Maladaptive Consequences of Mental Intrusions with Obsessive, Dysmorphic, Hypochondriac, and Eating-disorders Related Contents: Cross-cultural Differences / Consecuencias negativas de las intrusiones mentales con contenidos obsesivos, dismórficos, hipocondriacos y alimentarios: diferencias transculturales

AbstractBackground/Objective: Unwanted mental intrusions (UMIs) with contents related to Obsessive-Compulsive Disorder (OCD), Body Dysmorphic Disorder (BDD), Illness Anxiety Disorder (IAD), and Eating Disorders (EDs) are highly prevalent, independently of the cultural and/or social context. Cognitive-behavioral explanations for these disorders postulates that the escalation from common UMIs to clinically relevant symptoms depends on the maladaptive consequences (i.e., emotions, appraisals, and control strategies) of experiencing UMIs. This study examines, from a cross-cultural perspective, the cognitive-behavioral postulates of the maladaptive consequences of having UMIs. Method: Non-clinical 1,473 participants from Europe, the Middle-East, and South America completed the Questionnaire of Unpleasant Intrusive Thoughts to assess the maladaptive consequences of experiencing highly disturbing OCD, BDD, IAD, and EDs-related UMIs. Results: Findings revealed main effects for both the country and the consequences associated with the four UMI contents. Interaction effects between the consequences of each UMI content and the sample location were also observed. Conclusions: Cognitive-Behavioral models for OCD, BDD, IAD, and EDs should be implemented along with socio-cultural variables that increase the understanding of the role of these variables in the phenomenology of UMIs and their associated consequences.© 2021 Asociación Española de Psicología Conductual. Published by Elsevier España, S.L.U. This is an open access article under the CC BY−NC−ND license (http://creativecommons.org/licenses/by−nc−nd/4.0/).

ResumenIntroducción/Objetivo: Las intrusiones mentales no deseadas (IM) de contenidos relacio-nados con el Trastorno Obsesivo-Compulsivo (TOC), el Trastorno Dismórfico Corporal (TDC), la Ansiedad por la Enfermedad (AE), y los Trastornos Alimentarios (TAs) son muy prevalentes, independientemente de la cultura y/o el contexto social. Las explicaciones cognitivo-conductuales de esos trastornos postulan que la escalada de IM normales a síntomas clínicamente relevantes depende de las consecuencias desadaptativas (i.e., emociones, valoraciones y estrategias de control) de las IM. Este estudio examina los planteamientos sobre dichas consecuencias desde una perspectiva transcultural. Méto-do: 1.473 participantes de Europa, Oriente Medio y Suramérica completaron el Inventario de Pensamientos Intrusos Desagradables para evaluar las consecuencias desadaptativas de experimentar IM muy molestas con contenidos de TOC, TDC, AE y TAs. Resultados: Se ob-tuvieron efectos principales tanto para el país como para las consecuencias asociadas con los cuatro contenidos de IM, así como efectos de interacción entre las consecuencias de cada modalidad de IM y la localización de la muestra. Conclusiones: Los modelos cogniti-vo-conductuales sobre el TOC, el TDC, la AE y los TAs deben complementarse con varia-bles socioculturales que aumenten la comprensión del papel de esas variables en la feno-menología de las IM y sus consecuencias asociadas.© 2021 Asociación Española de Psicología Conductual. Published by Elsevier España, S.L.U. This is an open access article under the CC BY−NC−ND license (http://creativecommons.org/licenses/by−nc−nd/4.0/)

Maladaptive Consequences of Mental Intrusions with Obsessive, Dysmorphic, Hypochondriac, and Eating-disorders Related Contents: Cross-cultural Differences.

BACKGROUND/OBJECTIVE: Unwanted mental intrusions (UMIs) with contents related to Obsessive-Compulsive Disorder (OCD), Body Dysmorphic Disorder (BDD), Illness Anxiety Disorder (IAD), and Eating Disorders (EDs) are highly prevalent, independently of the cultural and/or social context. Cognitive-behavioral explanations for these disorders postulates that the escalation from common UMIs to clinically relevant symptoms depends on the maladaptive consequences (i.e., emotions, appraisals, and control strategies) of experiencing UMIs. This study examines, from a cross-cultural perspective, the cognitive-behavioral postulates of the maladaptive consequences of having UMIs. METHOD: Non-clinical 1,473 participants from Europe, the Middle-East, and South America completed the Questionnaire of Unpleasant Intrusive Thoughts to assess the maladaptive consequences of experiencing highly disturbing OCD, BDD, IAD, and EDs-related UMIs. RESULTS: Findings revealed main effects for both the country and the consequences associated with the four UMI contents. Interaction effects between the consequences of each UMI content and the sample location were also observed. CONCLUSIONS: Cognitive-Behavioral models for OCD, BDD, IAD, and EDs should be implemented along with socio-cultural variables that increase the understanding of the role of these variables in the phenomenology of UMIs and their associated consequences.

