Neuronal correlates of intensification and acceptance of symptoms during exposure therapy in patients with obsessive-compulsive disorder.

Introduction: Cognitive behaviour therapy with exposure and response prevention is efficient in treating patients with obsessive-compulsive disorder (OCD). Nevertheless, it would be helpful for many patients to complement the therapeutic treatment with acceptance strategies to further increase the therapeutic benefit. The aim of the present study was to examine neurobiological responses to acceptance and intensification strategies during symptom provocation alongside the psychotherapeutic process. Method: A total of 23 patients diagnosed with OCD (subtype: washing/contamination fear) was instructed to utilise either an acceptance strategy (ACS) or an intensification strategy (INS) to cope with their emotional and cognitive reactions to personalised symptom-triggering and neutral pictures. Fourteen patients participated twice: at the beginning [T1] and at the end [T2] of an inpatient multimodal treatment including cognitive behaviour therapy with response prevention to assess functional variations. Results: For the contrast of T1 and T2, ACS showed increased brain activity in the left inferior frontal gyrus (IFG), left caudate body, and posterior cingulate gyrus (PCC). They also showed decreased activity in the left anterior insula. INS showed decreased activation in right lingual gyrus and right caudate body. At T2, ACS showed increased activation compared to INS in the left cerebrum: IFG, caudate nucleus, middle and superior temporal gyrus, and PCC/cuneus. For the comparison of T1 and T2, the ACS revealed increased brain activity in the left IFG, left caudate body, and right inferior parietal lobe. It showed decreased activity in the left anterior insula. The INS revealed decreased activity in right lingual gyrus and right caudate body.The psychometric questionnaires suggested that patients were able to reduce obsession, compulsion, and depression symptoms. Furthermore, patients rated the ACS as more useful for themselves compared with the INS. Conclusion: The increased left IFG activity using ACS (T1 vs. T2) could be interpreted as a better inhibitory top-down process, while the increased PCC response might be due to a better reappraisal strategy after therapy. ACS seems to mobilise neuronal activations under therapy, especially in the left hemisphere. Both strategies showed reductions in emotional networks as a neuronal correlate of therapy success. Overall, ACS may be more efficient than INS, as rated by the patients and as in accordance with neurobiological findings.

Effects of acceptance-based strategies on psychological responses to disorder-relevant stimuli in inpatients with obsessive-compulsive disorder: An experimental study.

BACKGROUND AND OBJECTIVES: Preliminary findings suggest that acceptance and commitment therapy-informed exposure therapy may be an effective treatment for obsessive-compulsive disorder (OCD). However, there is a lack of experimental studies that have examined immediate effects of acceptance-based strategies during exposure to disorder-relevant stimuli in persons with OCD. METHODS: Fifty-three inpatients (64% female) with OCD participated in an experimental study during which they were exposed to obsessive-compulsive washing-relevant pictures and were instructed to either passively view these pictures for 5 s (neutral condition), to accept their feelings (acceptance condition) or to intensify their feelings (exposure condition) for 90 s each. RESULTS: The acceptance condition led to higher acceptance and lower unpleasantness of patients' current feelings compared to the neutral condition and to lower strength of obsessions and urge to perform compulsions but only when compared to the exposure condition. Higher self-reported OCD symptom severity related to higher unpleasantness and strength of obsessions, particularly in the neutral condition. LIMITATIONS: Future studies need to test whether the current findings translate to other stimuli and other forms of obsessions and compulsions. Due to the short duration, the exposure condition might have only mimicked the early phase of exposure and response prevention. CONCLUSIONS: Acceptance-based strategies during cue exposure immediately increase acceptance of and reduce unpleasant feelings. In line with the rationale of acceptance-based treatment approaches, which do not aim at immediate disorder-specific symptom reductions, effects on obsessions and compulsions may be more delayed or require repeated training sessions.

Frequency and level of self-efficacy predict the effectiveness of therapist- and self-guided exposure in obsessive compulsive disorder.

BACKGROUND: While exposure and response prevention (ERP) is the most effective treatment for obsessive compulsive disorder (OCD), less is known about the specific mechanisms underlying symptom change after ERP. AIMS: We tested the hypothesis that the frequency of self- and therapist-guided ERP related to the extent of symptom reduction and that this link is mediated by increased self-efficacy. METHOD: In a sample of 377 in-patients with a primary diagnosis of OCD receiving in-patient CBT, we assessed symptoms (YBOCS-SR) and self-efficacy (General Self-Efficacy Scale), before and after treatment, as well as the frequency of therapist- and self-guided ERP sessions. RESULTS: Patients with more therapist-guided ERP sessions during treatment showed more symptom reduction and the association of self-guided ERP on outcome was mediated by enhanced self-efficacy. CONCLUSIONS: These findings highlight the importance of both therapist- and self-guided ERP sessions and suggest that therapists should conduct a sufficient number of ERP sessions to optimise treatment.

