Obsessive-compulsive disorder subtypes: an attempted replication and extension of a symptom-based taxonomy

A symptom-based subgroup taxonomy for obsessive-compulsive disorder (OCD) was evaluated and refined. The Yale-Brown Obsessive-Compulsive Scale symptom checklist was scored and cluster analysis was conducted with a sample of OCD patients (N = 114). Results were compared to Calamari et al.'s (Behaviour Research and Therapy 37 (1999) 113) five subgroup model. Rules for determining the number of subgroups supported a more complex model. In between sample comparisons, a stable contamination subgroup was found in both a five and seven subgroup taxonomy. Between sample stability was not as strong for Harming, Obsessionals, Symmetry, and Certainty subgroups. Hoarding, as a distinctive subgroup, was unstable in separate samples. When the Calamari et al. sample and the present sample were combined (N = 220), we found a reliable Hoarding subgroup. More interpretable and stable models emerged with the combined samples suggesting that large clinical samples are needed to identify OCD subgroups. Greater support was found for a seven subgroup taxonomy based subgroup interpretability and validation measure differences. The potential utility of symptom-based subgroup models of OCD and alternative approaches are discussed. Identification of reliable and valid OCD subtypes may advance theory and treatment.     

The communicative functions of touch in humans, nonhuman primates, and rats: a review and synthesis of the empirical research

Although touch is one of the most neglected modalities of communication, several lines of research bear on the important communicative functions served by the modality. The authors highlighted the importance of touch by reviewing and synthesizing the literatures pertaining to the communicative functions served by touch among humans, nonhuman primates, and rats. In humans, the authors focused on the role that touch plays in emotional communication, attachment, bonding, compliance, power, intimacy, hedonics, and liking. In nonhuman primates, the authors examined the relations among touch and status, stress, reconciliation, sexual relations, and attachment. In rats, the authors focused on the role that touch plays in emotion, learning and memory, novelty seeking, stress, and attachment. The authors also highlighted the potential phylogenetic and ontogenetic continuities and discussed suggestions for future research.     

A test of psychotherapists' and nontherapists' recognition of correct and incorrect process in managing client resistance

Objective

Psychotherapist management of client resistance (i.e., opposition to change or the therapy process) has a significant impact on therapy outcomes. This study aimed at assessing psychotherapists' and nontherapists' abilities to recognise empirically supported correct and erroneous therapist responses to client resistance.

Method

Seventy-eight therapists and 111 nontherapists completed a rapidly administered novel skills test, Therapist Errors in Resistance Management (TERM), assessing recognition of correct and erroneous resistance management.

Results

Participants were, on average, less than half as accurate at recognising therapist errors (recognised below chance levels) compared with correct therapist responses to resistance (recognised above chance levels). Therapists outperformed nontherapists in accurate recognition of therapist responding. However, among the therapist group, greater clinical experience did not predict superior recognition of therapist errors.

Conclusion

These results indicate that therapists and nontherapists alike may have difficulty detecting erroneous therapist responses to resistance, tending to mistake empirically contraindicated directive responses for correct responding. This may reflect the difficult and unintuitive nature of correct resistance responding and may suggest a need for increased training in process acuity and resistance management in therapist education.     

The impact of conventional versus robust norming on cognitive characterization and clinical classification of MCI and dementia

We examined the impact of conventional versus robust normative approaches on cognitive characterization and clinical classification of MCI versus dementia. The sample included participants from the National Alzheimer's Coordinating Center Uniform Data Set. Separate demographically adjusted z-scores for cognitive tests were derived from conventional (n = 4273) and robust (n = 602) normative groups. To assess the impact of deriving scores from a conventional versus robust normative group on cognitive characterization, we examined likelihood of having a low score on each neuropsychological test. Next, we created receiver operating characteristic (ROC) curves for the ability of normed scores derived from each normative group to differentiate between MCI (n = 3570) and dementia (n = 1564). We examined the impact of choice of normative group on classification accuracy by comparing sensitivity and specificity values and areas under the curves (AUC). Compared with using a conventional normative group, using a robust normative group resulted in a higher likelihood of low cognitive scores for individuals classified with MCI and dementia. Comparison of the classification accuracy for distinguishing MCI from dementia did not suggest a statistically significant advantage for either normative approach (Z = −0.29, p = .77; AUC = 0.86 for conventional and AUC = 0.86 for robust). In summary, these results indicate that using a robust normative group increases the likelihood of characterizing cognitive performance as low. However, there is not a clear advantage of using a robust over a conventional normative group when differentiating between MCI and dementia.     

