Dimensionality of the Obsessive Beliefs Questionnaire (OBQ)

The Obsessive Beliefs Questionnaire (OBQ) is a self-report measure in development by the Obsessive Compulsive Cognitions Working Group (OCCWG), who studies cognitive aspects of obsessive–compulsive disorder (OCD). The aim of this paper was to evaluate the dimensionality of the OBQ in students (n = 995). Two models were tested in a confirmatory framework, corresponding to the OCCWG's (a) original six subscales (87 items), and (b) more recent three subscales (44 items). Both models fit the present data poorly; thus, an exploratory analysis was undertaken. Results revealed one large factor that is relevant, but not unique, to OCD, and three factors that are conceptually consistent with the OCCWG's recent three: (a) distorted beliefs about one's own thoughts, (b) perfectionism, and (c) inflated responsibility. Convergent and divergent validity analyses of the present OBQ factors generally supported the preceding interpretations. Readers are referred to the work of the OCCWG for revisions to the OBQ.     

Psychiatric Diagnosis as a Function of Assessor Profession and Sex

Diagnostic impressions formed by 26 clinicians after intake interviews with 200 randomly assigned outpatients at a community mental health center were analyzed by assessor discipline and sex and by patient sex and age level. Professional status was positively related to diagnostic severity among male assessors—nurses, social workers, psychologists, and psychiatrists made increasingly higher proportions of psychotic diagnoses. Female therapists were less likely than their male counterparts to render psychotic diagnoses. This finding was most robust for doctoral interviewers, especially psychologists, and for patients who were female or under 30. Results are discussed in relation to the need for a model of the diagnostic process that allows for the role of practitioner attributes. Previous largely negative findings may have had their source in the failure of contrived analogue procedures to evoke emotions in the rater comparable in intensity to those aroused in the real-life encounter.     

The Disgust Scale: item analysis, factor structure, and suggestions for refinement

In the 4 studies presented (N = 1,939), a converging set of analyses was conducted to evaluate the item adequacy, factor structure, reliability, and validity of the Disgust Scale (DS; J. Haidt, C. McCauley, & P. Rozin, 1994). The results suggest that 7 items (i.e., Items 2, 7, 8, 21, 23, 24, and 25) should be considered for removal from the DS. Secondary to removing the items, exploratory and confirmatory factor analyses revealed that the DS taps 3 dimensions of disgust: Core Disgust, Animal Reminder Disgust, and Contamination-Based Disgust. Women scored higher than men on the 3 disgust dimensions. Structural modeling provided support for the specificity of the 3-factor model, as Core Disgust and Contamination-Based Disgust were significantly predictive of obsessive- compulsive disorder (OCD) concerns, whereas Animal Reminder Disgust was not. Results from a clinical sample indicated that patients with OCD washing concerns scored significantly higher than patients with OCD without washing concerns on both Core Disgust and Contamination-Based Disgust, but not on Animal Reminder Disgust. These findings are discussed in the context of the refinement of the DS to promote a more psychometrically sound assessment of disgust sensitivity.     

The Cruelest Cure? Ethical Issues in the Implementation of Exposure-Based Treatments

Numerous studies have provided supportive evidence for the efficacy of exposure-based treatments for many psychological disorders. However, surprisingly few therapists use exposure therapy in the clinical setting. Although the limited use of exposure-based treatments may be partially attributable to a shortage of suitably trained therapists, exposure therapy also suffers from a “public relations problem” predicated upon concerns that it is cruel and at odds with some ethical considerations (e.g., first do no harm). This article provides an overview of ethical issues and considerations relevant to the use of exposure therapy. It is argued that the degree to which ethical issues become problematic in implementing exposure-based treatments is largely dependent upon the therapist's ability to create an adequately safe and professional context. Specific strategies that may be employed for avoiding potential ethical conflicts in the use of exposure-based treatments are discussed.     

Special series Subtypes of obsessive-compulsive disorder: Introduction

An accumulating body of research suggests that obsessive-compulsive disorder (OCD) is a heterogeneous condition, yet there is not yet a consensus on how best to conceptualize subtypes or dimensions of the disorder. This special series considers theoretical and practical issues pertaining to OCD subtypes. New possibilities for conceptualizing differences among OCD patients are considered, and avenues for treating different presentations of obsessions and compulsions are discussed. Treatment programs continue to be refined and outcome studies continue to demonstrate that tailoring cognitive-behavioral treatment toward specific presentations of OCD (e.g., contamination fears, severe obsessions) represents the future of OCD treatment. The articles in this special series are intended to further efforts to consider ways of better understanding the heterogeneity of OCD.     

The Impact of an Intensive Consciousness-Raising Curriculum on Adolescent Women

The impact of a consciousness-raising module offered in 50-minute class periods over 20 consecutive school days to junior and senior high school women was evaluated. Experimental and control groups were constituted randomly from a pool of volunteers. Subjects completed the attitudes toward women scale, the personal orientation inventory, and the Tennessee self-concept scale before and after the consciousness-raising experience. Results indicated that women who participated became more liberal in their beliefs about women's rights and roles and also showed increases along several dimensions of self-actualization. However, such gains did not radiate to self-concept.     

Thought control strategies in obsessive-compulsive disorder: a replication and extension

Previous research suggests that individuals with OCD use maladaptive strategies to control their unpleasant thoughts (Behav Res Ther (1977) 35, 775). These include worry and self-punishment strategies. In the present study we replicated and extended the previous findings by comparing thought control strategies used by patients with OCD to strategies used by anxious and non-anxious control participants. We also examined changes in thought control strategies for OCD patients who underwent cognitive-behavioral therapy. Compared to controls, OCD patients reported more frequent use of worry and punishment strategies, and less frequent use of distraction. Following successful treatment, OCD patients evidenced increased use of distraction and decreased use of punishment. Findings are discussed in terms of the cognitive model of OCD.     

Sudden Gains: How Important Are They During Exposure and Response Prevention for Obsessive-Compulsive Disorder?

Symptom reduction over the course of cognitive-behavioral therapy is not always distributed evenly across sessions. Some individuals experience a sudden gain, defined as a large, rapid, and stable decrease in symptoms during treatment. Although research documents a link between sudden gains and treatment for depression and anxiety, findings in the context of obsessive-compulsive disorder (OCD) treatment are mixed. The present study investigated the relationship between sudden gains and treatment outcome in 44 adults with OCD and addressed limitations of previous studies by measuring OCD symptoms dimensionally and comparing individuals who experience sudden gains to those who experience gradual gains of similar magnitude. Sudden gains were observed among 27% of participants, with highest rates among individuals with primary contamination symptoms. Participants who experienced a sudden gain had greater OCD symptom reductions at posttreatment (but not at follow-up), and this difference did not persist after controlling for gain magnitude. Thus, the importance of sudden gains during OCD treatment may be limited. Findings are discussed in light of inhibitory learning models of cognitive-behavioral therapy.