Treating Guilt-Inducing Self-Talk in Ocd with Dramatized Socratic Dialogue: A Step by Step Intervention.

Objective: Fear of moral guilt and conseque:nt increased attention to personal actions and intentions are the main ingredients of the self-criticism in patients suffering from obsessive-compulsive disorder (OCD). This pathogenic attitude takes shape in a typical guilt-inducing self-talk.The purpose of this work is to describe in detail a novel cognitive therapeutic procedure for OCD called "Dramatized Socratic Dialogue" (DSD). Method: DSD is a theory-oriented intervention that combine elements of Socratic dialogue, chairwork, and cognitive acceptance strategies derived from Mancini's model, which posits that obsessive-compulsive (OC) symptoms stem from a fear of deontological guilt. Results: DSD appears to have many strengths, being a theory-oriented treatment and focusing, as a therapeutic target, on the cognitive structures that determine pathogenic processes and OC symptoms. Furthermore, it is a short, flexible and tailor-made intervention. Conclusions: Detailed description of the intervention could foster future research perspectives and thus be used in evidence-based effectiveness studies to establish whether DSD reduces OC symptoms and to investigate its mechanism of action.

Guilt Feelings in Obsessive Compulsive Disorder: An Investigation between Diagnostic Groups.

Guilt plays a role in various forms of psychopathology. However, different types of guilt might be involved in different mental disorders. Obsessive-compulsive (OC) patients are prone to a type of guilt in which the violation of an internalized moral norm is necessary and sufficient, whereas data suggest that depression might be linked to more interpersonal types of guilt. However, the extent to which a specific guilt phenomenology is involved in each condition is yet to be determined. Here we assessed the association between different types of guilt and different diagnostic groups. Two clinical samples (33 OCD and 35 non-OCD) filled in the Moral Orientation Guilt Scale (MOGS) along with other OCD and depression measures. Regression was employed to test group differences in the MOGS subscales and to test the influence of MOGS subscales on OCD and depression levels. Results confirm that different types of guilt might be implicated in different psychopathological conditions. Specifically, moral norm violation guilt is more present in OC patients than in other disorders. Depression seems to be associated with different guilt feelings depending on the psychopathological condition, specifically in non-OC patients, with types of guilt involving a "victim", supporting the accounts viewing interpersonal guilt as involved in the emergence of depressive symptomatology and hyper-altruistic behavior as a vulnerability factor for depression.

Cognitive-Behavioral Treatment of Obsessive-Compulsive Disorder: The Results of a Naturalistic Outcomes Study.

Cognitive−behavioral therapy is a well-established treatment for obsessive−compulsive disorder (OCD). There are a variety of cognitive and behavioral strategies, and it is necessary to analyze the outcomes of the treatments. The aim of the present study is to verify the effectiveness of a treatment that combines evidence-based procedures and specific cognitive interventions highlighting the issue of acceptance. Forty patients with OCD were recruited and underwent a specific treatment procedure. All patients had a psychodiagnostic assessment for OCD using the Y−BOCS (Yale−Brown obsessive−compulsive scale) performed twice: before treatment (t0) and after nine months (t1). Data analysis showed a decrease in the scores between t0 and t1 according to the Y−BOCS in terms of the interference, severity, and impairment of obsessive−compulsive symptoms. A repeated-measures ANOVA showed a significant reduction in symptoms after treatment, with values of F (1, 39) = 137.56, p < 0.001, and η2 = 0.78. The ANOVA results were corroborated by a Wilcoxon signed-rank test. A reliable change index analysis indicated that 33 participants reported improvements in symptoms, of which 23 were clinically significant. The results showed clinical relevance for OCD treatment and highlighted how this cognitive procedure favored positive outcomes.

Imagery Rescripting on Guilt-Inducing Memories in OCD: A Single Case Series Study.

