Addressing anxiety through conversation and campus programming: a mixed methods exploration of student and parent perspectives.

Objective: This mixed methods study examined student and parent experiences with anxiety and preferences for campus-based programming to address anxiety. Participants: College students (n = 156) completed a survey, and 20 students participated in focus groups. Parents of college students (n = 85) completed a survey, and 12 parents completed a phone interview. Methods: Students and parents completed surveys about trait worry, mental health literacy, and preferences for proposed programming. Descriptive statistics were calculated. Students participated in focus groups, and parents completed interviews regarding their experiences and preferences. Thematic analysis was conducted with the coded focus group and interview transcripts. Results: Quantitative and qualitative findings revealed specific program preferences (eg scheduling). Qualitative findings highlighted mismatches between student and parent perspectives and opportunities for parental skill building. Conclusions: Students and their parents are open to and eager for campus programming that provides education, skills, and support for college students with anxiety.

Women veterans' attitudes toward family involvement in PTSD treatment: A mixed-methods examination.

Family member (FM) involvement in treatment for posttraumatic stress disorder (PTSD) has the potential to enhance veterans' sense of support and connection and reduce treatment dropout. Little is known, however, about women veterans' preferences, concerns, and goals regarding FM involvement in PTSD treatment. The study employed a mixed-methods approach consisting of surveys (n = 143) and interviews (n = 10) with women veterans seeking treatment for PTSD in a Veterans Affairs medical center. Married and partnered women veterans, and women veterans who identified as gay/lesbian, were more likely to be open to FM involvement. Results revealed a range of preferences and goals regarding FM involvement. Women veterans expressed a preference for joint sessions at the midpoint or near the end of treatment. Veterans' goals for FM involvement included enhancing the relationship with their FM and providing the FM with a basic understanding of PTSD. Conclusions, limitations, and future directions are discussed. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Family accommodation in PTSD: Proposed considerations and distinctions from the established transdiagnostic literature.

Accommodation is widely documented and studied among internalizing disorders; however, the conceptualization and study of accommodation in the context of posttraumatic stress disorder (PTSD) is relatively nascent. PTSD entails many diagnostic criteria-including exposure to a distinct Criterion A event, emotional numbing, and anger-that may uniquely influence accommodation and merit special consideration. Our aim was to review the impact of accommodation in PTSD, compare and contrast accommodation in PTSD to other disorders with a strong empirical evidence base regarding accommodation, and highlight considerations unique to PTSD and associated implications for accommodation. We conclude by providing considerations for future research and practice.

Delivered as Described: A Successful Case of Cognitive Processing Therapy With an Older Woman Veteran With PTSD.

Cognitive processing therapy (CPT) is a first-line, evidence-based treatment for posttraumatic stress disorder (PTSD). Little is known, however, about the use of CPT for older adults. As the United States population continues to grow and age, an understanding of the utility of CPT for older adults is vital. We present a case study describing the assessment and cognitive treatment of a 74-year-old woman veteran with PTSD secondary to military sexual trauma. CPT was associated with decreased PTSD symptoms as measured before and after treatment. Factors contributing to the veteran's response, as well as contextual and environmental factors, are discussed. The case demonstrates that CPT may be effective for older adults without major modification.

The effect of time since index trauma on trauma-related beliefs.

OBJECTIVE: Greater duration of negative trauma-related beliefs may inhibit improvements in these cognitions during posttraumatic stress disorder (PTSD) treatment. The goal of the current study was to examine the impact of time since trauma on change in negative trauma-related beliefs during PTSD treatment. METHOD: A sample of 126 adults diagnosed with PTSD were randomized to Cognitive Processing Therapy (CPT) or Written Exposure Therapy (WET) and completed the Posttraumatic Cognitions Inventory (PTCI) at pretreatment and 6, 12, 24, 36, and 60 weeks following the first treatment session. RESULTS: Consistent with past findings, negative cognitions related to the self, others, and self-blame decreased during and after trauma-focused therapy. Greater time since the trauma was associated with less improvement in negative trauma-related beliefs about the world and less early improvement in negative trauma-related beliefs about the self and self-blame. The effect of time since trauma on reduction in negative trauma-related beliefs about the world was stronger among participants randomized to CPT. CONCLUSIONS: These results indicate that trauma-focused therapies become less potent in reducing trauma-related beliefs as time progresses since trauma exposure, particularly in CPT, for beliefs about the world. Results indicate PTSD treatment should be provided in closer proximity to trauma exposure before negative trauma-related beliefs become inflexible. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

If you personalize it, will they use it?: Self-reported and observed use of a tailored, internet-based pain self-management program.

