Scott Hannan

Group cognitive-behavioral therapy for hoarding disorder: An open trial

Although cognitive-behavioral therapy (CBT) appears to be a promising treatment approach for hoarding disorder, treatment to date has been quite labor intensive. The goal of this study, therefore, was to assess the potential effectiveness of group CBT for hoarding, without home visits by the clinician. Forty-five individuals with hoarding disorder enrolled in either a 16 or 20 session program of group CBT; 30 (67%) completed treatment. Using mixed-effects models to account for missing data, we report data from 35 (78%) participants who provided enough data for analysis. Participants demonstrated significant improvements in hoarding symptoms, as well as symptoms of depression and anxiety, and quality of life. Improvements in hoarding symptoms were comparable to two published clinical trials on individual CBT for hoarding disorder. Results of this study suggest that group CBT for hoarding, without home discarding sessions by the clinician, may be an effective treatment option with the potential advantage of increasing treatment access by reducing clinician burden and cost of treatment.

Stepped care for obsessive-compulsive disorder: A pilot study

Cognitive-behavioral therapy incorporating exposure and ritual prevention (EX/RP) is the first-line psychosocial treatment of choice for obsessive-compulsive disorder (OCD). However, several barriers to care prevent many OCD patients from receiving this treatment. Previous research has indicated that some OCD patients may benefit from less intensive treatment options, such as bibliotherapy; however, it is not clear how to assign patients to their appropriate level of treatment. We suggest that an optimal approach may be to use a stepped care protocol, in which patients begin with a low-intensity treatment and then progress to more costly (but perhaps more efficacious) treatments as needed. In this pilot study, 11 adults with OCD initially received bibliotherapy EX/RP treatment; 20% of patients completing this treatment met stringent responder criteria. The remaining patients were then assigned to a therapist who provided brief education and EX/RP advice but did not actually assist patients with exposure exercises. Twenty-nine percent of patients who completed this treatment were classified as responders. The remaining patients then received the more traditional therapist-administered EX/RP; 67% of patients completing this treatment were responders. Across the entire protocol, 86% of treatment completers and 80% of the intent-to-treat sample were rated as “much improved” or “very much improved.” Cost-effectiveness analyses, in which the total cost of treatment was divided by the degree of symptom reduction, showed that stepped care compared favorably to other forms of EX/RP delivery. We provide a detailed case discussion that illustrates the clinical decision-making process and one patients response to different levels of treatment.

Mindfulness- and Acceptance-Based Behavior Therapy for Obsessive-Compulsive Disorder

Obsessive-compulsive disorder (OCD) is a chronic anxiety disorder, marked by recurrent, intrusive, and distressing thoughts (obsessions) and/or repetitive behaviors (compulsions) (American Psychiatric Association, 2004). Epidemiological data suggest a 6-month prevalence of 1–2% (Myers et al., 1984) and a lifetime prevalence of 2–3% (Robins et al., 1984). OCD symptoms often severely disrupt social and vocational functioning (Leon, Portera, & Weissman, 1995), and OCD is associated with a 40% unemployment rate (Steketee, Grayson,& Foa, 1987).Asurvey of individuals with OCD indicated that 20% spent 5–8 hr per day engaged in rituals, with 13% spending more than 17 hr per day during the most severe period of the disorder (Gallup Organization Inc., 1990).

Psychometric Properties of a Structured Diagnostic Interview for DSM-5 Anxiety, Mood, and Obsessive-Compulsive and Related Disorders:

Three hundred sixty-two adult patients were administered the Diagnostic Interview for Anxiety, Mood, and OCD and Related Neuropsychiatric Disorders (DIAMOND). Of these, 121 provided interrater reliability data, and 115 provided test–retest reliability data. Participants also completed a battery of self-report measures that assess symptoms of anxiety, mood, and obsessive-compulsive and related disorders. Interrater reliability of DIAMOND anxiety, mood, and obsessive-compulsive and related diagnoses ranged from very good to excellent. Test–retest reliability of DIAMOND diagnoses ranged from good to excellent. Convergent validity was established by significant between-group comparisons on applicable self-report measures for nearly all diagnoses. The results of the present study indicate that the DIAMOND is a promising semistructured diagnostic interview for DSM-5 disorders.

Psychometric properties of the Overall Anxiety Severity and Impairment Scale (OASIS) among psychiatric outpatients.

BACKGROUND The Overall Anxiety Severity and Impairment Scale (OASIS) is a brief, transdiagnostic measure used to assess anxiety severity and related interference. The OASIS has demonstrated strong psychometric properties in previous investigations, however, it has yet to be validated using a transdiagnostic clinician-rated measure. METHODS We evaluated the factor structure, convergent and discriminant validity, and illness severity cut-scores of the OASIS in a sample of outpatients (N=202). RESULTS A confirmatory factor analysis indicated an unidimensional structure provided the best fit. The OASIS demonstrated good convergent validity and internal consistency. Using the Clinical Global Impression-Severity Scale (CGI-S), ROC curves showed OASIS scores of 6, 10 and 12 to indicate moderate, marked and severe illness severity, respectively. CONCLUSIONS The OASIS is a unidimensional self-report measure with good convergent validity and data from the current study provide illness severity cut-scores.

Utility of the Outcome Questionnaire-45.2 in outpatient anxiety clinics: A comparison between anxiety patients with and without co-occurring depression

OBJECTIVE The Outcome Questionnaire-45.2 (OQ-45) is a self-report measure of general psychological distress. Although intended to be transdiagnostic, the OQ-45 may be best conceptualized as a measure of depression; as such, its utility in assessing other symptoms such as anxiety is unclear. METHOD We examined scores on the OQ-45 in a sample of 329 patients with anxiety and related disorders, half of whom had co-occurring depression. RESULTS Eighty-two percent of patients scored above the OQ-45 cutoff, whereas 18% were incorrectly screened out. Patients with co-occurring depression were more likely to score above the OQ-45 cutoff than nondepressed patients. Depression severity predicted many of the OQ-45 scales, even after controlling for anxiety severity. By contrast, most of the anxiety-specific measures failed to predict the OQ-45 after controlling for depression severity. CONCLUSIONS Findings suggest that the OQ-45 may not adequately capture anxiety symptoms and are discussed in terms of diagnostic screening and assessment.