INTRODUCCIÓN/OBJETIVO: Las intrusiones mentales no deseadas (IM) de contenidos relacionados con el Trastorno Obsesivo-Compulsivo (TOC), el Trastorno Dismórfico Corporal (TDC), la Ansiedad por la Enfermedad (AE), y los Trastornos Alimentarios (TAs) son muy prevalentes, independientemente de la cultura y/o el contexto social. Las explicaciones cognitivo-conductuales de esos trastornos postulan que la escalada de IM normales a síntomas clínicamente relevantes depende de las consecuencias desadaptativas (i.e., emociones, valoraciones y estrategias de control) de las IM. Este estudio examina los planteamientos sobre dichas consecuencias desde una perspectiva transcultural. MÉTODO: 1.473 participantes de Europa, Oriente Medio y Suramérica completaron el Inventario de Pensamientos Intrusos Desagradables para evaluar las consecuencias desadaptativas de experimentar IM muy molestas con contenidos de TOC, TDC, AE y TAs. RESULTADOS: Se obtuvieron efectos principales tanto para el país como para las consecuencias asociadas con los cuatro contenidos de IM, así como efectos de interacción entre las consecuencias de cada modalidad de IM y la localización de la muestra. CONCLUSIONES: Los modelos cognitivo-conductuales sobre el TOC, el TDC, la AE y los TAs deben complementarse con variables socioculturales que aumenten la comprensión del papel de esas variables en la fenomenología de las IM y sus consecuencias asociadas.

Dysmorphic and illness anxiety-related unwanted intrusive thoughts in individuals with obsessive-compulsive disorder.

BACKGROUND/OBJECTIVE: Unwanted intrusive thoughts (UITs) are considered normal variants of the obsessions found in obsessive-compulsive disorder (OCD). Similarly, intrusive and persistent preoccupations about appearance defects in body dysmorphic disorder (BDD) and images and thoughts about illness in illness anxiety disorder (IAD) are abnormal variants of the thoughts and concerns about appearance and health found in non-clinical individuals. This study examines whether patients with OCD have frequent and distressing UITs with contents related to BDD and IAD, in addition to OCD-related UITs. METHOD: Thirty-nine participants with OCD (Mage = 32.45, standard deviation [SD] = 11.57; 63% men) completed the Questionnaire of Unpleasant Intrusive Thoughts (QUIT), designed to assess obsessional, dysmorphic and illness anxiety UITs and their associated functional consequences (emotions, appraisals, and neutralizing or control strategies). RESULTS: Up to 71% of the individuals with OCD experienced the three UIT modalities. As expected, OCD-related UITs were the most frequent, although were no differences among the three UIT contents in terms of the disturbance they caused. The OCD intrusions were the most interfering, egodystonic and dysfunctionally appraised, and they instigated more neutralizing behaviours. Nonetheless, all UITs instigate the need to do something to alleviate the discomfort caused by their intrusion and attempts to suppress them. CONCLUSION: UITs with different contents not always related to typical obsessive themes are a common experience in patients with OCD. These UITs could have detrimental consequences for the course of the disorder itself, and they should be adequately addressed in both the assessment and treatment of these patients.

Illness-related intrusive thoughts and illness anxiety disorder.

INTRODUCTION: Intrusive thoughts about health threats (illness-ITs) are a potential cognitive risk factor for the development and maintenance of illness anxiety disorder (IAD). This study analyzes the dimensionality of illness-ITs from normalcy to psychopathology, and it evaluates whether the appraisals instigated by the Its mediate between these thoughts and IAD symptoms. METHODS: Two groups of individuals participated in the study and completed the Illness Intrusive Thoughts Inventory and the Whiteley Index. The first group was composed of 446 non-clinical community participants. Of them, 264 individuals (68.6% women; Mage  = 30.03 [SD = 13.83]) reported having experienced an upsetting illness-IT in the past three months and were then included in the main analyses. The second group included 31 patients with a current main diagnosis of IAD based on DSM-5 criteria (51.6% women; Mage  = 32.74 [SD = 9.69]). Their severity was assessed with the Hypochondriasis Yale-Brown Obsessive-Compulsive Scale -Modified version, with scores ranging from 15 to 58 (M = 46.12, SD = 9.41). RESULTS: Illness-ITs are common in both non-clinical individuals and in patients with IAD, and they instigate dysfunctional emotional, cognitive, and behavioral consequences, although with greater intensity in patients than in non-clinical individuals. The relationship between illness-ITs and IAD is mediated by overestimation of threat and thought-action fusion-probability appraisals. CONCLUSION: Illness-ITs are a dimensional cognitive experience. The way they are appraised facilitates their escalation into symptoms of IAD. PRACTITIONER POINTS: Provides support for the cognitive explanatory model of IAD and its usefulness in clinical practice. Indicates that the way people interpret and react to naturally occurring intrusive thoughts about illness seems to be a vulnerability marker for developing an illness anxiety disorder. Emphasizes that the meaning that patients with IAD ascribe to their intrusive thoughts about illnesses must be a main target in the cognitive-behavioral treatment of IAD. Suggests that the importance of intrusive thoughts in IAD does not lie in the frequency with which they are experienced, but in the way, they are appraised/interpreted, which is what determines whether they become a clinically significant symptom. Indicates that the relationship between illness intrusive thoughts and IAD symptoms in non-clinical individuals is based on: overestimating the negative consequences of experiencing an illness intrusive thought; and the appraisal that having such a thought would increase its likelihood of coming true. Shows that the frequency of illness-related intrusive cognitions is associated with worse cognitive and behavioral consequences.

The rates of co-occurring behavioural addictions in treatment-seeking individuals with obsessive-compulsive disorder: a preliminary report.