Little is known about how individuals with chronic pain use tailored internet-based interventions. This study is the first to compare self-reported skill module use to observed module access and to examine each of these in relationship to tailored recommendations to access specific content. Participants (N = 58) enrolled in a 10-week trial of the Pain EASE program, a tailored internet-based intervention that includes 10 pain self-management skill modules. Participants completed a "Self-Assessment," which was used to provide a "Personalized Plan" that encouraged accessing specific modules. Participants self-reported module use during weekly data collection telephone calls. Program log data were extracted to capture "observed" module use during the trial period. Findings indicated significantly greater self-reported use of the Pain EASE modules compared to observed access with log data. Further, log data revealed that participants accessed less than half of the modules recommended to them via tailoring.

GIV CARE: A Group Intervention to Reduce Accommodation Among Relatives of Individuals With Fear-Based Disorders.

Fear-based disorders (FBDs) occur in an interpersonal context as relatives (e.g., partners, parents) often accommodate symptoms. Symptom accommodation, which is ubiquitous and reinforces FBD behavior, is associated with increased FBD symptom severity and interferes with treatment. Accordingly, reducing accommodation represents a crucial aim for intervention. We describe a brief, manualized group intervention to decrease symptom accommodation and caregiver burden among cohabitating relatives of individuals with FBDs. The intervention is the first to date that (a) jointly includes parents and partners to target symptom accommodation, and (b) uses a transdiagnostic group treatment approach. We also provide preliminary empirical support for this group-based intervention among adult relatives (N = 20) that participated in the five weekly intervention sessions and completed assessments at baseline, posttreatment, and 1-month follow-up (1MFU). Preliminary results suggest that the group intervention is feasible and acceptable. Completers (n = 18) exhibited significant reductions in symptom accommodation and self-reported burden between baseline and 1MFU. The discussion identifies study limitations and future directions.

Better Together: A Review and Recommendations to Optimize Research on Family Involvement in CBT for Anxiety and Related Disorders.

Anxiety and related disorders (ARDs) occur in an interpersonal context. Individuals with ARDs respond well to individual cognitive behavioral therapy (CBT); however, there is room for improvement. As such, family members may be included to "enhance" treatment outcomes, yet findings from studies examining family involvement in CBT for ARDs are equivocal. The present paper (a) identifies methodological considerations for explaining inconsistent outcomes among CBT for ARDs with family involvement, and (b) reviews factors that affect outcomes of CBT for ARDs with family involvement including levels of involvement in treatment (e.g., number, duration, and spacing of sessions) and characteristics of who is involved in treatment (e.g., family member cognitions and cultural factors). Limitations of the literature and recommendations for future research are discussed. Researchers should focus on conducting studies that can test not whether but for whom and how family involvement can contribute to improved outcomes above and beyond individual CBT for ARDs.

Stuck in my head: Musical obsessions and experiential avoidance.

Earworms refer to catchy tunes that run repeatedly through a person's mind. Empirical literature regarding earworms is scant; however, some researchers have conceptualized the phenomenon as an unwanted intrusion in the context of obsessive-compulsive disorder. The current study expands upon past research by characterizing the experience of earworms and examining associations of earworm-related distress and interference with theoretical constructs of interest, including obsessive beliefs and experiential avoidance. Two hundred forty participants completed an online survey regarding the experience of musical obsessions (e.g., duration, frequency, distress) and related theoretical constructs (e.g., experiential avoidance) of interest. Descriptive results regarding the frequency, duration, and associated distress and interference of earworms are presented. Furthermore, results reveal that experiential avoidance is a unique predictor of earworm-related distress and interference. Results suggest that interference and distress due to earworms may be related to attempts to suppress them. Study conclusions, limitations, and directions for future research are discussed.

Discriminative Validity of the Dimensional Obsessive-Compulsive Scale for Separating Obsessive-Compulsive Disorder From Anxiety Disorders.

