Frédéric Langlois

Specificity of belief domains in OCD: Validation of the French version of the Obsessive Beliefs Questionnaire and a comparison across samples

This paper assesses the psychometric properties of the French version of the Obsessive Beliefs Questionnaire (OBQ-44) and investigates whether the questionnaire discriminates between obsessive-compulsive disorder (OCD), anxious control (AC), and non-clinical control (NCC) participants. A confirmatory factor analysis suggested a poor fit of the model. An exploratory factor analysis replicated the original factor structure. The subscales were moderately intercorrelated and highly correlated with the total score. There was partial support for convergent/divergent validity of the OBQ-44. In analyses of variance comparing the three samples, the participants in the OCD sample scored significantly higher than the participants in the AC and NCC samples on all of the OBQ-44 scores. In analyses of covariance comparing the OCD and NCC samples while controlling for general distress and age, the participants with OCD scored significantly higher than the NCC participants on all of the OBQ-44 scores. Implications of the current study are discussed.

Adaptation of a GAD Treatment for Hypochondriasis.

Health preoccupations are present in both generalized anxiety disorder (GAD) and hypochondriasis. Contrary to GAD, in which excessive anxiety and worry encompass a number of events or activities, health is the central theme of worry in hypochondriasis. A recent study demonstrated that two processes involved in GAD are also involved in health anxiety. In light of these findings, adapting the treatment for GAD to hypochondriasis was warranted. In the present study, 6 hypochondriacal patients participated in a multiple baseline single-case design. Patients were assessed by means of a structured interview before and after treatment. Treatment targeted the following components: (a) awareness of worry, (b) intolerance of uncertainty toward health, (c) faulty beliefs regarding worry and anxiety, (d) cognitive avoidance and relapse prevention of reassurance or avoidance behaviors, (e) poor orientation to physical symptoms and problems, and (f) relapse prevention. Following treatment, none of the 6 patients met criteria for hypochondriasis. Results confirmed that a treatment targeting excessive worry is effective for hypochondriasis. All participants reached a high end-state functioning at the 1-year follow-up. The clinical implications of these results are discussed.

Attentional bias, distractibility and short-term memory in anxiety

Abstract Cognitive effects of anxiety have been amply documented. Anxiety has been linked with an attentional bias toward threat, distractibility, and reductions in short-term memory (STM) capacity. These three functions have rarely been investigated jointly and permeability may account for some of the effects documented. In this experiment, we examine these three cognitive functions using one verbal and one visuospatial task. In the irrelevant speech paradigm, participants had to remember strings of letters while irrelevant neutral or threatening speech was presented. In the visuospatial sandwich paradigm, participants were asked to remember sequences of visuospatial targets sometimes presented within irrelevant distracters. We examined the links between state anxiety, worry, and indices of attentional bias toward threat, distractibility from neutral stimuli, and STM capacity. Results show that state anxiety was uniquely linked with impairments in STM while worry was more particularly related to distractibility, independently from permeability between the different cognitive functions. Attentional bias toward threat was linked with variance common to both anxiety and worry. An examination of clinical and non-clinical subgroups suggests that subjective threat perception and attentional bias toward threat are features that are particularly characteristic of clinical levels of anxiety. Our findings confirm the important links between anxiety and basic cognitive functions.

Characteristics of illness intrusions in a non-clinical sample.

This study examines whether illness intrusions can be distinguished from obsessional intrusions and worries. It also assesses the relationship between strategies, thought characteristics, and appraisal of illness intrusions. Two hundred and forty-three non-clinical participants identified an obsessive intrusive thought, a worry, and an illness intrusion. They evaluated each thought using items from the Cognitive Intrusions Questionnaire. The comparisons of intrusions showed that illness intrusions share characteristics of worries and obsessional intrusions, but also have their own characteristics. Illness intrusions seem to be particularly egosyntonic. The relationships between the strategies used to counter illness intrusions and their appraisal were also tested. Results support the idea that there are specific links between the evaluation of cognitive intrusions and the way they are processed. It demonstrated that escape/avoidance strategies are associated with the egodystonic nature of the thought and that problem-focused strategies are associated with the thoughts basis in reality. Illness intrusions may be conceptualised as either obsessions or worries. This study demonstrated that the category of an intrusive thought might not be as important as the way it is processed. It seems more important to consider appraisal of the disturbing thought and the way in which the person subsequently reacts and behaves.

Insomnia Symptoms Following Treatment for Comorbid Panic Disorder With Agoraphobia and Generalized Anxiety Disorder.

Abstract Patients with panic disorder with agoraphobia (PDA) or generalized anxiety disorder (GAD) frequently also suffer from insomnia. However, the impact of cognitive-behavioral therapy (CBT) for anxiety disorders on insomnia has been understudied. Furthermore, comorbidity between anxiety disorders is common. Our main objective was to assess the impact of CBT for PDA or GAD on insomnia. In a quasi-experimental design, 86 participants with PDA and GAD received conventional CBT for their primary disorder or combined CBT for both disorders. Overall, CBTs had a significant impact on reducing insomnia symptoms (&eegr;2 = 0.58). However, among people with insomnia at pretest (67%), 33% still had an insomnia diagnosis, and the majority (63%) had clinically significant residual insomnia following treatment. In conclusion, the CBTs had a positive effect on the reduction of insomnia, but a significant proportion of participants still had insomnia problems following treatment. Clinicians should address insomnia during CBT for PDA and GAD.

The Effect of a Combined Versus a Conventional Cognitive-Behavioral Therapy on Quality of Life for Comorbid Panic Disorder With Agoraphobia and Generalized Anxiety Disorder Preliminary Results

Concurrent panic disorder with agoraphobia (PDA) and generalized anxiety disorder (GAD) are the most common diagnostic occurrences among anxiety disorders. This particular comorbidity is associated with significant impairments in quality of life (QOL). The current study sought to investigate the efficacy of a combined cognitive-behavioral psychotherapy that addressed both conditions compared with a conventional psychotherapy, which attends solely to the primary disorder. The hypotheses postulated firstly, that both treatment conditions would lead to improvements in participants’ QOL and secondly, that the combined therapy would lead to greater QOL ameliorations. Twenty-five participants with comorbid PDA/GAD diagnoses were evaluated with a number of clinical interviews and self-report questionnaires, and were provided with either conventional or combined cognitive-behavioral psychotherapy, which consisted of 14 one-hour weekly sessions. Participants were once again evaluated in the same fashion 2-weeks after the completion of the psychotherapy. The results revealed that both conditions led to significant improvements in participants’ QOL, but that the two groups did not significantly differ in terms of the effect on QOL. The results also reveal that the two conditions did not significantly differ in terms of their effect on PDA and GAD symptomatology or psychiatric comorbidity. The results demonstrate that the combined psychotherapy, which addresses both conditions simultaneously, is similar to the conventional psychotherapy employed for the primary disorder in terms of QOL enhancement, symptom severity, and comorbidity reduction.