Kieron O'Connor

Recollections of parent-child relationships in patients with obsessive-compulsive disorder and panic disorder with agoraphobia

Objective: In previous studies, patients with different psychiatric conditions, as compared with matched controls, have reported that their parents were more protective and less caring towards them when they were children. However, studies investigating associations between parental behaviours and anxiety disorders have yielded inconsistent results. The aim of this study was to compare recalled parental behaviours in out‐patients with obsessive‐compulsive disorder (OCD), in out‐patients with panic disorder with agoraphobia (PDA), and in non‐anxious controls.

Cognitive-behaviour therapy and medication in the treatment of obsessive-compulsive disorder: a controlled study.

Objective: To evaluate the effect of combining cognitive-behaviour therapy (CBT) and medication in the treatment of obsessive-compulsive disorder (OCD). Method: Twenty-nine subjects diagnosed with OCD according to Diagnostic and Statistical Manual of Mental Disorders (DSM-III-R) criteria were recruited through the Anxiety Clinic of Louis-H Lafontaine Hospital. They were evaluated at baseline and after treatment on the Yale-Brown Obsessive Compulsive Scale (Y-BOCS) by a psychiatrist who was blind to treatment modality. Subjects rated their degree of resistance to their rituals and the strength of their obsessional beliefs. Subjects then received 1 of 4 treatments: medication and CBT simultaneously (n = 9), CBT only (n = 6), medication while on a wait-list for CBT (n = 6), or no treatment while on a wait-list for CBT (n = 5). Results: Multivariate analysis revealed that Y-BOCS scores and clinical ratings significantly improved posttreatment in all groups except the nontreatment wait-list control group. Subjects in the 2 active treatment groups receiving CBT showed reduced strength in their obsessional beliefs. The subsequent administration of CBT to those groups on the wait-list also decreased the strength of their primary obsessional beliefs and beliefs about the consequences of not performing the rituals. Conclusions: Our results suggest that either CBT or medication alone is more effective than no treatment. The combination of CBT and medication seems to potentiate treatment efficacy, and we found it more clinically beneficial to introduce CBT after a period of medication rather than to start both therapies simultaneously.

Inference processes in Obsessive-Compulsive Disorder: Some clinical observations

In this paper we outline a cognitive model of Obsessive-Compulsive Disorder (OCD) which proposes that the core belief of OCD evolves through a series of illogical inferences. These faulty inference processes involve inferring the plausibility of events on the basis of irrelevant associations, dismissing actual evidence on the grounds of going beyond surface reality to a deeper reality, and finally inferring that a completely fictional narrative is a remote probability. A therapy aimed specifically at changing these inference processes is illustrated with case examples of OCD clients who had not benefited from conventional behavior therapy. The inference based approach (IBA) complements existing cognitive-behavioral therapy but suggests that in certain cases, the conventional cognitive therapy view of OCD beliefs as exaggerated fears of remote possibilities may actually reinforce the obsessional belief since even remote events are real. The IBA on the contrary suggests that an important goal in therapy is to highlight this confusion found in OCD between imagination and reality and illuminate for the OCD client how their compulsions, far from reassuring them about a remote possibility, actually take them further away from reality and reinforce their imaginary doubt.

Evaluation of an Inference‐Based Approach to Treating Obsessive‐Compulsive Disorder

This study evaluated an inference‐based approach (IBA) to the treatment of obsessive‐compulsive disorder (OCD) by comparing its efficacy with a treatment based on the cognitive appraisal model (CAM) and exposure and response prevention (ERP). IBA considers initial intrusions in OCD (e.g. “Maybe the door is open”, “My hands could be dirty”) as idiosyncratic inferences about possible states of affairs arrived at through inductive reasoning. In IBA such primary inferences represent the starting point of obsessional doubt, and the reasoning maintaining the doubt forms the focus for therapy. This is unlike CAM, which regards appraisals of intrusions as the maintaining factors in OCD. Fifty‐four OCD participants, of whom 44 completed, were randomly allocated to CAM, ERP or IBA. After 20 weeks of treatment all groups showed a significant reduction in scores on the Yale‐Brown Obsessive Compulsive Scale (Y‐BOCS) and the Padua Inventory. Participants with high levels of obsessional conviction showed greater benefit from IBA than CAM. Appraisals of intrusions changed in all treatment conditions. Strength of primary inference was not correlated with symptom measures except in the case of strong obsessional conviction. Strength of primary inference correlated significantly with the Y‐BOCS insight item. Treatment matching for high and low conviction levels to IBA and CAM, respectively, may optimize therapy outcome.

