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Background and Objectives: Over the past 25 years Mental Contamination (MC) has become recognised as a distinct construct, particularly in relation to Obsessive Compulsive Disorder (OCD). MC is defined as feelings of contamination, often located internally, that arise in the absence of contact with a contaminant, with the source proposed to be human. Despite considerable interest from researchers and clinicians, there has not been a systematic review on the relationship between MC and OCD. Therefore, a systematic review was conducted to summarise and synthesise the current status of phenomenological and experimental evidence, mechanisms, assessment, measurement, and treatment of MC in OCD (PROSPERO: CRD42021223119)., Methods: All study designs were eligible provided the focus of the study was on MC and the implications of the study were linked to OCD. We searched PsychINFO, Embase, Medline, Ethos, ProQuest, conference abstracts and trial registries between 1990 and 2021. The Mixed Methods Appraisal tool was used to assess methodological quality of included studies., Results: We found 58 reports with a total of 67 studies that met criteria for inclusion in the review. Twenty-three of these studies used clinical samples, 28 were experimental, 12 focused on phenomenology and 8 addressed treatment. The quality of the studies was variable., Limitations: Grey literature was not included, thus there may be further unpublished MC studies that have not been included in the review., Conclusions: Based on the findings, mental contamination is a robust clinical construct within OCD that has important implications for understanding and treating the disorder., Competing Interests: Declaration of competing interest The authors declare no competing interests., (Copyright © 2022 Elsevier Ltd. All rights reserved.)

Background and Objectives: This paper reviews the development of the cognitive-behavioural model of obsessive-compulsive disorder (OCD) through the work of Dr. Jack Rachman and the research his ideas inspired or shaped., Methods: A narrative review of Rachman's work and important developments in related areas was conducted., Results: Rachman was highly responsive to theoretical and empirical developments in the field, and continuously developed his model of OCD over the course of his career. Key developments in his thinking and of those in related areas are described., Limitations: This is a narrative review that highlights important developments in the cognitive behavioural model of OCD only., Conclusions: The CBT model of OCD has strong empirical support and CBT treatment is the most effective psychotherapy. Continued development in our understanding of attachment and in the persistence of compulsions is warranted., Competing Interests: Declaration of competing interest I have no conflict of interest., (Copyright © 2022 Elsevier Ltd. All rights reserved.)

Background and Objectives: We know little about how symptoms of obsessive-compulsive disorder and depression interact during psychological therapy. Although some previous research suggests that reductions in the severity of depression are driven by reductions in OCD, support for this conclusion is limited due to the exclusion of individuals with severe depression and limitations of the statistical approaches used., Methods: This study re-examined the interaction between symptoms of OCD and depression during therapy in a sample of 137 adults with a primary diagnosis of OCD and a full range of depression severity. All participants received a 12 to 16-week specialist residential treatment. Participants completed the Florida Obsessive Compulsive Inventory and Patient Health Questionnaire for depression weekly. The relationship between severity of OCD and depression was examined using a random intercept cross-lagged panel model., Results: Both cross-lagged paths were significant, with prior levels of OCD influencing subsequent levels of depression, and prior levels of depression influencing subsequent levels of OCD., Limitations: The present study was conducted in a residential setting, meaning the findings may not generalise to outpatient settings characterised by less severe OCD and depression., Conclusions: Contrary to previous findings, which suggest that the influence of OCD on depression is far greater than the reverse, our findings suggest that OCD and depression influence each other equally. As improvements in mood can help to improve symptoms of OCD, it appears important to target depression concurrently during treatment for OCD. This would be a new treatment target for improvement outcomes in OCD., (Copyright © 2022 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Background and Objectives: Transdiagnostic mechanisms of change (txMOC) specific to cognitive behaviour therapy are poorly understood. Salkovskis (1996) proposed one such mechanism in terms of the shift towards an alternative, less negative view of their problems or cognitive flexibility. This hypothesis has been described as involving a shift in beliefs, from "theory A″ to "theory B". The objective of this research was to evaluate this hypothesis., Methods: Effectiveness of a novel txCBT and temporal changes in process and symptom measures were evaluated using a non-concurrent multiple baseline design and Tau-U calculations with thirteen participants (five with obsessive-compulsive disorder, two with panic disorder with agoraphobia and six with major depressive disorder). As a secondary analysis authors calculated Kendall's - Tau correlation between process and symptom measures, performed the Wilcoxon signed-rank test to assess treatment modules effect on negative thought and calculated Reliable change index (RCI)., Results: The txCBT was clearly effective for eight participants. The results varied dependent on the stimuli evaluated as negative or threatening. Level and trend of the ratings of belief in theory A followed the level and trend of symptom measures to a greater extent than the (inverse) level and trend of belief in theory B., Limitations: Only thirteen participants were recruited and evaluated., Conclusions: The results are consistent with the view that effective treatment may involve a txMOC characterized by the ability to shift from a relatively fixed negative view of their experience to a less negative psychologically focused alternative., (Copyright © 2020 Elsevier Ltd. All rights reserved.)

