Caractéristiques et traitements de l'obsession sans compulsion manifeste

Malgré les progrès substantiels de l'approche cognitive béhaviorale dans le traitement du Trouble obsessionnel-compulsif(TOC), les obsessions sans compulsion manifeste demeurent un défi pour le clinicien. Les trois présentes études constituent une première description détaillée d'un échantillon important composé de 29patients souffrant du trouble obsessionnel sans compulsion manifeste. La première étude confirme que les patients utilisent un vaste répertoire de stratégies pour chasser la pensée et pour diminuer le malaise. La deuxième démontre que l'évaluation des pensées varie en fonction des fluctuations de l'état émotionnel. La troisième étude montre qu'un traitement basé sur l'exposition, la prévention de la réponse et la restructuration cognitive produit des gains thérapeutiques cliniquement et statistiquement significatifs. Elle démontre clairement que la thérapie cognitive-comportementale est efficace pour des patients souffrant de pensées obsessionnelles alors que ceux-ci furent longtemps considérés comme réfractaires au traitement. Ces études fournissent un appui empirique aux modèles théoriques formulés pour expliquer le Trouble obsessionnel-compulsif. Les implications théoriques et cliniques sont discutées

Revising the Intolerance of Uncertainty Model of Generalized Anxiety Disorder: Evidence from UK and Italian Undergraduate Samples

The Intolerance of Uncertainty Model (IUM) of Generalized Anxiety Disorder (GAD) attributes a key role to Intolerance of Uncertainty (IU), and additional roles to Positive Beliefs about Worry (PBW), Negative Problem Orientation (NPO), and Cognitive Avoidance (CA), in the development and maintenance of worry, the core feature of GAD. Despite the role of the IUM components in worry and GAD has been considerably demonstrated, to date no studies have explicitly assessed whether and how PBW, NPO, and CA might turn IU into worry and somatic anxiety. The current studies sought to re-examine the IUM by assessing the relationships between the model’s components on two different non-clinical samples made up of UK and Italian undergraduate students. One-hundred and seventy UK undergraduates and 488 Italian undergraduates completed measures assessing IU, worry, somatic anxiety, depression, and refined measures of PBW, NPO, and CA. In each sample, two mediation models were conducted in order to test whether PBW, NPO, and CA differentially mediate the path from IU to worry and the path from IU to somatic anxiety. Secondly, it was tested whether IU also moderates the mediations. Main findings showed that, in the UK sample, only NPO mediated the path from IU to worry; as far as concern the path to anxiety, none of the putative mediators was significant. Differently, in the Italian sample PBW and NPO were mediators in the path from IU to worry, whereas only CA played a mediational role in the path from IU to somatic anxiety. Lastly, IU was observed to moderate only the association between NPO and worry, and only in the Italian sample. Some important cross-cultural, conceptual, and methodological issues raised from main results are discussed

Seeking certainty about intolerance of uncertainty: Addressing old and new issues through the intolerance of uncertainty scale-revised

Intolerance of Uncertainty is a trans-diagnostic process that spans a range of emotional disorders and it is usually measured through the Intolerance of Uncertainty Scale-12. The current study aims at investigating some issues in the assessment of Intolerance of Uncertainty (IU) through the Italian Intolerance of Uncertainty Scale-Revised, a measure adapted from the Intolerance of Uncertainty Scale-12 to assess IU across the lifespan. In particular we address the factor structure among a large community sample, measurement invariance across gender, age, and over time, together with reliability and validity of the overall scale and its subscales. The questionnaire was administered to community (N = 761; mean age = 35.86 +/- 14.01 years) and undergraduate (N = 163; mean age = 21.16 +/- 2.64 years) participants, together with other self-report measures assessing constructs theoretically related to IU. The application of a bifactor model shows that the Italian Intolerance of Uncertainty Scale-Revised possesses a robust general factor, thus supporting the use of the unit-weighted total score of the questionnaire as a measure of the construct. Furthermore, measurement invariance across gender, age, and over time is supported. Finally, the Italian Intolerance of Uncertainty Scale-Revised appears to possess adequate reliability and validity. These findings support the unidimensionality of the measure, a conceptually reasonable result in line with the trans-diagnostic nature of Intolerance of Uncertainty. In addition, this study and comparison with published factor structures of the Intolerance of Uncertainty Scale-12 and of the Intolerance of Uncertainty Scale-Revised identify some issues for the internal structure of the measure. In particular, concern is expressed for the Prospective IU subscale. In light of the promising psychometric properties, the use of the Italian Intolerance of Uncertainty Scale-Revised as a univocal measure is encouraged in both research and clinical practice

