The Inference-Based Approach (IBA) to the Treatment of Obsessive-Compulsive Disorder: An Open Trial Across Symptom Subtypes and Treatment-Resistant Cases.

The current open trial evaluated an inference-based approach (IBA) to the treatment of obsessive-compulsive disorder (OCD) across symptom subtypes and treatment-resistant cases. Following formal diagnosis through semi-structured interview by an independent evaluator, a total of 125 OCD participants across five major symptom subtypes entered a program of 24 sessions of treatment based on the IBA. An additional group of 22 participants acted as a natural wait-list control group. Participants were administered the Yale-Brown Obsessive-Compulsive Scale before and after treatment as the principal outcome measure, as well as measures of negative mood states, inferential confusion and obsessive beliefs. Level of overvalued ideation was assessed clinically at pre-treatment using the Overvalued Ideation Scale. After 24 weeks of treatment, 102 treatment completers across all major subtypes of OCD showed significant reductions on the Yale-Brown Obsessive-Compulsive Scale with effect sizes ranging from 1.49 to 2.53 with a clinically significant improvement in 59.8% of participants. No improvement was observed in a natural wait-list comparison group. In addition, IBA was effective for those with high levels of overvalued ideation. Change in inferential confusion and beliefs about threat and responsibility were uniquely associated with treatment outcome. The study is the first large-scale open trial showing IBA to be effective across symptom subtypes and treatment-resistant cases. The treatment may be particularly valuable for those who have previously shown an attenuated response to other treatments. Copyright © 2016 John Wiley & Sons, Ltd. KEY PRACTITIONER MESSAGE: Psychological treatment based on the inference-based approach is an effective treatment for all major subtypes of obsessive-compulsive disorder. The treatment is equally effective for those with high and low levels of overvalued ideation. Treatment based on the inference-based approach may be particularly valuable for those who have shown an attenuated response to cognitive-behaviour therapy as usual.

Evaluation of a cognitive psychophysiological model for management of tic disorders: an open trial.

BACKGROUND: Tic disorders, in particular chronic tic disorder and Tourette syndrome, affect about 1% of the population. The current treatment of choice is pharmacological or behavioural, addressing tics or the premonitory urges preceding tic onset. AIMS: The current study reports an open trial evaluating the effectiveness of a cognitive psychophysiological treatment addressing Tourette-specific sensorimotor activation processes rather than the tic. METHOD: Forty-nine people with Tourette syndrome and 36 people with chronic tics completed 10 weeks of individual cognitive psychophysiological therapy. Outcome measures included two tic severity scales and psychosocial measures. RESULTS: Post-treatment both groups had significantly improved on the tic scales with strong effect sizes across tic locations and complex and simple tics, maintained at 6-month follow-up with further change in perfectionism and self-esteem. CONCLUSIONS: The cognitive psychophysiological approach targeting underlying sensorimotor processes rather than tics in Tourette's and chronic tic disorder reduced symptoms with a large effect size.

Using Virtual Reality in the Inference-Based Treatment of Compulsive Hoarding.

The present study evaluated the efficacy of adding a virtual reality (VR) component to the treatment of compulsive hoarding (CH), following inference-based therapy (IBT). Participants were randomly assigned to either an experimental or a control condition. Seven participants received the experimental and seven received the control condition. Five sessions of 1 h were administered weekly. A significant difference indicated that the level of clutter in the bedroom tended to diminish more in the experimental group as compared to the control group F(2,24) = 2.28, p = 0.10. In addition, the results demonstrated that both groups were immersed and present in the environment. The results on posttreatment measures of CH (Saving Inventory revised, Saving Cognition Inventory and Clutter Image Rating scale) demonstrate the efficacy of IBT in terms of symptom reduction. Overall, these results suggest that the creation of a virtual environment may be effective in the treatment of CH by helping the compulsive hoarders take action over their clutter.

Diet and Doubt: A Clinical Case Study of Inference-Based Therapy for Bulimia Nervosa.

There is a recognized overlap between eating disorders (EDs) and obsessive-compulsive disorder (OCD) in terms of diagnosis, phenomenology, epidemiology, and psychological characteristics related to the disorder. In light of these similarities, a cognitive inference-based therapy (IBT) program, shown to be effective in treating OCD, was adapted for EDs. This case study describes the application of IBT treatment for a 35-year-old woman diagnosed with bulimia nervosa who also demonstrated overvalued ideation related to her body weight and shape. Over a 20-week period, the client's ED pathology significantly decreased. Notably, the frequency of binge episodes was reduced by 90% from pre- to posttreatment and by 100% at 6-month follow-up. Significant reductions were also observed in dietary restriction and overvalued ideation. This case study has important implications for the treatment of individuals with both an ED and strong overvalued ideas.

Meta-cognitions in tourette syndrome, tic disorders, and body-focused repetitive disorder.