Background and Objectives: There is conflicting research on how comorbid depression impacts the treatment of obsessive compulsive disorder (OCD) with exposure with response prevention. To better understand this relationship, the current study tests theoretical claims that greater depression limits motivation to engage in exposures, restricts habituation, and interferes with adaptive learning., Methods: Fifty-one individuals with OCD completed a diagnostic interview and self-report questionnaires assessing depression symptom severity and then participated in a standardized imaginal exposure protocol, in which they repeatedly approached an idiosyncratic fear deemed "moderately anxiety-provoking.", Results: Contrary to expectations, linear regression models indicated that depression symptom severity was not independently associated with motivation, subjective or objective within-session habituation or adaptive learning outcomes. However, the perceived likelihood of the best-case scenario occurring as a result of the exposure moderated the relationship between depression severity and motivation to engage in the exposure exercise., Limitations: Use of a one-session exposure protocol precludes conclusions regarding how depression is associated with outcomes in a full ERP treatment., Conclusions: Depression symptom severity was not independently associated with motivation, habituation, or adaptive learning. The observed non-significant effects suggest that degree of depression, on its own, is not a meaningful indicator of how patients with OCD will fare an exposure intervention., (Copyright © 2020 Elsevier Ltd. All rights reserved.)

Background and Objectives: The cognitive theory of compulsive checking in OCD proposes that checking behaviour is maintained by maladaptive beliefs, including those related to inflated responsibility and those related to reduced memory confidence. This study examined whether and when specific interventions (as part of a new cognitive therapy for compulsive checking) addressing these cognitive targets changed feelings of responsibility and memory confidence., Methods: Participants were nine adults with a primary or secondary diagnosis of OCD who reported significant checking symptoms (at least one hour per day) on the Yale-Brown Obsessive-Compulsive Scale. A single-case multiple baseline design was used, after which participants received 12 sessions of cognitive therapy. From the start of the baseline period through to the 1 month post-treatment follow-up assessment session, participants completed daily monitoring of feelings of responsibility, memory confidence, and their time spent engaging in compulsive checking., Results: Results revealed that feelings of responsibility significantly reduced and memory confidence significantly increased from baseline to immediately post-treatment, with very high effect sizes. Multilevel modelling revealed significant linear changes in feelings of responsibility (i.e., reductions over time) and memory confidence (i.e., increases over time) occurred following the sessions when these were addressed. Finally, we found that improvements in these over the course of the treatment significantly predicted reduced time spent checking., Limitations: The small sample size limits our ability to generalize our results., Conclusions: Results are discussed in terms of a focus on the timing of change in cognitive therapy., (Copyright © 2018 Elsevier Ltd. All rights reserved.)

Background and Objectives: Perfectionism is a transdiagnostic process that has been associated with a range of psychopathology and also with other transdiagnostic processes. We have previously shown that guided internet-based cognitive behavioural therapy (ICBT) can reduce symptoms of dysfunctional perfectionism, however, no impact was observed on symptoms of depression and anxiety. Here we explore the impact of guided ICBT for perfectionism on symptoms of other associated psychopathology, specifically obsessive-compulsive disorder (OCD) and eating disorders, and also on other associated transdiagnostic processes (self-esteem, intolerance of uncertainty, and self-compassion)., Methods: Participants who presented with clinical levels of perfectionism were randomised to an experimental group that received the intervention (n = 62), or a wait list control group (n = 58). Questionnaires assessing symptoms of OCD, eating disorders, self-esteem, intolerance of uncertainty, and fear of self-compassion were completed pre-intervention, post-intervention (12 weeks), and at follow-up (24 weeks). Between group effect sizes are reported., Results: The intervention led to significant decreases in symptoms of OCD (d = -0.9; CI: -1.4, -0.4) and eating disorders (d = -0.6; CI: -1.0, -0.1), and had an impact on other transdiagnostic processes resulting in increased self-esteem (d = 0.7; CI: 0.2, 1.2), decreases in intolerance of uncertainty (d = -0.9; CI: -1.4, -0.4), and fear of self-compassion (d = -0.8; CI: -1.3, -0.3). At follow-up changes were maintained in symptoms of OCD (d = -1.3; CI: -1.8, -0.8), disordered eating (d = -0.7; CI: -1.2, -0.2), intolerance of uncertainty (d = -0.8; CI: -1.2, -0.3), and fear of self-compassion (d = -1.0; CI: -1.5, -0.5)., Conclusions: Guided ICBT for perfectionism improves associated psychopathology and transdiagnostic processes. ClinicalTrials.gov registration no. NCT02756871., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

