20 research outputs found
The Behavior Avoidance Test: Association With Symptom Severity and Treatment Outcome in Obsessive-Compulsive Disorder
Behavior therapy of obsessive-compulsive disorder (OCD) aims to reduce avoidance,
rituals, and discomfort in OCD-relevant situations. The Behavioral Avoidance Test
(BAT) measures these behavior-related outcomes in individually challenging OCD-related
situations. The association of the BAT with OCD severity measures and its relevance
for treatment outcome is, however, still unclear. The current study investigates with
a retrospective analysis of a subsample of a pilot study, (1) if reactions on the BAT
are related to OCD severity measures in an OCD sample (n = 28), (2) if treatment
with two variants of cognitive-behavior therapy (exposure and response prevention vs.
metacognitive therapy) changes the BAT scores and (3) if these changes as well as
pretreatment BAT avoidance are relevant for OCD treatment outcome as measured by
the Yale-Brown Obsessive Compulsive Scale (Y-BOCS). Participants rated avoidance,
ritual, and discomfort in three individually challenging OCD-related situations before and
after therapy. For one of these situations, BAT dimensions were rated by the therapist
and an independent rater in addition to the patients’ ratings. Correlational analyses
found significant correlations between BAT discomfort and OCD severity measures like
the Y-BOCS. A repeated measures ANOVA with pre- and posttest scores showed that
all three BAT dimensions significantly decreased during both treatments. Hierarchical
regression analyses (controlling for Y-BOCS pretest scores) revealed that changes in BAT
discomfort as well as pretreatment BAT avoidance scores predicted the Y-BOCS posttest
score. These findings suggest that the BAT is a distinct measure of behavior-related
outcomes partly being relevant for OCD treatment outcome
Are depressive symptoms linked to a reduced pupillary response to novel positive information?—An eye tracking proof-of-concept study
IntroductionDepressive symptoms have been linked to difficulties in revising established negative beliefs in response to novel positive information. Recent predictive processing accounts have suggested that this bias in belief updating may be related to a blunted processing of positive prediction errors at the neural level. In this proof-of-concept study, pupil dilation in response to unexpected positive emotional information was examined as a psychophysiological marker of an attenuated processing of positive prediction errors associated with depressive symptoms.MethodsParticipants (N = 34) completed a modified version of the emotional Bias Against Disconfirmatory Evidence (BADE) task in which scenarios initially suggest negative interpretations that are later either confirmed or disconfirmed by additional information. Pupil dilation in response to the confirmatory and disconfirmatory information was recorded.ResultsBehavioral results showed that depressive symptoms were related to difficulties in revising negative interpretations despite disconfirmatory positive information. The eye tracking results pointed to a reduced pupil response to unexpected positive information among people with elevated depressive symptoms.DiscussionAltogether, the present study demonstrates that the adapted emotional BADE task can be appropriate for examining psychophysiological aspects such as changes in pupil size along with behavioral responses. Furthermore, the results suggest that depression may be characterized by deviations in both behavioral (i.e., reduced updating of negative beliefs) and psychophysiological (i.e., decreased pupil dilation) responses to unexpected positive information. Future work should focus on a larger sample including clinically depressed patients to further explore these findings
Metacognitive Change During Exposure and Metacognitive Therapy in Obsessive-Compulsive Disorder
Metacognitive therapy (MCT) has been shown to be a promising treatment approach
for obsessive-compulsive disorder (OCD). The changeability of metacognitions by
(metacognitive) treatment and its relevance to treatment outcome is, however, still
unclear. The current study investigates, (1) if treatment with MCT or exposure and
response prevention (ERP) in a randomized-controlled pilot trial (n = 24 patients with
OCD) changes OCD-specific metacognitions of thought fusion beliefs, beliefs about
rituals and stop signals, and (2) if these changes are relevant for the treatment outcome
in terms of patient- and therapist-rated OCD symptoms. ANOVA with pretest, posttest
and follow-up scores could show that all three metacognitions significantly decreased
during both treatments. Regarding thought fusion beliefs, a significant interaction
effect indicated a higher decrease after MCT than ERP treatment. In hierarchical
regression analyses, changes in stop signals from pre- to post-treatment significantly
predicted patient-rating OCD symptoms at post-treatment and follow-up at 3 months
after treatment. These changes were even predictive of post-treatment outcome after
controlling for general metacognitions and dysfunctional cognitive beliefs. These findings
support the assumption thatmetacognitions can change during both treatments and that
changes in stop signals might be relevant for the treatment outcome on the symptom
level in OCD
The Behavior Avoidance Test: Association With Symptom Severity and Treatment Outcome in Obsessive-Compulsive Disorder
Behavior therapy of obsessive-compulsive disorder (OCD) aims to reduce avoidance,
rituals, and discomfort in OCD-relevant situations. The Behavioral Avoidance Test
(BAT) measures these behavior-related outcomes in individually challenging OCD-related
situations. The association of the BAT with OCD severity measures and its relevance
for treatment outcome is, however, still unclear. The current study investigates with
a retrospective analysis of a subsample of a pilot study, (1) if reactions on the BAT
are related to OCD severity measures in an OCD sample (n = 28), (2) if treatment
with two variants of cognitive-behavior therapy (exposure and response prevention vs.