Objectives: To assess the rates of co-occurring putative 'behavioural addictions' in patients with obsessive-compulsive disorder (OCD).Methods: Twenty-three international centres specialising in the treatment of OCD were invited to participate in a survey of the rates of behavioural addictions and other relevant comorbidity within their samples.Results: Sixteen of 23 (69.6%) invited centres from 13 countries had sufficient data to participate in the survey. The use of validated diagnostic tools was discrepant, with most centres relying on a 'clinical diagnosis' to diagnose behavioural addictions. The final sample comprised of 6916 patients with a primary diagnosis of OCD. The reported rates of behavioural addictions were as follows: 8.7% for problematic internet use, 6.8% for compulsive sexual behaviour disorder, 6.4% for compulsive buying, 4.1% for gambling disorder and 3.4% for internet gaming disorder.Conclusions: Behavioural addictions should be better assessed for patients with OCD. The absence of diagnostic scales developed specifically for behavioural addictions and overlapping obsessive-compulsive phenomena such as compulsive checking of information on the internet may explain the relatively high rate of problematic internet use in this sample. The study encourages better efforts to assess and to conceptualise the relatedness of behavioural addictions to obsessive-compulsive 'spectrum' disorders.

The HEXACO-100 Across 16 Languages: A Large-Scale Test of Measurement Invariance.

The HEXACO Personality Inventory-Revised (HEXACO-PI-R) has become one of the most heavily applied measurement tools for the assessment of basic personality traits. Correspondingly, the inventory has been translated to many languages for use in cross-cultural research. However, formal tests examining whether the different language versions of the HEXACO-PI-R provide equivalent measures of the 6 personality dimensions are missing. We provide a large-scale test of measurement invariance of the 100-item version of the HEXACO-PI-R across 16 languages spoken in European and Asian countries (N = 30,484). Multigroup exploratory structural equation modeling and confirmatory factor analyses revealed consistent support for configural and metric invariance, thus implying that the factor structure of the HEXACO dimensions as well as the meaning of the latent HEXACO factors is comparable across languages. However, analyses did not show overall support for scalar invariance; that is, equivalence of facet intercepts. A complementary alignment analysis supported this pattern, but also revealed substantial heterogeneity in the level of (non)invariance across facets and factors. Overall, results imply that the HEXACO-PI-R provides largely comparable measurement of the HEXACO dimensions, although the lack of scalar invariance highlights the necessity for future research clarifying the interpretation of mean-level trait differences across countries.

Dysfunctional beliefs as mediators between illness-related intrusive thoughts and health anxiety symptoms.

BACKGROUND: Cognitive behavioural models of hypochondriasis assume that dysfunctional illness-related beliefs are involved in the genesis and maintenance of the disorder. The role that other more general dysfunctional beliefs about thoughts play in this disorder has also been highlighted. Internal triggers such as illness-related intrusive thoughts could activate these beliefs. AIM: The present paper examines whether general dysfunctional beliefs about distressing thoughts, such as intolerance of uncertainty, over-estimation of threat, and thought-action fusion-likelihood, mediate between illness-related intrusive thoughts and health anxiety symptoms. METHOD: A group of participants composed of individuals with hypochondriasis (n = 31; 51.5% women; mean age = 32.74 years, SD = 9.96) and community individuals (n = 219; 54.3% women; mean age = 39.56 years, SD = 15.20) completed a series of questionnaires to assess illness-related intrusive thoughts (INPIE), dysfunctional beliefs about thoughts (OBSI-R), and health anxiety symptoms (SHAI). RESULTS: Results from a multiple parallel mediation analysis indicate that over-estimation of threat partially mediated the relationship between illness-related intrusive thoughts and health anxiety symptoms. CONCLUSIONS: The results support the importance of the tendency to over-estimate the threat in the relationship between intrusive thoughts related to illness contents and health anxiety. Conceptual and clinical implications of these results are discussed.

The Spanish validation of the Short Health Anxiety Inventory: Psychometric properties and clinical utility.

BACKGROUND/OBJECTIVE: The Short Health Anxiety Inventory (SHAI) is a widely used self-report instrument to evaluate health anxiety. To assess the SHAI's factor structure, psychometric properties, and accuracy in differentiating Spanish non-clinical individuals from patients with severe health anxiety or hypochondriasis. METHOD: A total of 342 community participants (61.6% women; M age = 34.60, SD = 14.91) and 31 hypochondriacal patients (51.6% women; M age = 32.74, SD = 9.69) completed the SHAI and other self-reports assessing symptoms of hypochondriasis, depression, anxiety sensitivity, worry, and obsessive-compulsive. RESULTS: The original two-factor structure was selected as the best structure, based on its parsimony and empirical support (Factor 1: Illness likelihood; Factor 2: Negative consequences of illness). Moreover, the Spanish version of the SHAI demonstrated good construct and concurrent and discriminant validity, and internal consistency. A cutoff of 40.5 (total score) accurately distinguished non-clinical individuals from patients with severe health anxiety or hypochondriasis. CONCLUSIONS: The SHAI is an adequate screening instrument to measure health anxiety in Spanish-speaking community adults.

INTRODUCCIÓN/OBJETIVO: El Inventario Breve de Ansiedad por la Salud (SHAI, por sus iniciales en inglés) es un autoinforme ampliamente empleado para evaluar ansiedad por la salud. El objetivo es evaluar la estructura factorial del SHAI, sus propiedades psicométricas, y exactitud diferenciando entre población española no clínica y pacientes con hipocondría. MÉTODO: Un total de 342 participantes extraídos de la población general (66% mujeres, M edad  = 35, DT = 14,91) y 31 pacientes con hipocondría (51,6% mujeres; M edad  = 32,74, DT = 9,69 completaron el SHAI y otros autoinformes de síntomas hipocondriacos, depresión, sensibilidad a la ansiedad, preocupaciones y obsesivo-compulsivos. RESULTADOS: La estructura de dos factores propuesta originalmente fue seleccionada como la mejor estructura debido a su parsimonia y soporte empírico (Factor 1: Probabilidad de enfermar; Factor 2: Consecuencias negativas enfermedad). La versión española del SHAI muestra una buena consistencia interna, y validez de constructo, concurrente y discriminante. El punto de corte de 40,5 (puntuación total) permite distinguir entre los individuos no clínicos y los pacientes con elevada ansiedad por la salud o hipocondría. CONCLUSIONES: El SHAI es un instrumento adecuado para la detección de ansiedad por la salud en población adulta hispano hablante.

