Angela H. Smith

A Review of Internet Pornography Use Research: Methodology and Content from the Past 10 Years

Internet pornography (IP) use has increased over the past 10 years. The effects of IP use are widespread and are both negative (e.g., relationship and interpersonal distress) and positive (e.g., increases in sexual knowledge and attitudes toward sex). Given the possible negative effects of IP use, understanding the definition of IP, the types of IP used, and reasons for IP use is important. The present study reviews the methodology and content of available literature regarding IP use in nondeviant adult populations. The study seeks to determine how the studies defined IP, utilized validated measures of pornography use, examined variables related to IP, and addressed form and function of IP use. Overall, studies were inconsistent in their definitions of IP, measurement, and their assessment of the form and function of IP use. Discussion regarding how methodological differences between studies may impact the results and the ability to generalize findings is provided, and suggestions for future studies are offered.

Obsessive-compulsive personality traits: how are they related to OCD severity?

Previous research has demonstrated that comorbid obsessive-compulsive personality disorder (OCPD) in patients with obsessive-compulsive disorder (OCD) is associated with greater overall OCD severity, functional impairment, and poorer treatment outcomes (Coles et al., 2008; Lochner et al., 2010; Pinto, 2009). However, research has only examined the effects of OCPD categorically and has yet to thoroughly examine the impact of individual OCPD characteristics dimensionally. Thus, the present study sought to investigate the relationships between various OCPD-related dimensions (e.g., perfectionism, rigidity) and OCD symptomology and severity. The study recruited a sample of OCD patients (n=51) in the OCD units of two residential treatment facilities. Findings yielded significant relationships between OCD severity and the following OCPD dimensions: flexibility, doubts about actions (a dimension of perfectionism), and hoarding. Interpretations of these results and the implications for diagnosis, prognosis, and treatment outcome are discussed. Furthermore, the current study provides insight into a unique perspective which leaves room for more symptom overlap and variability between OCD and OCPD.

Distress from Sexual Thoughts: Do Religiosity, Emotions, and Thought Appraisal Matter?

Sexually intrusive thoughts (SITs) are commonly experienced; yet, there is a paucity of research on distress related to them. Given that the content is similar for intrusive thoughts and obsessions, examining factors related to obsessions in obsessive-compulsive disorder (e.g., thought appraisal and relationships to emotions) may help explain distress from SITs in nonclinical populations. Differences in affective experiences and religiosity may also explain variations in distress from SITs. Nonclinical participants (N = 291) completed questionnaires about frequency of, and distress from, SITs, thought appraisal, beliefs about sexual desire, and emotions. Distress from SITs was correlated with thought appraisal and beliefs about sexual desire, but not with religiosity. In regression analyses, beliefs about sexual desire and the frequency of SITs each predicted distress from SITs. Although thought appraisal is often implicated in obsessive-compulsive symptoms, these results indicate that beliefs about emotions may have a greater impact on distress.

Assessing sexually intrusive thoughts: Parsing unacceptable thoughts on the Dimensional Obsessive-Compulsive Scale

Sexual obsessions are a common symptom of obsessive-compulsive disorder (OCD), often classified in a broader symptom dimension that includes aggressive and religious obsessions, as well. Indeed, the Dimensional Obsessive-Compulsive Scale (DOCS) Unacceptable Thoughts Scale includes obsessional content relating to sexual, violent, and religious themes associated with rituals that are often covert. However, there is reason to suspect that sexual obsessions differ meaningfully from other types of unacceptable thoughts. We conducted two studies to evaluate the factor structure, initial psychometric characteristics, and associated clinical features of a new DOCS scale for sexually intrusive thoughts (SIT). In the first study, nonclinical participants (N=475) completed the standard DOCS with additional SIT questions and we conducted an exploratory factor analysis on all items and examined clinical and cognitive correlates of the different scales, as well as test-retest reliability. The SIT Scale was distinct from the Unacceptable Thoughts Scale and was predicted by different obsessional cognitions. It had good internal consistency and there was evidence for convergent and divergent validity. In the second study, we examined the relationships among the standard DOCS and SIT scales, as well as types of obsessional cognitions and symptom severity, in a clinical sample of individuals with OCD (N=54). There were indications of both convergence and divergence between the Unacceptable Thoughts and SIT scales, which were strongly correlated with each other. Together, the studies demonstrate the potential utility of assessing sexually intrusive thoughts separately from the broader category of unacceptable thoughts.

Client Perceptions of Therapy Component Helpfulness in Group Cognitive‐Behavioral Therapy for Anxiety Disorders

OBJECTIVE(S) Treatment credibility and client satisfaction have received relatively little research attention, but extant findings indicate that some clients and therapists differ in their perceptions of what is helpful about therapy, with greater divergence related to poorer outcomes. This study examined relationships between treatment credibility, perceptions of therapy helpfulness, and treatment response. METHOD Participants were 48 individuals (60.4% female; 53.2% Caucasian; mean age 32.79 years) with an anxiety disorder diagnosis. Participants completed a 12-week transdiagnostic treatment protocol; treatment credibility was rated after session 2, and treatment component helpfulness was rated posttreatment. RESULTS Treatment response was significantly correlated with perceived helpfulness of cognitive restructuring and exposure techniques, but not treatment credibility. Treatment responders recognized the helpfulness of factors considered to be important therapeutic processes. CONCLUSIONS Findings emphasize the importance of client perceptions of cognitive and behavioral techniques in treatment and suggest the need to monitor client perceptions throughout the treatment process.

