Predictors of acute outcomes for intensive residential treatment of obsessive-compulsive disorder.

For those who suffer with chronic and disruptive obsessive-compulsive disorder (OCD), who have not been sufficiently helped by outpatient treatments or medications, intensive residential treatment (IRT) is often the next best treatment option. To date, research of the predictors of treatment outcome in IRT for OCD are mixed and sometimes contradictory. Additionally, although comorbidity is common for patients in this setting, the inclusion of comorbidity as a potential predictor of outcome has been mostly lacking in research to date. The current study aimed to address these issues by utilizing optimal indices of treatment outcomes, while incorporating comorbidity into our analyses, in order to identify the predictors of treatment outcomes in the IRT for OCD setting. To this end, we analysed outcome data from 379 patients receiving IRT for OCD at the Rogers Memorial OCD Center between August 2012, and December 2017. Results indicated that the most important predictor of treatment outcome was obsession severity at admission. Specifically, higher obsession severity at admission predicted poorer treatment outcomes at discharge. Clinical implications and suggestions for future research were discussed in the manuscript.

Computerized response inhibition training for children with trichotillomania.

Evidence suggests that trichotillomania is characterized by impairment in response inhibition, which is the ability to suppress pre-potent/dominant but inappropriate responses. This study sought to test the feasibility of computerized response inhibition training for children with trichotillomania. Twenty-two children were randomized to the 8-session response inhibition training (RIT; n = 12) or a waitlisted control (WLT; n = 10). Primary outcomes were assessed by an independent evaluator, using the Clinical Global Impression-Improvement (CGI-I), and the NIMH Trichotillomania Severity (NIMH-TSS) and Impairment scales (NIMH-TIS) at pre, post-training/waiting, and 1-month follow-up. Relative to the WLT group, the RIT group showed a higher response rate (55% vs. 11%) on the CGI-I and a lower level of impairment on the NIMH-TIS, at post-training. Overall symptom reductions rates on the NIMH-TSS were 34% (RIT) vs. 21% (WLT) at post-training. The RIT's therapeutic gains were maintained at 1-month follow-up, as indicated by the CGI-I responder status (= 66%), and a continuing reduction in symptom on the NIMH-TSS. This pattern of findings was also replicated by the 6 waitlisted children who received the same RIT intervention after post-waiting assessment. Results suggest that computerized RIT may be a potentially useful intervention for trichotillomania.

The functional value of preventive and restorative safety behaviors: A systematic review of the literature.

Safety behaviors are unnecessary actions used to prevent, escape from, or reduce the severity of a perceived threat. Most cognitive-behavioral theorists posit that the use of safety behaviors during exposure is maladaptive because they interfere with fear reduction. However, there is growing evidence suggesting that the use of safety behaviors can facilitate exposure. In general, the findings are mixed as to whether safety behaviors should be made available during exposure-based interventions. The aim of the current review was to evaluate whether safety behaviors should be made accessible during exposure, and whether under certain circumstances, they facilitate or hinder important exposure outcomes. We examined two functional types of safety behaviors: preventive and restorative. A thorough review of the safety behavior literature from the last three decades was conducted. The evidence suggests (restorative) safety behaviors that allow for full confrontation with a core threat do not interfere with meaningful indicators of successful exposure, whereas (preventive) safety behaviors that hinder engagement with the stimulus or experience may weaken exposure outcomes. The theoretical and clinical implications of these findings are discussed and future directions in the investigation of safety behaviors are suggested.

Computerized attention retraining for individuals with elevated health anxiety.

BACKGROUND AND OBJECTIVES: Current cognitive-behavioral theorists conceptualize hypochondriasis as excessive health anxiety (HA). Growing evidence suggests that elevated HA is associated with attentional bias (AB) toward potential health-threat information. DESIGN: This study aimed to examine the effects of attention retraining among individuals with elevated HA, using the established attention modification programs (AMP) designed to train participants to disengage attention from ideographically chosen health-threat words. METHODS: Thirty-six randomly assigned individuals with elevated HA completed eight twice-weekly sessions of the AMP (n = 18) or the attention control condition (ACC; n = 18). RESULTS: Despite using the well-established AMP protocol widely used within the field of anxiety disorders, we did not find evidence for change in AB following training. Further, AMP did not outperform ACC in reducing HA and other relevant emotional symptoms. However, both AMP and ACC evidenced overall significant symptom reduction in most of the outcome measures, including overall HA, anxiety sensitivity, general depression and anxiety, and somatic complaints. CONCLUSIONS: Further research is needed to better understand the effects and mechanisms of AMP as a possible cognitive intervention for HA.