פרסומים

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