The Spanish validation of the Short Health Anxiety Inventory: Psychometric properties and clinical utility / Validación española del Inventario Breve de Ansiedad por la Salud: propiedades psicométricas y utilidad clínica

Background/Objective: The Short Health Anxiety Inventory (SHAI) is a widely used self-report instrument to evaluate health anxiety. To assess the SHAI's factor structure, psychometric properties, and accuracy in differentiating Spanish non-clinical individuals from patients with severe health anxiety or hypochondriasis. Method: A total of 342 community participants (61.6% women; Mage = 34.60, SD = 14.91) and 31 hypochondriacal patients (51.6% women; Mage = 32.74, SD = 9.69) completed the SHAI and other self-reports assessing symptoms of hypochondriasis, depression, anxiety sensitivity, worry, and obsessive-compulsive. Results: The original two-factor structure was selected as the best structure, based on its parsimony and empirical support (Factor 1: Illness likelihood; Factor 2: Negative consequences of illness). Moreover, the Spanish version of the SHAI demonstrated good construct and concurrent and discriminant validity, and internal consistency. A cutoff of 40.5 (total score) accurately distinguished non-clinical individuals from patients with severe health anxiety or hypochondriasis. Conclusions: The SHAI is an adequate screening instrument to measure health anxiety in Spanish-speaking community adults

Introducción/Objetivo: El Inventario Breve de Ansiedad por la Salud (SHAI, por sus iniciales en inglés) es un autoinforme ampliamente empleado para evaluar ansiedad por la salud. El objetivo es evaluar la estructura factorial del SHAI, sus propiedades psicométricas, y exactitud diferenciando entre población española no clínica y pacientes con hipocondría. Método: Un total de 342 participantes extraídos de la población general (66% mujeres, Medad = 35, DT = 14,91) y 31 pacientes con hipocondría (51,6% mujeres; Medad = 32,74, DT = 9,69 completaron el SHAI y otros autoinformes de síntomas hipocondriacos, depresión, sensibilidad a la ansiedad, preocupaciones y obsesivo-compulsivos. Resultados: La estructura de dos factores propuesta originalmente fue seleccionada como la mejor estructura debido a su parsimonia y soporte empírico (Factor 1: Probabilidad de enfermar; Factor 2: Consecuencias negativas enfermedad). La versión española del SHAI muestra una buena consistencia interna, y validez de constructo, concurrente y discriminante. El punto de corte de 40,5 (puntuación total) permite distinguir entre los individuos no clínicos y los pacientes con elevada ansiedad por la salud o hipocondría. Conclusiones: El SHAI es un instrumento adecuado para la detección de ansiedad por la salud en población adulta hispano hablante

The cross-cultural and transdiagnostic nature of unwanted mental intrusions.

BACKGROUND/OBJECTIVE: Unwanted mental intrusions (UMIs), typically discussed in relation to Obsessive-Compulsive Disorder (OCD), are highly prevalent, regardless of the specific nationality, religion, and/or cultural context. Studies have also shown that UMIs related to Body Dysmorphic Disorder (BDD), Illness anxiety/Hypochondriasis (IA-H), and Eating Disorders (EDs) are commonly experienced. However, the influence of culture on these UMIs and their transdiagnostic nature has not been investigated. METHOD: Participants were 1,473 non-clinical individuals from seven countries in Europe, the Middle-East, and South America. All the subjects completed the Questionnaire of Unpleasant Intrusive Thoughts, which assesses the occurrence and discomfort of four UMI contents related to OCD, BDD, IA-H, and EDs, and symptom questionnaires on the four disorders. RESULTS: Overall, 64% of the total sample reported having experienced the four UMIs. The EDs intrusions were the most frequently experienced, whereas hypochondriacal intrusions were the least frequent but the most disturbing. All the UMIs were significantly related to each other in frequency and disturbance, and all of them were associated with clinical measures of OCD, BDD, IA-H, and EDs. CONCLUSIONS: UMIs are a common phenomenon across different cultural contexts and operate transdiagnostically across clinically different disorders.

INTRODUCCIÓN/OBJETIVO: Las intrusiones mentales no deseadas (IM), clásicamente estudiadas en relación con el trastorno obsesivo-compulsivo (TOC), tienen una prevalencia elevada independientemente de la nacionalidad, religión, y/o el contexto cultural. Las investigaciones muestran que también es habitual experimentar IM sobre contenidos relacionados con el trastorno dismórfico corporal (TDC), la ansiedad por la enfermedad/hipocondría (AE-H) y los trastornos alimentarios (TCA). Sin embargo, la influencia de la cultura sobre estas IM y su naturaleza transdiagnóstica no se han investigado. MÉTODO: Participaron 1.473 personas de siete países de Europa, Oriente Medio y Suramérica. Todas completaron el Cuestionario de Pensamientos Intrusos Desagradables, que evalúa la ocurrencia y malestar asociados a cuatro contenidos de IM relacionados con TOC, TDC, AE-H y TCA, y cuestionarios sobre síntomas de los cuatro trastornos. RESULTADOS: El 64% de la muestra total había experimentado las cuatro modalidades de IM. Las IM-TCA fueron las más frecuentes y las hipocondríacas las menos, pero las más molestas. Todas las IM mantuvieron relaciones entre sí, tanto en frecuencia como en molestia, y todas se asociaron con las medidas clínicas de TOC, TDC, AE-H y TCA. CONCLUSIONES: Las IM son una experiencia habitual en diferentes contextos culturales y operan de modo transdiagnóstico en trastornos clínicamente distintos.

