to be one of the best available self-report instruments for measuring observable obsessive-compulsive problems such as washing and checking. However, it has several limitations and requires updating. Our revision of the MOCI, the Vancouver Obsessional Compulsive Inventory (VOCI), was designed to provide assessment of a range of obsessions, compulsions, avoidance behaviour, and personality characteristics of known or theoretical importance in obsessive-compulsive disorder (OCD). The development of the VOCI is described, and we provide evidence of its reliability and validity. Our findings in samples of people with OCD, people with other anxiety disorders or depression, community adults, and undergraduate students suggest that the VOCI is a promising new measure. We anticipate that, like its predecessor, the VOCI will have widespread use in both research and clinical settings.     

Obsessions and compulsions: Dimensional structure, reliability, convergent and divergent validity of the padua inventory

This study presents data on dimensional structure, reliability, convergent and divergent validity of the Padua Inventory (PI). In a sample (n = 430) of normal Dutch subjects. The dimensional structure and the strength of the factors were comparable to those found in the Italian sample. The reliability of the PI was found to be satisfactory. As hypothesized substantial correlations were found between the PI and related scales of the Maudsley Obsessive-Compulsive Inventory (MOCI) and between the PI and the subscales Sensitivity, Hostility and Depression of the revised version of the Symptom Checklist. Low correlations were found between the PI on the one side and the Eysenck Personality Questionnaire revised Extraversion, Psychoticism and Social Desirability scale on the other side. Finally, the mean score of the PI differs across the Italian, American and Dutch samples. This is of theoretical interest and deserves further study.     

Reliability and validity of the Padua Inventory in an Iranian population

In order to study the reliability and validity of the Padua Inventory (PI), its items were translated into Persian and then back-translated into English as suggested by Brislin, Lonner, Thorndike, Cross-cultural research methods, Wiley, New York, 1973. Using the translated version of the PI, two studies were carried out. The first study included 219 healthy participants selected from Shiraz city in Iran to examine the reliability and factorial structure of the PI via test-retest, internal consistency and principal component analysis methods. The results of this study showed good reliability for the PI and confirmed its factorial structure reported by previous studies. The second study included four groups of participants as follows: patients with obsessive-compulsive disorder (OCD), patients with anxiety disorders, patients with depressive disorder and normal individuals. The PI scores were able to differentiate between OCD patients and normal individuals, but failed to differentiate between neurotic and OCD patients. Two subscales of PI-R version of the PI (precision and washing) differentiated depressive and OCD patients.     

Prevalence of DSM-III-R disorders among nonclinical compulsive checkers and noncheckers in a college student sample.

The prevalence of lifetime DSM-III-R disorders was assessed in a sample of 100 college students who were classified as compulsive checkers (n = 50) or noncheckers (n = 50) on the basis of their responses to the Checking subscale of the Maudsley Obsessional-Compulsive Inventory (MOCI). DSM-III-R disorders were assessed on the basis of responses to the Diagnostic Interview Schedule, Version III Revised (DIS-III-R), administered by trained, lay interviewers, blind to Ss' checking status. Checkers, compared to noncheckers, were significantly more likely to meet lifetime diagnostic criteria for Major Depressive Episode, Drug Abuse/Dependence, and Social Phobia. Analysis of a subsample (n = 74) selected on the basis of the consistency of responses to the MOCI across two administrations replicated the above effects, with two exceptions: (1) checkers were more likely to meet criteria for Obsessive Compulsive Disorder than were noncheckers, and (2) for males, but not females, Simple Phobia was more prevalent among checkers than among noncheckers. These findings extend our previous work by demonstrating that 'nonclinical' checking behavior is associated with a broad range of psychological syndromes and may, in fact, be more strongly associated with other disorders than it is with Obsessive Compulsive Disorder in a nonclinical sample.     