Background and Objectives: This study examined the occurrence of sudden gains (or reversal of gains) among children with obsessive-compulsive disorder (OCD) during the course of cognitive-behavioral therapy (CBT), as well as the association of sudden gains with treatment response, treatment group, and pre-treatment clinical characteristics., Methods: The sample consisted of 136 youth (ages 7-17) with a primary diagnosis of OCD who were randomized in a double-blinded fashion to 10 sessions of CBT with augmentation of either d-cycloserine or placebo. Sudden gain status was determined based on clinician-rated obsessive-compulsive symptom severity, which was collected on 9 occasions across the study period., Results: 42.6% of youth experienced at least one sudden gain, which tended to occur either after starting exposure and response prevention or towards the end of treatment. After applying the Benjamini-Hochberg procedure for multiple comparisons, there were no significant pre-treatment predictors of sudden gains and only reduced insight predicted the reversal of gains. Individuals with at least one sudden gain had improved overall treatment outcomes, measured both by reduction in OCD symptom severity, and by global illness severity., Limitations: Several clinical constructs were not examined. Symptomatology was not assessed at every treatment session. Differences in those who achieved sudden gains and those who did not may be obscured. There is the possibility that a sudden gain reflected a scoring error generated by an optimistic or inaccurate report. Finally, a relatively homogenous sample may limit the generalizability of results., Conclusions: The course of CBT for pediatric OCD is variable with many children experiencing sudden gains, but a sizable percentage experience a reversal of gains which was related to reduced insight. Sudden gains tended to occur after starting exposure and response prevention and towards the end of treatment., Trialsregistration: ClinicaltrialsgovRegistry:NCT00864123. https://www.clinicaltrials.gov/ct2/show/NCT00864123., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

Background and Objectives: Although research suggests that introducing varying levels of fear during exposure enhances outcomes for some anxiety-related problems, this has not been examined in the context of obsessions. The current preliminary study tested the hypothesis that introducing variability in exposure intensity would improve long-term outcomes relative to traditional gradual (hierarchical) exposure METHODS: Adults (N = 40) with a moderately distressing unacceptable obsessional thought were randomly assigned in parallel to four twice-weekly sessions of: (a) gradual exposure (EXP-G; n = 19) emphasizing hierarchical exposure completion, or (b) variable exposure (EXP-V; n = 21) emphasizing variability in exposure intensity RESULTS: There were no significant differences in pre to post changes between groups using self-report, interview, or behavioral outcomes (as evaluated by an independent assessor blind to treatment condition). Group comparisons at 3-month follow-up did not reach statistical significance but were moderate in magnitude. Specifically, as measured by clinical interview (the Yale-Brown Obsessive-Compulsive Scale; primary outcome) and self-report, individuals in the EXP-G group maintained gains at 3-month follow-up, while the EXP-V group continued to improve. Treatment expectancies and satisfaction were comparable for both groups. Five participants withdrew from the EXP-G condition, and none withdrew from the EXP-V condition. In contrast to previous studies, variability in subjective and physiological fear during exposure did not predict outcomes LIMITATIONS: The study employed an analogue sample with moderate unacceptable obsessions, and results should be replicated in clinical samples CONCLUSIONS: Variable exposure warrants future study to understand the mechanisms, moderators, and implications of this novel approach., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

Background and Objectives: Cognitive-behavioral theorists posit that safety behaviors (SBs) interfere with important exposure processes and should be removed from therapy. However, there is growing evidence to suggest that restorative SBs (RSB; those that allow for full confrontation with a core threat) do not adversely affect exposure outcomes, and their implementation during exposure should be further examined., Methods: The current study evaluated exposure with the continuous use of RSB (E + CONT) versus discontinuation of RSB (E + DISC), in comparison to exposure with no RSB (ERP). Sixty-seven nonclinical participants completed 15 trials of exposure in which they touched a potentially contaminated stimulus with or without RSB. Behavioral approach tasks were completed at pretreatment, post-treatment, and two-week follow-up to examine changes in subjective distress and degree of behavioral approach., Results: The three conditions were not different on clinical symptoms and behavioral approach at post-treatment and follow-up, indicating that the hypothesized superiority effect of E + DISC was not supported. However, ratings obtained during repeated exposure trials indicated that E + DISC evidenced greater symptom reduction following the removal of RSB., Limitations: The use of a healthy undergraduate sample and standardization of the exposure procedure., Conclusions: Although findings were contrary to hypotheses, these data provide added support for the benign role of RSB as compared to conventional exposure. Furthermore, the removal of RSB may lead to more favorable process outcomes during exposure. The theoretical and clinical implications of these findings are discussed, and future directions are provided., (Copyright © 2018 Elsevier Ltd. All rights reserved.)

