Common rituals in obsessive-compulsive disorder and implications for treatment: A mixed-methods study.

Obsessive-compulsive disorder (OCD) is characterized by engagement in rituals that serve to obtain certainty and prevent feared outcomes. Exposure and response prevention is most effective when rituals are resisted, yet existing self-report measures of OCD limit identification of the full range of possible rituals, and little is known about how rituals might cluster together and predict worsened severity and poorer treatment outcomes. In a retrospective sample of 641 adult patients who received intensive OCD treatment, the present study used a mixed-methods approach to (a) identify and validate treatment provider-identified rituals using the Yale-Brown Obsessive-Compulsive Scale, (b) identify clustering patterns of rituals, and (c) examine the impact of these clusters on severity and treatment outcomes. Sixty-two discrete rituals clustered into eight higher order ritual clusters: avoidance, reassurance, checking, cleaning/handwashing, just right, rumination, self-assurance, and all other rituals. At admission, reassurance predicted greater intolerance of uncertainty (IU) and rumination predicted less OCD severity. Only one ritual cluster-just right-predicted treatment outcomes; patients with just right rituals had worse IU at discharge and significantly longer length of treatment (average 7.0 days longer). Clinical observation can identify more nuanced and individualized rituals than self-report assessment alone. Patients presenting with just right rituals may benefit less from treatment focused on harm avoidance and habituation; instead, treatment should be tailored to the idiosyncrasies of incompleteness and not just the right experiences. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Comparing efficacy of telehealth to in-person mental health care in intensive-treatment-seeking adults.

The heightened acuity in anxiety and depressive symptoms catalyzed by the COVID-19 pandemic presents an urgent need for effective, feasible alternatives to in-person mental health treatment. While tele-mental healthcare has been investigated for practicability and accessibility, its efficacy as a successful mode for delivering high-quality, high-intensity treatment remains unclear. This study compares the clinical outcomes of a matched sample of patients in a private, nation-wide behavioral health treatment system who received in-person, intensive psychological treatment prior to the COVID-19 pandemic (N = 1,192) to the outcomes of a distinctive group of patients who received telehealth treatment during the pandemic (N = 1,192). Outcomes are measured with respect to depressive symptoms (Quick Inventory of Depressive Symptomatology-Self-Report; QIDS-SR) and quality of life (Quality of Life Enjoyment and Satisfaction Questionnaire; Q-LES-Q). There were no significant differences in admission score on either assessment comparing in-person and telehealth groups. Patients in the partial hospitalization level of care stayed longer when treatment was remote. Results suggest telehealth as a viable care alternative with no significant differences between in-person and telehealth groups in depressive symptom reduction, and significant increases in self-reported quality of life across both groups. Future research is needed to replicate these findings in other healthcare organizations in other geographical locations and diverse patient populations.

Efficacy of intensive CBT telehealth for obsessive-compulsive disorder during the COVID-19 pandemic.

Despite evidence for the effectiveness of cognitive behavioral therapy (CBT) for obsessive-compulsive disorder (OCD), many individuals with OCD lack access to needed behavioral health treatment. Although some literature suggests that virtual modes of treatment for OCD are effective, it remains unclear whether intensive programs like partial hospitalization and intensive outpatient programs (PHP and IOPs) can be delivered effectively over telehealth (TH) and within the context of a global pandemic. Limited extant research suggests that clinicians perceive attenuated treatment response during the pandemic. The trajectory and outcomes of two matched samples were compared using linear mixed modeling: a pre-COVID in-person (IP) sample (n = 239) and COVID TH sample (n = 239). Findings suggested that both modalities are effective at treating OCD and depressive symptoms, although the pandemic TH group required an additional 2.6 treatment days. The current study provides evidence that PHP and IOP treatment delivered via TH during the COVID-19 pandemic is approximately as effective as pre-pandemic IP treatment and provides promising findings for the future that individuals with complicated OCD who do not have access to IP treatment can still experience significant improvement in symptoms through TH PHP and IOP treatment during and potentially after the pandemic.

Semantic constraint, reading control, and the granularity of form-based expectations during semantic processing: Evidence from ERPs.

We investigated the role that semantic constraint and participant control over stimulus presentation have on early stages of visual word recognition. Namely, we tested how the presence of a highly constraining sentential context influences the expectations that readers have during incremental sentence processing. Further, we tested whether allowing participants to self-pace the experiment affected early sensory perceptions of written stimuli. Event-related potentials (ERPs) were recorded in three experiments. Participants read sentences containing a target word from one of four conditions: 1) the target, spelled as expected; 2) the target with two internal characters transposed; 3) a nonword one vowel different from a target; or 4) an illegal consonant string. In Experiment 1, sentences were minimally constraining up to the target word (average cloze at target word: 0.01); in Experiments 2 and 3, sentences were highly constraining (average cloze at target word: 0.93). In both Experiments 1 and 2, sentences were presented using rapid-serial-visual presentation (RSVP). In Experiment 3, participants saw the same sentences used in Experiment 2 but were allowed to self-pace the presentation of each word in every trial. In Experiments 1 and 2, results showed early neural sensitivity to nonsensical consonant strings only, and only when they appeared within high constraint. In Experiment 3, results showed graded N170 effects to all target words containing unexpected visual information. P600 modulations were observed in all three experiments, indexing the difficulty of processing unexpected orthography, particularly in downstream, integrative processing. Results support a nuanced view of early visual processing, namely one arguing that visual processing is more fine-grained the more control participants have over how they read.

"Going to town": Large-scale norming and statistical analysis of 870 American English idioms.

An idiom is classically defined as a formulaic sequence whose meaning is comprised of more than the sum of its parts. For this reason, idioms pose a unique problem for models of sentence processing, as researchers must take into account how idioms vary and along what dimensions, as these factors can modulate the ease with which an idiomatic interpretation can be activated. In order to help ensure external validity and comparability across studies, idiom research benefits from the availability of publicly available resources reporting ratings from a large number of native speakers. Resources such as the one outlined in the current paper facilitate opportunities for consensus across studies on idiom processing and help to further our goals as a research community. To this end, descriptive norms were obtained for 870 American English idioms from 2,100 participants along five dimensions: familiarity, meaningfulness, literal plausibility, global decomposability, and predictability. Idiom familiarity and meaningfulness strongly correlated with one another, whereas familiarity and meaningfulness were positively correlated with both global decomposability and predictability. Correlations with previous norming studies are also discussed.

Cues, quantification, and agreement in language comprehension.

We investigated factors that affect the comprehension of subject-verb agreement in English, using quantification as a window into the relationship between morphosyntactic processes in language production and comprehension. Event-related brain potentials (ERPs) were recorded while participants read sentences with grammatical and ungrammatical verbs, in which the plurality of the subject noun phrase was either doubly marked (via overt plural quantification and morphological marking on the noun) or singly marked (via only plural morphology on the noun). Both acceptability judgments and the ERP data showed heightened sensitivity to agreement violations when quantification provided an additional cue to the grammatical number of the subject noun phrase, over and above plural morphology. This is consistent with models of grammatical comprehension that emphasize feature prediction in tandem with cue-based memory retrieval. Our results additionally contrast with those of prior studies that showed no effects of plural quantification on agreement in language production. These findings therefore highlight some nontrivial divergences in the cues and mechanisms supporting morphosyntactic processing in language production and comprehension.