Mairwen K. Jones

Danger ideation reduction therapy (DIRT) for obsessive-compulsive washers. A controlled trial

Twenty-one OCD sufferers with washing/contamination concerns took part in a controlled treatment trial at the Anxiety Disorders Clinic, University of Sydney. Eleven of the subjects received danger ideation reduction therapy (DIRT) over eight, 1 h weekly group sessions conducted by the second author. Ten subjects were placed on a wait list and did not receive DIRT or any other treatment. DIRT procedures were solely directed at decreasing danger-related expectancies concerning contamination and did not include exposure, response prevention or behavioral experiments. Components of DIRT include attentional focusing, filmed interviews, corrective information, cognitive restructuring, expert testimony, microbiological experiments and a probability of catastrophe assessment task. All subjects were assessed at pre-treatment, post-treatment and three-month follow-up using the Maudsley Obsessional-Compulsive Inventory, Leyton Obsessionality Inventory, Beck Depression Inventory and a Self Rating of Severity Scale. Changes from pre-treatment to after treatment (post-treatment and follow-up scores averaged) were significantly greater in the DIRT condition than in the control condition for all measures. No significant differences were obtained between groups on post-treatment to follow-up change on any measure. The implications of these findings for theoretical models of OCD and its management are discussed.

The cognitive mediation of obsessive-compulsive handwashing.

The potential mediating roles of danger expectancies, responsibility, perfectionism, anticipated anxiety and self-efficacy on obsessive-compulsive handwashing were examined. Ratings were obtained from 27 obsessive-compulsive patients before and during a behavioural avoidance test involving a compound stimulus of potting soil, animal hair, food scraps and raw meat. Correlation and partial correlation analyses were conducted to examine the relationships between the cognitive predictor variables and anxiety, urge to wash, time in task and duration of post-test washing. Large and significant relationships between danger expectancies and the dependent measures were obtained, even when alternative mediators were held constant. No other variable remained significantly related to any of the dependent measures when severity of disease ratings were held constant. Results suggest that of the cognitive variables examined, danger expectancies are the most likely mediator of washing-related behaviour in obsessive-compulsive disorder.

Role of perceived danger in the mediation of obsessive‐compulsive washing

The role of danger expectancies in sub‐clinical Obsessive‐Compulsive Disorder (OCD) was examined in 18 undergraduate students who had displayed washing/contamination concerns. The perceived level of danger in a Behavioural Avoidance Test (BAT) involving a compound stimulus of potting soil, animal hair, food scraps, and raw meat was manipulated by varying the instructions participants were given at the commencement of the BAT. Participants were randomly allocated into a high‐danger instruction condition or a low‐danger instruction condition. Participants in the higher‐danger instruction condition had higher mean ratings for anxiety and urge to wash, showed greater avoidance, and spent longer washing their hands at the completion of the task than participants in the low‐danger instruction condition. However, only the differences in avoidance scores and post‐BAT washing were statistically significant. These findings are discussed in relation to danger‐based models of OCD. Depression and Anxiety 8:121–125, 1998.

Flooding and Mental Health: A Systematic Mapping Review

Background Floods are the most common type of global natural disaster. Floods have a negative impact on mental health. Comprehensive evaluation and review of the literature are lacking. Objective To systematically map and review available scientific evidence on mental health impacts of floods caused by extended periods of heavy rain in river catchments. Methods We performed a systematic mapping review of published scientific literature in five languages for mixed studies on floods and mental health. PUBMED and Web of Science were searched to identify all relevant articles from 1994 to May 2014 (no restrictions). Results The electronic search strategy identified 1331 potentially relevant papers. Finally, 83 papers met the inclusion criteria. Four broad areas are identified: i) the main mental health disorders—post-traumatic stress disorder, depression and anxiety; ii] the factors associated with mental health among those affected by floods; iii) the narratives associated with flooding, which focuses on the long-term impacts of flooding on mental health as a consequence of the secondary stressors; and iv) the management actions identified. The quantitative and qualitative studies have consistent findings. However, very few studies have used mixed methods to quantify the size of the mental health burden as well as exploration of in-depth narratives. Methodological limitations include control of potential confounders and short-term follow up. Limitations Floods following extreme events were excluded from our review. Conclusions Although the level of exposure to floods has been systematically associated with mental health problems, the paucity of longitudinal studies and lack of confounding controls precludes strong conclusions. Implications We recommend that future research in this area include mixed-method studies that are purposefully designed, using more rigorous methods. Studies should also focus on vulnerable groups and include analyses of policy and practical responses.

Is the essay resubmission option a formative or a summative assessment and does it matter as long as the grades improve

Typically, essays are used as summative rather than formative assessments and students experience them as tasks rather than learning opportunities. Thus, the aim of this study was to see whether providing students with detailed formative feedback and an opportunity to resubmit their essay would improve their essays writing skills. Twenty‐six out of 54 third‐year psychology students resubmitted their essay. Of those 26 resubmitted essays, 18 were awarded higher grades. Although the students observed that their skills had improved, they mainly perceived the resubmission option as a ‘safety net’ and were motivated to use it as a way of improving their grades. Lack of time was the most common reason given for not resubmitting. Therefore, lecturers may be faced with a challenge of finding ways of not only providing formative feedback but also encouraging students to use it as such.

