Do obsessional beliefs discriminate OCD without tic patients from OCD with tic and Tourette's syndrome patients?

There is considerable overlap in symptomatology between Tourette's syndrome (TS) and obsessive-compulsive disorder (OCD). Increased rates of tics are found in OCD and up to 60% obsessive-compulsive symptoms in TS. However, in OCD obsessive-compulsive symptoms are more often anxiety-related and, as a consequence, aimed at anxiety-reduction, whereas in TS these symptoms are more stimulus-bound. Therefore, it is of clinical interest to study whether these phenomenological differences are reflected in differences between dysfunctional cognitions accompanying OC symptoms in OCD with or without tics and TS. Current cognitive theory of OCD ascertains that specific dysfunctional beliefs are important in the etiology and maintenance of OCD. To assess these beliefs, the obsessive-compulsive beliefs questionnaire-87 (OBQ-87) has been developed. In the present study, OBQ-87 scores of OCD patients without tics, OCD with tics, and TS (without OCD) patients were compared to those of normal controls. Results: OCD without tic patients exhibited higher OBQ-87 scores than TS patients. No differences were found between OCD with or without tic patients on any of the OBQ-87 subscales. These results suggest that: (1) dysfunctional beliefs have no discriminative power with respect to OCD with or without tic patients; (2) the direct relationship between types of OC symptoms and specific dysfunctional beliefs is questionable. Therefore, one can doubt the specificity of cognitive theory of OCD to explain specific OC behavior.     

Treatment of obsessive-compulsive disorder: cognitive behavior therapy vs. exposure and response prevention

The efficacy of contemporary cognitive therapy for obsessive–compulsive disorder (OCD) has only recently been investigated. The current study compares exposure and response prevention (ERP) and cognitive behavior therapy (CBT) delivered in an individual format. Participants were randomly assigned to the 12 consecutive-week CBT or ERP treatment. Based on 59 treatment completers, there was no significant difference in YBOCS scores between CBT and ERP at post-treatment or at 3-month follow-up. A higher percentage of CBT participants obtained recovered status at post-treatment (67%) and at follow-up (76%), compared to ERP participants (59% and 58%, respectively), but the difference was not significant. Effect sizes (ESs) were used to compare the results of the current study with a previous study conducted at our center that utilized group CBT and ERP treatments, as well as other controlled trials that have compared CBT and ERP. The significance of these results is discussed and a comparison is made with the existing literature.     

A comparison of autogenous/reactive obsessions and worry in a nonclinical population: a test of the continuum hypothesis

Employing the autogenous-reactive model of obsessions (Behaviour Research and Therapy 41 (2003) 11-29), this study sought to test a hypothesized continuum where reactive obsessions fall in between autogenous obsessions and worry with respect to several thought characteristics concerning content appraisal, perceived form, and thought triggers. Nonclinical undergraduate students (n=435) were administered an online packet of questionnaires designed to examine the three different types of thoughts. Main data analyses included only those displaying moderate levels of obsessions or worries (n=252). According to the most distressing thought, three different groups were formed and compared: autogenous obsession (n=34), reactive obsession (n=76), and worry (n=142). Results revealed that (a) relative to worry, autogenous obsessions were perceived as more bizarre, more unacceptable, more unrealistic, and less likely to occur; (b) autogenous obsessions were more likely to take the form of impulses, urges, or images, whereas worry was more likely to take the form of doubts, apprehensions, or thoughts; and (c) worry was more characterized by awareness and identifiability of thought triggers, with reactive obsessions through these comparisons falling in between. Moreover, reactive obsessions, relative to autogenous obsessions, were more strongly associated with both severity of worry and use of worrying as a thought control strategy. Our data suggest that the reactive subtype represents more worry-like obsessions compared to the autogenous subtype.     

Cognitive-behaviour therapy for depersonalisation disorder: an open study

Depersonalisation (DP) and derealisation (DR) are subjective experiences of unreality in, respectively, one's sense of self and the outside world. These experiences occur on a continuum from transient episodes that are frequently reported in healthy individuals to a chronic psychiatric disorder that causes considerable distress (depersonalisation disorder: DPD). Despite the relatively high rates of reporting these symptoms, little research has been conducted into psychological treatments for this disorder. We report on an open study where 21 patients with DPD were treated individually with cognitive behavioural therapy (CBT). The therapy involved helping the patients re-interpret their symptoms in a non-threatening way as well as reducing avoidances, safety behaviours and symptom monitoring. Significant improvements in patient-defined measures of DP/DR severity as well as standardised measures of dissociation, depression, anxiety and general functioning were found at post-treatment and six-months follow-up. Moreover, there were significant reductions in clinician ratings on the Present State Examination (Wing, Cooper & Sartorius, 1974), and 29% of participants no longer met criteria for DPD at the end of therapy. These initial results suggest that a CBT approach to DPD may be effective, but further trials with larger sample sizes and more rigorous research methodology are needed to determine the specificity of this approach.     

Does coping predict CO2-induced panic in patients with panic disorder?