Objective: We investigated the diagnostic efficiency and clinical utility of the Dimensional Obsessive-Compulsive Scale (DOCS) and subscales for distinguishing obsessive-compulsive disorder (OCD) from anxiety disorders (ADs). Method: A total of 369 participants (167 male, Mage = 29.61 years) diagnosed with DSM-IV OCD or AD, recruited from specialty clinics across the United States, completed clinical interviews and self-report questionnaires, including the DOCS. Receiver operating characteristic analyses and diagnostic likelihood ratios (DiLRs) determined discriminative validity and provided clinical utility. Logistic regressions tested for incremental validity in the DOCS-total scale and subscales in predicting OCD status. Results: The DOCS-total scale and Contamination subscale performed best in differentiating between OCD and AD diagnosis (DOCS-total: Area under curve [AUC] = .75, p < .001; Contamination: AUC = .70, p < .001) as compared with the other subscales. At high scores (DOCS-total: 28+, Contamination: 6+), Contamination was more effective than the DOCS-total in differentiating OCD from ADs, with high scores in Contamination quadrupling OCD odds and DOCS-total by about threefold (Contamination DiLR+ = 4.04, DOCS-total DiLR+ = 2.82). At low scores (DOCS-total: 0-9, Contamination: 0-2), the converse was true, with low scores in Contamination cutting OCD odds by half and DOCS-total by one fifths (Contamination DiLR- = 0.52, DOCS-total DiLR- = 0.23). Conclusion: At high scores, the Contamination subscale is the most helpful subscale to differentiate OCD and ADs. For low scores, the DOCS-total scale performs the best among the scales.

Sudden Gains: How Important Are They During Exposure and Response Prevention for Obsessive-Compulsive Disorder?

Symptom reduction over the course of cognitive-behavioral therapy is not always distributed evenly across sessions. Some individuals experience a sudden gain, defined as a large, rapid, and stable decrease in symptoms during treatment. Although research documents a link between sudden gains and treatment for depression and anxiety, findings in the context of obsessive-compulsive disorder (OCD) treatment are mixed. The present study investigated the relationship between sudden gains and treatment outcome in 44 adults with OCD and addressed limitations of previous studies by measuring OCD symptoms dimensionally and comparing individuals who experience sudden gains to those who experience gradual gains of similar magnitude. Sudden gains were observed among 27% of participants, with highest rates among individuals with primary contamination symptoms. Participants who experienced a sudden gain had greater OCD symptom reductions at posttreatment (but not at follow-up), and this difference did not persist after controlling for gain magnitude. Thus, the importance of sudden gains during OCD treatment may be limited. Findings are discussed in light of inhibitory learning models of cognitive-behavioral therapy.

Is the hierarchy necessary? Gradual versus variable exposure intensity in the treatment of unacceptable obsessional thoughts.

BACKGROUND AND OBJECTIVES: Although research suggests that introducing varying levels of fear during exposure enhances outcomes for some anxiety-related problems, this has not been examined in the context of obsessions. The current preliminary study tested the hypothesis that introducing variability in exposure intensity would improve long-term outcomes relative to traditional gradual (hierarchical) exposure METHODS: Adults (N = 40) with a moderately distressing unacceptable obsessional thought were randomly assigned in parallel to four twice-weekly sessions of: (a) gradual exposure (EXP-G; n = 19) emphasizing hierarchical exposure completion, or (b) variable exposure (EXP-V; n = 21) emphasizing variability in exposure intensity RESULTS: There were no significant differences in pre to post changes between groups using self-report, interview, or behavioral outcomes (as evaluated by an independent assessor blind to treatment condition). Group comparisons at 3-month follow-up did not reach statistical significance but were moderate in magnitude. Specifically, as measured by clinical interview (the Yale-Brown Obsessive-Compulsive Scale; primary outcome) and self-report, individuals in the EXP-G group maintained gains at 3-month follow-up, while the EXP-V group continued to improve. Treatment expectancies and satisfaction were comparable for both groups. Five participants withdrew from the EXP-G condition, and none withdrew from the EXP-V condition. In contrast to previous studies, variability in subjective and physiological fear during exposure did not predict outcomes LIMITATIONS: The study employed an analogue sample with moderate unacceptable obsessions, and results should be replicated in clinical samples CONCLUSIONS: Variable exposure warrants future study to understand the mechanisms, moderators, and implications of this novel approach.

Scrupulosity, Religious Affiliation and Symptom Presentation in Obsessive Compulsive Disorder.

