Cognitive-behavioral therapy booster treatment in pediatric obsessive-compulsive disorder: A utilization assessment pilot study.

BACKGROUND: Cognitive-behavioral therapy (CBT) for pediatric obsessivecompulsive disorder (OCD) is effective, although many individuals report they need continued support after completing treatment. METHODS: Six monthly drop-in booster sessions were offered to 94 youth with OCD and their parents who previously had completed a 12-week group family-based CBT program (GF-CBT). This report describes program utilization rates and participant satisfaction levels. RESULTS: Twenty-three percent (n = 22) of invited youths with OCD attended ≥1 booster session; 63% of attendees participated in >1 session. The mean number of attended sessions was 2.84 (standard deviation = 1.74). No significant group differences between booster attendees and non-attendees were found in terms of age, sex, ethnicity, parental education, or symptom severity at baseline or end of GF-CBT. Booster session attendees were more likely to have comorbidities than non-attendees (82% vs 58%; P = .045). Most participants were recent treatment completers (59%). Based on participant feedback, booster sessions were valuable, with perceived benefits related to peer interaction and support, skills review, and homework development. CONCLUSIONS: Cognitive-behavioral therapy booster sessions for pediatric OCD seem to be an acceptable approach that a significant percentage of recent treatment completers would utilize. Further research is needed to examine program efficacy and to draw conclusions about key program features.

ENT involvement and orobuccal movements' disorders in Pandas patients: assessment and rehabilitations tools.

OBJECTIVE: PANDAS are known as the spectrum of autoimmune pathologies related to a previous or current infection by group A beta-hemolytic streptococcus (SBEGA), dealing with several neuropsychiatric manifestations that mainly affect pediatric age. The main features consist of behavioral disease or movement disease characterized by acute-onset, presenting especially through infant period or adolescence. Specific manifestations, occurring during the progression of the disease, are the presence of otorhinolaryngologic symptoms (ENT) and orofacial movement disorders associated with temporomandibular joint pain. PATIENTS AND METHODS: We enrolled 130 children (5-15 years) with a clinical diagnosis of PANDAS between 2012 and 2018. Participants were assessed using ENT specific parameters, PSG to examine respiratory disorders and conventional audiological evaluation. Descriptive and comparative statistical analyses were performed with a control group of 51 healthy patients. RESULTS: The prevalence of ENT symptoms associated was significantly detected in 88 patients of 130 in Group A (relative frequency (%) 67.6; p=0.041) and in 51 patients of 130 in the control Group B (relative frequency (%) 39.2; p=0.063). In relation to prevalence of SDB, 54 subjects have presented nocturnal respiratory obstructive symptoms from mild to severe (relative frequency (%) 61.3; p=0.033) vs. 20 patients of Group B (relative frequency (%) 39.2; p=0.055). The obstructive severity average type was correlated to the consensual adenotonsillar development (size 3-4), (relative frequency (%) 45.4; p=0.047). The audiological deficits found were mostly of transmissive type with OME correlated and linked to the presence of occasional episodes of AOM. The four PANDAS patients who presented orobuccal dystonia (relative frequency (%) 4.54; p=0.091) achieved an improvement of the algic symptoms through the exercises of self-rehabilitation. CONCLUSIONS: Findings from our study show that respiratory diseases, characterizing a group of patients with pandas, are the direct consequences of the malformed or hypertrophic condition and suggesting in these conditions surgical therapy as an approaching tool.

Compulsive Digital Gaming: An Emerging Mental Health Disorder in Children.

Excessive digital gaming is emerging as a mental health disorder because youngsters are losing control of their lives by wasting their time by indulging in online multiplayer games. The popularity of the games can be gauged by the fact that India's online gaming market of US $360 million is expected to grow to $ 1 billion by 2021. Video gaming is an obsessive compulsive disorder. The players enjoy creating and building relationships with other online characters, which provides a virtual community feeling at the expense of one-to-one social interactions and real life bonding. In due course of time, the players are preoccupied or "hooked" to the games and display mood swings like irritability, restlessness, and aggressive behavior when they are denied the playing gadgets. Realizing the multifarious health hazards of digital gaming, WHO has recently classified it as a mental health disorder in the 11th revision of its International Classification of Diseases (ICD-11) so that it is accorded the state health benefits for its prevention and treatment. The technology is both a boon as well as a bane, the option is with us. It is important to avoid all obsessions or compulsions in life in order to follow the philosophy of "middle path".

Does modifying personal responsibility moderate the mental contamination effect?