Self-compassion and emotion regulation difficulties in obsessive-compulsive disorder.

Lack of self-compassion and deficits in emotion regulation are associated with various psychopathological symptoms and may play a role in the development and maintenance of obsessive-compulsive disorder (OCD). However, further empirical research is still needed to better understand these constructs in the context of this disorder. The present study investigated the relation between self-compassion, emotion regulation difficulties, obsessive beliefs, and obsessive-compulsive symptom severity in 90 patients with OCD using self-report questionnaires. Symptom severity and obsessive beliefs were negatively correlated to self-compassion and positively associated with emotion regulation difficulties. Additionally, self-compassion showed a negative relation to emotion regulation difficulties. Emotion regulation difficulties-but not self-compassion-predicted symptom severity when controlling for obsessive beliefs and depression in a hierarchical regression analysis. Further analyses showed that emotion regulation deficits mediated the relationship between self-compassion and OCD symptom severity. Our results provide preliminary evidence that targeting self-compassion and putting more emphasis on emotion regulation deficits might be promising treatment approaches for patients with OCD. Future studies could investigate which specific interventions that directly address these variables improve treatment outcome.

Common change factors and mediation of the alliance-outcome link during treatment of depression.

OBJECTIVE: Alliance, Mastery/Self-Efficacy, Problem Actualization, and Problem Clarification exemplify common or nonspecific factors of change in psychotherapy (Grawe, 1997). In this study, we tested the hypothesis that other change factors mediate the alliance-outcome link on a within-person level over the treatment course. METHOD: Our sample consisted of 193 patients with major depression undergoing intensive inpatient cognitive-behavioral-based therapy. Each week, we assessed depressive symptoms (using the Beck Depression Inventory-II) and change factors during individual therapy. Multilevel mediation models were used to test our hypothesis. RESULTS: As expected, within-person change in Alliance (differentiated into Emotional Bond and Contentment with the Therapist) as well as Mastery/Self-Efficacy and Problem Clarification predicted symptom change over the course of therapy. Moreover, the relation between Contentment with the Therapist and subsequent change in depression was mediated by increased Mastery/Self-Efficacy on a within-person level. CONCLUSIONS: Our data suggest that within-person change of alliance and other general change factors precede symptom change in depressive patients, and that the link between alliance and outcome may be partially mediated by enhanced Mastery/Self-Efficacy. Future studies should further elucidate the mechanisms responsible for the alliance-outcome link. (PsycINFO Database Record

Weight Suppression But Not Symptom Improvement Predicts Weight Gain During Inpatient Treatment for Bulimia Nervosa.

OBJECTIVE: Fear of gaining weight is a common obstacle to seeking treatment for bulimia nervosa (BN). We investigated changes in body mass index (BMI) during inpatient treatment for BN in relation to treatment outcome and weight suppression (WS). METHODS: Female inpatients of a specialized eating disorders clinic were grouped as deteriorated/unchanged, reliably improved, and clinically significantly improved based on Eating Disorder Inventory-2 scores. Repeated measures ANOVA was employed to examine changes in BMI between admission and discharge depending on treatment outcome and WS. RESULTS: One-hundred seventy-nine patients were included. Overall, the average BMI significantly increased by 0.54 kg/m2 (SD = 1.24). Repeated measures ANOVA revealed no association of change in BMI with treatment outcome [F(df) = 1.13 (2166), p = 0.327] but with WS [F(df) = 2.76 (3166), p < 0.044]. DISCUSSION: Bulimia nervosa can be successfully treated without causing excessive weight gain. Patients with higher WS might expect somewhat more weight gain. Copyright © 2017 John Wiley & Sons, Ltd and Eating Disorders Association.

Change in obsessive beliefs as predictor and mediator of symptom change during treatment of obsessive-compulsive disorder - a process-outcome study.

