Family accommodation in obsessive-compulsive disorder: An updated systematic review and meta-analysis.

Family accommodation might play a crucial role in obsessive-compulsive disorder (OCD). Previous systematic reviews on family accommodation in OCD have focused on specific populations or variables or are outdated. We conducted a preregistered systematic review and meta-analysis on family accommodation in adults, children, and adolescents with OCD (CRD42021264461). We searched PubMed, Scopus, and Web of Science using the keywords "family accommodation" and "obsessive-compulsive disorder. One hundred-eight studies involving 8928 individuals with OCD were included. Our results indicate that levels of family accommodation in OCD are moderate, that there is a significant positive correlation between family accommodation and OCD severity (r = 0.42), that baseline family accommodation does not predict pre- to post-treatment change in OCD severity (g = -0.03), and that family accommodation decreases as a result of both individual and family-focused cognitive behavioral therapy for OCD (g = 2.00 and g = 1.17, respectively). Our findings highlight the relevance of family accommodation in OCD and may help guide assessment and treatment.

Cool Kids: Cognitive Behavioral Therapy in a Spanish Sample of Children and Adolescents with Anxiety Disorders.

Anxiety disorders (ADs) negatively impact functioning and life quality. Studies on cognitive behavioral therapy (CBT) have demonstrated its short- and long-term efficacy. Cool Kids (CK) is a 10-session CBT-based group program administered to participants with ADs aged 7-17 years and their parents, and it has demonstrated efficacy compared with control groups. This study analyzes the effectiveness of CK in a clinical cohort of Spanish children and adolescents with ADs. CK was offered to 57 patients with AD and their caregivers at the Hospital Clínic, Barcelona. In all global registered measures, the results demonstrated a reduction of symptoms and their interference in daily functioning. Moreover, a significant improvement was observed in participants who completed more sessions. Thus, CK reduced the severity of anxiety and its interference over individual and family functioning.

Spanish validation of the parenting version of the "Spence Child Anxiety Scale" (SCAS-P) in a clinical sample / Validación española de la versión para padres de la “Escala de ansiedad infantil de Spence” (SCAS-P) en una muestra clínica

The child version of the Spence Children’s Anxiety Scale (SCAS-C) has demonstrated good psychometric properties, but research has scarcely focused on the parent version of the questionnaire (SCAS-P). We aimed to validate the Spanish version of the SCAS-P in a clinical sample (N= 137) of children and adolescents through their parents’ responses. The Spanish version of the SCAS-P showed good internal consistency for the total scale and for most subscales (Cronbach´s alpha between .49 y .83) and excellent test-retest reliability for all subscales (r between .71 and .91). Furthermore, convergent and divergent validity were supported by higher correlations with other measures of anxiety (r= .51), and lower correlations with measures of depression (r= .43) and externalizing problems (r= .34). For the first time in an exclusively clinical sample, the original factor structure of the SCAS-P based on six correlated factors was partially confirmed. The validation of the SCAS-P in a clinical sample provides professionals with a tool that better reflects the characteristics of their patients (AU)

La versión infantil de la “Escala de ansiedad infantil de Spence” (SCAS-C) posee buenas propiedades psicométricas, pero existe poca investigación sobre la versión para padres. Nuestro objetivo fue validar la versión española del SCAS-P en una muestra clínica (N= 137) de niños y adolescentes a través de las respuestas de sus padres. El SCAS-P mostró una buena consistencia interna para la escala total y para la mayoría de las subescalas (α de Cronbach entre 0,49 y 0,83) y una excelente fiabilidad test-retest para todas las subescalas (r entre 0,71 y 0,91). Además, la validez convergente y divergente fueron respaldadas por correlaciones significativas con otras puntuaciones de ansiedad (r= 0,51), y correlaciones más bajas con puntuaciones de depresión (r= 0,43) y problemas exteriorizados (r= 0,34), respectivamente. Por primera vez en una muestra exclusivamente clínica, se confirmó parcialmente la estructura factorial original del SCAS-P basada en seis factores correlacionados. La validación del SCAS-P en población clínica aporta a los profesionales una herramienta que refleja mejor las características de sus pacientes (AU)

Psychometric Properties of the Children's Version of the Spence Children's Anxiety Scale (SCAS) in a Spanish Clinical Sample.