Psychometric Properties of the French and English Versions of the Vancouver Obsessional‐Compulsive Inventory and the Symmetry Ordering and Arranging Questionnaire

The Vancouver Obsessional‐Compulsive Inventory (VOCI) and the Symmetry Ordering and Arranging Questionnaire (SOAQ) are self‐report measures that assess a wide variety of symptoms and features of obsessive‐compulsive disorder (OCD) including checking, contamination, obsessions, hoarding, “just right”, indecisiveness, and symmetry, ordering and arranging obsessions and compulsions. The original English versions of the VOCI and SOAQ have been shown to demonstrate excellent psychometric properties. The present study examined the reliability and validity of French translations of these measures in a non‐clinical sample, and also involved the collection of supplementary psychometric information about the English versions of the scales from a new sample. Volunteer undergraduate students completed questionnaire packages including the VOCI and SOAQ, as well as measures of obsessive‐compulsive, phobic and depressive symptomatology in their native language of either French or English. Results indicate that the French versions of the VOCI and SOAQ demonstrate similar and excellent psychometric properties to the English versions and that these measures are highly valid and reliable assessment tools for use in clinical and research applications in both languages.

Beyond Reasonable Doubt: Reasoning Processes in Obsessive-Compulsive Disorder and Related Disorders

Traditionally, obsessive-compulsive disorder has been classified as an anxiety disorder, but there is increasing evidence that it has schizotypal features ? in other words it is a belief disorder. Beyond Reasonable Doubt moves comprehensively through theoretical, experimental, clinical and treatment aspects of reasoning research, and contains a detailed treatment manual of great value to practitioners, including assessment and treatment protocols and case studies

Cognitive behaviour therapy and medication in the treatment of obsessive–compulsive disorder

Objective:  To compare cognitive behaviour therapy (CBT) with CBT plus medication; medication alone; and placebo in the treatment of adult obsessive–compulsive disorder (OCD).

The Menace Within: Obsessions and the Self

The current article attempts to provide a theoretical account of obsessions about blasphemy, sexuality, and aggression from an inference-based perspective. It is argued that self-evaluative and self-representational dimensions in obsessions need to be taken into account to allow for the misrepresentation of mental states. A persuasive narrative containing rhetorical devices informs the misrepresentation of mental states and gives credibility to the obsession. These narrative devices seem to originate from a distrust of the self where the person overinvests in a sense of self-as-could-be rather than a sense of self-as-is, which consequently gives rise to a discordance between the person and the obsession (i.e., egodystonicity). The article concludes with some theoretical and clinical implications for cognitive models of obsessive-compulsive disorder.

Emotion regulation and other psychological models for body-focused repetitive behaviors

The term body-focused repetitive behaviors (BFRBs) refers to a group of recurrent, problematic, destructive behaviors directed toward the body, including hair-pulling, skin-picking, and nail-biting. Individuals with BFRBs report diminished control over the behavior and a range of physical and psychological sequelae. Recent research on psychological models for BRFBs has investigated the role of emotion regulation (ER), and many authors in this area have conceptualized problematic body-focused behavior as a maladaptive ER mechanism. This article organizes and reviews the empirical research on the ER model for BRFBs. First, the three most common BFRBs are described, as are the conceptualization, phenomenological similarities and covariation, and psychological and physical impact of BFRBs. Next, psychodynamic models and several cognitive-behavioral (CB) models are described. The article focuses on the ER model, including a review of studies of comorbidity in BFRBs, naturalistic and experimental studies, studies of subtypes of BFRBs, and treatment trials. The implications of the findings are discussed and the authors make recommendations for future research. The article concludes with a discussion of the limitations of psychological models for BFRBs and the limitations of the review.

Seeing White Bears That Are Not There: Inference Processes in Obsessions

Meta-cognition refers to the notion of thoughts about one’s own thoughts and has been defined as knowledge and cognition about cognitive phenomena (Flavell, 1979). In recent years, meta-cognitive models have provided accounts of the maintenance of anxiety disorders (e.g., Wells, 2000). Meta-cognitive models would argue that the thoughts about the appearance and utility of otherwise normal thoughts generate anxiety. In this article we apply a meta-cognitive approach to understanding obsessions but, rather than thoughts about thoughts, we suggest that the ruminations in obsessive-compulsive disorder (OCD) without overt compulsions result largely from thoughts about thoughts that do not actually occur. Persons with obsessions thinks they might have or might have had the thoughts, and through a meta-cognitive process termed “inferential confusion,” confuse these imagined thoughts with actual thoughts. This account would explain the repetitive, compulsive yet ego-dystonic nature of obsessions. The justification, provided by patients with OCD, for treating imaginary thoughts as actual thoughts appears to be an imaginary narrative, which produces and maintains the obsessional preoccupation, and seems imposed on reality by a distorted inductive reasoning process.