How Parents Still Help Emerging Adults Get Their Homework Done: The Role of Self-Regulation as a Mediator in the Relation Between Parent–Child Relationship Quality and School Engagement

Although parents are increasingly involved in their college students’ academic lives, scholars have yet to investigate parents’ role in their college students’ school engagement. We hypothesized that college students’ self-regulation would mediate the relation between parent–child relationship quality and school engagement. For the 790 undergraduates who completed questionnaires online, self-regulation mediated the relation between mother–child relationship quality and school engagement for men, and an indirect effect was found for the relation between father–child relationship quality and school engagement by way of self-regulation. Therefore, parents continue to matter in promoting their college students’ academic success.     

Evaluating the Utility of MFT Models in the Treatment of Trauma: Implications for Affect Regulation

The purpose of this paper is to discuss polyvagal theory as a theoretical foundation for helping clinicians more effectively treat clients who have experienced major trauma. More specifically, we emphasize that through the use of both modern and post-modern models, marriage and family therapists may use emotion regulation strategies to assist clients in overcoming the negative repercussions of traumatic events. We suggest that the nature of emotional arousal which accompanies trauma alters the physical process by which the body regulates future affective stimuli in ways that are potentially detrimental to human relationships. We then offer a discussion of how a selection of MFT models contain strategies that promote reconnection to self and others that should be utilized with greater precision, ultimately to target the physiological symptoms of trauma-altered emotion regulation processes. Finally, we discuss the need for more specific, process-oriented research that integrates cross-disciplinary theory to contribute to a more intricate and useful understanding of the treatment of trauma in the relational context.     

Effects of delay fading and signals on self‐control choices by children

The current study is a systematic replication and extension of work by Schweitzer & Sulzer‐Azaroff (1988). The effects of delay fading alone and in combination with signals on choices between larger, delayed reinforcers and smaller, immediate reinforcers by four children with language deficits were examined. For one of the two children exposed to delay fading alone, larger reinforcers were selected at longer delays relative to the initial self‐control assessment. For all four children, the delay‐fading‐plus‐signal condition resulted in selection of larger reinforcers at considerably longer delays relative to the self‐control assessment.     

Examining Self-Concealment within the Framework of Psychological Inflexibility and Mindfulness: A Preliminary Cross-Sectional Investigation

Although self-concealment has been a central topic in the field of personality and applied psychologies, it remains somewhat unclear how it should be conceptualized. The present study investigated self-concealment within the framework of psychological inflexibility and mindfulness, two major emotion/behavior regulation processes integrated into contemporary cognitive behavioral models of behavioral health. One-thousand sixty college undergraduates (77 % female; n = 816) completed a web-based survey that included the measures of interest. Results revealed that psychological inflexibility was positively and uniquely associated with self-concealment. The association between mindfulness and self-concealment was moderated by gender; higher levels of self-concealment predicted lower levels of mindfulness for women only and were associated with sexual-minority men, but self-concealment did not vary for women as a function of sexual orientation status. Additional results and future directions are also discussed.     

Why Is Cancer Genetic Counseling Underutilized by Women Identified as at Risk for Hereditary Breast Cancer? Patient Perceptions of Barriers Following a Referral Letter

Family history information comprises an important tool in identifying and referring patients at risk for hereditary breast and ovarian cancer (HBOC) to cancer genetic counseling. Despite recommendations and support provided by numerous professional organizations, cancer genetic counseling services are underutilized by atrisk patients. This study aimed to: (1) determine the rate of genetic counseling utilization following a referral letter, (2) characterize factors (barriers and supports) which influenced uptake of services, and (3) identify potential strategies for increasing utilization. This study evaluated the uptake of cancer genetic counseling among 603 screening mammography patients identified as having an increased risk for HBOC based on National Comprehensive Cancer Network (NCCN) guidelines. At risk individuals and their primary care providers were mailed a referral letter recommending genetic counseling. Three focus groups (N = 24) were conducted to identify responses to receiving a letter recommending genetic counseling, barriers to seeking genetic counseling, and facilitating factors to utilizing these services. Participant responses were qualitatively analyzed using thematic and cross case analysis. Within one year, 50/603 (8 %) of the identified at-risk women completed a genetic counseling appointment. Participant-perceived barriers which influenced their decision not to seek genetic counseling included lack of relevance and utility, limited knowledge about genetic counseling, concerns about the genetic counseling process, and concerns about cost and insurance coverage. Participant-perceived facilitating factors which would support a decision to seek genetic counseling included greater awareness and education about genetic counseling services when receiving a referral, and improved follow up and guidance from their provider. Findings from this study support the need for patient and primary care provider education, and improved provider-patient communication to increase uptake of genetic counseling services.     

Using Visual Journaling in Individual Counseling: A Case Example

The purpose of this article is to describe and illustrate through a hypothetical case example how visual journaling, a form of expressive arts counseling, can be adapted for use in individual counseling. Counselors may consider using visual journaling as a counseling intervention when working with clients who may not have words for what they are feeling or experiencing, and for clients who tend to be very analytical. Visual journaling can be a way to bypass the intellect and give clients another way to access their experience.