Cognitive-behavioral treatment of childhood obsessive-compulsive disorder in community-based clinical practice: clinical significance and benchmarking against efficacy

Objective

To evaluate the feasibility and outcomes of evidence-based (EB) manualized, cognitive-behavioral treatment (CBT) for childhood obsessive-compulsive disorder (OCD), when delivered in an outpatient community-based specialist clinic.

Method

This study, conducted in an outpatient private clinic in South-East Queensland Australia, involved thirty-three children and adolescents with OCD. Children were assessed at pre- and post-treatment, by means of diagnostic interviews, symptom severity interviews, and self-report. Treatment involved 12 sessions CBT delivered either individually or in small groups and included parental involvement.

Results

Manualized CBT could be transported to the community setting effectively, with 63% of the current sample responding positively, based on post-treatment diagnosis. Significant change was evident across a wide-range of outcomes; including, diagnostic severity, symptom severity, child reported depression and anxiety, and both child and parent reported OCD functional impairment.

Conclusions

This study provides evidence for the transportability of manualized CBT in clinical community practice for pediatric OCD. The next important step is larger community based dissemination and effectiveness studies to advance both research and clinical practice outcomes.     

Facial asymmetry detection in patients with body dysmorphic disorder

Cognitive-behavioral models of body dysmorphic disorder (BDD) propose that individuals with BDD may possess a better or more developed sense of aestheticality than do individuals without BDD. Evidence for this proposition, however, is limited. One perceptual process that could contribute to heightened aestheticality is the ability to detect differences in symmetry. In this experiment we tested whether individuals with BDD (n = 20), relative to individuals with obsessive compulsive disorder (OCD; n = 20) and healthy controls (n = 20), show an enhanced ability to detect differences in the symmetry of others’ faces, symmetry of dot arrays, and/or show a greater preference for symmetrical faces. Individuals with BDD were not significantly more accurate in detecting differences in facial symmetry or dot arrays relative to individuals with OCD and healthy controls. Individuals with OCD took longer to make facial symmetry judgments than did individuals in the other two groups. All participants, regardless of diagnostic group, preferred more symmetrical faces than nonsymmetrical ones. Taken together, our results do not support a heightened perceptual ability or evaluative preference for symmetry among individuals with BDD.     

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.     

An investigation of differential reinforcement of alternative behavior without extinction

We manipulated relative reinforcement for problem behavior and appropriate behavior using differential reinforcement of alternative behavior (DRA) without an extinction component. Seven children with developmental disabilities participated. We manipulated duration (Experiment 1), quality (Experiment 2), delay (Experiment 3), or a combination of each (Experiment 4), such that reinforcement favored appropriate behavior rather than problem behavior even though problem behavior still produced reinforcement. Results of Experiments 1 to 3 showed that behavior was often sensitive to manipulations of duration, quality, and delay in isolation, but the largest and most consistent behavior change was observed when several dimensions of reinforcement were combined to favor appropriate behavior (Experiment 4). Results suggest strategies for reducing problem behavior and increasing appropriate behavior without extinction.     

Victimization and PTSD in a Faroese youth total-population sample

Petersen, T., Elklit, A. & Olesen, J. G. (2010). Victimization and PTSD in a Faroese youth total-population sample. Scandinavian Journal of Psychology, 51, 56–62.
The prevalence of twenty traumatic events and negative life events in relation to posttraumatic stress disorder (PTSD) was studied in a Faroese total-population sample of 687 eighth-grade students with a mean age of 14.2 years. Ninety-four percent of the females and 89% of the males were directly exposed to or had witnessed at least one traumatic event or a negative life event. The odds ratios for PTSD after direct and indirect exposure to specific events are described. The lifetime prevalence of PTSD was 20%, whereas another 14% reached a subclinical level of PTSD. After exposure, females had PTSD more than twice as often as males. Being exposed to multiple traumatic events, living with a single parent, and having experienced a traumatic event or a negative life event within the last year were all associated with PTSD and its subscales.     

