Laura E. Fabricant

The relevance of analogue studies for understanding obsessions and compulsions

Analogue samples are often used to study obsessive-compulsive (OC) symptoms and related phenomena. This approach is based on the hypothesis that results derived from such samples are relevant to understanding OC symptoms in individuals with a diagnosis of obsessive-compulsive disorder (OCD). Two decades ago, Gibbs (1996) reviewed the available literature and found initial support for this hypothesis. Since then there have been many important advances addressing this issue. The purpose of the present review was to synthesize various lines of research examining the assumptions of using analogue samples to draw inferences about people with OCD. We reviewed research on the prevalence of OC symptoms in non-clinical populations, the dimensional (vs. categorical) nature of these symptoms, phenomenology, etiology, and studies on developmental and maintenance factors in clinical and analogue samples. We also considered the relevance of analogue samples in OCD treatment research. The available evidence suggests research with analogue samples is highly relevant for understanding OC symptoms. Guidelines for the appropriate use of analogue designs and samples are suggested.

Enhancing Exposure and Response Prevention for OCD: A Couple-Based Approach

The effectiveness of individual therapy by exposure and response prevention (ERP) for obsessive–compulsive disorder (OCD) is well established, yet not all patients respond well, and some show relapse on discontinuation. This article begins by providing an overview of the personal and interpersonal experiences of OCD, focusing on interpersonal processes that maintain OCD symptoms and interfere with ERP. The study then describes a couple-based treatment program that the authors have developed to enhance ERP for individuals with OCD who are in long-term relationships. This program involves psychoeducation, partner-assisted exposure therapy, couple-based interventions aimed at changing maladaptive relationship patterns regarding OCD (i.e., symptom accommodation), and general couple therapy. Three case examples are presented to illustrate the couple-based techniques used in this treatment program.

Treating Obsessive-Compulsive Disorder in Intimate Relationships: A Pilot Study of Couple-Based Cognitive-Behavior Therapy

Although cognitive-behavioral therapy (CBT) involving exposure and response prevention (ERP) is an established treatment for obsessive-compulsive disorder (OCD), not all patients respond optimally, and some show relapse upon discontinuation. Research suggests that for OCD patients in close relationships, targeting relationship dynamics enhances the effects of CBT. In the present study, we developed and pilot tested a 16-session couple-based CBT program for patients with OCD and their romantic partners. This program included (a) partner-assisted ERP, (b) techniques targeting maladaptive relationship patterns focal to OCD (e.g., symptom accommodation), and (c) techniques targeting non OCD-related relationship stressors. OCD, related symptoms, and relationship functioning were assessed at baseline, immediately following treatment (posttest), and at 6- and 12-month follow-up. At posttest, substantial improvements in OCD symptoms, relationship functioning, and depression were observed. Improvements in OCD symptoms were maintained up to 1year. Results are compared to findings from studies of individual CBT for OCD and discussed in terms of the importance of addressing interpersonal processes that maintain OCD symptoms.

Just to be certain: Confirming the factor structure of the Intolerance of Uncertainty Scale in patients with obsessive-compulsive disorder

Intolerance of uncertainty (IU) is a cognitive construct in obsessive-compulsive disorder (OCD); yet no studies exist confirming the factor structure of the most widely used measure of IU, the intolerance of uncertainty scale (IUS), in OCD patients. Moreover, no studies have examined how scores on this measure relate to OCD symptom dimensions. Accordingly, the present study examined a 12-item two-factor revised version of the IUS (IUS-12) in 205 OCD patients. Confirmatory factor analysis verified the scales two-factor structure. The measure also demonstrated high internal consistency and the IUS-12 was correlated moderately with another self-report measure of IU. Finally, theoretically consistent and specific relationships emerged between the IUS-12 and OCD symptom dimensions. These findings are discussed in terms of implications for the assessment and treatment of OCD, and specifically how elevated scores on the IUS-12 subscales may be utilized to identify subtleties in the presentation of OCD-related problems with IU.

Experiential Avoidance and Saving Cognitions in the Prediction of Hoarding Symptoms

The cognitive-behavioral approach to hoarding implicates dysfunctional beliefs about possessions (i.e., “saving cognitions”). Acquiring and saving possessions can be conceptualized as avoidance behaviors that prevent feeling the distress provoked by such beliefs in certain situations (e.g., discarding). Experiential avoidance (EA) involves an unwillingness to endure upsetting emotions, thoughts, memories, and other private experiences, and deliberate efforts to control or escape from them. EA has been investigated in several clinical disorders, but to date little investigation of the role of EA in hoarding has been made. The present study examined EA in the prediction of hoarding symptoms. A large sample of unscreened undergraduates completed measures of EA, saving cognitions, and hoarding symptoms. EA predicted the acquisition and clutter components of hoarding even after controlling for saving cognitions and general distress. However, EA was not uniquely associated with the difficulty discarding component of hoarding. Implications for future research are discussed.