Patients with panic disorder (PD) show maladaptive coping but the role of coping in the pathogenesis of panic is unclear. This study examined general coping and panic-specific coping as predictors of fear responding to CO2 inhalation. Subjective and physiological responses including panic attacks were assessed in 45 patients with PD and 45 matched nonclinical controls. Measures of coping were the primary predictors used in the analyses. Consistent with other reports, patients with PD reported increased emotion-focused coping and there was an association between emotion-focused coping and subjective reactivity. However, only panic-specific coping predicted panic attacks in response to the CO2 challenge.     

Cognitive therapy for post-traumatic stress disorder: development and evaluation

The paper describes the development of a cognitive therapy (CT) program for post-traumatic stress disorder (PTSD) that is based on a recent cognitive model (Behav. Res. Therapy 38 (2000) 319). In a consecutive case series, 20 PTSD patients treated with CT showed highly significant improvement in symptoms of PTSD, depression and anxiety. A subsequent randomized controlled trial compared CT (N = 14) and a 3-month waitlist condition (WL, N = 14). CT led to large reductions in PTSD symptoms, disability, depression and anxiety, whereas the waitlist group did not improve. In both studies, treatment gains were well maintained at 6-month follow-up. CT was highly acceptable, with an overall dropout rate of only 3%. The intent-to-treat effect sizes for the degree of change in PTSD symptoms from pre to post-treatment were 2.70-2.82 (self-report), and 2.07 (assessor-rated). The controlled effect sizes for CT versus WL post-treatment scores were 2.25 (self-report) and 2.18 (assessor-rated). As predicted by the cognitive model, good treatment outcome was related to greater changes in dysfunctional post-traumatic cognitions. Patient characteristics such as comorbidity, type of trauma, history of previous trauma, or time since the traumatic event did not predict treatment response, however, low educational attainment and low socioeconomic status were related to better outcome.     

Perception of control over anxiety mediates the relation between catastrophic thinking and social anxiety in social phobia

Cognitive models of social phobia (social anxiety disorder) assume that individuals with social phobia experience anxiety in social situations in part because they overestimate the social cost associated with a potentially negative outcome of a social interaction. Some emotion theorists, on the other hand, point to the perception of control over anxiety-related symptoms as a determinant of social anxiety. In order to examine the relationship between perceived emotional control (PEC), estimated social cost (ESC), and subjective anxiety, we compared three alternative structural equation models: Model 1 assumes that PEC and ESC independently predict social anxiety; Model 2 assumes that ESC partially mediates the relationship between PEC and anxiety, and Model 3 assumes that PEC partially mediates the relationship between ESC and anxiety. We recruited 144 participants with social phobia and administered self-report measures of estimated social cost, perceived anxiety control, and social anxiety. The results support Model 3 and suggest that "costly" social situations are anxiety provoking in part because social phobic individuals perceive their anxiety symptoms as being out of control.     

Derived manding in children with autism: synthesizing Skinner's verbal behavior with relational frame theory

Mand functions for two stimuli (A1 and A2) were trained for 3 children with autism and were then incorporated into two related conditional discriminations (A1-B1/A2 -B2 and B1-C1/B2-C2). Tests were conducted to probe for a derived transfer of mand response functions from A1 and A2 to C1 and C2, respectively. When 1 participant failed to demonstrate derived transfer of mand response functions, transfer training using exemplars was conducted. When participants had demonstrated derived transfer of mand functions, the X1 and X2 tokens that were employed as reinforcers for mand responses were incorporated into two conditional discriminations (X1-Y1/X2-Y2 and Y1-Z1/Y2-Z2). Tests were conducted for derived transfer of reinforcing functions. Finally, tests were conducted to determine if the participants would demonstrate derived manding for the derived reinforcers (present C1 and C2 to mand for Z1 and Z2, respectively). Derived transfer of functions was observed when the sequence of training and testing was reversed (i.e., training and testing reinforcing functions before mand response functions) and when only minimal instructions were provided.     

Evaluation of pharmacological treatment of impulsivity in children with attention deficit hyperactivity disorder

We used an assessment that involved competing reinforcer dimensions in a concurrent-schedules arrangement to examine the effects of stimulant medication on impulsivity (i.e., sensitivity of choices to reinforcer immediacy relative to rate, quality, and effort) with 4 students with attention deficit hyperactivity disorder. The assessments were administered in the context of a double-blind, placebo-controlled, counterbalanced reversal design. Reinforcer immediacy was the most influential dimension for 3 of the students and the second most influential dimension for 1 of the students across placebo and medication conditions; medication did not affect these sensitivities.     

Behavioral assessment of impulsivity: a comparison of children with and without attention deficit hyperactivity disorder

We conducted a brief computer-based assessment involving choices of concurrently presented arithmetic problems associated with competing reinforcer dimensions to assess impulsivity (choices controlled primarily by reinforcer immediacy) as well as the relative influence of other dimensions (reinforcer rate, quality, and response effort), with 58 children. Results were compared for children with attention deficit hyperactivity disorder (ADHD) who were and were not receiving medication, and with typically developing children without ADHD. Within-subject and between-groups analyses of the ordinal influence of each of the reinforcer dimensions were conducted using both time- and response-allocation measures. In general, the choices of children with ADHD were most influenced by reinforcer immediacy and quality and least by rate and effort, suggesting impulsivity. The choices of children in the non-ADHD group were most influenced by reinforcer quality, and the influence of immediacy relative to the other dimensions was not statistically significant. Results are discussed with respect to the implications for assessment and treatment of ADHD.