BACKGROUND AND OBJECTIVES: Mental contamination is the psychological sense of internal dirtiness that arises in the absence of physical contact with a perceived contaminant. Mental contamination can be evoked through imagining perpetrating a moral transgression. This study experimentally evoked mental contamination by asking men to imagine perpetrating a non-consensual kiss. It explored whether reducing sense of personal responsibility for the kiss moderated the mental contamination effect. METHODS: Male students (N = 60) imagined giving either a consensual or non-consensual kiss. Personal responsibility for the kiss was manipulated in one of two non-consensual kiss conditions by way of the inclusion of social influence information. Feelings of mental contamination were assessed by self-report and through a behavioural index. RESULTS: Mental contamination was successfully induced in the two non-consensual kiss conditions. There was evidence to support the hypothesis that reducing personal responsibility might moderate specific components of mental contamination (shame, dirtiness and urge to cleanse). The effect of responsibility modification was evident in the self-report measures, but not in the behavioural index. LIMITATIONS: The sample comprised male university students which limits generalizability of the findings. The behavioural assessment of mental contamination was limited to a proxy measure. CONCLUSIONS: Imagined moral violations are associated with increases in indices of mental contamination. Further research should investigate whether feelings of shame, dirtiness and urge to cleanse are particularly responsive to responsibility modifications.

There is an app for that! The current state of mobile applications (apps) for DSM-5 obsessive-compulsive disorder, posttraumatic stress disorder, anxiety and mood disorders.

Mental health apps are viewed as a promising modality to extend the reach of mental health care beyond the clinic. They do so by providing a means of assessment, tracking, and treatment through a smartphone. Given that nearly 2/3 of the American population owns a smartphone, mental health apps offer the possibility of overcoming treatment barriers such as geographic location or financial barriers. Unfortunately, the excitement surrounding mental health apps may be premature as the current supporting literature regarding their efficacy is limited. The app marketplace is littered with apps claiming to treat or assess symptoms, but even those created by reputable organizations or those incorporating components of evidence-based treatments have not yet been validated in terms of their efficacy. This review aims to provide a comprehensive review of the current state of the mental health app literature by examining published reports of apps designed for DSM-5 anxiety and mood disorders, OCD, and PTSD. The breadth of apps reviewed includes those oriented around assessment, symptom tracking, and treatment as well as "multipurpose" apps, which incorporate several of these components. This review will also present some of the most popular mental health apps which may have clinical utility and could be prescribed to clients. While we discuss many potential benefits of mental health apps, we focus on a number of issues that the current state of the app literature presents. Overall there is a significant disconnect between app developers, the scientific community and health care, leaving the utility of existing apps questionable.

Approaching contamination-related stimuli with an implicit Approach-Avoidance Task: Can it reduce OCD symptoms? An online pilot study.

BACKGROUND AND OBJECTIVES: Dual-process models suggest that automatic behavioral tendencies contribute to the development and maintenance of Obsessive Compulsive Disorder (OCD) symptoms. The aim of the present study was to investigate the potential of the Approach-Avoidance Task (AAT) to reduce OCD symptoms and associated distress. METHODS: The study was set up as an online intervention. Participants with OCD symptoms (N = 101) were randomly assigned either to one of two experimental conditions or a waitlist control group upon completion of an online baseline survey. Participants were instructed to respond to contamination-related and neutral pictures by pulling or pushing a computer mouse, respectively. In one AAT condition, contamination-relevant pictures remained on the screen one second after pulling (lock condition), while pictures disappeared immediately after pulling in the standard AAT. Participants completed an online re-assessment four weeks after baseline. RESULTS: For analyses, only data of patients with contamination-related OCD symptoms were analyzed. A significant reduction in distress caused by OCD symptoms was found for both AAT training groups. Furthermore, a reduction in compulsions occurred for the group using the standard AAT. No significant effect was found for the control group. LIMITATIONS: Implicit behavioral tendencies prior to and after training were not assessed. CONCLUSIONS: Findings tentatively suggest that the AAT might be effective in reducing washing-/contamination-related OCD symptoms.

Anxiety sensitivity as a predictor of outcome in the treatment of obsessive-compulsive disorder.

