PREDICTORS OF FAMILY ACCOMMODATION ACROSS FEAR-BASED DISORDERS

Fear-based disorders (FBDs) are associated with significant caregiver burden and family distress. Specifically, symptom accommodation is ubiquitous in families with relatives affected by FBDs, yet no study to date has examined potential psychological predictors of symptom accommodation across diagnoses and relatives. The current study examined psychological predictors (e.g., empathic concern) of symptom accommodation among co-residing relatives of individuals diagnosed with FBDs. Participants (n = 49) completed a series of clinical interviews via phone and an online self-report battery between November 2014 and October 2015. Study hypotheses were partially supported, as results showed that accommodation occurred to similar degrees across relatives with various relationships and FBDs. Further, empathic concern and expressed emotion emerged as marginally significant predictors of symptom accommodation. Study findings, limitations, and future directions are discussed.Master of Art

GIV CARE: A group intervention to reduce accommodation among relatives of individuals with fear-based disorders

Fear-based disorders (FBDs) occur in an interpersonal context as relatives (e.g., partners, parents) often accommodate symptoms. Symptom accommodation, which is ubiquitous and reinforces FBD behavior, is associated with increased FBD symptom severity and interferes with treatment. Accordingly, reducing accommodation represents a crucial aim for intervention. The current study tested a brief, manualized group intervention to decrease symptom accommodation and caregiver burden among relatives. The study was the first intervention to date that a) jointly included parents and partners to target symptom accommodation, and b) used a transdiagnostic group treatment approach. Adult relatives (N=20) participated in an intervention that included five weekly, two-hour sessions, as well as assessments at baseline, post-treatment, and one-month follow-up. Results revealed that a transdiagnostic, relative-only group intervention to reduce symptom accommodation was feasible and acceptable. Participants that completed the intervention (n = 18) exhibited reductions in symptom accommodation; however, modifications to improve the effectiveness of the intervention are warranted. Study limitations and future directions are discussed.Doctor of Philosoph

The Relative Contributions of Experiential Avoidance and Distress Tolerance to OC Symptoms

Background: Obsessive beliefs account for substantial (but not all) obsessive-compulsive (OC) symptoms. Intolerance of internal experiences (IIE), which encompasses the constructs of experiential avoidance (EA) and distress tolerance (DT), refers to difficulty managing unwanted thoughts, emotions, and other internal states, and might add to current explanatory models. Although IIE appears to be conceptually relevant to obsessive-compulsive (OC) symptoms, scant research has examined this relationship empirically. Aim: The present study examined the relative contributions of EA and DT as predictors of OC symptom dimensions. Method: A nonclinical sample ( n = 496) completed self-report questionnaires measuring general distress, EA, DT and OC symptom dimensions. Results: All variables of interest were significantly (all p s ≤ .001) correlated with one another, such that higher general distress, higher EA, and lower DT were associated with greater OC symptom severity for all symptom dimensions; however, only EA independently predicted obsessional symptoms, but not other OC symptom dimensions. Conclusions: One's willingness to endure (i.e. EA), rather than their ability to tolerate (i.e. DT) unpleasant internal experiences best predicts obsessional symptoms (i.e. obsessing) above and beyond general distress. Potential implications for understanding, assessing, and treating OC symptoms are discussed

Anxiety sensitivity as a predictor of outcome in the treatment of obsessive-compulsive disorder

BACKGROUND AND OBJECTIVES: To address the fact that not all individuals who receive cognitive-behavioral therapy (CBT) for obsessive-compulsive disorder (OCD) exhibit complete symptom reduction, research has examined factors that predict outcome; however, no studies have examined anxiety sensitivity (AS) as a predictor of outcome of CBT for OCD. AS refers to the fear of anxious arousal that results from mistaken beliefs about the dangerousness of anxiety-related body sensations. It is important to understand whether AS influences OCD treatment outcome, considering that (a) some obsessions directly relate to AS, and (b) OCD patients with high AS may be reluctant to engage in anxiety-provoking components of CBT for OCD. METHODS: Patients (N = 187) with a primary diagnosis of OCD who received residential CBT for OCD participated in this study, which involved completing a self-report battery at pre- and post-treatment. RESULTS: Results supported study hypotheses, in that (a) baseline AS positively correlated with baseline OCD severity, and (b) greater baseline AS prospectively predicted higher posttreatment OCD symptom severity even after controlling for pretreatment OCD and depression severity. LIMITATIONS: The study was limited by its use of an older measure of AS, reliance on self-report measures, and nonstandardized treatment across participants. CONCLUSIONS: Findings highlight the importance of AS in the nature and treatment of OCD. Clinical implications and future directions are discussed

Enhancing the ecological validity of the Beads Task as a behavioral measure of intolerance of uncertainty

To broaden the measurement of intolerance of uncertainty (IU) beyond self-report methods, recent research has examined the Beads Task as a behavioral measure of IU. In the present study, we enhanced this task to increase its ecological validity by maximizing decisional uncertainty and the importance of a correct response. Undergraduate participants (n=102) completed the Beads Task with instructions that they would complete the Cold Pressor Task (CPT) if they answered incorrectly. As hypothesized, baseline CPT endurance time and self-reported pain level were weakly associated with later Beads Task distress during the decision-making process. Furthermore, in vivo Beads Task distress was associated with self-report inhibitory IU, which measures avoidance and paralysis in the face of uncertainty, but not with prospective IU, perfectionism, or general psychological distress after making statistical adjustments for multiple comparisons. Comparisons to previous work using the Beads Task, clinical implications, and avenues for future research are discussed

Exposure therapy for OCD from an acceptance and commitment therapy (ACT) framework

This article addresses the use of exposure therapy for OCD as informed by an acceptance and commitment therapy (ACT) framework. The model on which ACT is based is covered, including its philosophy, basic research, targeted process of change, individual treatment components, and general manual. Specific suggestions for how to prepare, select, set up, and conclude exposure exercises from an ACT perspective are included and illustrated using the case of Monica as an example. Empirical support for this approach is briefly covered

Adding Acceptance and Commitment Therapy to Exposure and Response Prevention for Obsessive-Compulsive Disorder: A Randomized Controlled Trial

The objective of this study was to test whether treatment acceptability, exposure engagement, and completion rates could be increased by integrating acceptance and commitment therapy (ACT) with traditional exposure and response prevention (ERP). 58 adults (68% female) diagnosed with obsessive-compulsive disorder (OCD; M age = 27, 80% white) engaged in a multisite randomized controlled trial of 16 individual twice-weekly sessions of either ERP or ACT + ERP. Assessors unaware of treatment condition administered assessments of OCD, depression, psychological flexibility, and obsessional beliefs at pretreatment, posttreatment, and six-month follow-up. Treatment acceptability, credibility/expectancy, and exposure engagement were also assessed. Exposure engagement was high in both conditions and there were no significant differences in exposure engagement, treatment acceptability, or dropout rates between ACT + ERP and ERP. OCD symptoms, depression, psychological flexibility, and obsessional beliefs decreased significantly at posttreatment and were maintained at follow-up in both conditions. No between-group differences in outcome were observed using intent to treat and predicted data from multilevel modeling. ACT + ERP and ERP were both highly effective treatments for OCD, and no differences were found in outcomes, processes of change, acceptability, or exposure engagement