The Spence Children's Anxiety Scale (SCAS) has demonstrated good psychometric properties in several countries and cultures. Nevertheless, most of the previous studies that explore these properties have combined clinical and community samples. We aimed to validate the Spanish version of the SCAS in a large clinical sample (N = 130) of children and adolescents. The Spanish adaptation of the SCAS showed good internal consistency for the total scale, and good test-retest reliability for all the subscales. Furthermore, its convergent and discriminant validity were supported by significant correlations with other anxiety questionnaires (Screen for Child Anxiety Related Emotional Disorders [SCARED], Youth Self-Report [YSR] subscales for anxiety disorders and internalizing symptomatology), and lower or non-significant correlations with depression symptoms and externalizing symptoms scales respectively. For the first time in a purely clinical sample, the original factor structure of the SCAS based on six correlated factors was confirmed. Future studies need to evaluate whether the factorial structure of the present instrument is the most suitable for use in clinical populations.

Psychometric properties of the children's version of the Spence Children's Anxiety Scale (SCAS) in a Spanish clinical sample

The Spence Children's Anxiety Scale (SCAS) has demonstrated good psychometric properties in several countries and cultures. Nevertheless, most of the previous studies that explore these properties have combined clinical and community samples. We aimed to validate the Spanish version of the SCAS in a large clinical sample (N = 130) of children and adolescents. The Spanish adaptation of the SCAS showed good internal consistency for the total scale, and good test-retest reliability for all the subscales. Furthermore, its convergent and discriminant validity were supported by significant correlations with other anxiety questionnaires (Screen for Child Anxiety Related Emotional Disorders [SCARED], Youth Self-Report [YSR] subscales for anxiety disorders and internalizing symptomatology), and lower or non-significant correlations with depression symptoms and externalizing symptoms scales respectively. For the first time in a purely clinical sample, the original factor structure of the SCAS based on six correlated factors was confirmed. Future studies need to evaluate whether the factorial structure of the present instrument is the most suitable for use in clinical populations

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Adaptación española del "Cuestionario de miedo a las arañas" (FSQ): validez, fiabilidad, sensibilidad al cambio terapéutico y estructura factorial / Spanish adaptation of the Fear of Spiders Questionnaire (FSQ): Validity, reliability, sensitivity to therapeutic change and factor structure

El objetivo del presente trabajo era evaluar las propiedades psicométricas y la estructura factorial de la versión española del "Cuestionario de miedo a las arañas" (FSQ), así como su sensibilidad al cambio terapéutico. Fueron evaluados 740 participantes con miedo a las arañas con el FSQ, el apartado de ansiedadrasgo del "Inventario de ansiedad estado-rasgo" (STAI-T) y el "Cuestionario de salud del paciente para la depresión" (PHQ-9). La versión española del FSQ mostró una excelente consistencia interna (alfa= 0,966), una buena validez divergente (r con el STAI-T= 0,108 y r con el PHQ-9= 0,081) y una adecuada fiabilidad test-retest (r= 0,799). El FSQ fue sensible al cambio terapéutico, t(49)= 2,70; p= 0,009; d= 0,25, y reveló una estructura bifactorial (Evitación y búsqueda de ayuda y Miedo al daño) que explicaba el 71% de la varianza total. La versión española del FSQ es un instrumento válido y fiable que permite evaluar el miedo a las arañas tanto en poblaciones clínicas como subclínicas

The goal of the study was to evaluate the psychometric properties and the factorial structure of the Spanish version of the Fear of Spiders Questionnaire (FSQ), as well as its sensitivity to therapeutic change. Seven hundred and forty participants with fear of spiders were evaluated with the FSQ, the anxiety-trait section of the State-Trait Anxiety Inventory (STAI-T) and the Patient Health Questionnaire for depression (PHQ-9). The Spanish version of the FSQ showed excellent internal consistency (aflfa= .966), good divergent validity (r with STAI-T= .108 and r with PHQ-9= .081) and adequate test-retest reliability (r= .799). The FSQ was sensitive to therapeutic change, t(49)= 2.70, p= .009, d= 0.25, and revealed a two-factor structure (Avoidance and seeking help, and Fear of harm) that explained 71% of the total variance. The Spanish version of the FSQ is a valid and reliable instrument that allows assessing the fear of spiders in both clinical and subclinical populations

The Scarier the Better: Maximizing Exposure Therapy Outcomes for Spider Fear.

