"Not Just Right Experiences" in adolescents: phenomenology and associated characteristics.

Efforts to understand the nature of "Not Just Right Experiences" (NJREs) have expanded the scientific understanding of obsessive-compulsive (OC) behavior. Approximately 80% of unselected adults report experiencing NJREs and these experiences have been found to highly correlate with OC behavior. The purpose of this study was to assess NJREs in an unselected sample of adolescents (ages 14-17; N = 152), to compare their experience with adults (N = 237), and to assess the relation between NJREs and OC symptoms. Findings from questionnaires completed on the Internet were consistent with previous findings in adults, 81% of adolescents endorsed recently having an NJRE. Some reactions differed according to age: adults reported NJREs as more frequent and adolescents endorsed feeling more compelled to respond. Surprisingly, OC symptoms were not significantly related to NJREs in the adolescents. Implications, limitations, and future directions for the study of NJREs in youth are discussed.

Targeting Co-Sleeping in Children With Anxiety Disorders Using a Modified Bedtime Pass Intervention: A Case Series Using a Changing Criterion Design.

Children with anxiety disorders experience high rates of sleep-related problems, with co-sleeping and resistance to sleeping independently being among the more frequent problems reported. Although extinction-based behavioral sleep interventions have repeatedly been shown to be highly effective for treating bedtime resistance, the primary obstacle to their implementation is parent discomfort with these procedures. The bedtime pass intervention was developed to minimize extinction bursts when implementing extinction procedures for childhood sleep problems. Several studies have found this intervention to be effective for treating bedtime resistance behaviors, but not co-sleeping specifically, in nonclinical samples of children. The current paper describes the use of a modified bedtime pass procedure to target problematic co-sleeping and related bedtime resistance behaviors in two children with anxiety disorders who presented for treatment at an outpatient pediatric anxiety specialty clinic. A changing criterion, single subject methodology was used to evaluate the effectiveness of this procedure. Data indicate that both children were able to transition from co-sleeping with parents every night, to sleeping independently, with relatively limited need for contact with parents at night during the intervention. These findings extend the data for the bedtime pass procedure to both co-sleeping and children with anxiety disorders. Clinical implications of these findings are discussed given the limited guidance for treating comorbid sleep problems in anxious children. Strengths and limitations of the data being drawn from a clinical treatment setting are also discussed.

Clinical presentation of not-just right experiences (NJREs) in individuals with OCD: Characteristics and response to treatment.

There is increasing recognition that instead of being motivated by a desire to prevent harm and reduce anxiety, some obsessive-compulsive symptoms may be driven by a desire to get things 'just right' or 'complete' and to reduce a sense of discomfort. However, existing data is largely from non-clinical samples. Therefore, in the current paper we examine the clinical presentation of not just right experiences (NJREs) in patients diagnosed with OCD and compare their experiences to both anxious and unselected controls. Then, we provide preliminary data on NJREs before and after cognitive behavioral therapy (exposure and response prevention). First, individuals with OCD were found to report experiencing significantly more NJREs and being more distressed by them compared to anxious controls and unselected controls. Next, there was some support for the specificity of NJREs to feelings of incompleteness. Finally, we found that after completing treatment, patients reported experiencing significantly less NJREs and experienced less distress associated with the NJREs. In conclusion we believe that more work on the role of NJREs is warranted and that characterizing OCD symptoms as either based on harm avoidance or incompleteness/NJREs may be a useful framework for classifying OCD symptoms.

Adolescent Mental Health Literacy: Young People's Knowledge of Depression and Social Anxiety Disorder.

PURPOSE: Understanding why nearly 80% of youth ages 6-18 years with a mental disorder fail to receive treatment represents an important public health priority. International data suggest that underrecognition of mental illness and the need for treatment are barriers to service utilization. This study extends work to a U.S. sample of 1,104 adolescents. METHODS: High School students were invited to participate in a self-report study assessing knowledge and beliefs regarding mental illness. Participants completed the survey in groups at school and read vignettes portraying peers experiencing major depression, social anxiety disorder, and a situation where the individual has to cope with a common life stressor followed by a series of questions in reference to each vignette. RESULTS: Adolescents had better recognition of depression than social anxiety disorder and were more likely to recommend seeking help for it. However, <50% of youth recognized depression. Family, friends, and counselors were recommended as sources of help. Differences according to the sex of the respondent and person in the vignette were observed. CONCLUSIONS: These data are among the first to provide information regarding the mental health literacy of American adolescents and suggest potential points for intervention. Pending replication of the findings herein, efforts to help adolescents recognize mental health problems and to increase the likelihood of recommending professional help will be important.

Obsessive-Compulsive Symptoms and Beliefs in Adolescents: A Cross-Sectional Examination of Cognitive Models.

Cognitive models of obsessive-compulsive disorder (OCD) posit that particular beliefs transform normal intrusions into disturbing obsessions. A wealth of data shows that such beliefs and obsessive-compulsive (OC) symptoms are related in adults. However, there is markedly less information regarding OCD-related beliefs in youth. The purpose of this study was to assess the relation between OCD-related beliefs and OC symptoms in unselected adolescents (ages 13-18 years; N = 159). Findings from questionnaires completed on the Internet were consistent with previous findings in adults. Increased levels of OCD-related beliefs were related to increased levels of OC symptoms. Perfectionism and certainty beliefs had a specific relation with symmetry and ordering symptoms. Contrary to expectation, levels of OCD-related beliefs in this unselected sample were similar to those found in prior studies of youth diagnosed with OCD. Implications, limitations, and future directions for the study of OCD-related beliefs in youth are discussed.