The cross-cultural and transdiagnostic nature of unwanted mental intrusions / Expresión transcultural y naturaleza transdiagnóstica de las intrusiones mentales no deseadas

Background/Objective: Unwanted mental intrusions (UMIs), typically discussed in relation to Obsessive-Compulsive Disorder (OCD), are highly prevalent, regardless of the specific nationality, religion, and/or cultural context. Studies have also shown that UMIs related to Body Dysmorphic Disorder (BDD), Illness anxiety/Hypochondriasis (IA-H), and Eating Disorders (EDs) are commonly experienced. However, the influence of culture on these UMIs and their transdiagnostic nature has not been investigated. Method: Participants were 1,473 non-clinical individuals from seven countries in Europe, the Middle-East, and South America. All the subjects completed the Questionnaire of Unpleasant Intrusive Thoughts, which assesses the occurrence and discomfort of four UMI contents related to OCD, BDD, IA-H, and EDs, and symptom questionnaires on the four disorders. Results: Overall, 64% of the total sample reported having experienced the four UMIs. The EDs intrusions were the most frequently experienced, whereas hypochondriacal intrusions were the least frequent but the most disturbing. All the UMIs were significantly related to each other in frequency and disturbance, and all of them were associated with clinical measures of OCD, BDD, IA-H, and EDs. Conclusions: UMIs are a common phenomenon across different cultural contexts and operate transdiagnostically across clinically different disorders

Introducción/Objetivo: Las intrusiones mentales no deseadas (IM), clásicamente estudiadas en relación con el trastorno obsesivo-compulsivo (TOC), tienen una prevalencia elevada independientemente de la nacionalidad, religión, y/o el contexto cultural. Las investigaciones muestran que también es habitual experimentar IM sobre contenidos relacionados con el trastorno dismórfico corporal (TDC), la ansiedad por la enfermedad/hipocondría (AE-H) y los trastornos alimentarios (TCA). Sin embargo, la influencia de la cultura sobre estas IM y su naturaleza transdiagnóstica no se han investigado. Método: Participaron 1.473 personas de siete países de Europa, Oriente Medio y Suramérica. Todas completaron el Cuestionario de Pensamientos Intrusos Desagradables, que evalúa la ocurrencia y malestar asociados a cuatro contenidos de IM relacionados con TOC, TDC, AE-H y TCA, y cuestionarios sobre síntomas de los cuatro trastornos. Resultados: El 64% de la muestra total había experimentado las cuatro modalidades de IM. Las IM-TCA fueron las más frecuentes y las hipocondríacas las menos, pero las más molestas. Todas las IM mantuvieron relaciones entre sí, tanto en frecuencia como en molestia, y todas se asociaron con las medidas clínicas de TOC, TDC, AE-H y TCA. Conclusiones: Las IM son una experiencia habitual en diferentes contextos culturales y operan de modo transdiagnóstico en trastornos clínicamente distintos

Can Brief, Daily Training Using a Mobile App Help Change Maladaptive Beliefs? Crossover Randomized Controlled Trial.

BACKGROUND: Obsessive-compulsive disorder (OCD) is a disabling condition with a wide variety of clinical presentations including contamination fears, fear of harm, and relationship-related obsessions. Cognitive behavioral models of OCD suggest that OC symptoms result from catastrophic misinterpretations of commonly occurring intrusive experiences and associated dysfunctional strategies used to manage them. OCD-related maladaptive beliefs including inflated responsibility, importance and control of thoughts, perfectionism, and intolerance for uncertainty increase the likelihood of such misinterpretations. OBJECTIVE: Considering accumulating evidence suggesting that mobile health (mHealth) apps based on cognitive-behavioral principles may lead to significant reductions in psychopathological symptoms, we assessed the effectiveness of a novel cognitive training app (GGRO) designed to challenge OCD-related beliefs. METHODS: A total of 97 students were randomized to groups undertaking immediate-use (iApp) or delayed use (dApp) of GGRO. All participants were requested to complete Web-based assessments, with questionnaires relating to maladaptive beliefs, mood, and OC symptoms at baseline (T1), 15 days from baseline (T2), and 30 days from baseline (T3). Participants in iApp group started using the app at baseline and continued using the app for 15 consecutive days. They were then requested to stop using the app until T3. Participants in the dApp group were requested to wait for 15 days and only then start using the app (crossover) for 15 consecutive days. RESULTS: All participants used the app for a mean of 14.07 (SD 1.41) days with 2.94 levels per day. Consistent with previous findings, app use was associated with medium-large effect size reductions in both iApp (n=51) and dApp (n=46) groups. In the iApp group, all effects remained significant during the 15 days of follow-up. Analyses focusing on the first two assessment occasions revealed significant treatment × repeated measures interactions on maladaptive beliefs, several OC symptom measures, and self-esteem. CONCLUSIONS: This study provides further evidence for the efficacy of GGRO as a mobile-delivered training exercise that is useful for reducing OCD-related beliefs and symptoms. TRIAL REGISTRATION: ClinicalTrials.gov NCT03571464; https://clinicaltrials.gov/ct2/show/NCT03571464 (Archived by WebCite at http://www.webcitation.org/7675sYPsH).

Treatments used for obsessive-compulsive disorder-An international perspective.