Danger ideation reduction therapy (DIRT): preliminary findings with three obsessive-compulsive washers.

Three obsessive-compulsive patients received Danger Ideation Reduction Therapy (DIRT) in an initial treatment trial. All three subjects presented with contamination/washing concerns but refused to participate in exposure and response prevention. DIRT is solely directed at decreasing danger-related expectancies concerning contamination. DIRT procedures do not attempt to address inflated personal responsibility. In addition, DIRT does not involve direct or filmed exposure to contamination-related stimuli, or behavioural experiments. Components of DIRT include corrective information cognitive restructuring, filmed interviews, microbiological experiments, attentional focusing and Hoekstras (1989) probability of catastrophe estimation task. Treatment consisted of between six and ten 1-hr weekly sessions. At post-treatment, substantial reductions in scores on the Padua Inventory, Maudsley Obsessional-Compulsive Inventory and two global rating scales were apparent for all subjects. These improvements were maintained at a 3-month follow-up. The theoretical and clinical implications of these preliminary findings are discussed.

No evidence of attentional bias in obsessive compulsive checking on the dot probe paradigm.

Attentional biases have been proposed as maintaining and causal factors in anxiety, and it has been suggested that training attentional bias can impact on emotional responding. Given the severity of obsessive compulsive disorder (OCD) and the considerable number of clients who do not respond to traditional therapies, understanding the factors that maintain anxiety in OCD is critical for the development of effective treatments. This study investigated attentional biases in a homogenous group of OCD patients whose primary concern was checking (OCD-Check; n=18) compared to a Control group individually matched for age, gender and level of education (Control; n=18) using a dot probe task. No evidence of attentional bias, or of differences in orienting to or disengaging from checking-relevant stimuli, was found in the OCD group compared to the matched Control group. From this data, it would appear that attentional bias may not be a feature of obsessive compulsive checking. The limitations of the present study and future research directions are discussed.

The relevance of associative learning pathways in the development of obsessive–compulsive washing

The relevance of associative learning in the development of Obsessive-Compulsive Disorder (OCD) was investigated in a group of 23 OCD patients whose main concern was washing and 23 age and sex matched control subjects who did not have OCD. OC washers completed an origins instrument based on Menzies and Clarkes (1993, Behaviour Research and Therapy, 31, 355-365) Origins Questionnaire (OQ) for the phobic disorders. Control subjects completed a modified version of this measure designed to give a comprehensive picture of their experiences with relevant contamination-related stimuli. In general, the results question the relevance of associative-learning per se in the development of OC washing. Direct and indirect conditioning events were very rare in the OCD group, accounting for less than 13% of cases. No significant differences between groups were found in the proportion of subjects who knew other OC washers, or had experienced direct associative-learning events prior to onset. Contrary to expectation, significantly more non-OCD subjects had experienced vicarious learning events related to dirt and washing than OCD subjects. However, of note, associative-learning events that took place during episodes of depression were significantly more frequently reported in the OCD group than in the control group. Depression appeared to play a facilitating role in the associative-learning of OC washing. The implications of these findings for theoretical accounts of OCD are discussed.

The etiology of fear of spiders

Abstract The origins of fear of spiders in an undergraduate student sample was investigated. Spider-fearful (n=19) and non-fearful (n=19) groups were formed on the basis of extreme scores to the spider item on the FSS-III (Wolpe&Lang, 1969). Spider-fearful subjects completed Menzies and Clarkes (1993a) recently constructed Origins Questionnaire (OQ), while non-fearful subjects completed a modified version of this measure. No cases of spider fear were found to originate with direct conditioning, vicarious conditioning, or information/instruction. In contrast, 63% of the sample claimed to have always been afraid of spiders, i.e., from their first encounter. These data question the significance of simple associative-learning events in the origin of fear of spiders, and are taken to support the recently proposed non-associative account of Menzies and Clarke (1993a, 1993b). Inconsistencies with some earlier studies in which high frequencies of classical conditioning have been found are explained in terms of t...

A study of attitudes toward sexuality issues among health care students in australia.

SUMMARY This study examined the attitudes of 1132 higher education students enrolled in health profession education degree programs. Students were asked to indicate their anticipated level of comfort in a variety of interactions including working with a lesbian client or a homosexual male, and asking a client about his or her sexual orientation. Students also indicated whether they perceived their degree program had dealt adequately with these issues. High levels of discomfort were identified in our large sample of students. Approximately 30% of the sample indicated they would be uncomfortable working with a lesbian client and 27% of the sample indicated that they would feel uncomfortable if working with a male homosexual client. There were significant differences for these two items depending on the students gender. Female students indicated significantly higher levels of comfort in dealing with homosexual male clients than did their male counterparts. Male students indicated significantly greater comfort in dealing with lesbian clients. More than half of our sample indicated that they would not be comfortable asking about a clients sexual orientation. Over 75% of senior-year students believed that their degree program had not adequately dealt with these issues. The impact of homophobia and discomfort on the quality of care health professionals provide for lesbian and gay clients and the role of educational strategies to reduce this are discussed.