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IMPORTANCE Obsessive-compulsive disorder (OCD) is one of the world's most disabling illnesses according to the World Health Organization. Serotonin reuptake inhibitors (SRIs) are the only medications approved by the Food and Drug Administration to treat OCD, but few patients achieve minimal symptoms from an SRI alone. In such cases, practice guidelines recommend adding antipsychotics or cognitive-behavioral therapy consisting of exposure and ritual prevention (EX/RP). OBJECTIVE To compare the effects of these 2 SRI augmentation strategies vs pill placebo for the first time, to our knowledge, in adults with OCD. DESIGN, SETTING, AND PARTICIPANTS A randomized clinical trial (conducted January 2007-August 2012) at 2 academic outpatient research clinics that specialize in OCD and anxiety disorders. Patients (aged 18-70 years) were eligible if they had OCD of at least moderate severity despite a therapeutic SRI dose for at least 12 weeks prior to entry. Of 163 who were eligible, 100 were r

Surprisingly, only 3 self-report measures that directly assess pediatric obsessive-compulsive disorder (OCD) have been developed. In addition, these scales have typically been developed in small samples and fall to provide a quick assessment of symptoms across multiple domains. Therefore, the current paper presents initial psychometric data for a quick assessment of pediatric OCD across multiple symptom domains, a child version of the Obsessive Compulsive Inventory (the OCI-CV). Data from a sample of over 100 youth ages 7 to 17 with a primary DSM-IV diagnosis of OCD support the use of the 21-item OCI-CV. Results support the use of the OCI-CV as a general index of OCD symptom severity and in 6 symptom domains parallel to those assessed by the revised adult version of the scale (OCI-R). The OCI-CV showed strong retest reliability after approximately 1.5 weeks in a subsample of 64 participants and was significantly correlated with clinician-rated OCD symptom severity and parent and child

The current meta-analysis reviews 24 studies on self-reported emotional reactions to facial expressions (social rejection, social acceptance, and neutral) in socially anxious versus nonanxious individuals. We hypothesized that socially anxious individuals would perceive all face types as less approachable, more negative, and more arousing. After correcting for biases, results showed that socially anxious individuals, compared to controls, reported lower approachability to all types of expressions and higher arousal in response to neutral expressions. Variances among effects usually could not be explained by the proposed moderators. This suggests that current conceptualizations of social anxiety should take into account the willingness to approach social stimuli rather than global measures of emotion or arousal.

We examined fear, avoidance and physiological symptoms during cognitive-behavioral therapy (CBT) for social anxiety disorder (SAD). Participants were 177 individuals with generalized SAD who underwent a 14-week group CBT as part of a randomized controlled treatment trial. Participants filled out self-report measures of SAD symptoms at pre-treatment, week 4 of treatment, week 8 of treatment, and week 14 of treatment (post-treatment). Cross-lagged Structural Equation Modeling indicated that during the first 8 weeks of treatment avoidance predicted subsequent fear above and beyond previous fear, but fear did not predict subsequent avoidance beyond previous avoidance. However, during the last 6 weeks of treatment both fear and avoidance predicted changes in each other. In addition, changes in physiological symptoms occurred independently of changes in fear and avoidance. Our findings suggest that changes in avoidance spark the cycle of change in treatment of SAD, but the cycle may continu

Objective: There has been little research on the development of the therapeutic alliance in cognitive behavioral therapy (CBT). This study aims to examine the development of therapeutic alliance in CBT for panic disorder. Method: Nineteen patients were treated with CBT for panic disorder. Pre- and post-session data of the therapeutic alliance and panic symptoms and cognitions were collected. Results: Several patterns were observed, including a sawtooth pattern (within-session improvements followed by decline between sessions; 63% of the patients), sudden gains in the alliance (58%), and late stabilization (89%). The sawtooth pattern was related to less symptom reduction between sessions (explained variance = 20-48%). Though not statistically significant, there were moderate effect sizes for the relationships between outcomes and early alliance and sudden gains (explained variance = 13-17%). Conclusions: Overall, results suggest that intensive data collection is likely to yield underst

The empirical literature on the relationship between moral thought-action fusion (TAF) and obsessive-compulsive disorder (OCD) is characterized by mixed findings. Previous studies have reported religious group differences in moral TAF and the relationship between moral TAF and religiosity. In light of those studies and considering the apparent role of moral TAF in scrupulosity, the purpose of this investigation was to evaluate the possible role of religion as a moderator of the relationship between moral TAF and OCD symptoms. The results revealed that (a) Christians endorsed higher levels of moral TAF than did Jews independent of OCD symptoms; (b) religiosity was correlated with moral TAF in Christians but not in Jews, suggesting that Christian religious adherence is related to beliefs about the moral import of thoughts; and (c) moral TAF was related to OCD symptoms only in Jews. That is, for Christians, moral TAF was related to religiosity but not OCD symptoms, and for Jews, moral TA

Individuals with obsessive-compulsive disorder (OCD) seem to judge harm caused actively and passively as morally equivalent. In contrast, people generally choose harm by omission over harm by commission, a propensity known as omission bias. Two studies examined the hypothesis that OCD is associated with less omission bias. In Study 1, with a student population, symptoms of OCD and related cognitions were negatively associated with omission bias about washing and checking scenarios targeting common OCD fears. In contrast, neither symptoms nor cognitions related to OCD were associated with general omission bias. In Study 2, individuals with self-reported OCD evinced less omission bias about washing and checking scenarios than did individuals without OCD. Again, general omission bias was not related to OCD. These results support the idea that individuals with elevated OCD symptoms distinguish less than others between acts of omission and commission for harm relevant to general OCD concer