BACKGROUND: Scrupulosity is a common yet understudied presentation of obsessive compulsive disorder (OCD) that is characterized by obsessions and compulsions focused on religion. Despite the clinical relevance of scrupulosity to some presentations of OCD, little is known about the association between scrupulosity and symptom severity across religious groups. AIMS: The present study examined the relationship between (a) religious affiliation and OCD symptoms, (b) religious affiliation and scrupulosity, and (c) scrupulosity and OCD symptoms across religious affiliations. METHOD: One-way ANOVAs, Pearson correlations and regression-based moderation analyses were conducted to evaluate these relationships in 180 treatment-seeking adults with OCD who completed measures of scrupulosity and OCD symptom severity. RESULTS: Scrupulosity, but not OCD symptoms in general, differed across religious affiliations. Individuals who identified as Catholic reported the highest level of scrupulosity relative to individuals who identified as Protestant, Jewish or having no religion. Scrupulosity was associated with OCD symptom severity globally and across symptom dimensions, and the magnitude of these relationships differed by religious affiliation. CONCLUSIONS: Findings are discussed in terms of the dimensionality of scrupulosity, need for further assessment instruments, implications for assessment and intervention, and the consideration of religious identity in treatment.

A randomized controlled trial of the judicious use of safety behaviors during exposure therapy.

Safety behaviors-actions performed to prevent, escape from, or reduce the severity of perceived threat-are typically eliminated during exposure therapy for clinical anxiety. Yet some experts have called for the strategic and "judicious use" of safety behaviors during exposure to improve treatment acceptability/tolerability without diminishing its efficacy. Empirical findings regarding this debate are mixed and existing work is subject to several methodological limitations. The current randomized controlled trial incorporated longitudinal design and multimethod assessment to compare the efficacy of traditional exposure with the elimination of safety behaviors (E/ESB) and exposure with judiciously used safety behaviors (E/JU). Adults with clinically significant spider fear (N = 60) were randomized to four twice-weekly sessions of E/ESB or E/JU. Self-report and behavioral measures were administered at pretreatment, posttreatment, and 1-month follow-up. Participants exhibited large effects on all measures from pretreatment to posttreatment, with no change from posttreatment to follow-up. There were no significant group differences in treatment outcome or treatment acceptability/tolerability. Exploratory analyses were used to compare behavioral and inhibitory learning processes between conditions. Clinical implications, study limitations, and future directions are discussed in terms of inhibitory learning theory.

Adding acceptance and commitment therapy to exposure and response prevention for obsessive-compulsive disorder: A randomized controlled trial.

The objective of this study was to test whether treatment acceptability, exposure engagement, and completion rates could be increased by integrating acceptance and commitment therapy (ACT) with traditional exposure and response prevention (ERP). 58 adults (68% female) diagnosed with obsessive-compulsive disorder (OCD; M age = 27, 80% white) engaged in a multisite randomized controlled trial of 16 individual twice-weekly sessions of either ERP or ACT + ERP. Assessors unaware of treatment condition administered assessments of OCD, depression, psychological flexibility, and obsessional beliefs at pretreatment, posttreatment, and six-month follow-up. Treatment acceptability, credibility/expectancy, and exposure engagement were also assessed. Exposure engagement was high in both conditions and there were no significant differences in exposure engagement, treatment acceptability, or dropout rates between ACT + ERP and ERP. OCD symptoms, depression, psychological inflexibility, and obsessional beliefs decreased significantly at posttreatment and were maintained at follow-up in both conditions. No between-group differences in outcome were observed using intent to treat and predicted data from multilevel modeling. ACT + ERP and ERP were both highly effective treatments for OCD, and no differences were found in outcomes, processes of change, acceptability, or exposure engagement.

New Directions in the Cognitive-Behavioral Treatment of OCD: Theory, Research, and Practice.

The beneficial effects of cognitive-behavioral interventions (particularly exposure and response prevention) for OCD are among the most consistent research findings in the mental health literature. Nevertheless, even after an adequate trial, many individuals experience residual symptoms, and others never receive adequate treatment due to limited access. These and other issues have prompted clinicians and researchers to search for ways to improve the conceptual and practical aspects of existing treatment approaches, as well as look for augmentation strategies. In the present article, we review a number of recent developments and new directions in the psychological treatment of OCD, including (a) the application of inhibitory learning approaches to exposure therapy, (b) the development of acceptance-based approaches, (c) involvement of caregivers (partners and parents) in treatment, (d) pharmacological cognitive enhancement of exposure therapy, and (e) the use of technology to disseminate effective treatment. We focus on both the conceptual/scientific and practical aspects of these topics so that clinicians and researchers alike can assess their relative merits and disadvantages.