OBJECTIVE: The objective of this study was to characterise international trends in the use of psychotropic medication, psychological therapies, and novel therapies used to treat obsessive-compulsive disorder (OCD). METHODS: Researchers in the field of OCD were invited to contribute summary statistics on the characteristics of their samples. Consistency of summary statistics across countries was evaluated. RESULTS: The study surveyed 19 expert centres from 15 countries (Argentina, Australia, Brazil, China, Germany, Greece, India, Italy, Japan, Mexico, Portugal, South Africa, Spain, the United Kingdom, and the United States) providing a total sample of 7,340 participants. Fluoxetine (n = 972; 13.2%) and fluvoxamine (n = 913; 12.4%) were the most commonly used selective serotonin reuptake inhibitor medications. Risperidone (n = 428; 7.3%) and aripiprazole (n = 415; 7.1%) were the most commonly used antipsychotic agents. Neurostimulation techniques such as transcranial magnetic stimulation, deep brain stimulation, gamma knife surgery, and psychosurgery were used in less than 1% of the sample. There was significant variation in the use and accessibility of exposure and response prevention for OCD. CONCLUSIONS: The variation between countries in treatments used for OCD needs further evaluation. Exposure and response prevention is not used as frequently as guidelines suggest and appears difficult to access in most countries. Updated treatment guidelines are recommended.

Creencias disfuncionales sobre la salud y la enfermedad: Un estudio familiar / Dysfunctional beliefs about health and illness: A family study

Los modelos cognitivos sobre la hipocondría postulan que las experiencias tempranas con la enfermedad promueven el desarrollo de creencias disfuncionales sobre la enfermedad. Estas creencias pueden permanecer latentes y activarse ante un incidente crítico. Los estudios publicados aportan datos que avalan de manera indirecta estos planteamientos. Teniendo en cuenta que en el núcleo familiar primario se comparten experiencias sobre la enfermedad, examinamos la relación entre las creencias disfuncionales que los progenitores y sus descendientes mantienen sobre la enfermedad y los pensamientos, tales como la intolerancia a la incertidumbre y la sobreestimación de la amenaza, y las relaciones entre dichas creencias, la sintomatología hipocondríaca y depresiva. Cuarenta estudiantes universitarios y sus progenitores (27 padres y 36 madres) completaron auto-informes sobre creencias disfuncionales acerca de la enfermedad, los pensamientos y síntomas hipocondríacos y depresivos. Los resultados mostraron que las creencias disfuncionales sobre la enfermedad y la sobrestimación de la amenaza de los padres, pero no de las madres, se asociaban con las de sus hijos e hijas. Asimismo, las creencias disfuncionales de padres, hijos, e hijas, se relacionaron con síntomas de hipocondría y depresión

Cognitive models about hypochondriasis postulate that early experiences with illness can lead individuals to develop dysfunctional beliefs about having an illness. These beliefs can remain in a latent state and be triggered by a critical incident. Published studies have provided data partially supporting these assumptions. Considering that the primary family context shares experiences about illness, we examined the relationships between the dysfunctional beliefs that parents and their offsprings maintain about illness and thoughts, such as intolerance to uncertainty and over-estimation of threat, as well as the relationships between these beliefs with hypochondriacal and depressive symptoms. Forty university students and their parents (27 fathers and 36 mothers) completed self-reports on dysfunctional beliefs about illness, thoughts and symptoms of hypochondriasis and depression. Results indicated that the fathers' dysfunctional beliefs about illness and overestimation of threat, but not those of mothers, were associated with their sons and daughters beliefs. Likewise, the dysfunctional beliefs of fathers, sons, and daughters were related to symptoms of hypochondriasis and depression

Assisting relapse prevention in OCD using a novel mobile app-based intervention: A case report.

Mobile health apps increase the accessibility of cognitive-behavioral-based interventions before, during, or following treatment. GGOC is a mobile app designed to challenge maladaptive beliefs in obsessive-compulsive disorder (OCD). This single-case study assesses the usefulness of GGOC as a relapse prevention tool for OCD. The patient was a 26-year-old woman with severe contamination and washing/cleaning OCD symptoms (Y-BOCS = 33). GGOC was used for relapse prevention following CBT treatment. The patient completed 47 levels dedicated to OCD-relevant maladaptive beliefs. Before and after GGOC, the Y-BOCS, Obsessive-Compulsive Inventory (OCI-R), Obsessive Beliefs Questionnaire (OBQ-20), and Depression subscale of the Depression, Anxiety, Stress Scale were completed. The OBQ-20 and OCI-R scores decreased from pre- to post-GGOC. The Y-BOCS decreased from 7 pre-GGOC to 2 post-GGOC. Findings support the efficacy of GGOC as a relapse prevention tool for individuals with OCD, and its contribution to maintaining gains after CBT.

Functional links of obsessive, dysmorphic, hypochondriac, and eating-disorders related mental intrusions.

Unwanted mental intrusions (UMIs) are the normal variants of obsessions in Obsessive-Compulsive Disorder (OCD), preoccupations about defects in Body Dysmorphic Disorder (BDD), images about illness in Hypochondriasis (HYP), and thoughts about eating in Eating Disorders (EDs). The aim was to examine the similarities and differences in the functional links of four UMI contents, adopting a within-subject perspective. Method: 438 university students and community participants (M age = 29.84, SD = 11.41; 70.54% women) completed the Questionnaire of Unpleasant Intrusive Thoughts (QUIT) to assess the functional links (emotions, appraisals, and neutralizing/control strategies) of the most upsetting UMIs with OCD, BDD, HYP and EDs-contents. Results: HYP-related intrusions caused the highest emotional impact, OCD-related intrusions were the most interfering, and EDs-related intrusions interfered the least. The four UMI were equally ego-dystonic. Women appraised OCD-related intrusions more dysfunctionally, but men appraised the four intrusive contents similarly. All UMI instigated the urge to "do something", to keep them under control and/or neutralizing them. Conclusions: Similarities among the functional links of intrusions related to OCD, BDD, HYP and EDs contents support their transdiagnostic nature and they might contribute to understanding common factors in these disorders.