BACKGROUND AND OBJECTIVES: Criticism is thought to play an important role in obsessive-compulsive disorder (OCD), and obsessive behaviors have been considered as childhood strategies to avoid criticism. Often, patients with OCD report memories characterized by guilt-inducing reproaches. Starting from these assumptions, the aim of this study is to test whether intervening in memories of guilt-inducing reproaches can reduce current OCD symptoms. The emotional valence of painful memories may be modified through imagery rescripting (ImRs), an experiential technique that has shown promising results. METHODS: After monitoring a baseline of symptoms, 18 OCD patients underwent three sessions of ImRs, followed by monitoring for up to 3 months. Indexes of OCD, depression, anxiety, disgust, and fear of guilt were collected. RESULTS: Patients reported a significant decrease in OCD symptoms. The mean value on the Yale-Brown Obsessive Compulsive Scale (Y-BOCS) changed from 25.94 to 14.11. At the 3-month follow-up, 14 of the 18 participants (77.7%) achieved an improvement of ≥35% on the Y-BOCS. Thirteen patients reported a reliable improvement, with ten reporting a clinically significant change (reliable change index = 9.94). Four reached the asymptomatic criterion. Clinically significant changes were not detected for depression and anxiety. CONCLUSIONS: Our findings suggest that after ImRs intervention focusing on patients' early experiences of guilt-inducing reproaches there were clinically significant changes in OCD symptomatology. The data support the role of ImRs in reducing OCD symptoms and the previous cognitive models of OCD, highlighting the role of guilt-related early life experiences in vulnerability to OCD.

Psychometric properties of saving cognition inventory in Italian nonclinical samples

The main purpose of the study was aimed to examine the psychometric properties of the Saving Cognition Inventory (SCI) in Italian nonclinical samples. Two studies were conducted: (a) study 1 was focused on the confirmation of the factorial structure, internal consistency reliability, and subscales' intercorrelations on a sample of 252 participants; (b) study 2 was focused on gathering construct validity data on a sample of 244 participants. In addition to the SCI, other seven self-report measures were administered in order to assess hoarding, depression, anxiety, and obsessive compulsive disorder symptoms. Our results supported the hypothesis of four adequately reliable dimensions. Support for both concurrent and convergent validity was provided by significant and positive correlations between SCI scores and the other administered measures. Despite generalization of outcoming findings are limited, overall our research suggests that the SCI may be a valuable tool. Nevertheless, additional studies are still needed

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Hoarding rating scale-interview: reliability and construct validity in a nonclinical sample

The Hoarding Rating Scale-Interview (HRS-I) is a brief semi-structured interview that assesses five aspects of hoarding disorder: difficulty discarding, clutter, excessive acquisition, distress, and impairment. The aim of this study was to develop an Italian version of the HRS-I and examine its psychometric properties, in terms of reliability and construct validity. The HRS-I was administered to a sample of non-clinical adults (N= 491) along with a battery of selected self-report measures. The reliability was evaluated in terms of internal consistency. Cronbach's alpha and corrected item-total correlations indicated satisfactory scale homogeneity. The construct validity was addressed by providing evidence of both criterion and construct validity. In this direction, the relationships between HRS-I and other measures of the same or related constructs were investigated. In line with the findings of the original study, the general pattern of results was of a stronger association for like subscales than for unlike subscales. On the whole, empirical results indicated promising psychometric properties of the HRS Italian version in a nonclinical sample. Limitations of the study and the utility of the HRS-I in clinical and research settings are discussed

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Not just right experience: is it influenced by feelings of guilt?

Individuals with obsessive-compulsive disorder (OCD) experience increased guilt. Further, these individuals often report uncomfortable sensations of things being not quite right ("not just right experiences"--NJREs). As to the relation between these psychological phenomena, it was hypothesized that feelings of guilt may enhance NJRE. In two experiments, we demonstrated that the induction of a guilty emotion resulted in increased NJRE, and this finding was qualified by an interaction with trait guilt. Induced guilt was followed by stronger feelings of things being not just right only in high-trait-guilt participants. In the low-trait-guilt participants NJRE was weaker. Moreover, we found a meaningful relationship between both NJRE and trait guilt and OCD features.