Case formulation—A vehicle for change? Exploring the impact of cognitive behavioural therapy formulation in first episode psychosis: A reflexive thematic analysis

Objectives: Formulation is considered a fundamental process of cognitive behavioural therapy for psychosis (CBTp). However, an exploration into the personal impact of different levels of case formulation (CF) from a service user perspective (SU) is lacking, particularly for those experiencing a first episode of psychosis. Design: This Big Q qualitative design used semi-structured interviews. Methods: Reflexive thematic analysis (TA) was used to analyse 10 participant interviews. NVivo 12 computer-assisted qualitative data analysis software aided data organisation and analysis. Results: One overarching theme ‘CF – A vehicle for change?’ was developed as a pattern of shared meaning across the data set. Three main themes related to the overarching theme: (1) Vicious cycles: ‘I never really thought about it being me maintaining the problems’ (including one subtheme – Self-empowerment: ‘Only you can make the changes for yourself’); (2) Early life experiences: ‘My experiences have shaped the person that I am, therefore, it's not my fault’ (including one subtheme – Disempowerment: ‘[My] core beliefs have been damaged’); and (3) Keep it simple: ‘Don't push it too far over the top in case it becomes like spaghetti’. Conclusions: Maintenance formulations may be experienced as self-blaming, but also self-empowering, which may help to facilitate change. Longitudinal formulations may be experienced as non-blaming, but also disempowering, which may inhibit change. Simple CF diagrams may also facilitate change, whereas overly complex CFs may inhibit change. How CBTp therapists might look to improve the impact of different levels of CF for service users (SUs) in first episode psychosis (FEP) are described

BHPR research: qualitative1. Complex reasoning determines patients' perception of outcome following foot surgery in rheumatoid arhtritis

Background: Foot surgery is common in patients with RA but research into surgical outcomes is limited and conceptually flawed as current outcome measures lack face validity: to date no one has asked patients what is important to them. This study aimed to determine which factors are important to patients when evaluating the success of foot surgery in RA Methods: Semi structured interviews of RA patients who had undergone foot surgery were conducted and transcribed verbatim. Thematic analysis of interviews was conducted to explore issues that were important to patients. Results: 11 RA patients (9 ♂, mean age 59, dis dur = 22yrs, mean of 3 yrs post op) with mixed experiences of foot surgery were interviewed. Patients interpreted outcome in respect to a multitude of factors, frequently positive change in one aspect contrasted with negative opinions about another. Overall, four major themes emerged. Function: Functional ability & participation in valued activities were very important to patients. Walking ability was a key concern but patients interpreted levels of activity in light of other aspects of their disease, reflecting on change in functional ability more than overall level. Positive feelings of improved mobility were often moderated by negative self perception ("I mean, I still walk like a waddling duck”). Appearance: Appearance was important to almost all patients but perhaps the most complex theme of all. Physical appearance, foot shape, and footwear were closely interlinked, yet patients saw these as distinct separate concepts. Patients need to legitimize these feelings was clear and they frequently entered into a defensive repertoire ("it's not cosmetic surgery; it's something that's more important than that, you know?”). Clinician opinion: Surgeons' post operative evaluation of the procedure was very influential. The impact of this appraisal continued to affect patients' lasting impression irrespective of how the outcome compared to their initial goals ("when he'd done it ... he said that hasn't worked as good as he'd wanted to ... but the pain has gone”). Pain: Whilst pain was important to almost all patients, it appeared to be less important than the other themes. Pain was predominately raised when it influenced other themes, such as function; many still felt the need to legitimize their foot pain in order for health professionals to take it seriously ("in the end I went to my GP because it had happened a few times and I went to an orthopaedic surgeon who was quite dismissive of it, it was like what are you complaining about”). Conclusions: Patients interpret the outcome of foot surgery using a multitude of interrelated factors, particularly functional ability, appearance and surgeons' appraisal of the procedure. While pain was often noted, this appeared less important than other factors in the overall outcome of the surgery. Future research into foot surgery should incorporate the complexity of how patients determine their outcome Disclosure statement: All authors have declared no conflicts of interes

Les intrusions cognitives et leur relation aux symptômes anxieux, dépressifs et compulsifs