ANTECEDENTES/OBJETIVO: Las intrusiones mentales no deseadas (IM) son la variante normativa de obsesiones en el Trastorno Obsesivo-Compulsivo (TOC), preocupaciones por defectos en el Trastorno Dismórfico Corporal (TDC), imágenes sobre enfermedad en Hipocondría (TH) y pensamientos sobre alimentación en los Trastornos Alimentarios (TA). El objetivo fue examinar similitudes y diferencias en las relaciones funcionales de los cuatro contenidos de IM, adoptando una perspectiva intra-sujeto. MÉTODO: 438 estudiantes universitarios y participantes de la comunidad (M edad = 29,84; DT = 11,41; 70,54% mujeres) completaron el Inventario de Pensamientos Intrusos Desagradables, que evalúa las relaciones funcionales (emociones, valoraciones y estrategias de neutralización/control) de las IM más molestas con contenidos TOC, TDC, TH y TA. RESULTADOS: Las IM-TH evocaron más emociones negativas, las IM-TOC fueron las que más interfirieron y las IM-TA las que menos. Todas fueron igualmente egodistónicas. Las IM-TOC fueron las más disfuncionalmente valoradas por las mujeres, pero los hombres valoraron los cuatro contenidos de forma similar. Todas las IM promovieron la necesidad de "hacer algo" para controlarla/neutralizarla. CONCLUSIONES: Las similitudes en las relaciones funcionales de intrusiones relacionadas con contenidos del TOC, el TDC, el TH y los TA apoyan su naturaleza transdiagnóstica, pudiendo contribuir a la comprensión de los factores comunes entre esos trastornos.

Fases temporales y variables motivacionales: dos perspectivas complementarias en el proceso de búsqueda de ayuda por enfermedad mental / Temporary stages and motivational variables: Two complementary perspectives in the help-seeking process for mental disorders

Introducción: La búsqueda de ayuda profesional por enfermedad mental es un proceso complejo, con etapas y momentos temporales diferentes, en el que desempeñan un papel especialmente relevante los aspectos motivacionales. Sin embargo, no hay instrumentos de evaluación que permitan valorar tanto las variables temporales como las motivacionales. El objetivo de este estudio es ofrecer información detallada sobre ambos conjuntos de variables, mediante un instrumento específicamente diseñado para ello, de tal manera que se pueda comprender mejor el proceso de búsqueda de tratamiento. Material y métodos: Participaron 152 pacientes ambulatorios que habían solicitado ayuda profesional en una unidad de salud mental del SNS. Los diagnósticos principales fueron: trastorno obsesivo-compulsivo (n=71), agorafobia (n=21), trastorno depresivo mayor (n=18), anorexia nerviosa (n=20) y dependencia a cocaína (n=22). Los pacientes fueron evaluados mediante una entrevista estructurada, específicamente diseñada para el estudio. Asimismo, se obtuvieron datos sobre gravedad y calidad de vida. Resultados: Los pacientes con agorafobia y depresión mayor tardaron menos en reconocer los síntomas que los pacientes de los otros grupos. Asimismo, los pacientes con depresión mayor demoraron menos en solicitar ayuda profesional. Las variables motivacionales se agruparon en 3 conjuntos: motivos de consulta, relacionados con el malestar y la falta de control; motivos de demora de la consulta, relacionados con la minimización del problema; y motivos asociados al estigma. Conclusiones: Los resultados indican la necesidad de valorar las distintas variables motivacionales implicadas en las diferentes etapas del proceso de búsqueda de ayuda profesional. La entrevista que presentamos ha mostrado ser útil para ello

Introduction: Help-seeking for mental disorders is a complex process, which includes different temporary stages, and in which the motivational variables play an especially relevant role. However, there is a lack of instruments to evaluate in depth both the temporary and motivational variables involved in the help-seeking process. This study aims to analyse in detail these two sets of variables, using a specific instrument designed for the purpose, to gain a better understanding of the process of treatment seeking. Material and methods: A total of 152 patients seeking treatment in mental health outpatient clinics of the NHS were individually interviewed: 71 had Obsessive-Compulsive Disorder, 21 had Agoraphobia, 18 had Major Depressive Disorder), 20 had Anorexia Nervosa, and 22 had Cocaine Dependence. The patients completed a structured interview assessing the help-seeking process. Disorder severity and quality of life was also assessed. Results: The patients with agoraphobia and with major depression took significantly less time in recognising their mental health symptoms. Similarly, patients with major depression were faster in seeking professional help. Motivational variables were grouped in 3 sets: motivators for seeking treatment, related to the negative impact of symptoms on mood and to loss of control over symptoms; motivators for delaying treatment, related to minimisation of the disorder; and stigma-associated variables. Conclusions: The results support the importance of considering the different motivational variables involved in the several stages of the help-seeking process. The interview designed to that end has shown its usefulness in this endeavour

Escalation from normal appearance related intrusive cognitions to clinical preoccupations in Body Dysmorphic Disorder: A cross-sectional study.

