Acceptability,Feasibility, and Effectiveness of Internet-Based Cognitive-Behavioral Therapy for Obsessive-Compulsive Disorder in New York

Cognitive-behavioral therapy (CBT), consisting of exposure and response prevention (EX/RP), is both efficacious and preferred by patients with obsessive–compulsive disorder (OCD), yet few receive this treatment in practice. This study describes the implementation of an Internet-based CBT program (ICBT) developed in Sweden in individuals seeking OCD treatment in New York. After translating and adapting the Swedish ICBT for OCD, we conducted an open trial with 40 adults with OCD. Using the RE-AIM implementation science framework, we assessed the acceptability, feasibility, and effectiveness of ICBT. The Yale–Brown Obsessive Compulsive Scale (Y-BOCS) was the primary outcome measure. Of 40 enrolled, 28 participants completed the 10-week ICBT. In the intent-to-treat sample (N = 40), Y-BOCS scores decreased significantly over time (F = 28.12, df = 2, 49, p < . 001). Depressive severity (F = 5.87, df = 2, 48, p < . 001), and quality of life (F = 12.34, df = 2, 48, p < . 001) also improved. Sensitivity analyses among treatment completers (N = 28) confirmed the intent-to-treat results, with a large effect size for Y-BOCS change (Cohen’s d = 1.38). ICBT took less time to implement than face-to face EX/RP and participants were very to mostly satisfied with ICBT. On a par with results in Sweden, the adapted ICBT program reduced OCD and depressive symptoms and improved quality of life among individuals with moderate to severe OCD. Given its acceptability and feasibility, ICBT deserves further study as a way to increase access to CBT for OCD in the United States.     

Solving the problem of creeping minimalism

Abstract

In this paper I discuss the so-called problem of creeping minimalism, the problem of distinguishing metaethical expressivism from its rivals once expressivists start accepting minimalist theories about truth, representation, belief, and similar concepts. I argue that Dreier’s ‘explanation’ explanation is almost correct, but by critically examining it we not only get a better solution, but also draw out some interesting results about expressivism and non-representationalist theories of meaning more generally.     

Extraversion and job performance: How context relevance and bandwidth specificity create a non-linear,positive, and asymptotic relationship

The personality factor of extraversion has been associated with performance in some occupations (e.g., sales), and it has been one of the most consistent personality predictors of leadership. Recent research indicates that extraversion could have a non-linear relation with performance. At the same time, many researchers have contended that scholars should utilize measures of personality narrower than factors and that the bandwidth and relevance of personality should fit both the criterion and the context of a study. We argue and find that by examining an aspect of extraversion (i.e., social potency) in a particular vocational context (i.e., enterprising job demands), non-linear, asymptotic (diminishing marginal benefits) effects will be demonstrated on a relevant type of performance (i.e., enterprising job performance). We review implications, limitations, and avenues for future research.     

Couple Identity Gaps,the Management of Conflict,and Biological and Self‐Reported Stress in Romantic Relationships

This study investigates the role of couple identity gaps in romantic partners' communicative and physiological management of stress during a conflict‐inducing discussion task. A total of 118 couples participated in a laboratory study in which they engaged in a conflict‐inducing discussion. Perceptions of intra‐ and extrarelationship couple identity gaps were associated with greater self‐reported anxiety and stress for men and greater negativity for women during the conversation. Extrarelationship identity gaps were also significantly associated with heightened cortisol and (salivary alpha‐amylase) sAA reactivity and delayed recovery, especially for women. The study extends the research on couple identity by introducing the concept of identity gaps into relational contexts to help explain why couples vary in their ability to manage stress.     

Untersuchungen zur Handlungs- und Affektpsychologie

Ohne Zusammenfassung     

Outcome of patients rehabilitated through a New Zealand forensic psychiatry service: A 7.5 year retrospective study

This paper describes a 7.5 year retrospective study of all patients discharged from inpatient forensic services to forensic community team (FCT) follow-up from the Auckland Regional Forensic Psychiatry Service. Patients' files were studied for clinical, criminal, and risk data, type of service delivered, and final level of function achieved in the community. Rearrest, re-hospitalization, and reimprisonment data were obtained from clinical, court, and prison records.105 patients were included. The most common diagnosis was a psychotic disorder, and index offending behaviour was typically violent. The median period of inpatient stay was 36 months and mean subsequent FCT follow-up 21.7 months (SD 17.8). The majority of patients were from Maori and Pacific Island ethnic groups. At the end of the study, half were in independent living, half were in some form of employment, and 19% were readmitted to a forensic hospital.One patient was rearrested but not reimprisoned whilst under forensic community team care. However, 9 of the 48 who were discharged to general mental health services were rearrested and 5 reimprisoned. Only two offences were as serious as the original index offence.Broad based assertive, mandated, and committed forensic rehabilitation can achieve high quality outcomes. These levels of function may not be sustained under less assertive care.     

Is belief reasoning automatic?

Understanding the operating characteristics of theory of mind is essential for understanding how beliefs, desires, and other mental states are inferred, and for understanding the role such inferences could play in other cognitive processes. We present the first investigation of the automaticity of belief reasoning. In an incidental false-belief task, adult subjects responded more slowly to unexpected questions concerning another person's belief about an object's location than to questions concerning the object's real location. Results in other conditions showed that responses to belief questions were not necessarily slower than responses to reality questions, as subjects showed no difference in response times to belief and reality questions when they were instructed to track the person's beliefs about the object's location. The results suggest that adults do not ascribe beliefs to agents automatically.     

Conditions under which children experience inhibitory difficulty with a "button-press" go/no-go task

Go/no-go tasks seem to provide a simple marker of inhibitory development in young children. Children are told to respond to one stimulus on go trials but to make no response to another stimulus on no-go trials; responding on no-go trials is assumed to reflect a failure to inhibit the go response. However, there is evidence to suggest that a type of go/no-go task, which we call the "button-press" task, does not require inhibition. We investigated the conditions under which young children (M=3 years 6 months, N=120) experience inhibitory difficulty with this type of task. The data suggest that the speed of stimulus presentation is crucial and that other studies using this type of task have presented the stimuli too briefly. The importance of establishing the inhibitory credentials of a task before it is used as a marker of inhibitory control is emphasized.     

Challenges using motivational interviewing as an adjunct to exposure therapy for obsessive-compulsive disorder

Exposure and response prevention (EX/RP) is an efficacious treatment for obsessive-compulsive disorder (OCD). However, patients often do not adhere fully to EX/RP procedures. Motivational interviewing (MI) has been shown to improve treatment adherence in other disorders. This pilot study used a randomized controlled design to examine whether MI can be successfully added to EX/RP and whether this intervention (EX/RP + MI) could improve patient adherence to between-session EX/RP procedures relative to EX/RP alone. Thirty adults with OCD were randomized to 18 sessions of EX/RP or EX/RP + MI. Therapists rated patient adherence at each exposure session. Independent evaluators assessed change in OCD and depressive symptoms, and patients completed self-report measures of readiness for change and quality of life. The two treatment conditions differed in degree of congruence with MI but not in conduct of EX/RP procedures. Both groups experienced clinically significant improvement in OCD symptoms, without significant group differences in patient adherence. There are several possible reasons why EX/RP + MI had no effect on patient adherence compared to standard EX/RP, each of which has important implications for the design of future MI studies in OCD. We recommend that MI be further evaluated in OCD by exploring alternative modes of delivery and by focusing on patients less ready for change than the current sample.