metacognitive therapy) changes the BAT scores and (3) if these changes as well as
pretreatment BAT avoidance are relevant for OCD treatment outcome as measured by
the Yale-Brown Obsessive Compulsive Scale (Y-BOCS). Participants rated avoidance,
ritual, and discomfort in three individually challenging OCD-related situations before and
after therapy. For one of these situations, BAT dimensions were rated by the therapist
and an independent rater in addition to the patients’ ratings. Correlational analyses
found significant correlations between BAT discomfort and OCD severity measures like
the Y-BOCS. A repeated measures ANOVA with pre- and posttest scores showed that
all three BAT dimensions significantly decreased during both treatments. Hierarchical
regression analyses (controlling for Y-BOCS pretest scores) revealed that changes in BAT
discomfort as well as pretreatment BAT avoidance scores predicted the Y-BOCS posttest
score. These findings suggest that the BAT is a distinct measure of behavior-related
outcomes partly being relevant for OCD treatment outcome
The Behavior Avoidance Test: Association With Symptom Severity and Treatment Outcome in Obsessive-Compulsive Disorder
Behavior therapy of obsessive-compulsive disorder (OCD) aims to reduce avoidance,
rituals, and discomfort in OCD-relevant situations. The Behavioral Avoidance Test
(BAT) measures these behavior-related outcomes in individually challenging OCD-related
situations. The association of the BAT with OCD severity measures and its relevance
for treatment outcome is, however, still unclear. The current study investigates with
a retrospective analysis of a subsample of a pilot study, (1) if reactions on the BAT
are related to OCD severity measures in an OCD sample (n = 28), (2) if treatment
with two variants of cognitive-behavior therapy (exposure and response prevention vs.
metacognitive therapy) changes the BAT scores and (3) if these changes as well as
pretreatment BAT avoidance are relevant for OCD treatment outcome as measured by
the Yale-Brown Obsessive Compulsive Scale (Y-BOCS). Participants rated avoidance,
ritual, and discomfort in three individually challenging OCD-related situations before and
after therapy. For one of these situations, BAT dimensions were rated by the therapist
and an independent rater in addition to the patients’ ratings. Correlational analyses
found significant correlations between BAT discomfort and OCD severity measures like
the Y-BOCS. A repeated measures ANOVA with pre- and posttest scores showed that
all three BAT dimensions significantly decreased during both treatments. Hierarchical
regression analyses (controlling for Y-BOCS pretest scores) revealed that changes in BAT
discomfort as well as pretreatment BAT avoidance scores predicted the Y-BOCS posttest
score. These findings suggest that the BAT is a distinct measure of behavior-related
outcomes partly being relevant for OCD treatment outcome
Metacognitive Change During Exposure and Metacognitive Therapy in Obsessive-Compulsive Disorder
Metacognitive therapy (MCT) has been shown to be a promising treatment approach
for obsessive-compulsive disorder (OCD). The changeability of metacognitions by
(metacognitive) treatment and its relevance to treatment outcome is, however, still
unclear. The current study investigates, (1) if treatment with MCT or exposure and
response prevention (ERP) in a randomized-controlled pilot trial (n = 24 patients with
OCD) changes OCD-specific metacognitions of thought fusion beliefs, beliefs about
rituals and stop signals, and (2) if these changes are relevant for the treatment outcome
in terms of patient- and therapist-rated OCD symptoms. ANOVA with pretest, posttest
and follow-up scores could show that all three metacognitions significantly decreased
during both treatments. Regarding thought fusion beliefs, a significant interaction
effect indicated a higher decrease after MCT than ERP treatment. In hierarchical
regression analyses, changes in stop signals from pre- to post-treatment significantly
predicted patient-rating OCD symptoms at post-treatment and follow-up at 3 months
after treatment. These changes were even predictive of post-treatment outcome after
controlling for general metacognitions and dysfunctional cognitive beliefs. These findings
support the assumption thatmetacognitions can change during both treatments and that
changes in stop signals might be relevant for the treatment outcome on the symptom
level in OCD
Providing open-label placebos remotely-A randomized controlled trial in allergic rhinitis.
