Examination of a brief computerized Cognitive Anxiety Sensitivity intervention on obsessive-compulsive symptoms.

OBJECTIVES: Despite the existence of several first-line treatments for obsessive-compulsive disorder (OCD), many patients fail to experience symptom reduction and/or do not complete treatment. As a result, the field has increasingly moved towards identifying and treating malleable underlying risk factors that may in turn improve treatment efficacy. One salient underlying risk factor, anxiety sensitivity (AS) cognitive concerns, has been found to be uniquely associated with obsessive-compulsive (OC) symptom dimensions. However, no studies have yet examined whether reductions in AS cognitive concerns will lead to subsequent reductions in OC symptoms. METHODS: The current study attempted to fill this gap by recruiting individuals reporting elevations on both AS cognitive concerns and at least one OC symptom dimension. Participants were randomly assigned to receive either a one-session AS cognitive concerns intervention (n = 35) or a single health information control session (n = 37). AS cognitive concerns were assessed at post-intervention and one-month follow-up. RESULTS: The active intervention produced significantly greater reductions in AS cognitive concerns post-intervention than the control intervention. However, this effect was no longer significant at one-month follow-up. Further, while there was not an effect of treatment condition on OC symptoms at one-month follow-up, changes in AS cognitive concerns from baseline to post-intervention mediated changes in OC symptoms at one-month follow-up. CONCLUSIONS: Findings support previous research attesting to the malleable nature of AS. Extending this research, findings provide initial support for the efficacy of AS interventions among individuals with elevated OC symptoms. PRACTITIONER POINTS: Clinicians should consider assessing anxiety sensitivity (AS) among patients with obsessive-compulsive disorder. If elevated, clinicians should consider targeting AS as an adjunct to treatment as usual.

Predictors of insomnia symptoms and nightmares among individuals with post-traumatic stress disorder: an ecological momentary assessment study.

Despite the high levels of comorbidity between post-traumatic stress disorder (PTSD) and sleep disturbance, little research has examined the predictors of insomnia and nightmares in this population. The current study tested both PTSD-specific (i.e. PTSD symptoms, comorbid anxiety and depression, nightmares and fear of sleep) and insomnia-specific (i.e. dysfunctional beliefs about sleep, insomnia-related safety behaviours and daily stressors) predictors of sleep quality, efficiency and nightmares in a sample of 30 individuals with PTSD. Participants participated in ecological momentary assessment to determine how daily changes in PTSD- and insomnia-related factors lead to changes in sleep. Multi-level modelling analyses indicated that, after accounting for baseline PTSD symptom severity, PTSD-specific factors were associated with insomnia symptoms, but insomnia-specific factors were not. Only daytime PTSD symptoms and fear of sleep predicted nightmares. Both sleep- and PTSD-related factors play a role in maintaining insomnia among those with PTSD, while nightmares seem to be linked more closely with only PTSD-related factors.

An examination of the role of intolerance of distress and uncertainty in hoarding symptoms.

BACKGROUND: Hoarding disorder (HD) is a common and debilitating disorder characterized by an accumulation of and failure to discard one's possessions. The identification and examination of underlying factors that may contribute to hoarding symptoms are needed to elucidate the nature of the disorder and refine existing treatments. Two transdiagnostic vulnerability factors that have been associated with hoarding symptoms are distress intolerance (DI) and intolerance of uncertainty (IU). OBJECTIVES: This study examined the relationships between DI, IU, and symptoms of hoarding in two samples consisting of outpatients and individuals recruited from Amazon's Mechanical Turk. We hypothesized that DI and IU would show unique and interactive associations with hoarding symptoms. RESULTS: Across both samples, DI and IU were significantly associated with hoarding symptoms. However, DI and IU did not interact in their prediction of symptoms, and only IU remained a significant predictor, when accounting for relevant covariates. CONCLUSIONS: Results suggest that IU is a robust predictor of hoarding symptoms and may be a promising and novel treatment target for HD.

