A comparison of cognitive restructuring and thought listing for excessive acquiring in hoarding disorder

Excessive acquiring is a common symptom of hoarding disorder (HD). Little is known about subjective distress associated with acquiring in HD. The present study examined acquiring- related distress and reactions to cognitive restructuring (CR) in 92 individuals with HD and 66 community control (CC) participants. All participants identified an item of interest at a high-risk acquiring location and then decided whether or not to acquire the item. HD participants completed the acquiring task while receiving a CR-based intervention or a thought-listing (TL) control condition. Results showed that HD participants reported more severe distress and greater urges to acquire the item of interest than did CC participants. Nevertheless, subjective distress decreased in both groups following the acquiring task. There were no differences in acquiring- related distress between the CR and TL conditions. The findings indicate that subjective distress may decrease after relatively short periods of time in individuals with HD, but that a single session of CR may not alleviate acquiring-related distress in HD participants.R01 MH068007 - NIMH NIH HHS; R01 MH068008 - NIMH NIH HHSAccepted manuscrip

Experimental Investigations of the Judicious Use of Safety Behaviour in Exposure Therapy for Contamination Fear

Compulsive washing and contamination fear are among the most common symptoms of obsessive-compulsive disorder (OCD). Exposure and response prevention (ERP) is an effective treatment for OCD, but a substantial proportion of clients/patients refuse this treatment entirely or drop out prematurely. A proposed solution involves the judicious use of safety behaviour to enhance the acceptability of ERP. However, to this author’s knowledge, there are currently no published guidelines for the judicious use of safety behaviour in exposure, and questions remain about how best to incorporate safety behaviour into existing treatments. For instance, which kinds of safety behaviour may be beneficial in treatment, and which may be harmful? Who decides when to eliminate the safety behaviour during treatment, the client/patient or the therapist? The present studies made a first attempt at addressing these questions. In the first study, a clinical sample of individuals with contamination-related OCD (N = 60) was randomized to receive an exposure session with no safety aid (ERP), a routinely-used safety aid (RU), or a never-used safety aid (NU). Significant reductions in contamination fear severity were observed in all conditions. However, participants in the NU condition demonstrated the lowest self-reported contamination fear severity at post-treatment. Further, the NU condition received the highest acceptability and anticipated adherence ratings. In the second study, a subclinical sample of undergraduate students (N = 100) was assigned to complete an exposure session for contamination fear under one of three fading conditions: participant-initiated, experimenter-initiated (based on time), or experimenter-initiated (based on participant-reported distress levels). Compared to the experimenter initiated time-based condition, the participant-initiated condition demonstrated significantly greater reductions in obsessive beliefs and peak fear, as well as marginally higher treatment expectancy ratings. There were no differences in outcome or acceptability between the participant-initiated and experimenter initiated distress-based conditions. The results of these studies are discussed in terms of the cognitive-behavioural theory and treatment of anxiety and related disorders, and of the potential benefits of judiciously incorporating safety behaviour into effective treatments

Safety Behaviour Enhances the Acceptability of Exposure

Compulsive washing and contamination fears are among the most common symptoms of obsessive-compulsive disorder (OCD). Research suggests that exposure and response prevention (ERP) is effective for OCD. However, ERP is prone to dropouts and refusals, and a substantial proportion of clients therefore do not receive the care they need. A proposed solution involves the judicious use of safety behaviour to enhance the acceptability of exposure-based interventions. The current study aimed to test this proposed solution. Participants were 70 undergraduate students who completed two exposure exercises for contamination fear, one with safety behaviour and one without. Participants then rated the acceptability of the two exercises. Exposure with safety behaviour (ESB) was rated as significantly more acceptable than exposure and response prevention (ERP). Furthermore, subjective fear ratings were lower and behavioural approach to a series of contaminants was greater in the ESB condition. Results demonstrated the acceptability-enhancing potential of safety behaviour in exposure, and are discussed in terms of both theoretical and practical aspects of safety behaviour, exposure, and evidence-based interventions for anxiety disorders

A Comparison of Cognitive Restructuring And Thought Listing For Excessive Acquiring In Hoarding Disorder

Excessive acquiring is a common symptom of hoarding disorder (HD). Little is known about subjective distress associated with acquiring in HD. The present study examined acquiring-related distress and reactions to cognitive restructuring (CR) in 92 individuals with HD and 66 community control (CC) participants. All participants identified an item of interest at a high-risk acquiring location and then decided whether or not to acquire the item. HD participants completed the acquiring task while receiving a CR-based intervention or a thought-listing (TL) control condition. Results showed that HD participants reported more severe distress and greater urges to acquire the item of interest than did CC participants. Nevertheless, subjective distress decreased in both groups following the acquiring task. There were no differences in acquiring-related distress between the CR and TL conditions. The findings indicate that subjective distress may decrease after relatively short periods of time in individuals with HD, but that a single session of CR may not alleviate acquiring-related distress in HD participants

Psychometric Properties of the Hoarding Rating Scale-Interview

The present study tested the psychometric properties of an expanded version of the Hoarding Rating Scale (HRS-I), a semistructured interview for hoarding disorder (HD). Eighty-seven adults with HD and 44 healthy control (HC) participants were assessed using the HRS-I and completed a battery of self-report measures of HD severity, negative affect, and functional impairment. All interviews were audio recorded. From the HD participants, 21 were randomly selected for inter-rater reliability (IRR) analysis and 11 for test-retest reliability (TRR) analysis. The HRS-I showed excellent internal consistency (α = 0.87). IRR and TRR in the HD sample were good (intra-class coefficients = 0.81 and 0.85, respectively). HRS-I scores correlated strongly with scores on the self-report Saving Inventory-Revised (SI-R); partial correlations indicated that the HRS-I clutter, difficulty discarding, and acquiring items correlated significantly and at least moderately with corresponding SI-R subscales, when controlling for the other SI-R subscales. The HD group scored significantly higher on all items than did the HC group, with large effect sizes (d = 1.28–6.58). ROC analysis showed excellent sensitivity (1.00) and specificity (1.00) for distinguishing the HD and HC groups with a cutoff score of 11. Results and limitations are discussed in light of prior research

The impact of beliefs about face recognition ability on memory retrieval processes in young and older adults

This study examined whether beliefs about face recognition ability differentially influence memory retrieval in older compared to young adults. Participants evaluated their ability to recognise faces and were also given information about their ability to perceive and recognise faces. The information was ostensibly based on an objective measure of their ability, but in actuality, participants had been randomly assigned the information they received (high ability, low ability or no information control). Following this information, face recognition accuracy for a set of previously studied faces was measured using a remember– know memory paradigm. Older adults rated their ability to recognise faces as poorer compared to young adults. Additionally, negative information about face recognition ability improved only older adults’ ability to recognise a previously seen face. Older adults were also found to engage in more familiarity than item-specific processing than young adults, but information about their face recognition ability did not affect face processing style. The role that older adults’ memory beliefs have in the meta-cognitive strategies they employ is discussed