BACKGROUND AND OBJECTIVES: To address the fact that not all individuals who receive cognitive-behavioral therapy (CBT) for obsessive-compulsive disorder (OCD) exhibit complete symptom reduction, research has examined factors that predict outcome; however, no studies have examined anxiety sensitivity (AS) as a predictor of outcome of CBT for OCD. AS refers to the fear of anxious arousal that results from mistaken beliefs about the dangerousness of anxiety-related body sensations. It is important to understand whether AS influences OCD treatment outcome, considering that (a) some obsessions directly relate to AS, and (b) OCD patients with high AS may be reluctant to engage in anxiety-provoking components of CBT for OCD. METHODS: Patients (N = 187) with a primary diagnosis of OCD who received residential CBT for OCD participated in this study, which involved completing a self-report battery at pre- and post-treatment. RESULTS: Results supported study hypotheses, in that (a) baseline AS positively correlated with baseline OCD severity, and (b) greater baseline AS prospectively predicted higher posttreatment OCD symptom severity even after controlling for pretreatment OCD and depression severity. LIMITATIONS: The study was limited by its use of an older measure of AS, reliance on self-report measures, and nonstandardized treatment across participants. CONCLUSIONS: Findings highlight the importance of AS in the nature and treatment of OCD. Clinical implications and future directions are discussed.

Secondary outcomes from the pediatric obsessive compulsive disorder treatment study II.

The Pediatric Obsessive-Compulsive Disorder Treatment Study II (POTS II) investigated the benefit of serotonin reuptake inhibitor (SRI) augmentation with cognitive behavioral therapy (CBT). Primary outcomes focused on OCD symptom change and indicated benefit associated with a full course of CBT. Given that the majority of youth with OCD suffer from significant comorbid symptoms and impaired quality of life, the current study examined POTS II data for effects on secondary outcomes. Participants were 124 youth ages 7-17 years with a primary diagnosis of OCD who were partial responders to an adequate SRI trial. Participants were randomized to medication management, medication management plus instructions in cognitive behavioral therapy (CBT), or medication management plus full CBT. Acute effects on non-OCD anxiety, depression, inattention, hyperactivity, and quality of life were examined across treatment conditions. Improvement across treatment was observed for non-OCD anxiety, inattention, hyperactivity, and quality of life. Changes were generally significantly greater in the group receiving full CBT. Child-rated depression was not found to change. OCD-focused treatment lead to improvement in other areas of psychopathology and functioning. For youth who are partial responders to SRI monotherapy, augmentation with full CBT may yield the greatest benefit on these secondary outcomes. CLINICAL TRIALS REGISTRATION: Treatment of Pediatric OCD for SRI Partial Responders, Clinicaltrials.gov Identifier: NCT00074815, http://clinicaltrials.gov/show/NCT00074815.

Online computer-aided vicarious exposure for OCD symptoms: A pilot study.

BACKGROUND AND OBJECTIVES: Computer-aided vicarious exposure (CAVE) for obsessive-compulsive disorder (OCD) is an intervention in which participants learn and rehearse exposure with response prevention (ERP) by directing a character around a virtual world. This study aimed to pilot an online CAVE program for OCD in a community sample with high OCD symptomatology. METHODS: Participants (n = 78) were allocated to an intervention group (three 45-min weekly CAVE sessions) or to a waitlist control group. The treatment group were asked to complete three 45-min sessions over a four week period. RESULTS: Those who completed at least one CAVE session showed greater improvement on measures of OCD symptomatology at one-month post-treatment (d = 0.49-0.81) compared to waitlist (d = 0.01-0.1). Older age, past treatment and higher symptom severity were associated with non-adherence. LIMITATIONS: These findings should be considered preliminary due to sample size limitations and an absence of an active control group. However, the findings suggest that further development and evaluation of the program is warranted. CONCLUSIONS: Preliminary findings suggest that online CAVE programs have potential to bridge treatment gaps among those reluctant to attend treatment or engage with in vivo exposure exercises. These programs may also have potential applications as an adjunct to face-to-face or online cognitive behavioural therapy.

Individuals with high obsessive-compulsive tendencies or undermined confidence rely more on external proxies to access their internal states.