An Initial Investigation of the Relationship Between Insomnia and Hoarding.

OBJECTIVE: Insomnia has been shown to have profound negative consequences on multiple aspects of daily functioning. Despite increased interest in the association between insomnia and psychopathology, no research has examined the relationships between insomnia and hoarding. The aim of the current investigation was to examine the associations between insomnia and hoarding severity. METHODS: Participants consisted of patients with hoarding disorder (n = 24). RESULTS: Results revealed that insomnia was a significant predictor of increased hoarding severity. In addition, when examining the relationships among insomnia and specific hoarding symptoms, sleep difficulties were associated with increased acquiring and difficulty discarding behaviors. CONCLUSIONS: These findings add to a growing body of literature on insomnia and various forms of psychopathology, as well as research on symptoms related to hoarding. Reducing insomnia symptoms among hoarders may help to reduce hoarding-related behaviors and increase treatment efficacy.

Exaggerated interpretation bias for uncertain information as a predictor of anxiety-related symptoms: A new method of assessment for IU.

BACKGROUND AND OBJECTIVES: Intolerance of uncertainty (IU), or fear of the unknown, is as an important transdiagnostic risk factor across anxiety-related conditions, namely generalized anxiety disorder (GAD), obsessive compulsive disorder (OCD), and social anxiety disorder (SAD). IU is typically indexed using self-report measures. Given the importance of multi-method assessments and the shortcomings associated with existing behavioral indices of IU, additional methods of assessment are needed. Emerging literature supports the use of interpretation bias (IB) paradigms to index constructs such as IU. However, only one study to date has examined the association between an IU-focused IB paradigm (IU-IB) and self-report IU and no research has investigated whether an IU-IB paradigm would be related to increased anxiety-related symptoms. METHODS: The current investigation examined the utility of an IU-IB paradigm across two separate samples wherein participants completed an interpretation bias task and self-report measures. Sample 1 included 86 participants (74.4% female; Mage = 19.14) and sample 2 included 138 participants (79.7% female; Mage = 18.88). RESULTS: Findings from Study 1 indicated a significant association between an exaggerated IU-IB and symptoms of GAD and OCD, and this relationship held after covarying for negative affect. Study 2 results indicated a significant relationship between an exaggerated IU-IB and symptoms of GAD, OCD, and SAD, after covarying for negative affect. LIMITATIONS: The current study had a variety of limitations, including the use of cross-sectional data and an undergraduate sample. CONCLUSIONS: These findings provide an important replication and extension of previous work and highlight the transdiagnostic utility of this IU-IB task.

Interpersonal trauma and hoarding: The mediating role of aggression.

BACKGROUND: A growing body of literature indicates that exposure to interpersonal trauma contributes to the onset or exacerbation of hoarding symptoms. However, little research has explored psychosocial factors that may help to explain the relationship between interpersonal trauma and hoarding symptoms. One outcome of trauma exposure that may be associated with hoarding symptoms is aggression, defined as the tendency to experience and express hostility and anger, and to engage in aggressive behavior. Therefore, the current study examined the relationship between hoarding and aggression, as well as the mediating role of aggression in the relationship between exposure to interpersonal trauma and hoarding symptoms. METHODS: Community participants (n = 258) completed a battery of questionnaires assessing trauma exposure, hoarding symptoms, aggression, and negative affect. RESULTS: Results revealed that when accounting for negative affect, hoarding symptoms were associated with greater aggression, and the relationship between exposure to interpersonal trauma and hoarding symptoms was mediated by aggression. Specificity analyses indicated that depression symptoms and emotion dysregulation did not mediate the relationship between interpersonal trauma exposure and hoarding, providing further support for the importance of aggression. LIMITATIONS: Findings should be interpreted in light of limitations, including the use of cross-sectional and self-report data, and a general community sample. CONCLUSIONS: Taken together, our findings suggest that interpersonal processes, such as aggression toward others, may be associated with increased hoarding symptoms.