BackgroundPlacebos can reduce physical symptoms even when provided with full honesty and disclosure. Yet, the precise mechanisms underlying the effects of "open-label placebos" (OLPs) have remained subject of debate. Furthermore, it is unclear whether OLPs are similarly effective when provided remotely, as is sometimes required e.g. in the current COVID-19 pandemic.MethodsIn a randomized-controlled trial, we examined the effects of OLP plus treatment as usual (TAU) compared to TAU alone on symptom reduction in people with allergic rhinitis (N = 54) over the course of two weeks. Due to the COVID-19 pandemic, OLP was provided remotely (i.e. sent via postal service). To investigate the potential influence of the clinical encounter on the effects of OLP, we manipulated the perception of the virtual clinical encounter, both with respect to verbal and nonverbal factors (augmented vs. limited encounter).ResultsThe results of the manipulation check confirmed that the augmented clinical encounter was evaluated more positively than the limited encounter, in terms of perceived warmth of the provider. Participants from all treatment groups showed significant symptom reduction from baseline to two weeks later, but OLP had no incremental effect over TAU. Participants benefitted more from OLP when they did not take any other medication against allergic symptoms than when taking medication on demand. When controlling for baseline symptoms, a significant treatment by encounter interaction was found, pointing to greater symptom improvement in the OLP group when the encounter was augmented, whereas the control group improved more when the encounter was limited.DiscussionThe study demonstrates that providing OLP and enhancing the encounter remotely is possible, but their effectiveness might be lower in comparison to previous studies relying on physical patient-provider interaction. The study raises questions for future research about the potential and challenges of remote placebo studies and virtual clinical encounters. The study has been registered as a clinical trial at ISRCTN (record number: 39018)
Correction: Providing open-label placebos remotely-A randomized controlled trial in allergic rhinitis.
[This corrects the article DOI: 10.1371/journal.pone.0248367.]
Medication adherence in the general population.
BACKGROUND: Adherence to medication is low in specific populations who need chronic medication. However, adherence to medication is also of interest in a more general fashion, independent of specific populations or side effects of particular drugs. If clinicians and researchers expect patients to show close to full adherence, it is relevant to know how likely the achievement of this goal is. Population based rates can provide an estimate of efforts needed to achieve near complete adherence in patient populations. The objective of the study was to collect normative data for medication nonadherence in the general population. METHODS AND FINDINGS: We assessed 2,512 persons (a representative sample of German population). Adherence was measured by Rief Adherence Index. We also assessed current medication intake and side effects. We found that at least 33% of Germans repeatedly fail to follow their doctor's recommendations regarding pharmacological treatments and only 25% of Germans describe themselves as fully adherent. Nonadherence to medication occurs more often in younger patients with higher socioeconomic status taking short-term medications than in older patients with chronic conditions. Experience with medication side effects was the most prominent predictor of nonadherence. CONCLUSIONS: The major strengths of our study are a representative sample and a novel approach to assess adherence. Nonadherece seems to be commonplace in the general population. Therefore adherence cannot be expected per se but needs special efforts on behalf of prescribers and public health initiatives. Nonadherence to medication should not only be considered as a drug-specific behaviour problem, but as a behaviour pattern that is independent of the prescribed medication