Evaluation of an in vivo measure of thought-action fusion

Thought–action fusion (TAF) refers to maladaptive beliefs about the relationship between mental events and behaviors, and is associated with obsessional problems. Currently, the self-report Thought–Action Fusion Scale (TAFS) is the most widely used measure of TAF, but a single assessment modality limits research that can be conducted on this phenomenon. This study evaluated the validity of an in vivo paradigm that assesses both Moral TAF (the belief that thoughts are the moral equivalent of actions) and Likelihood TAF (the belief that thinking about a negative event increases the probability of the event itself). In this paradigm, participants were asked to contemplate two negative events involving a beloved relative: (a) I hope (relative) is in a car accident today and (b) I hope I have sex with (relative). Participants then provided in vivo ratings of anxiety, estimates of likelihood, and moral wrongness related to the negative thoughts. Results provided evidence for the convergent validity of the in vivo ratings for both sentences. These findings are discussed in terms of clinical care, the assessment of TAF, and the implications for future research on this theoretically important construct.

How is the Beads Task related to intolerance of uncertainty in anxiety disorders

Intolerance of uncertainty (IU) is a cognitive bias associated with anxiety disorders that has only been reliably measured using self-report instruments. The current study investigated relationships between a probabilistic inference task - the Beads Task - and self-report IU. Individuals with anxiety disorders (ANX) and non-anxious controls (NAC) completed self-report measures as well as the Beads Task at three levels of difficulty. The Beads Task successfully induced task-related uncertainty as the decision became more difficult. While the two groups did not differ on the observable performance related measures, the ANX group was significantly more distressed during the task than were the NACs. Moreover, among the ANX group, self-reported IU was correlated with draws to decision and distress during the task. The Beads Task appears to provoke distress associated with uncertainty for anxious individuals, rather than altering their behavioral responses; thus, clinical implications and avenues for future research are discussed.

The contribution of experiential avoidance and social cognitions in the prediction of social anxiety.

BACKGROUND Cognitive models propose that social anxiety arises from specific dysfunctional cognitions about the likelihood and severity of embarrassment. Relational frame theory (RFT), on the other hand, posits that social anxiety arises from the unwillingness to endure unpleasant internal experiences (i.e. experiential avoidance [EA]). Although cognitive models have garnered empirical support, it may be that newer models such as RFT can improve our ability to predict and treat social anxiety. AIMS We aimed to elucidate the relationship between dysfunctional cognitions and EA, as well as their independent and relative contributions to the prediction of social anxiety symptoms. We hypothesized that dysfunctional cognitions and EA would each be associated with social anxiety, as well as with each other. We also predicted that both EA and dysfunctional cognitions would remain independent predictors of social anxiety symptoms after controlling for each other and general distress. METHOD Undergraduates high (n = 173) and low (n = 233) in social anxiety completed measures of social anxiety, dysfunctional cognitions, EA, and general distress. The overall sample was 66.3% female; mean age = 20.01 years (SD = 2.06). RESULTS Correlational analyses revealed that EA, dysfunctional cognitions, and social anxiety symptoms were moderately correlated with one another. Additionally, hierarchical regression analyses revealed that dysfunctional cognitions predicted social anxiety symptoms even after controlling for EA; the reverse was not found. CONCLUSIONS RESULTS suggest that EA and social anxiety specific cognitive distortions overlap to a moderate extent. EA does not add to the prediction of social anxiety symptoms above and beyond dysfunctional cognitions. Additional theoretical and treatment implications of the results are discussed.

Differences in Obsessive–Compulsive Symptoms and Obsessive Beliefs: A Comparison between African Americans, Asian Americans, Latino Americans, and European Americans

Clinical research has increasingly considered ethnic group differences in the expression of anxiety disorders, but to date few investigations have focused specifically on the symptoms of obsessive–compulsive disorder (OCD). We examined group differences in OC symptoms, related cognitions (“obsessive beliefs”), and their associations. The sample included European American (N = 1199), African American (N = 215), Asian American (N = 116), and Latino American (N = 72) participants. African American and Asian American participants reported more contamination-related OC symptoms than did European Americans. Asian Americans also reported elevated levels of obsessive beliefs. Moreover, group membership moderated the relationship between obsessive beliefs and certain dimensions of OC symptoms. These findings suggest group differences in the experience of OC symptoms and related cognitions, and that the cognitive-behavioral model of some OC symptoms could be refined and tailored for groups underrepresented in OCD research to date.

Psychological Predictors of Anxiety in Response to the H1N1 (Swine Flu) Pandemic

Pandemic illnesses, such as the H1N1 influenza (swine flu) are often highly publicized in the mass media and can be associated with high levels of anxiety and compensatory behavior (e.g., using hand sanitizers). The present research sought to investigate the psychological processes associated with swine-flu related anxiety during the H1N1 influenza pandemic of 2009–2010. Participants were 315 college students who completed survey measures between September 25th 2009 and February 16th 2010, which encompassed the peak of flu season and a time of intense media attention to this particular outbreak. Data revealed that anxiety in response to the swine flu was common in the sample. Regression analysis indicated that health anxiety, contamination fears and disgust sensitivity were significant predictors of swine flu-related anxiety. Implications for how concerns over pandemic illnesses such as the swine flu can be conceptualized and clinically managed are discussed.