Feasibility and Acceptability of Cognitive Bias Modification for Interpretation as an Adjunctive Treatment for OCD and Related Disorders: A Pilot Randomized Controlled Trial.

Cognitive models implicate interpretation bias in the development and maintenance of obsessive compulsive and related disorders (OCRDs), and research supports Cognitive Bias Modification for Interpretation (CBM-I) in targeting this mechanism. However, prior studies in OCRDs have been limited to nonclinical populations, adolescents, and adults in a laboratory setting. This study evaluated the feasibility and acceptability of CBM-I as an adjunctive intervention during intensive/residential treatment (IRT) for adults with OCRDs. We modified a lab-based CBM-I training for adults seeking IRT for OCRDs, and conducted a feasibility trial (N = 4) and subsequent pilot RCT; participants (N = 31) were randomized to receive CBM-I or psychoeducation. Benchmarks were met for feasibility, acceptability, and target engagement. From pre- to post-intervention, the CBM-I group showed a large effect for change in interpretation bias (d = .90), whereas this effect was trivial (d = .06) for psychoeducation. This was the first study to evaluate CBM-I in naturalistic treatment for adults seeking IRT for OCRDs. Findings support the feasibility and acceptability of CBM-I in this novel sample and setting. A larger scale RCT is needed to determine whether CBM-I can enhance OCRD treatment response.

Examination of Outcomes among Sexual Minorities in Treatment for Obsessive-Compulsive and Related Disorders.

The first-line psychological treatment for obsessive-compulsive and related disorders (OCRDs) is exposure and response prevention (ERP). As the first study to examine treatment outcomes for sexual minorities, it is crucial to examine: (1) how treatment-seeking individuals who identify as sexual minorities compare to heterosexual individuals in symptom severity at admission, length of stay in treatment, and (2) whether ERP is equally effective for sexual minorities. The current study explored these questions in an intensive/residential treatment (IRT) program for OCRDs. Adult participants (N = 191) completed self-reported measures of OCD severity, distress tolerance, and depression at program admission, in the first four weeks of treatment, and at discharge. No differences were found between groups for treatment outcome, although slight differences (non-significant) emerged at baseline for OCRD severity, distress tolerance, and depression. Sexual orientation was not predictive of OCRD severity at weeks 1-4, and number of days spent in treatment was not associated with sexual orientation. This is the first study exploring whether sexual orientation is predictive of treatment outcomes for individuals diagnosed with OCRDs. Results suggest that outcomes did not differ and participation in the program resulted in an overall improvement of symptoms regardless of sexual orientation, however several study limitations are discussed. Future studies should replicate these findings, attempt to collect a larger sample, incorporate qualitative feedback from treatment, and examine outcomes in gender minorities.

Cognitive control training for urgency: A pilot randomized controlled trial in an acute clinical sample.

Urgency - rash action in the context of strong emotion - is a facet of impulsivity closely related to many psychological disorders. Deficits in working memory and response inhibition are potential mechanisms underlying urgency, and a previous study showed that cognitive training targeting these domains is efficacious in reducing urgency. However, the feasibility and efficacy of this intervention has not yet been tested in a clinical sample or naturalistic treatment setting. To fill this gap, we conducted a pilot study of cognitive training for individuals reporting high levels of urgency in a partial hospitalization program. We evaluated this intervention in an open trial (n = 20), followed by a randomized controlled trial (n = 46) comparing cognitive training plus treatment as usual to treatment as usual. Results supported the feasibility and acceptability of cognitive training. Participants in the training group showed significant improvement on cognitive tasks, but groups did not differ in urgency. In pooled analyses combining the open trial and RCT, there was a significant reduction in distress intolerance in the training group only. Results indicate the potential benefit of cognitive training for distress intolerance, but do not support the use of cognitive training for urgency in acute clinical settings. The study conducted in the RCT phase of this manuscript is registered on ClinicalTrials.gov (NCT: NCT03527550). The full trial protocol is available on ClinicalTrials.gov.

Reevaluating the psychometric properties of symptom measures within longitudinal contexts: The Yale-Brown Obsessive Compulsive Scale and Dimensional Obsessive-Compulsive Scale.

As research and clinical settings increasingly emphasize questions of change, it is crucial that our mechanistic and outcome variables are established as reliable and valid measures of such change. However, there is often a mismatch between the purposes for which symptom measures were developed and validated versus their application. Traditional psychometric theory has focused largely on between-person change, whereas increasingly research and clinical questions concern within-person change. We examined the psychometric properties of two commonly used measures of obsessive-compulsive symptoms (Yale-Brown Obsessive Compulsive Scale, YBOCS; Dimensional Obsessive-Compulsive Scale, DOCS) within a longitudinal treatment context (N = 570). Regarding reliability, we applied traditional (i.e., internal consistency at each week) and novel methods that allow for examination of the reliability of both within- and between-person change (i.e., variance partitioning based on generalizability theory). We examined longitudinal concurrent validity by correlating per-person slopes of obsessive-compulsive and depression symptom measures obtained via mixed-effects models. Within-person change reliability was acceptable or good for the YBOCS and DOCS total scores (.77, .83), suggesting that these measures are capable of capturing meaningful changes that exist within persons over time, and between-person change reliability was excellent (.99-1.0). Per-person slopes analyses supported the longitudinal concurrent validity of both measures. Our data support the continued use of the YBOCS and DOCS as measures of obsessive-compulsive symptoms for the purpose of many longitudinal research questions. The current study provides a template for reestablishing the psychometric properties of other commonly used measures in the context of longitudinal investigations. (PsycInfo Database Record (c) 2021 APA, all rights reserved).