BACKGROUND: Cognitive models of obsessive-compulsive disorder suggest that changes in obsessive beliefs are a key mechanism of treatments for obsessive-compulsive disorder. Thus, in the present process-outcome study, we tested whether changes in obsessive beliefs during a primarily cognitive behavioral inpatient treatment predicted treatment outcome and whether these changes mediated symptom changes over the course of treatment. METHODS: Seventy-one consecutively admitted inpatients with obsessive-compulsive disorder were assessed with the Yale-Brown Obsessive-Compulsive Scale and the Obsessive Beliefs Questionnaire at treatment intake, after six weeks of treatment and at discharge, and with the Beck-Depression-Inventory-II at intake and discharge. RESULTS: Changes in obsessive beliefs during the first six weeks of treatment predicted obsessive-compulsive symptoms at discharge when controlling for obsessive-compulsive and depressive symptoms at intake in a hierarchical regression analysis. Multilevel mediation analyses showed that reductions in obsessive beliefs partially mediated improvements in obsessive-compulsive symptoms over time. CONCLUSIONS: Our findings indicate that decreasing obsessive beliefs in inpatient cognitive behavioral therapy for obsessive-compulsive disorder might be a promising treatment approach.

Brief report: Impression formation in high-functioning autism: role of nonverbal behavior and stereotype activating information.

Little is known about whether stereotypes influence social judgments of autistic individuals, in particular when they compete with tacit face-to-face cues. We compared impression formation of 17 subjects with high-functioning autism (HFA) and 17 age-, gender- and IQ-matched controls. Information about the profession of a job applicant served as stereotype activating information. The target person's nonverbal behavior was presented as a computer animation showing two virtual characters in interaction. Contrary to our hypothesis, HFA participants were as sensitive to nonverbal cues as controls. Moreover, HFA showed a tendency to evaluate persons more positively. This might indicate a routine HFA apply in impression formation in order to compensate for their deficit in intuitive understanding of nonverbal communication cues.

A comparison of schemas, schema modes and childhood traumas in obsessive-compulsive disorder, chronic pain disorder and eating disorders.

BACKGROUND: In this study, we investigated early maladaptive schemas (EMS), schema modes and childhood traumas in patients suffering from obsessive-compulsive disorder (OCD) in contrast to patients with other Axis I disorders. Based on cognitive theories on OCD, our main research question was whether schemas belonging to the domain of 'impaired autonomy and performance' are more prevalent in OCD than in both eating disorders (ED) and chronic pain disorder (CPD). SAMPLING AND METHODS: EMS, schema modes and traumatic childhood experiences were measured in 60 patients with OCD, 41 with ED, 40 with CPD and 142 healthy controls. To analyze differences between the groups, MANCOVAs were conducted followed by deviation contrasts. Depression level, age and gender were considered as possible covariates. RESULTS: OCD patients scored higher on 4 EMS, 2 of which belong to the domain 'impaired autonomy and performance'. ED patients had higher scores in the EMS 'emotional inhibition' and CPD patients on the Childhood Trauma Questionnaire subscale 'physical neglect'. CONCLUSIONS: These results suggest that there might be typical schema patterns associated with OCD and ED. We can also conclude that a higher prevalence of traumatic experiences does not necessarily coincide with more EMS and schema modes.

Getting a grip on social gaze: control over others' gaze helps gaze detection in high-functioning autism.

We investigated the influence of control over a social stimulus on the ability to detect direct gaze in high-functioning autism (HFA). In a pilot study, 19 participants with and 19 without HFA were compared on a gaze detection and a gaze setting task. Participants with HFA were less accurate in detecting direct gaze in the detection task, but did not differ in their ability to establish direct gaze in the setting task. In the main experiment, the results of the pilot study were replicated with 37 participants with and 39 without HFA, suggesting that individuals with HFA have a specific deficit in the passive perception of social cues as opposed to the active control, which seems to be intact.

Responses to nonverbal behaviour of dynamic virtual characters in high-functioning autism.

We investigated feelings of involvement evoked by nonverbal behaviour of dynamic virtual characters in 20 adults with high-functioning autism (HFA) and high IQ as well as 20 IQ-matched control subjects. The effects of diagnostic group showed that subjects with autism experienced less "contact" and "urge" to establish contact across conditions and less "interest" than controls in a condition with meaningful facial expressions. Moreover, the analyses within groups revealed that nonverbal behaviour had less influence on feelings in HFA subjects. In conclusion, disturbances of HFA subjects in experiencing involvement in social encounters with virtual characters displaying nonverbal behaviour do not extend to all kinds of feelings, suggesting different pathways in the ascription of involvement in social situations.