Predictors of Accommodation Among Families Affected by Fear-Based Disorders.

Symptom accommodation-behaviors that family members engage in either to prevent or alleviate a loved one's anxiety-is ubiquitous in families with relatives affected by fear-based disorders (FBDs), yet little research has examined the extent to which certain psychological factors predict symptom accommodation. The current study examined several potential predictors (e.g., empathic concern) among co-residing relatives of individuals diagnosed with FBDs. Participants (n = 53) completed a series of clinical interviews and self report measures. Results indicated that accommodation occurred to similar degrees across relatives with various relationships to the individual with a FBD, as well as across different FBDs. Further, the predictors jointly explained a significant amount of variance in accommodation; although, no single construct emerged as a unique predictor. Empathic concern and expressed emotion emerged as marginally significant predictors of symptom accommodation. Conclusions, limitations, and future directions are discussed.

Set shifting and visuospatial organization deficits in body dysmorphic disorder.

Individuals with body dysmorphic disorder (BDD) over-attend to perceived defect(s) in their physical appearance, often becoming "stuck" obsessing about perceived flaws and engaging in rituals to hide flaws. These symptoms suggest that individuals with BDD may experience deficits in underlying neurocognitive functions, such as set-shifting and visuospatial organization. These deficits have been implicated as risk and maintenance factors in disorders with similarities to BDD but have been minimally investigated in BDD. The present study examined differences in neurocognitive functions among BDD participants (n = 20) compared to healthy controls (HCs; n = 20). Participants completed neuropsychological assessments measuring set-shifting (Cambridge Neuropsychological Test Automated Battery Intra-Extra Dimensional Set Shift [IED] task) and visuospatial organization and memory (Rey-Osterrieth Complex Figure Test [ROCF]). Results revealed a set-shifting deficit among BDD participants compared to HCs on the IED. On the ROCF, BDD participants exhibited deficits in visuospatial organization compared to HCs, but they did not differ in visuospatial memory compared to HCs. Results did not change when accounting for depression severity. Findings highlight neurocognitive deficits as potential endophenotype markers of clinical features (i.e., delusionality). Understanding neuropsychological deficits may clarify similarities and differences between BDD and related disorders and may guide targets for BDD treatment.

Predictors of illness anxiety symptoms in patients with obsessive compulsive disorder.

Illness anxiety and OCD symptoms appear to overlap in their presentation as well as in other conceptually important ways (e.g., dysfunctional cognitions). Little research, however, has directly examined these putative relationships. The present study examined the extent to which illness anxiety symptoms were associated with OCD symptom dimensions and relevant cognitive factors in a large treatment-seeking sample of patients with OCD. Patients completed a battery of self-report measures of OCD and health anxiety symptoms and related cognitive biases. Results from regression analyses indicated that illness anxiety symptoms were associated with harm obsessions and checking rituals, as well as with the tendency to overestimate threat and responsibility for harm. Illness anxiety was not associated with perfectionism. Conceptual and clinical implications of these findings are discussed.

Experiential avoidance and dysfunctional beliefs in the prediction of body image disturbance in a nonclinical sample of women.

Body image disturbance (BID) refers to persistent dissatisfaction, distress, and dysfunction related to some aspect(s) of one's physical appearance. Cognitive models of BID highlight the importance of dysfunctional beliefs in maintaining BID. Relational Frame Theory (RFT), in contrast, posits that psychological distress is sustained by the unwillingness to experience aversive internal experiences (i.e., experiential avoidance [EA]). The present study tested the hypothesis that both dysfunctional beliefs and EA uniquely predict BID even after accounting for general distress. A nonclinical female sample (N=100) completed measures of general distress, dysfunctional beliefs about appearance, EA, and BID in addition to providing in vivo anxiety ratings after looking at their most dissatisfactory facial feature in a vanity mirror. Linear regression analyses showed that dysfunctional beliefs, but not EA, accounted for significant unique variance in BID outcomes. Implications for understanding, assessing, and treating clinically significant BID are discussed.