BACKGROUND AND OBJECTIVES: The Seeking Proxies for Internal States (SPIS) hypothesis predicts that obsessive-compulsive disorder (OCD) is associated with a deficit in subjective convictions, which may lead to a reliance on external substitutes for the perceptions of an individual's internal states. Two well-designed studies were performed for the present work that adopted a false bio-feedback procedure in a muscle tension task to examine the SPIS hypothesis. METHODS: The false bio-feedback paradigm was used to investigate our hypothesis. NeXus-10 Mark II hardware and V2011 BioTrace + software (Mind Media B.V., Herten, Netherlands) were utilized to measure the muscle tension of the flexor carpiulnaris muscle, which characterized the target's internal state. In addition, false EMG changes were recorded and displayed on a computer monitor and were considered external proxies. RESULTS: Study 1 demonstrated that the participants with high obsessive-compulsive (OC) tendencies were more affected by the false bio-feedback and exhibited lower confidence in their judgments regarding their muscle tension compared with the participants with low OC tendencies. These findings indicate that subjects with high OC tendencies were more influenced by self-perception effects. In contrast, the subjects in the undermined confidence group in Study 2 were more easily influenced by the false bio-feedback compared with the control group, which suggests that the subjects in the undermined confidence group were more affected by self-perception effects. LIMITATIONS: We did not combine the undermined confidence with OC tendencies or OCD symptoms in our paradigm to investigate their joint effects on self-perception. CONCLUSIONS: Our findings provide further evidence that supports the SPIS hypothesis, which indicates that OC tendencies and the confidence in an individual's recognition of internal states appear to have similar effects on the assessment of internal states and reliance on proxies.

Moving Perspectives on Patient Competence: A Naturalistic Case Study in Psychiatry.

Patient competence, defined as the ability to reason, appreciate, understand, and express a choice is rarely discussed in patients with obsessive compulsive disorder (OCD), and coercive measures are seldom used. Nevertheless, a psychiatrist of psychologist may doubt whether OCD patients who refuse treatment understand their disease and the consequences of not being treated, which could result in tension between respecting the patient's autonomy and beneficence. The purpose of this article is to develop a notion of competence that is grounded in clinical practice and corresponds with the experiences of patients with obsessions and/or compulsions. We present a naturalistic case study giving both the patient's and the therapist's perspective based on in-depth interviews and a narrative analysis. The case study shows that competence is not merely an assessment by a therapist, but also a co-constructed reality shaped by the experiences and stories of patient and therapist. The patient, a medical student, initially told her story in a restitution narrative, focusing on cognitive rationality. Reconstructing the history of her disease, her story changed into a quest narrative where there was room for emotions, values and moral learning. This fitted well with the therapist's approach, who used motivational interventions with a view to appealing to the patient's responsibility to deal with her condition. We conclude that in practice both the patient and therapist used a quest narrative, approaching competence as the potential for practical reasoning to incorporate values and emotions.

A novel cognitive intervention for compulsive checking: Targeting maladaptive beliefs about memory.

BACKGROUND AND OBJECTIVES: Compulsive checking is one of the most common symptoms of obsessive-compulsive disorder (OCD). Recently it has been proposed that those who check compulsively may believe their memory is poor, rather than having an actual memory impairment. The current study sought to develop and assess a brief cognitive intervention focused on improving maladaptive beliefs about memory, as they pertain to both checking symptoms and memory performance. METHODS: Participants (N = 24) with a diagnosis of OCD and clinical levels of checking symptomatology were randomly assigned either to receive two weekly 1-hour therapy sessions or to self-monitor during a similar waitlist period. Time spent checking, checking symptoms, maladaptive beliefs about memory, and visuospatial memory were assessed both pre- and post-treatment/waitlist. RESULTS: Results showed that compared to the waitlist condition, individuals in the treatment condition displayed significant decreases in their maladaptive beliefs about memory and checking symptoms from pre- to post-intervention. They also exhibited increased recall performance on a measure of visuospatial memory. Changes in beliefs about memory were predictors of reduced post-intervention checking, but were not predictive of increased post-intervention memory scores. LIMITATIONS: The lack of long term follow-up data and use of a waitlist control leave questions about the stability and specificity of the intervention. CONCLUSIONS: Findings provide preliminary evidence that strategies targeting beliefs about memory may be worthy of inclusion in cognitive-behavioural approaches to treating compulsive checking.

A systematic review of the neural bases of psychotherapy for anxiety and related disorders.

Brain imaging studies over two decades have delineated the neural circuitry of anxiety and related disorders, particularly regions involved in fear processing and in obsessive-compulsive symptoms. The neural circuitry of fear processing involves the amygdala, anterior cingulate, and insular cortex, while cortico-striatal-thalamic circuitry plays a key role in obsessive-compulsive disorder. More recently, neuroimaging studies have examined how psychotherapy for anxiety and related disorders impacts on these neural circuits. Here we conduct a systematic review of the findings of such work, which yielded 19 functional magnetic resonance imaging studies examining the neural bases of cognitive-behavioral therapy (CBT) in 509 patients with anxiety and related disorders. We conclude that, although each of these related disorders is mediated by somewhat different neural circuitry, CBT may act in a similar way to increase prefrontal control of subcortical structures. These findings are consistent with an emphasis in cognitive-affective neuroscience on the potential therapeutic value of enhancing emotional regulation in various psychiatric conditions.