Psychometric properties of the OCI-R in a college sample

Two studies examined the psychometric properties of the Obsessive-Compulsive Inventory-Revised (OCI-R; Psychol. Assessment 14 (2002) 485) in a nonclinical student sample. In Study 1, we investigated the factor structure and internal consistency of the OCI-R using a sample of 395 undergraduate students. At a second testing session 1 month later, 178 students completed the OCI-R. Test-retest reliability was examined using data from 94 students who completed the OCI-R in both sessions. Convergent validity was also assessed with the Maudsley Obsessive-Compulsive Inventory (MOCI). In Study 2, we further investigated the convergent and divergent validity of the OCI-R using a new sample of 221 students who completed a battery of measures of obsessive-compulsive symptoms, worry, and depression. There was a significant order effect for both the OCI-R and the MOCI: means of each measure were significantly lower when presented second. Despite the order effect, statistical analyses indicated that the OCI-R has adequate test-retest reliability for the full scale and subscale scores, solid factor structure, and high internal consistency. Convergent validity with other measures of obsessive-compulsive symptoms was moderate to excellent, and divergent validity was good. The results indicate that the OCI-R is a short, psychometrically sound self-report measure of obsessive-compulsive symptoms.     

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.     

The Maudsley Obsessional-Compulsive Inventory: a psychometric investigation on Chinese normal subjects

The 30-item Maudsley Obsessional-Compulsive Inventory (MOCI) was administered to 183 normal English-speaking Chinese subjects. The inventory achieved modest to relatively low internal consistency as a scale and as four subscales. Three independent dimensions of obsessional complaints interpretable as Perfectionistic and Repetitive Checking, Fear of Contamination, and Doubting Rumination emerged in the factor analysis of item responses. While the first factor corresponded to the Checking component, the second to the Cleaning component, the third was reminiscent of the Doubting, Ruminating and Slowness components. The responses to the MOCI were also explored in their correlations with depression and assertiveness. These results were discussed in in terms of the development of a refined and shortened version of the MOCI and their implications for developing differential treatment models for obsessive-compulsive patients.     

Maudsley Obsessional-Compulsive Inventory: obsessions and compulsions in a nonclinical sample

Obsessive-compulsive disorder is increasingly being studied in nonclinical samples. The self-report instruments used to select these samples, however, have not been validated with a diagnostic interview. This study thus investigated the predictive validity of the Maudsley Obsessional-Compulsive Inventory (MOCI) using the Anxiety Disorders Interview Schedule (ADIS), a semi-structured interview created according to DSM-III guidelines. Four sections of the ADIS--generalized anxiety disorder, simple phobia, social phobia and obsessive-compulsive disorder--were administered to 11 individuals who scored in the top 2% and 11 individuals who scored in the normal range of the MOCI 6-7 months prior to the interview. High nonclinical MOCI scorers reported more frequent and severe obsessions and compulsions as well as greater disturbance by these symptoms. In addition, the high MOCI group experienced more general worry and interference from worry, and more frequent and severe physiological symptoms when they worry. However, the two groups did not differ in terms of simple and social phobia symptoms. High MOCI scorers thus did not report a broad range of anxiety symptoms or fears, but specific obsessions and compulsions. These results provide further support for the validity of the MOCI in nonclinical samples over a 6-7 month interval.     

Measuring Obsessions Without Worry: Convergent and Discriminant Validity of the Revised Padua Inventory in an Icelandic Student Population

The revised Padua Inventory (Padua Inventory-Washington State University Revision or PI-WSUR) was investigated in an Icelandic student population ( n = 431). The inventory was explicitly constructed to minimize the overlap between the measurement of obsessionality and worry. Its relationships with the Maudsley-Obsessive-Compulsive Inventory (MOCI) and the Penn State Worry Questionnaire (PSWQ) were investigated. The factor structure of the PI-WSUR was studied as well as the relations of PI-WSUR subscales with corresponding scales on the MOCI (checking, contamination). It was further investigated whether a factor analysis of the PI-WSUR together with PSWQ would indicate that the PI-WSUR and its different components were relatively uncontaminated by variance shared with worry. The results generally supported the psychometric properties of the Icelandic version of the PI-WSUR as well as its relative independence of PSWQ specifically.     

