Ethical Considerations in the Treatment of Compulsive Hoarding

Although empirically supported treatment for compulsive hoarding is in its preliminary stages, some information has emerged regarding ethical challenges experienced in treating this population. Our aims are twofold: (a) to inform the clinical community of ethical complications when conducting treatment for hoarding clients, and (b) to provide a decision-making model for ensuring quality and ethical care of hoarding clients. The ethical challenges (boundary crossings, dual roles, privacy/confidentiality, record keeping, fees, and cultural competence in treatment) were discovered through multiple roundtable discussions, supervision, and in the course of delivering empirically supported treatment protocols. A literature search was conducted to identify research that addressed ethical concerns. A decision-making model addressing ethical challenges in treatment of compulsive hoarding was developed.     

James Marsh,Process, Praxis,and Transcendence

Continental Philosophy Review -     

Patient utilization of cognitive-behavioral therapy for OCD

The current study examined utilization of cognitive-behavioral therapy (CBT) by individuals receiving treatment for obsessive-compulsive disorder (OCD). Participants were 202 adults with primary DSM-IV OCD who enrolled in a longitudinal, observational study of the course of OCD and completed 2 years of annual follow-up interviews using the Longitudinal Interval Follow-Up Evaluation. One hundred twenty participants reported that a mental health professional recommended CBT for their OCD symptoms at some point during the 2-year follow-up period. One quarter (n = 31) of these participants did not initiate CBT despite receiving a treatment recommendation. Thirty-one percent of the 89 participants who entered CBT endorsed dropping out of CBT prematurely and less than one third received an adequate “dose” of CBT sessions. Self-reported CBT drop-out rates were significantly greater than attrition rates reported in clinical trials using intensive schedules of exposure and ritual prevention (EX/RP). Perceived environmental barriers and fears regarding treatment participation were the most frequently endorsed reasons for not participating or dropping out of CBT. Despite its efficacy for OCD, many individuals with clinically significant symptoms fail to initiate CBT when recommended by a mental health professional, receive treatments that are less intensive than those used in clinical trials, or drop out of treatment prematurely. Financial costs of CBT, difficulty attending sessions, and fears regarding treatment are significant barriers to initiating and completing therapy.     

Attention and memory cues in concept learning as a function of task complexity and age

The effects of attention and memory cues on concept learning performance were investigated as a function of task complexity and grade level of Ss. It was found that: (1) the attention and memory cues were closely interrelated in their effects upon performance with both significantly improving performance at all but the lowest levels of complexity; (2) both types of cues considerably lessened the effect of stimulus complexity upon performance; and (3) the attention cue elicited the best performance from Ss in the first through ninth grades, while the memory cue elicited the best performance from 4-year-old and kindergarten Ss.     

Reasonability,normativity, and the cosmopolitan imagination: Arendt,Korsgaard, and Rawls

In this essay I consider the normative implications of the notion of reasonability for the construction of an idea of public reason that is cosmopolitan in scope. First, I consider the argument for the distinction between reason and reasonability in the work of Sibley and Rawls. Second, I evaluate the normative implications of reasonability through a consideration of Korsgaard's recent work. Third, I argue for a notion of reasonability that moves us beyond a Kantian concept of autonomy through a consideration of the relationship between reasonability and judgment vis-à-vis Arendt's work on Kant's Third Critique. Finally, I argue for a cosmopolitan appropriation of the notion of reasonability based on Kant's notion of the aesthetic idea. The latter argument relaxes the bonds of public reason, moving us beyond the domain of ethnocentricism.     

Neurosurgical approaches to intractable obsessive-compulsive disorder

Although significant progress has been made over the last decade in the treatment of obsessive-compulsive disorder (OCD), approximately 20% of OCD patients remain refractory to nonsurgical therapies, including pharmacologic and cognitive-behavioral therapy. Because a number of neural circuits involving the basal ganglia, thalamus, limbic system, and frontal lobes have been implicated in the pathophysiology of OCD, the need for an effective intervention in these patients has brought the focus on surgical approaches, including cingulotomy and capsulotomy procedures. Unlike free-hand surgical approaches used in the past, current neurosurgical interventions have been greatly enhanced by advances in technology, which allow lesioning to an accuracy of 1 mm. Today's neurosurgical approaches have shown significant benefit in as many as 60% of refractory patients, while preserving personality and cognitive functioning and limiting morbidity. A study of gamma knife capsulotomy conducted at Brown University School of Medicine showed that 40% of patients undergoing two lesioning procedures were much or very much improved 2 years postsurgery. The inherent obstacles to conducting placebo-controlled studies in these severely ill patients mean that further study is required to identify optimal candidates for surgical intervention.