Los estudios de imaginología cerebral desde hace más de dos décadas ban delineado los circuitos neurales de la ansiedad y los trastornos relacionados, particularmente las regiones involucradas en el procesamiento del miedo y en los síntomas obsesivo compulsivos. El circuito neural del procesamiento del miedo incluye la amígdala y las cortezas cingulada anterior e insular, mientras que el circuito tálamo-estriado-cortical juega un papel clave en el trastorno obsesivo-compulsivo. Más recientemente, los estudios de neuroimágenes han examinado cómo la psicoterapia para la ansiedad y los trastornos relacionados impacta en estos circuitos neurales. En este artículo se realiza una revision sistemática de los hallazgos de estos trabajos, los que comprenden 19 estudios de resonancia magnética functional que examinan las bases neurales de la terapia cognitivo-conductual (TCC) en 509 patientes con ansiedad y trastornos relacionados. Se concluye que aunque la ansiedad y cada uno de los trastornos relationados está mediado por circuitos neurales algo diferentes, la TCC puede actuar de manera similar para aumentar el control prefrontal de las estructuras subcorticales. Estos hallazgos son consistentes con el énfasis de la neurociencia cognitivo-afectiva en el potential valor terapéutico del aumento de la regulación emocional en varias condiciones psiquiátricas.

Ces 20 dernières années, des études d'imagerie cérébrale ont défini les circuits neuronaux de l'anxiété et des troubles apparentés, en particulier les régions impliquées dans les processus de peur et les symptômes obsessionnels-compulsifs. L'amygdale, le cortex insulaire et le cortex cingulaire antérieur sont impliqués dans les circuits neuronaux des processus de peur, tandis que le circuit cortico-striato-thalamique joue un rôle dans les troubles obsessionnels-compulsifs. Plus récemment, des études de neuro-imagerie ont analysé comment la psychothérapie pour l'anxiété et les troubles apparentés influent sur ces circuits neuronaux. Nous menons ici une étude méthodique sur les résultats de ces travaux, qui a permis d'aboutir à 19 études d'imagerie fonctionnelle par résonance magnétique analysant les bases neuronales d'une thérapie cognitivo-comportementale (TCC) chez 509 patients atteints d'anxiété et de troubles apparentés. Bien que l'anxiété et les troubles apparentés soient induits par différents circuits neuronaux, nous concluons que la TCC peut agir de la même façon pour accroître le contrôle préfrontal des structures sous-corticales. Ces résultats sont cohérents avec l'accent mis dans les neurostiences cognitivo-affectives, sur la valeur thérapeutique potentielle de l'amélioration de la régulation émotionnelle dans diverses pathologies psychiatriques.

Highly efficacious cognitive-coping therapy for overt or covert compulsions.

Pharmacotherapy and cognitive-behavioral therapy (CBT) present limitations when they are used to treat obsessive-compulsive disorder (OCD), a severe and debilitating psychiatric disorder. To search for more efficacious treatment, we investigated the effects of pharmacotherapy plus cognitive-coping therapy (pCCT) on adult OCD patients with overt or covert compulsions. Two hundred and fifteen OCD patients were randomized into pharmacotherapy plus psychological support (PPS, n=107) and pCCT (n=108). The Yale-Brown Obsessive Compulsive Scale (Y-BOCS) was used to measure severity of symptoms in the OCD patients. The Y-BOCS scores were significantly lower in pCCT than in PPS in both acute term (<3 months) and long-term follow-up. In pCCT, severity of symptoms was not different between those with covert compulsions and those with overt compulsions, but was significantly reduced at any post-treatment time-point. Y-BOCS scores in the two subtype compulsions were significantly lower in pCCT than in PPS at any post-treatpost-treatment time-point. Compared with PPS, effect size, response rate and remission rate were significantly higher in pCCT. Our findings corroborated with the hypothesis that pCCT could efficaciously treat OCD with overt compulsions or covert compulsion, suggesting that pCCT might be a potential option for adult OCD.

Exposure to unwanted intrusions, neutralizing and their effects on self-worth and obsessive-compulsive phenomena.