Current cognitive approaches to Body Dysmorphic Disorder (BDD) assume that appearance-related intrusive cognitions and their functional consequences characterize the disorder, in a similar way that obsessive intrusive thoughts characterize the Obsessive-Compulsive Disorder (OCD). This study explores whether normal but unwanted appearance-related intrusive thoughts (AITs), escalate to clinical AITs when they are dysfunctionally appraised and instigate counterproductive neutralizing strategies. From a sample of 344 non-clinical individuals who reported a highly upsetting AIT during the past three months two subgroups were extracted according to their high (n = 68) and low (n = 276) vulnerability to BDD. The subjects in the high-risk group obtained significantly higher scores on the frequency of the most disturbing AIT and its emotional impact, interference, and appraisals evaluated with the Appearance Intrusions Questionnaire (AIQ). Additionally, two subgroups of 15 subjects each, with high and low risk to BDD, were formed and their scores were compared to 10 patients with BDD. The AIT had a greater emotional negative impact and more severe consequences on individuals with BDD compared to individuals at high-risk of BDD, which in turn, reported worse consequences of the AIT than those at low-risk. These results empirically support the similarities between BDD and OCD regarding their functional and phenomenological characteristics.

Functional links of obsessive, dysmorphic, hypochondriac, and eating-disorders related mental intrusions / Relaciones funcionales de las intrusiones mentales con contenidos obsesivos, dismórficos, hipocondríacos y alimentarios

Background/Objective: Unwanted mental intrusions (UMIs) are the normal variants of obsessions in Obsessive-Compulsive Disorder (OCD), preoccupations about defects in Body Dysmorphic Disorder (BDD), images about illness in Hypochondriasis (HYP), and thoughts about eating in Eating Disorders (EDs). The aim was to examine the similarities and differences in the functional links of four UMI contents, adopting a within-subject perspective. Method: 438 university students and community participants (Mage = 29.84, SD = 11.41; 70.54% women) completed the Questionnaire of Unpleasant Intrusive Thoughts (QUIT) to assess the functional links (emotions, appraisals, and neutralizing/control strategies) of the most upsetting UMIs with OCD, BDD, HYP and EDs-contents. Results: HYP-related intrusions caused the highest emotional impact, OCD related intrusions were the most interfering, and EDs-related intrusions interfered the least. The four UMI were equally ego-dystonic. Women appraised OCD-related intrusions more dysfunctionally, but men appraised the four intrusive contents similarly. All UMI instigated the urge to «do something», to keep them under control and/or neutralizing them. Conclusions: Similarities among the functional links of intrusions related to OCD, BDD, HYP and EDs contents support their transdiagnostic nature and they might contribute to understanding common factors in these disorders (AU)

Antecedentes/Objetivo: Las intrusiones mentales no deseadas (IM) son la variante normativa de obsesiones en el Trastorno Obsesivo-Compulsivo (TOC), preocupaciones por defectos en el Trastorno Dismórfico Corporal (TDC), imágenes sobre enfermedad en Hipocondría (TH) y pensamientos sobre alimentación en los Trastornos Alimentarios (TA). El objetivo fue examinar similitudes y diferencias en las relaciones funcionales de los cuatro contenidos de IM, adoptando una perspectiva intra-sujeto. Método: 438 estudiantes universitarios y participantes de la comunidad (Medad = 29,84; DT = 11,41; 70,54% mujeres) completaron el Inventario de Pensamientos Intrusos Desagradables, que evalúa las relaciones funcionales (emociones, valoraciones y estrategias de neutralización/ control) de las IM más molestas con contenidos TOC, TDC, TH y TA. Resultados: Las IM-TH evocaron más emociones negativas, las IM-TOC fueron las que más interfirieron y las IM-TA las que menos. Todas fueron igualmente egodistónicas. Las IM-TOC fueron las más disfuncionalmente valoradas por las mujeres, pero los hombres valoraron los cuatro contenidos de forma similar. Todas las IM promovieron la necesidad de «hacer algo» para controlarla/neutralizarla. Conclusiones: Las similitudes en las relaciones funcionales de intrusiones relacionadas con contenidos del TOC, el TDC, el TH y los TA apoyan su naturaleza transdiagnóstica, pudiendo contribuir a la comprensión de los factores comunes entre esos trastornos (AU)

A novel approach to challenging OCD related beliefs using a mobile-app: An exploratory study.

BACKGROUND AND OBJECTIVES: According to cognitive models, obsessive compulsive symptoms result from catastrophic misinterpretations of commonly occurring intrusive experiences and the use of counterproductive strategies to manage them. Obsessive Compulsive Disorder (OCD) related beliefs such as inflated responsibility, importance of thoughts and perfectionism increases the likelihood of such misinterpretations. Consistent with a growing body of literature supporting the usefulness of mobile delivered technologies in fostering cognitive behavior change, the present study assessed the effectiveness of a novel cognitive training exercise designed to challenge OCD-related beliefs. This mobile app training exercise consists of users having to pull statements challenging OCD beliefs towards themselves (downwards) and to throw away (push upwards) contra-productive self-statements. METHODS: 36 third-year BA students started the trial. Twenty completed pre and post measures of OCD-beliefs, mood and OCD symptoms including relationship-obsessions. Participants were instructed to complete 3 min of daily training for a period of 15 days. RESULTS: No significant differences were found between completers and non-completers on demographic and most symptom related measures at Time 1. Repeated-measures MANOVA of the 20 completers showed a significant reduction on all OCD symptoms measures and on OCD-beliefs. No significant reduction was found in depression symptoms. Regression analysis showed change in levels of OCD-beliefs was associated with reduction in OCD symptoms at Time 2 over and above OCD symptoms at Time 1. LIMITATIONS: The study is an open trial with non-clinical participants. CONCLUSIONS: This mobile delivered training exercise may be useful for the reduction and relapse prevention of OCD-related beliefs and symptoms.