The relationship between schizotypal and obsessive-compulsive features in university students

Comorbid schizotypal personality disorder (SPD) is relatively common in patients with obsessive-compulsive disorder. Some have argued, however, that the severity of the primary disorder results in inflated estimates of personality disorder. The present investigation explored the possibility that schizotypal features are also significantly related to obsessive-compulsive features in a nonclinical sample. One-hundred and ninety-two student volunteers completed the Maudsley Obsessional-Compulsive Inventory (MOCI) and the Schizotypal Personality Questionnaire (SPQ), the latter being a self-report inventory designed to tap all nine features of DSM-III-R SPD. Correlations between schizotypal and obsessive-compulsive features were strongest for compulsive checking as opposed to compulsive washing, slowness or doubting. Regression analyses revealed that only the MOCI checking subscale was a significant independent predictor of the total SPQ schizotypal score. Findings indicate that schizotypal features are also found in association with nonclinical levels of obsessive-compulsive features, particularly checking behaviors. The influence of gender on these findings are discussed.     

The Maudsley Obsessional-Compulsive Inventory and OCD in a Norwegian nonclinical sample

The 30 item Maudsley Obsessional-Compulsive Inventory (MOCI) was given to 294 under graduate students. The inventory achieved an acceptable internal consistence, but somewhat low reliability. There were no sex difference in total MOCI score, or in any of the subscales. 31% of the variance seemed to be explained by item 18: "attending too much to details", and more than 65% of the variance is explained by the checking subscale. The data give some interesting indications of the prevalence of OCD in the population.     

Psychometric analysis of racial differences on the Maudsley Obsessional Compulsive Inventory

Black university students scored significantly higher than White students on the Maudsley Obsessional Compulsive Inventory (MOCI). They tended to endorse more Cleaning and Checking subscale items in the pathological direction. Subsequent analyses examined whether this finding is a reflection of valid group differences in the prevalence of OCD or a psychometric artifact. Structured interviews were conducted to determine the correspondence of MOCI scores with OCD diagnoses. The race difference in endorsement frequency on the MOCI did not extend to OCD diagnoses. The MOCI scores showed modest predictive validity in Whites, but they did not predict interview-based diagnoses in Blacks. Multivariate item response theory was then employed to examine race differences in the Cleaning and Checking subscales. Equivalent item discrimination parameters fit the data for Black and White participants for both subscales. A more restrictive model in which relative item difficulties were also constrained to be equal for Black and White participants did not fit. This interaction between race and item difficulty suggests that the items do not have equivalent psychometric properties in Blacks and Whites.     

A Norwegian adaptation of the Penn State Worry Questionnaire: factor structure, reliability, validity and norms

A Norwegian version of the Penn State Worry Questionnaire (PSWQ) was administered to 304 undergraduate students together with the Beck Depression Inventory (BDI), the State-Trait Anxiety Inventory (STAI) and the Maudsley Obsessive Compulsive Inventory (MOCI). The PSWQ was also administered to a community sample comprising 879 subjects, together with the Beck Anxiety Inventory (BAI), the Beck Depression Inventory II (BDI II) and the White Bear Suppression Inventory (WBSI). Structural equation modeling showed that a three-factor solution of the PSWQ gave the best goodness of fit. The Norwegian version of the PSWQ demonstrated adequate psychometric properties in terms of reliability and validity in both samples. Females scored higher than males on PSWQ.     

THE EFFECTS OF MODELLING ON THE CONTINGENT PRAISE OF MENTAL RETARDATION COUNSELLORS

A multiple-baseline design was used to evaluate the effects of a simple modelling procedure on the contingent praise of five counsellors while they conducted hygiene-training sessions in toothbrushing and hand-and-face washing with severely retarded children. After varying numbers of baseline sessions, each counsellor watched a model who conducted a series of toothbrushing sessions, in which he conspicuously praised correct toothbrushing responses and approximations to correct responses. No modelling occurred during hand-and-face washing sessions. As a result of several exposures to the model's performance, levels of response-contingent praise provided by four of the five counsellors during toothbrushing sessions increased sharply over baseline. The levels of counsellor praise showed parallel increases during hand-and-face washing sessions. A two-week followup showed that the levels of praise obtained through modelling were maintained in the model's absence.     