OBJECTIVE: To explore if self-reported presence of thinking about tics or body-focused repetitive behaviours (BFRBs; gests) are direct triggers of tic or gest onset in 3 groups: Tourette syndrome (TS; n =18), persistent chronic tic disorders (TDs; n = 42), and a comparison group with BFRB (n = 36). METHOD: The 3 groups completed a thinking about tics inventory, listing 22 items derived from clinician consensus that asked whether thoughts always, sometimes, or never exclusively triggered tic onset. Other questionnaires measured mood, perfectionism, impulsivity, premonitory urge, and self-rated tension. Sixty-three participants completed the inventory twice, and the inventory was completed pre- and post-behavioural intervention by a further 54. RESULTS: The ranking of the thoughts reported as likely to trigger tics or gests was positively correlated across TD and BFRB groups. Exploratory principal components analysis of a reduced 12-item set (the thinking about tics inventory) in TS and TD groups revealed that such thoughts could be grouped into 3 separate subscales: thoughts about the interference of tics or gests, thoughts anticipating tics or gests, and thoughts about whether the person has permission to perform the tic or the gest. The 3 sets of subscales showed good and acceptable internal consistency and overall score showed good test-retest reliability, suggesting thoughts about tics or gests are robust and measurable. The subscales correlated with impulsivity, tic or behaviour severity, and ratings of frequency decreased post-behavioural treatment. CONCLUSIONS: Thinking about tics or gests is reported as triggering tics or gests in both TD and BFRB, and meta-cognition seems independent of premonitory sensations and relates to distinct clinical characteristics in each clinical group.

Psychotherapy Augmentation through Preconscious Priming.

OBJECTIVE: To test the hypothesis that repeated preconscious (masked) priming of personalized positive cognitions could augment cognitive change and facilitate achievement of patients' goals following a therapy. METHODS: Twenty social phobic patients (13 women) completed a 36-weeks study beginning by 12 weeks of group behavioral therapy. After the therapy, they received 6 weeks of preconscious priming and 6 weeks of a control procedure in a randomized cross-over design. The Priming condition involved listening twice daily with a passive attitude to a recording of individualized formulations of appropriate cognitions and attitudes masked by music. The Control condition involved listening to an indistinguishable recording where the formulations had been replaced by random numbers. Changes in social cognitions were measured by the Social Interaction Self Statements Test (SISST). RESULTS: Patients improved following therapy. The Priming procedure was associated with increased positive cognitions and decreased negative cognitions on the SISST while the Control procedure was not. The Priming procedure induced more cognitive change when applied immediately after the group therapy. CONCLUSION: An effect of priming was observed on social phobia related cognitions in the expected direction. This self administered addition to a therapy could be seen as an augmentation strategy.

Meta-analytic review of the impact of cognitive-behavior therapy for insomnia on concomitant anxiety.

INTRODUCTION: Concomitant anxiety and insomnia is a frequent problem encountered by mental health professionals. PRIMARY OBJECTIVE: To assess the impact of cognitive-behavior therapy for insomnia (CBT-I) on associated anxiety. METHOD: Systematic search for clinical trials of CBT-I in PsycInfo, Medline, and Proquest Dissertations and Theses. RESULTS: Of the 216 CBT-I trials reviewed, 72 (33.3%) reported data on anxiety. The combined effect size (ES) of CBT-I on anxiety was 0.406 [95% CI 0.318-0.493], indicating a small to moderate effect of CBT-I on concomitant anxiety. Anxiety and anxiety-related constructs were measured with 31 different questionnaires or questionnaire subscales, the majority of which were used only once in the sample of studies. CONCLUSIONS: CBT-I has only a moderate impact on anxiety in individuals who present insomnia with or without a comorbid anxiety disorder. A careful evaluation of residual anxiety should be conducted subsequent to CBT-I. Further research should focus on standardizing the assessment of anxiety in insomnia research.

The impact of cognitive-behavior therapy for anxiety disorders on concomitant sleep disturbances: a meta-analysis.

INTRODUCTION: Sleep disturbances are present in approximately 70% of individuals with an anxiety disorder (AD). Treatments for AD may alleviate associated sleep problems, but empirical support for this view is sparse. OBJECTIVE: To assess state of knowledge about the impact of CBT for AD on sleep disturbances. METHOD: Systematic search for clinical trials of CBT for any AD in PsycINFO, MedLine, and Proquest Dissertations and Theses. RESULTS: Of 1205 studies, only 25 (2.07%) reported sleep data. The combined ES of CBT for AD on sleep was 0.527 [95%CI 0.306-0.748], indicating a moderate effect of anxiety treatment on concomitant sleep difficulties. The impact did not significantly differ according to study design, sleep variable or anxiety disorder. CONCLUSIONS: Although substantial amounts of research documented the efficacy of CBT for AD, very few reported its effect on concomitant sleep problems. Current state of knowledge does not permit definitive conclusions and future research is needed.