A Norwegian version of the Obsessive‐Compulsive Inventory–Revised: Psychometric properties

Solem, S., Hjemdal, O., Vogel, P.A. & Stiles, T.C. (2010). A Norwegian version of the Obsessive‐Compulsive Inventory–Revised: Psychometric properties. Scandinavian Journal of Psychology 51, 509–516. The aims of this study were to test the psychometric properties of the Norwegian version of the Obsessive‐Compulsive Inventory–Revised (OCI‐R). The study included a student/community control sample (N = 1167) and a clinical sample (N = 72) with a diagnosis of obsessive‐compulsive disorder (OCD). The results indicated a good fit for the six‐factor structure of the OCI‐R. The mean scores and standard deviations were similar to that of studies from other countries as was the internal consistency. The OCI‐R scores were significantly higher in the OCD sample compared to the control sample. All the subscales, except hoarding, were significant predictors of obsessive‐compulsive severity, and the OCI‐R subscales seemed to be in agreement with the different subtypes of OCD according to DSM‐IV. The OCI‐R showed meaningful correlations with measures related to obsessive compulsive symptoms. As expected, it showed the strongest correlation with the Yale‐Brown Obsessive Compulsive Scale, followed by measures of worry, anxiety, and depression. In summary, the Norwegian OCI‐R showed adequate psychometric properties suggesting it could be a suitable measure of obsessive‐compulsive symptoms.     

Narrative exposure therapy for posttraumatic stress disorder in tortured refugees: A preliminary uncontrolled trial

Halvorsen, J.Ø. & Stenmark, H. (2010). Narrative exposure therapy for posttraumatic stress disorder in tortured refugees: A preliminary uncontrolled trial. Scandinavian Journal of Psychology 51, 495–502. Torture has severe mental health effects, especially in terms of posttraumatic stress disorder (PTSD) and depression. However, there is still a lack of empirical treatment studies. The present paper presents data on 16 torture survivors receiving 10 sessions of narrative exposure therapy (NET). Symptoms of PTSD and depression, assessed by Clinician‐Administered PTSD Scale (CAPS) and Hamilton Rating Scale for Depression (HRSD), decreased significantly from pre‐treatment to 6‐month follow‐up, with Cohen’s d effect sizes of 1.16 and 0.84, respectively. Although treatment gains were moderate, further research on evidence‐based treatments for PTSD and depression in refugee torture survivors is warranted.     

Terminated Seed: Death,Proprietary Kinship and the Production of (Bio)Wealth

What is mental disorder and how can it be identified? These are complex and multifaceted questions, given the multiple ambiguities that centre on the psychopathological concepts employed within contemporary psychiatry and psychology. Yet, scientists investigating mental disorders must successfully resolve these uncertainties if research is to continue. For neuroscientists studying the contested conditions antisocial personality disorder and psychopathy, psychiatric and psychological classifications and concepts are used to substantiate one another. This co-produces epistemological and ontological un/certainties, without wholly resolving philosophical and methodological questions regarding what mental disorders are and how they can be recognised. Indeed, these ambiguities are rendered (relatively) unimportant. This kind of practical uncertainty work is thus an important aspect of the investigative process, performing an essential role in the continuation of scientific knowledge production, the legitimation of professional orientations, and the validation of psychopathological concepts.     

A cross-modal weapon focus effect: The influence of a weapon's presence on memory for auditory information

To examine whether a weapon's presence impairs witnesses' memory for auditory information (as it impairs memory for visual information), we conducted two experiments in which undergraduates watched one version of a videotape depicting a male target who held either a weapon or a neutral object and conversed with a female character. The semantic content of his remarks was either easy or difficult to comprehend. The weapon's presence did not affect voice identification accuracy or memory for the target's vocal characteristics (e.g., pitch, loudness, speech rate) but did worsen memory for semantic content in the Difficult Comprehension condition. Our results can be explained by multiple resource models of attention, which propose separate resource “pools” for different sensory modalities.     

The mental representation of living and nonliving things: Differential weighting and interactivity of sensorial and non-sensorial features

Warrington and colleagues (Warrington & McCarthy, 1983, 1987; Warrington & Shallice, 1984) claimed that sensorial and functional-associative (FA) features are differentially important in determining the meaning of living things (LT) and nonliving things (NLT). The first aim of the present study was to evaluate this hypothesis through two different access tasks: feature generation (Experiment 1) and cued recall (Experiment 2). The results of both experiments provided consistent empirical support for Warrington and colleagues' assumption. The second aim of the present study was to test a new differential interactivity hypothesis that combines Warrington and colleagues' assumption with the notion of a higher number of intercorrelations and hence of a stronger connectivity between sensorial and non-sensorial features for LTs than for NLTs. This hypothesis was motivated by previous reports of an uncrossed interaction between domain (LTs vs NLTs) and attribute type (sensorial vs FA) in, for example, a feature verification task (Laws, Humber, Ramsey, & McCarthy, 1995): while FA attributes are verified faster than sensorial attributes for NLTs, no difference is observed for LTs. We replicated and generalised this finding using several feature verification tasks on both written words and pictures (Experiment 3), including in conditions aimed at minimising the intervention of priming biases and strategic or mnemonic processes (Experiment 4). The whole set of results suggests that both privileged relations between features and categories, and the differential importance of intercorrelations between features as a function of category, modulate access to semantic features.