Three-year outcomes of adults with anxiety and related disorders following cognitive-behavioral therapy in a non-research clinical setting

Anxiety and related disorders are highly prevalent and costly to society. Fortunately, a large number of randomized controlled trials have demonstrated the efficacy of cognitive behavioral therapy (CBT) in the treatment of anxiety and related disorders. A smaller number of effectiveness studies have also demonstrated that similar outcomes to randomized controlled trials can be obtained in "real-world" settings. There is minimal research, however, into long-term outcomes in effectiveness research. This study describes the outcomes of 98 individuals with anxiety and related disorders treated in an outpatient, fee-for-service setting using a case formulation CBT approach. Participants were followed up each year after their discharge, for a period of 3 years. The results indicate that patients maintained their treatment gains, with large effect sizes obtained from pre-treatment to each follow-up time point (d = 1.11-1.60). The results provide preliminary evidence to suggest that individuals treated with CBT in "real-world" settings maintain their treatment gains in the long-term

Treatment Outcome and Predictors of Internet Guided Self-Help for Obsessive-Compulsive Disorder

Internet-guided self-help (iGSH) has amassed significant empirical support for a variety of psychiatric conditions; however, it is not known who responds best to these treatments. This open trial examined the clinical outcomes and predictors of a 17-week iGSH program for obsessive-compulsive disorder (OCD). Therapist support was provided either in person or by phone 9 times for an average of 13 minutes per session. Twenty-four patients initiated treatment, and 17 of these (70.8%) completed. Results of the intent-to-treat sample indicated statistically significant improvements at posttreatment with large treatment effects for OCD symptoms as assessed by the Yale Brown Obsessive-Compulsive Scale (d = 0.87), and small to moderate improvements in depression (d = 0.19), functioning (d = 0.53), and quality of life (d = -0.18). These outcomes were largely maintained over a 6-month follow-up. Readiness to reduce avoidance of OCD triggers and attendance to therapist sessions were moderately associated with posttreatment response, and correctly classified the responder status (defined as clinically significant change) of nearly 9 out of 10 patients at posttreatment. These same variables did not predict responder status at 6-month follow-up. These results lend further empirical support to iGSH as a treatment for OCD and provide direction on the development of predictor models to identify patients who are and are not likely to acutely respond to iGSH

A Contemporary Psychometric Evaluation of the Obsessive Compulsive Inventory - Revised (OCI-R)

Traditionally, hoarding symptoms were coded under obsessive-compulsive disorder (OCD), however, in DSM-5 hoarding symptoms are classified as a new independent diagnosis, hoarding disorder (HD). This change will likely have a considerable impact on the self-report scales that assess symptoms of OCD, as these scales often include items measuring symptoms of hoarding. This study evaluated the psychometric properties of one of the most commonly used self-report measures of OCD symptoms, the Obsessive-Compulsive Inventory - Revised (OCI-R), in a sample of 474 individuals with either OCD (n = 118), HD (n = 201) or no current or past psychiatric disorders (n = 155). Participants with HD were diagnosed according to the proposed DSM-5 criteria. For the purposes of this study the OCI-R was divided into two scales; the OCI-OCD (measuring the 5 dimensions of OCD) and the OCI-HD (measuring the hoarding dimension). Evidence of validity for the OCI-OCD and OCI-HD was obtained by comparing scores with the Saving Inventory Revised (SI-R), the Hoarding Rating Scale (HRS) and the Beck Anxiety Inventory (BAI). Receiver operating curves for both subscales indicated good sensitivity and specificity for cut-scores determining diagnostic status. The results indicated that the OCI-OCD and OCI-HD subscales are reliable and valid measures that adequately differentiate between DSM-5 diagnostic groups. Implications for the future use of the OCI-R in OCD and HD samples are discussed

A Contemporary Psychometric Evaluation of the Obsessive Compulsive Inventory-Revised (OCI-R)

Traditionally, hoarding symptoms were coded under obsessive-compulsive disorder (OCD), however, in DSM-5 hoarding symptoms are classified as a new independent diagnosis, hoarding disorder (HD). This change will likely have a considerable impact on the self-report scales that assess symptoms of OCD, since these scales often include items measuring symptoms of hoarding. This study evaluated the psychometric properties of one of the most commonly used self-report measures of OCD symptoms, the Obsessive-Compulsive Inventory-Revised (OCI-R), in a sample of 474 individuals with either OCD (n = 118), HD (n = 201), or no current or past psychiatric disorders (n = 155). Participants with HD were diagnosed according to the proposed DSM-5 criteria. For the purposes of this study the OCI-R was divided into two scales: the OCI-OCD (measuring the five dimensions of OCD) and the OCI-HD (measuring the hoarding dimension). Evidence of validity for the OCI-OCD and OCI-HD was obtained by comparing scores with the Saving Inventory Revised (SI-R), the Hoarding Rating Scale (HRS) and the Beck Anxiety Inventory (BAI). Receiver operating curves for both subscales indicated good sensitivity and specificity for cut-scores determining diagnostic status. The results indicated that the OCI-OCD and OCI-HD subscales are reliable and valid measures that adequately differentiate between DSM-5 diagnostic groups. Implications for the future use of the OCI-R in OCD and HD samples are discussed

The relationship between self-reported and objective neuropsychological impairments in patients with hoarding disorder

Although hoarding disorder (HD) is characterized by self- and clinician-reported difficulties with cognitive functioning, studies of neuropsychological performance have yielded little evidence of consistent, clinical-level cognitive impairments. The aim of this study was to quantify this inconsistency and to examine whether this pattern is unique to HD. Fifty-three adults (20 with HD, 19 with obsessive compulsive disorder (OCD) and minimal hoarding symptoms, and 14 with OCD and a high degree of hoarding symptoms (OCD-H)) completed self-report and objective neuropsychological tests of inhibition, attention, and memory. The three groups differed significantly on self-reported attention and memory deficits, with the HD group reporting greater difficulties. However, the groups performed comparably on objective neuropsychological tests of inhibition, attention, immediate and delayed nonverbal memory, and immediate verbal memory. The OCD-H group demonstrated a greater rate of impairment on a test of delayed verbal memory. The HD group was characterized by lower concordance rates between self-report and objective memory impairment. The groups did not differ significantly in concordance rates for self-report and objective measures of attention and inhibition. Understanding the discrepancy between self-report and objective neuropsychological measures may help to better characterize the role of cognitive processes in HD