Objective: Empirically based studies have demonstrated that prolonged exposure therapy effectively reduces posttraumatic stress disorder (PTSD) symptoms in a vast range of traumas, yet reports of the efficacy of such therapies in combat- and terror-related PTSD are scarce. In this article, we examine the efficacy of prolonged exposure therapy in combat- and terror-related PTSD in comparison to treatment as usual (TAU). Method: Between July 2002 and October 2005, 30 patients of a trauma unit within a psychiatric outpatient clinic were recruited and randomized into prolonged exposure versus TAU therapies. Patients were diagnosed with chronic PTSD (Mini-International Neuropsychiatric Interview criteria) related to combat- (n=19) or terror-related (n=11) trauma. Main outcome measures included symptoms of PTSD and depression, as measured by the PTSD Symptom Scale-Interview Version and the Beck Depression Inventory. Results: Posttraumatic stress disorder symptom severity was significantly l

Disclosed is a process for the manuf. of tomato products, comprises the steps of: (a) pretreating the tomatoes by conventional operations, including crushing; (b) subjecting them to heat treatment; (c) sepg. the crushed tomatoes into serum and pulp contg. at least 500 ppm of lycopene; (d) subjecting the pulp to solvent extn., in order to ext. therefrom an oleoresin contg. lycopene; (e) sepg. the spent pulp; and (f) sepg. the lycopene ext. from the solvents, whereby to obtain oleoresin contg. the lycopene and to recover the solvents. [on SciFinder(R)]

Research on deficits in emotion regulation has devoted considerable attention to emotion-regulation strategies. We propose that deficits in emotion regulation may also be related to emotion-regulation goals. We tested this possibility by assessing the direction in which depressed people chose to regulate their emotions (i.e., toward happiness, toward sadness). In three studies, clinically depressed participants were more likely than nondepressed participants to use emotion-regulation strategies in a direction that was likely to maintain or increase their level of sadness. This pattern was found when using the regulation strategies of situation selection (Studies 1 and 2) and cognitive reappraisal (Study 3). The findings demonstrate that maladaptive emotion regulation may be linked not only to the means people use to regulate their emotions, but also to the ends toward which those means are directed.

The earliest descriptions of obsessive-compulsive disorder (OCD) were religious, as was the understanding of their origins. With the emancipation, religion in OCD was relegated to its status today: a less common symptom of OCD in most Western societies known as scrupulosity. The frequency of scrupulosity in OCD varies in the literature from 0% to 93% of cases, and this variability seems predicated on the importance of religious belief and observance in the community examined. Despite the similarities between religious ritual and compulsions, the evidence to date that religion increases the risk of the development of OCD is scarce. Scrupulosity is presented as a classic version of OCD, with obsessions and compulsions, distress, and diminished functioning similar to those of other forms of OCD. The differentiation between normal religiosity and scrupulosity is presented, and the unique aspects of cognitive-behavioral therapy in treating scrupulosity, especially in religious populations

Whereas some theories of cognitive behavioral therapies (CBT) propose that acceptance and reappraisal conflict with one another, we propose that one component of acceptance, self-acceptance of negative emotions (being nonjudgmental of oneself for experiencing negative emotions), and reappraisal may facilitate one another. We hypothesized that emotion regulation (self-efficacy and frequency of suppression and reappraisal) would be associated with a stronger correlation between self-acceptance and more positive/less negative affect. We also examined whether self-acceptance is associated with a stronger correlation between emotion regulation and affect. Participants (n = 267) completed measures of self-acceptance, affect, and emotion regulation. Use of emotion regulation strategies was associated with stronger relationships between self-acceptance and affect, and self-acceptance was associated with stronger relationships between emotion regulation and affect. This suggests that self-acce

{Objective: This article describes the long-term effects of augmenting serotonin reuptake inhibitors (SRIs) with exposure and ritual prevention or stress management training in patients with DSM-IV obsessive-compulsive disorder (OCD). Method: Between November 2000 and November 2006, 111 OCD patients from 2 academic outpatient centers with partial SRI response were randomized to the addition of exposure and ritual prevention or stress management training, delivered twice weekly for 8 weeks (acute phase); 108 began treatment. Responders (38 of 52 in the exposure and ritual prevention condition, 11 of 52 in the stress management training condition) entered a 24-week maintenance phase. The Yale-Brown Obsessive Compulsive Scale (YBOCS) was the primary outcome measure. Results: After 24 weeks, patients randomized to and receiving exposure and ritual prevention versus stress management training had significantly better outcomes (mean YBOCS scores of 14.69 and 21.37, respectively; t=2.88

{Objective: To compare outcomes after 6-month maintenance treatment of adults diagnosed with obsessive-compulsive disorder (OCD) based on DSM-IV criteria who responded to acute treatment with serotonin reuptake inhibitors (SRIs) augmented by exposure and response prevention (EX/RP) or risperidone. Method: A randomized trial was conducted at 2 academic sites from January 2007 through December 2012. In the acute phase, 100 patients on therapeutic SRI dose with at least moderate OCD severity were randomized to 8 weeks of EX/RP, risperidone, or pill placebo. Responders entered the 6-month maintenance phase, continuing the augmentation strategy they received acutely (n = 30 EX/RP