BACKGROUND: While exposure therapy effectively reduces anxiety associated with specific phobias, not all individuals respond to treatment and some will experience a return of fear after treatment ceases. AIMS: This study aimed to test the potential benefit of increasing the intensity of exposure therapy by adding an extra step that challenged uncontrollability (Step 15: allowing a spider to walk freely over one's body) to the standard fear hierarchy. METHOD: Fifty-one participants who had a severe fear of spiders completed two 60-min exposure sessions 1 week apart in a context that was either the same or different from the baseline and follow-up assessment context. Participants were categorized into groups based on the last hierarchy step they completed during treatment (Step 14 or fewer, or Step 15). RESULTS: Those who completed Step 15 had greater reductions in fear and beliefs about the probability of harm from baseline to post-treatment than those who completed fewer steps. Although completing Step 15 did not prevent fear from returning after a context change, it allowed people to maintain their ability to tolerate their fear, which earlier steps did not. Despite some fear returning after a context change, individuals who completed Step 15 tended to report greater reductions in fear from baseline to the follow-up assessment than participants who completed 14 or fewer steps. CONCLUSIONS: Overall, these results suggest that more intensive exposure that directly challenges harm beliefs may lead to greater changes in fear and fear beliefs than less intensive exposure.

Attentional Control and Fear Extinction in Subclinical Fear: An Exploratory Study.

Attentional control (AC) and fear extinction learning are known to be involved in pathological anxiety. In this study we explored whether individual differences in non-emotional AC were associated with individual differences in the magnitude and gradient of fear extinction (learning and recall). In 50 individuals with fear of spiders, we collected measures of non-emotional AC by means of self-report and by assessing the functioning of the major attention networks (executive control, orienting, and alerting). The participants then underwent a paradigm assessing fear extinction learning and extinction recall. The two components of the orienting network functioning (costs and benefits) were significantly associated with fear extinction gradient over and above the effects of trait anxiety. Specifically, participants with enhanced orienting costs (i.e., difficulties in disengaging attention from cues not relevant for the task) showed faster extinction learning, while those with enhanced orienting benefits (i.e., attention facilitated by valid cues) exhibited faster extinction recall as measured by fear-potentiated startle and Unconditioned Stimulus expectancies, respectively. Our findings suggest that, in non-emotional conditions, the orienting component of attention may be predictive of fear extinction. They also show that the use of fear extinction gradients and the exploration of individual differences in non-emotional AC (using performance-based measures of attentional network functioning) can provide a better understanding of individual differences in fear learning. Our findings also may help to understand differences in exposure therapy outcomes.

Does fear extinction in the laboratory predict outcomes of exposure therapy? A treatment analog study.

Fear extinction models have a key role in our understanding of anxiety disorders and their treatment with exposure therapy. Here, we tested whether individual differences in fear extinction learning and fear extinction recall in the laboratory were associated with the outcomes of an exposure therapy analog (ETA). Fifty adults with fear of spiders participated in a two-day fear-learning paradigm assessing fear extinction learning and fear extinction recall, and then underwent a brief ETA. Correlational analyses indicated that enhanced extinction learning was associated with better ETA outcome. Our results partially support the idea that individual differences in fear extinction learning may be associated with exposure therapy outcome, but suggest that further research in this area is needed.

Are there glutamate abnormalities in subjects at high risk mental state for psychosis? A review of the evidence.

New approaches to underlying alterations in psychosis suggest increasing evidence of glutamatergic abnormalities in schizophrenia and an association between these abnormalities and certain core psychopathological alterations such as cognitive impairment and negative symptoms. Proton magnetic resonance spectroscopy ((1)H MRS) is an MR-based technique that enables investigators to study glutamate function by measuring in vivo glutamatergic indices in the brain. In this article we review the published studies of (1)H MRS in subjects with an at-risk mental state (ARMS) for psychosis. The primary aim was to investigate whether alterations in glutamate function are present before the illness develops in order to expand our understanding of glutamatergic abnormalities in prodromal phases. Three databases were consulted for this review. Titles and abstracts were examined to determine if they fulfilled the inclusion criteria. The reference lists of the included studies were also examined to identify additional trials. Eleven final studies were included in this review. Significant alterations in glutamate metabolites across different cerebral areas (frontal lobe, thalamus, and the associative striatum) in subjects with an ARMS for psychosis are reported in six of the trials. A longitudinal analysis in two of these trials confirmed an association between these abnormalities and worsening of symptoms and final transition to psychosis. Considering that five other studies found no significant differences across these same areas, we can conclude that more research is needed to confirm glutamatergic abnormalities in subjects with an ARMS for psychosis. However, future research must overcome the methodological limitations of existing studies to obtain reliable results.