Smoking-Specific Experiential Avoidance is Indirectly Associated with Trait Worry and Smoking Processes among Treatment-Seeking Smokers

Limited work has examined worry, or apprehensive anticipation about future negative events, in terms of smoking. One potential explanatory factor is the tendency to respond inflexibly and with avoidance in the presence of smoking-related distress (smoking-specific experiential avoidance). Participants (n = 465) were treatment-seeking daily smokers. Cross-sectional (pre-treatment) self-report data were utilized to assess trait worry, smoking-specific experiential avoidance, and four smoking criterion variables: nicotine dependence, motivational aspects of quitting, perceived barriers to smoking cessation, and severity of problematic symptoms reported in past quit attempts. Trait worry was significantly associated with greater levels of nicotine dependence, motivation to quit smoking, perceived barriers for smoking cessation, and more severe problems while quitting in the past; associations occurred indirectly through higher levels of smoking-specific experiential avoidance. Findings provide initial support for the potential role of smoking-specific experiential avoidance in explaining the association between trait worry and a variety of smoking processes.

Transdiagnostic assessment of anxiety symptoms using the Anxiety Disorder Diagnostic Questionnaire – weekly version

ABSTRACT Background: Norton and Robinson [2010. Development and evaluation of the anxiety disorder diagnostic questionnaire. Cognitive Behaviour Therapy, 39(2), 137–149. doi:10.1080/16506070903140430] developed the Anxiety Disorder Diagnostic Questionnaire (ADDQ) as a transdiagnostic assessment of fear and anxiety to address problems in using diagnosis-specific measures as well as limitations with the extant transdiagnostic measures of anxiety. The present study validated a weekly version of the ADDQ, the Anxiety Disorder Diagnostic Questionnaire – Weekly (ADDQ-W) allowing session-by-session transdiagnostic assessment of anxiety. Method: Data were a secondary analysis of 49 treatment-seeking outpatient adults from a previous clinical trial. The ADDQ-W was administered weekly over the course of 12-group therapy sessions. Results: The ADDQ-W was a valid weekly measure and neither scores, F(2, 37) = 2.70, p = .08, nor trajectories of change, F(2, 37) = 0.31, p = .73, differed by primary diagnosis, though power was limited. Rate of ADDQ-W change was predictive of change in both primary diagnosis severity, t = 2.40, p = .02, β = 0.32, and overall severity, t = 3.01, p < .01, β = 0.36, at post-treatment. Conclusions: This study has established initial support for the use of the brief, easily scored, ADDQ-W for repeated assessment over treatment using a diagnostically heterogeneous clinical sample of treatment-seeking individuals.

Motivational Interviewing as an Adjunct to Cognitive Behavioral Therapy for Anxiety

OBJECTIVE This study examined the effect of a single session motivational interviewing (MI) intervention on engagement in a 12-week transdiagnostic group cognitive behavioral therapy (CBT) treatment for anxiety. METHOD Participants were randomized to MI (N = 20) or non-MI (N = 19) conditions before enrolling in a 12-week group CBT program. Participants in the MI condition received an individual 50-minute MI session adapted from the longer MI pretreatment protocol, developed by Westra and Dozois () and Westra (). RESULTS Rates of treatment initiation and treatment expectancies were significantly higher among participants who received the MI pretreatment intervention. Results indicate substantial reduction in clinician-rated anxiety severity after transdiagnostic group CBT, with no significant differences between MI and non-MI conditions. CONCLUSION These findings suggest that a single MI pretreatment session may have positive effects on proximal measures of treatment engagement, but that these effects may not affect the severity of anxiety symptoms over the course of CBT.

Examining the effects of accommodation and caregiver burden on relationship satisfaction in caregivers of individuals with OCD.

Obsessive-compulsive disorder (OCD) is a debilitating condition that does not always respond well to treatment. People with OCD often require a great deal of assistance from caregivers or family members, which is referred to as family accommodations. Caregivers may experience a great deal of stress, depression, and other problems as a result of caring for their loved one with OCD. They may have decreased relationship satisfaction due to the accommodations required by their family member. The present study examines the experience family members have of caring for someone with OCD and how it relates to caregiver burden, relationship satisfaction, and level of family accommodations. Participants for this study included 50 caregivers of individuals with OCD. Analyses were primarily correlational in nature. Results found that high relationship satisfaction was correlated with caregiver burden and OCD severity.

Prognostic Indicators of Treatment Response for Adults with Anxiety

This chapter discusses the prognostic indicators of treatment response for adults with anxiety. Evidence for the effect of comorbidity on the presentation of anxiety disorders and the effect on treatment outcomes is reviewed. Additional therapeutic factors that influence treatment response are presented along with treatment approaches aimed at overcoming treatment barriers.