BACKGROUND: Although there is a growing body of literature to support the importance of understanding self processes in the experience of obsessive-compulsive disorder (OCD), no experimental research has directly examined the relationship between self-construals and phenomena central to OCD. The current study examined the effect that unwanted intrusions and neutralizing responses have on self-worth, distress and urge to neutralize. METHODS: After listening to repeated audio recordings of idiosyncratic unwanted intrusions, a combined nonclinical and clinical OCD sample were asked to respond with either their chosen neutralizing strategy (experimental) or a refocus counting strategy (control). Each condition comprised of a 12-min responding period (respond) followed by an equivalent non-response period (listen). Participants completed each condition, and were randomly allocated into the condition completed first. Ratings of discomfort, urge to neutralize, and self-worth were measured throughout. RESULTS: Neutralizing and refocussing responses were both associated with decreases in discomfort and higher self-worth. The expected rebound effect for discomfort and urge to neutralize for the listen period after neutralizing was found. LIMITATIONS: Methodological problems lead to missing data, although this was corrected with the use of Multi Level Modelling (MLM) analysis on a combined sample. The small clinical sample meant that comparison between the two populations was not possible. CONCLUSIONS: Findings support cognitive accounts that neutralizing is involved in the development and maintenance of OCD, and suggest that neutralizing is a purposeful response aimed to help reinstate self-worth. Implications and directions for future research are discussed.

Factors associated with prolonging psychological treatment for anxiety disorders / Factores asociados a la prolongación del tratamiento psicológico en los trastornos de ansiedad

BACKGROUND: Anxiety disorders are one of the disorders most frequently requested for psychological attention. The purpose of this study is to identify the factors that can explain a longer duration of psychological treatment for anxiety disorders. METHOD: 202 patients from the University Psychology Clinic of the Complutense University of Madrid were analyzed. RESULTS: Multivariate regression analysis showed that the presence of obsessive-compulsive disorder and the application of arousal control techniques followed by modeling and other specific techniques were the best predictors of treatment duration. CONCLUSION: Reducing as much as possible the number of techniques applied without reducing intervention efficacy is suggested. In some disorders that produce a greater life disorganization, it may be useful to try to organize the patient's life either as a first goal or at the same time as the intervention program, so as to increase its effectiveness and reduce the number of sessions

ANTECEDENTES: uno de los motivos más frecuentes de atención psicológica son los trastornos de ansiedad. El objetivo de este trabajo es identificar los factores que pueden explicar una mayor duración del tratamiento psicológico en los problemas de ansiedad. MÉTODO: se analizaron los datos de 202 pacientes de la Clínica Universitaria de Psicología de la Universidad Complutense de Madrid. RESULTADOS: el análisis de regresión multivariado mostró que los mayores predictores de la duración del tratamiento eran la presencia de un diagnóstico principal de Trastorno Obsesivo-Compulsivo y la aplicación de técnicas para el control de la activación seguidas de modelado y otras técnicas específicas. CONCLUSIONES: se recomienda reducir en la medida de lo posible el número de técnicas aplicadas sin que se reduzca la eficacia de la intervención. En algunos trastornos que producen una mayor desestructuración puede ser conveniente intentar organizar la vida del paciente antes o durante el programa de intervención para incrementar la efectividad y reducir el número de sesiones

Citizenship and recovery: two intertwined concepts for civic-recovery.

BACKGROUND: Validation of the psychometric properties of a new measure of citizenship was required for a research project in the province of Quebec, Canada. This study was meant to study the interplay between recovery- and citizenship-oriented supportive employment. As recovery and citizenship were expected to be two related concepts, convergent validity between the Citizenship Measure (CM) and the Recovery Assessment Scale (RAS) was tested. METHODS: Study objectives were to: 1) conduct exploratory factor analyses on the CM and confirmatory factor analysis on the RAS tools (construct validity), 2) calculate Cronbach's alphas for each dimension emerging from objective 1 (reliability), and 3) calculate correlations between all dimensions from both tools (convergent validity). Data were collected from 174 individuals with serious mental illness, working in social firms. Serious mental illnesses include major depression, schizophrenia, bipolar disorder, obsessive compulsive disorder, panic disorder, post traumatic stress disorder and borderline personality disorder. RESULTS: Five factors emerged from the exploratory factor analysis of the CM, with good reliability. Confirmatory factor analyses showed that the short and the long versions of the RAS present satisfactory results. Finally, the correlation matrix indicated that all dimensions from both tools are significantly correlated, thus confirming their convergent validity. CONCLUSIONS: This study confirms the validity and reliability of two tools, CM and RAS. These tools can be used in combination to assess citizenship and recovery, both of which may be combined in the new concept of civic-recovery.