Predictors of treatment outcome for youth receiving intensive residential treatment for obsessive–compulsive disorder (OCD)

ABSTRACT

Little is known about the predictors of outcome from intensive residential treatment of OCD. This study aimed to examine age, gender, and baseline OCD severity, as well as measures of comorbid anxiety and depressive, internalizing/externalizing, and inattention symptoms, as predictors of treatment outcome in adolescents receiving intensive residential treatment for OCD.

The sample comprised 314 adolescents aged 13–17 years with treatment-resistant OCD and a Children’s Yale–Brown Obsessive–Compulsive Scale Self-Report (CY-BOCS-SR) total score ≥16. Bivariate and multiple regression models were used to evaluate the predictors of continuous OCD severity outcome and treatment response.

Results of the bivariate regression analyses of predictors demonstrated that length of treatment, pre-treatment OCD severity, and symptoms of anxiety and depression significantly predicted post-treatment OCD severity, while only symptoms of depression and anxiety predicted treatment response. When including all predictors in the same model, only baseline OCD severity remained a significant predictor of post-treatment OCD severity, and none of the assessed variables significantly predicted treatment response.

Results indicate that low pre-treatment OCD severity predicts lower OCD severity following treatment, although it did not predict treatment response.     

PRIVATE THEORIES AND PSYCHOTHERAPEUTIC TECHNIQUE

That if real success is to attend the effort to bring a man to a definite position, one must first of all take pains to find him where he is and begin there. This is the secret of the art of helping others (Kierkegaard [] 1962, p.?27)

The aim of this study is to explore the importance, to the therapeutic process, of the relation between the patient's and the therapist's problem formulations and private theories of pathogenesis and cure. Four cases of young adults in psychoanalytic psychotherapy were compared, two with unequivocally positive and two with more ambiguous outcome at termination. The patients and therapists were interviewed about their private theories initially and at termination of therapy, and a qualitative comparison was made between the cases. In the two more successful cases the therapists had early in therapy perceived obstacles for the therapeutic work in the patients' ways of thinking, feeling, and relating, and made interpretative interventions focusing on these. This was not observed in the less successful cases. In the more successful cases the patient's and the therapist's private theories were more similar at termination than initially, whereas the opposite development was found in the less successful cases. One hypotheses generated is that the therapeutic process can be facilitated by a therapist listening to the patient's private theories, making interpretative interventions focusing on obstacles to the therapeutic work, including contradictions between their private theories, and monitoring the patient's reactions to these interventions.     

Exploring client contribution in a cognitive intervention for test anxiety

Aim: To study client contributions in cognitive therapy. Specifically, to study ways of making an intervention against test anxiety work, based on interviews with 32 test‐anxious university students. Method: Interviews after their first examination following the intervention were analysed using a thematic analysis. Results: Although most participants reacted positively to the intervention, concerns emerged that adopting positive self‐statements might be deceptive. Concerns about the untruthfulness of positive self‐statements led clients to generate several possible resolutions, namely, to examine flaws in negative self‐statements, to realise that there is more than one realistic way to construe things, to consider the evidence in the form of reduced anxiety, to consider manageable steps, and to seek interpersonal validation of positive self‐statements. Conclusions: The results offer concrete resolutions developed by clients that might be useful for other clients who have reservations about positive self‐statements.     

Between a suffering body and a body in a state of need: Aulagnier’s theory of discourses on the body applied to primitive mental states

ABSTRACT

In her theory of discourses on the body, Aulagnier makes the comparison of the concept of ‘a suffering body’ and the concept of ‘a body in a state of need’. The last type is what she thinks is often found in addiction, anorexia and in borderline states, conditions marked by a radical negativity. On the other hand, ‘a suffering body’ is a concept that indicates a relation and two bodies, mother’s and child’s, that communicate. Suffering and infantile sexuality is a first attempt to accept separation by weaving a net of fantasy over the abyss of lack and separation. If pleasure and suffering are lacking as representations, the sensory reactions may exist physiologically but without psychical existence. The concepts of ‘a suffering body’ and 'a body in a state of need' will enable us to think about important structural differences between neurotic-, borderline- and psychotic conditions. As a foundation for her concepts lies a metapsychological elaborations of three kinds of processes for representation: the primal-, the primary- and the secondary process.     

Friend or foe? Postdivorce hostility among recently divorced individuals

High levels of hostility often occur during and postdivorce and may significantly affect the quality of life, parent–child relationships, and social functioning of divorcees. Moreover, hostility may predict aggressive and violent behavior. This study sought to (a) compare average general hostility levels of a large sample of Danish divorcees to the norms of the general adult Danish population, (b) compare general hostility levels between male and female divorcees, and (c) investigate the explanatory value of various sociodemographic and divorce-related factors on postdivorce general hostility and whether these factors differ across gender. Cross-sectional baseline data (N = 1,856) from a larger randomized controlled trial study was used in this study. Normative data from a general sample of Danish adults (N = 2,040) was used for comparisons of hostility levels between our study sample and the Danish background population. This study found that male and female divorcees did not report significantly different hostility levels. However, participants reported significantly higher hostility levels postdivorce than the comparative Danish norm sample. Significant predictors of postdivorce hostility were lower age, lower educational level, infidelity as a reason for divorce, higher degree of postdivorce conflict, worse communication with the former spouse, the former spouse as the initiator of the divorce, and new partner status with neither divorcees having a new partner, or only the former spouse having a new partner. The predictive strength of the factors did not differ across gender. The findings may be especially relevant for interventions targeting problematic outcomes postdivorce (e.g., preventing aggressive behavior).