Les intrusions, cognitives sont des pensées, des images ou des impulsions persistantes et répétitives, et sont perçues comme ayant une origine interne. Elle sont très difficiles à contrôler. Deux études portant sur ces intrusions ont été menées chez une population normale. Elles ont pour but de permettre une meilleure compréhension des troubles obsessifs-compulsifs, puisque ces études portent sur un phénomène analogue à celui observé dans une population clinique. Cent vingt-cinq (125) étudiants universitaires ont complété un questionnaire qui portait sur sept intrusions cognitives. Ils ont aussi complété des inventaires mesurant des symptômes dépressifs, anxieux et compulsifs. Dans la première étude, trois styles dominants de réponse face aux intrusions ont été identifiés. Pour un premier groupe, les sujets n'utilisaient aucune réponse face à leurs intrusions. Les sujets d'un deuxième groupe utilisaient des stratégies d'évitement et d'évasion. Ces sujets rapportaient plus de tristesse, d'inquiétude, de culpabilité et de désapprobation face à leurs intrusions que ceux du premier groupe. Enfin, les sujets d'un troisième utilisaient une stratégie de réflexion attentive. Ces derniers sujets expérimentaient des formes d'intrusions plus variées, et ces intrusions étaient plus souvent déclenchées par des stimuli. Les sujets de ces deux derniers groupes, mettant de l'avant des stratégies délibérées pour chasser leurs intrusions, rapportaient avoir plus de difficulté à y arriver que ceux du premier groupe. Également, ils indiquaient plus de symptômes anxieux. Les analyses intra-sujets appuyaient les comparaisons entre groupes. Elles révélaient que les intrusions associées aux stratégies d'évitement et d'évasion reçoivent plus de désapprobation que celles associées à une méthode attentive.Dans la deuxième étude, une analyse factorielle des items portant sur les intrusions cognitives a été menée. Cinq facteurs ont été retenus et interprétés. Il s'agit de la détresse générale, l'évaluation, le contrôle, la diversité et l'attention. Une analyse de régression hiérarchique a révélé que les facteurs détresse et diversité étaient prédicteurs de symptômes dépressifs et anxieux. Le facteur évaluation, composé de responsabilité perçue, de désapprobation et de culpabilité étaient également associé à la dépression. Cependant, il était le seul prédicteur significatif de symptômes compulsifs. Le facteur contrôle était un prédicteur significatif de l'anxiété.Les résultats des deux études sont discutés en fonction de la formulation cognitive-béhaviorale des troubles obsessifs-compulsifs de Salkovskis (1985). Les résultats représentent un appui partiel pour le modèle, mais exposent aussi certaines limitations.Cognitive intrusions are persistent or repetitive thoughts, images, or impulsions that intrude on on going activity, are of internal origin, and are difficult to control. Two analogue studies were conducted on a normal population to advance understanding of obsessive-compulsive problems. One hundred and twenty-five (125) university students completed a questionnaire describing and evaluating seven cognitive intrusions and inventories of depressive, anxious, and compulsive symptoms. In the first study, three dominant response styles were identified on the basis of strategies used in response to intrusions. The first group used no effortful response for their intrusions. A second group who engaged in escape/avoidance strategies reported greater sadness, worry, guilt, and disapproval than the no effortful response group. A third group who used an attentive thinking strategy reported more varied forms and more frequently triggered intrusions than the no effortful response group. The second and third groups who both used effortful response strategies reported more difficulty removing their intrusions and were more anxious than the no effortful response group. Within-subject analyses supported the group comparisons and showed that intrusions eliciting escape/avoidance strategies were evaluated more disapprovingly than thoughts eliciting attentive thinking. In the second study, factor analysis on the cognitive intrusion questionnaire items identified five factors that were interpreted as general distress, evaluation, control,diversity, and attention. Hierarchical regression analyses showed that the distress and diversity factors were predictors of depressive and anxious symptoms. The evaluation factor consisting of perceived responsibility, disapproval and guilt ratings was also associated with depression and was the only significant predictor of compulsive behavior. The control factor was a significant predictor of anxiety

The first 15 years of the Cognitive Behaviour Therapist: A protocol for a systematic bibliometric review

the Cognitive Behaviour Therapist (tCBT) is an interdisciplinary, peer-reviewed, online practitioner journal for CBT therapists, supervisors, and trainers. it is managed and published by Cambridge University Press for the British Association for Behavioural & Cognitive Psychotherapies. It features a range of papers, including practice-focused articles detailing clinical interventions, research reports concerning the practice of cognitive behaviour therapy, case reports, audits relevant to practice, and reviews of clinical scales. The journal also publishes papers with an education, training, or supervision focus, as well as literature reviews directly relevant to CBT practitioners. The first volume of tCBT was published in 2008; the 2022 volume represents the fifteenth. The aim of this review is to track the journal’s development, growth, spread, interest and impact over the first 15 years