Hoarding in a compulsive buying sample

Previous research has indicated that many compulsive buyers also suffer from compulsive hoarding. The present work specifically examined hoarding in a compulsive buying sample. Sixty-six treatment-seeking compulsive buyers were assessed prior to entering a group therapy for compulsive buying using the Compulsive Buying Scale (CBS), the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS)-Shopping Version, the Compulsive Acquisition Scale (CAS), the German-CBS, the Saving Inventory-Revised (SI-R), the Maudsley Obsessive Compulsive Inventory (MOCI), the Barratt Impulsiveness Scale (BIS-11), and the Structured Clinical Interview for DSM-IV Axis I (SCID). Inclusion criteria were current problems with compulsive buying according to the proposed diagnostic criteria for compulsive buying by McElroy, Keck, Pope, Smith, and Strakowski [(1994). Compulsive buying: A report of 20 cases. Journal of Clinical Psychiatry, 55, 242-248]. Our results support the assumption that many but not all compulsive buyers suffer from compulsive hoarding. A significant association between the SI-R and the compulsive buying measures CBS, Y-BOCS-SV, German-CBS, and the CAS-Buy subscale was found, which is mostly caused by the SI-R subscale acquisition. The SI-R subscales clutter and difficulty discarding were more closely associated with the CAS-Free subscale and with obsessive-compulsive symptoms. Hoarding compulsive buyers reported more severe buying symptoms and obsessive-compulsive symptoms and presented with a higher psychiatric co-morbidity, especially any current affective, anxiety and eating disorder. Specific therapeutic interventions for compulsive buyers who also report compulsive hoarding appear indicated.     

Relationship of Maudsley Obsessional-Compulsive Inventory Subscales with Negative Priming

The relationship between the 4 subscales (Checking, Cleaning, Doubting, Slowness) and total score of the Maudsley Obsessional-Compulsive Inventory (MOCI) and performance in a negative-priming task and a response-speed task in 102 undergraduates was examined. Only Cleaning subscale performance correlated with magnitude of negative priming. Performance on the Checking, Slowing, and Doubting subscales was not significantly related to the magnitude of negative priming. The not significant correlation between Checking score and negative priming magnitude supports the findings of Maki, O'Neill, and O'Neill (1994), who observed that compulsive checking (of, e.g., whether the stove is turned off) appeared to be unrelated to deficiencies in inhibitory control. The present results are not, however, consistent with the view that obsessive-compulsive characteristics (as measured by the MOCI) result in a disruption in and a reduction of inhibitory control (Enright & Beech, 1993).     

When to Change the Treatment Plan: An Analysis of Diminishing Returns in VA Patients Undergoing Prolonged Exposure and Cognitive Processing Therapy

Evidence-based treatments for posttraumatic stress disorder (PTSD) often produce significant symptom reduction within eight sessions. However, some patients take longer to respond and a better understanding of predictors of later response can help guide treatment. In the current study, the cohort consisted of all VA patients with a PTSD diagnosis who received at least eight sessions of documented evidence-based treatment within a 6-month period in FY16-FY17 and had at least two PTSD symptom assessments. We examined the proportion of patients who achieved meaningful change (defined as at least 50% reduction in self-reported PTSD symptoms), both within the first eight sessions and subsequently. Fourteen percent of patients achieved meaningful change within eight sessions and 10% subsequently. Symptom change within the first eight sessions was highly predictive of subsequent change. Those who experienced at least 20% symptom reduction by session eight were twice as likely to subsequently achieve meaningful change as compared with all patients who continued treatment. Patients receiving service-connected disability compensation were less likely and White patients more likely to achieve meaningful change. Without some degree of symptom reduction by session eight, patients are unlikely to achieve meaningful change if treatment is not enhanced or changed.     

Factor Analysis of Scales Composed of Binary Items: Illustration with the Maudsley Obsessional Compulsive Inventory

It is well known that traditional factor analytic methods are designed for use with continuous data, and suboptimal for items with 2 response options (i.e., binary items). Nevertheless, traditional methods have been employed in all previous assessment of the dimensionality of the Maudsley Obsessional Compulsive Inventory (MOCI), a true/false measure of obsessive–compulsive symptoms ( R. J. Hodgson &; S. Rachman, 1977). The aim of this paper is to illustrate 2 techniques that are more suitable for factor-analyzing binary items than traditional methods, through application to the MOCI (n = 1,080). Computer files for use with the TESTFACT (D. Wilson, R. L. Wood, &; R. Gibbons, 1991 ) and Mplus (Muthén &; Muthén, 1998) computer programs are provided. Results from an inappropriately applied principal axis factor analysis are presented for comparison, and factor structures, loadings, and interfactor correlations are compared across methods.