Emotion regulation and OCD among sexual minority people: Identifying treatment targets.

Sexual minority individuals experience higher rates of psychopathology, such that sexual minority people are nine times more likely to receive a diagnosis or treatment for obsessive-compulsive disorder (OCD) compared to heterosexual people. Poor emotion regulation capacity is a risk factor for OCD, but little is known about sexual orientation differences in dimensions of emotion regulation and how dimensions of emotion regulation relate to OCD severity among sexual minority people. The aims of the current study include 1) comparing sexual minority to heterosexual people on OCD severity and emotion regulation capacity upon admission to treatment for OCD, and 2) examining emotion regulation in relation to OCD severity among sexual minority people. Participants (N = 470) were adults in partial hospital/residential treatment with an average stay of 59.7 days (SD = 25.3), including 22 % sexual minority people. Sexual minority people reported a lower emotion regulation capacity. Among the largest three subgroups (heterosexual, bi+, and gay/lesbian), bi+ individuals reported a lower emotion regulation capacity compared to heterosexual but not gay/lesbian people. Results suggest there are sexual orientation differences in emotion regulation capacity, and that bi+ people have the most difficulty with ER. There is a need for OCD treatment to directly target emotion regulation strategies and be affirming of sexual minority identities.

Multi-method assessment of suicidal thoughts and behaviors among patients in treatment for OCD and related disorders.

Obsessive-compulsive and related disorders (OCRDs) are associated with increased risk of suicidal thoughts and behaviors (STBs), yet research characterizing suicidality in OCRDs remains limited. A major challenge in assessing STBs is the reliance on explicit self-report. This study utilized multi-method assessment to examine changes in both implicit and explicit STBs in 31 adults receiving partial/residential treatment for OCRDs. Assessments were administered at admission and weekly during treatment. Approximately three-quarters of participants reported lifetime suicidal thoughts, with 16 % reporting a prior suicide attempt. OCD severity was significantly correlated with lifetime suicidal thoughts, and was significantly higher for those with lifetime suicidal thoughts and prior attempts compared to those without. Implicit biases towards death were not associated with OCD severity, and did not predict explicitly endorsed STBs. This is the first study to measure both explicit and implicit STBs in adults with OCRDs. Limitations included small sample size and lack of racial/ethnic diversity. Given the majority had recent suicidal thoughts and one in six had a prior attempt, we emphasize the importance of STB assessment in OCD treatment settings.

Examination of Outcomes among Sexual Minorities in Treatment for Obsessive-Compulsive and Related Disorders.

The first-line psychological treatment for obsessive-compulsive and related disorders (OCRDs) is exposure and response prevention (ERP). As the first study to examine treatment outcomes for sexual minorities, it is crucial to examine: (1) how treatment-seeking individuals who identify as sexual minorities compare to heterosexual individuals in symptom severity at admission, length of stay in treatment, and (2) whether ERP is equally effective for sexual minorities. The current study explored these questions in an intensive/residential treatment (IRT) program for OCRDs. Adult participants (N = 191) completed self-reported measures of OCD severity, distress tolerance, and depression at program admission, in the first four weeks of treatment, and at discharge. No differences were found between groups for treatment outcome, although slight differences (non-significant) emerged at baseline for OCRD severity, distress tolerance, and depression. Sexual orientation was not predictive of OCRD severity at weeks 1-4, and number of days spent in treatment was not associated with sexual orientation. This is the first study exploring whether sexual orientation is predictive of treatment outcomes for individuals diagnosed with OCRDs. Results suggest that outcomes did not differ and participation in the program resulted in an overall improvement of symptoms regardless of sexual orientation, however several study limitations are discussed. Future studies should replicate these findings, attempt to collect a larger sample, incorporate qualitative feedback from treatment, and examine outcomes in gender minorities.

Feasibility and Acceptability of Cognitive Bias Modification for Interpretation as an Adjunctive Treatment for OCD and Related Disorders: A Pilot Randomized Controlled Trial.

Cognitive models implicate interpretation bias in the development and maintenance of obsessive compulsive and related disorders (OCRDs), and research supports Cognitive Bias Modification for Interpretation (CBM-I) in targeting this mechanism. However, prior studies in OCRDs have been limited to nonclinical populations, adolescents, and adults in a laboratory setting. This study evaluated the feasibility and acceptability of CBM-I as an adjunctive intervention during intensive/residential treatment (IRT) for adults with OCRDs. We modified a lab-based CBM-I training for adults seeking IRT for OCRDs, and conducted a feasibility trial (N = 4) and subsequent pilot RCT; participants (N = 31) were randomized to receive CBM-I or psychoeducation. Benchmarks were met for feasibility, acceptability, and target engagement. From pre- to post-intervention, the CBM-I group showed a large effect for change in interpretation bias (d = .90), whereas this effect was trivial (d = .06) for psychoeducation. This was the first study to evaluate CBM-I in naturalistic treatment for adults seeking IRT for OCRDs. Findings support the feasibility and acceptability of CBM-I in this novel sample and setting. A larger scale RCT is needed to determine whether CBM-I can enhance OCRD treatment response.