Background and Objectives: Dysfunctional interpretations of intrusive thoughts are implicated in the etiology and maintenance of Obsessive-Compulsive Disorder (OCD). Cognitive Bias Modification training for interpretations (CBM-I) has successfully modified dysfunctional interpretations in the context of several disorders, including OCD. However, research regarding CBM-I's impact on symptom reduction and behavior is mixed, which limits its clinical application. Further, support for the specific efficacy of CBM-I in individuals with contamination concerns is limited. The current study aimed to modify dysfunctional interpretations in individuals with contamination concerns, and examine the effect of the modification on both interpretation bias and performance on a behavioral approach task (BAT)., Methods: Participants (N = 74) completed a word-sentence association task by indicating whether a threatening or benign word was related to an ambiguous scenario. The active condition received feedback designed to reduce maladaptive interpretations; the control condition received random feedback., Results: Findings revealed that the active-but not the control-condition showed a significant decrease in interpretation bias for threat cues. Analyses of behavioral effects indicated that when ceiling effects were accounted for, the active condition completed more BAT steps than the control condition (p = 0.06; d = 0.45)., Limitations: The current study is preliminary and requires replication with a clinical sample., Conclusions: Completion of the CBM-I was beneficial for reducing dysfunctional interpretations relevant to naturally-occurring contamination concerns and, importantly, this reduction may help those individuals approach feared situations., (Copyright © 2017 Elsevier Ltd. All rights reserved.)

Background and Objectives: According to cognitive models, obsessive compulsive symptoms result from catastrophic misinterpretations of commonly occurring intrusive experiences and the use of counterproductive strategies to manage them. Obsessive Compulsive Disorder (OCD) related beliefs such as inflated responsibility, importance of thoughts and perfectionism increases the likelihood of such misinterpretations. Consistent with a growing body of literature supporting the usefulness of mobile delivered technologies in fostering cognitive behavior change, the present study assessed the effectiveness of a novel cognitive training exercise designed to challenge OCD-related beliefs. This mobile app training exercise consists of users having to pull statements challenging OCD beliefs towards themselves (downwards) and to throw away (push upwards) contra-productive self-statements., Methods: 36 third-year BA students started the trial. Twenty completed pre and post measures of OCD-beliefs, mood and OCD symptoms including relationship-obsessions. Participants were instructed to complete 3 min of daily training for a period of 15 days., Results: No significant differences were found between completers and non-completers on demographic and most symptom related measures at Time 1. Repeated-measures MANOVA of the 20 completers showed a significant reduction on all OCD symptoms measures and on OCD-beliefs. No significant reduction was found in depression symptoms. Regression analysis showed change in levels of OCD-beliefs was associated with reduction in OCD symptoms at Time 2 over and above OCD symptoms at Time 1., Limitations: The study is an open trial with non-clinical participants., Conclusions: This mobile delivered training exercise may be useful for the reduction and relapse prevention of OCD-related beliefs and symptoms., (Copyright © 2018 Elsevier Ltd. All rights reserved.)

Background and Objectives: Safety behaviors, defined as engagement in avoidance within safe environments, are a key symptom of obsessive-compulsive and related disorders. They may interfere with daily functioning and as such their emission should be reduced. The purpose of the current study is to investigate the effects of the non-contingent presentation of safety signals (cues produced by safety behaviors) on reducing safety behaviors in participants self-reporting low and high OCD profiles., Methods: In total, 32 participants were asked to play a game to gain points and avoid their loss. After having developed avoidance behavior, evidenced by maintaining all of their earned points, they were exposed to safe environments where no point loss was programmed. In Test 1, safety cues (blue bar) were produced contingent on performing safety behaviors. In Test 2, safety cues were presented continuously without any response requirement., Results: Findings demonstrated that high OCD group displayed higher rates of safety behaviors than low OCD group. However, exposure to the non-contingent presentation of safety signals eliminated their emission in both groups., Limitations: Future studies need to evaluate the effects of different non-contingent schedules on the suppression of safety behaviors., Conclusions: These findings contribute to the literature by demonstrating that non-contingent introduction of safety signals eliminated safety behaviors completely, even in high OCD participants, who performed safety behavior at higher rates. Such a treatment protocol may ameliorate exposure therapy in which response prevention constitutes a key element and is generally associated with increased drop-out rates., (Copyright © 2017 Elsevier Ltd. All rights reserved.)

Background and Objectives: Research on incompleteness and not-just right experiences, (INC/NJREs) indicate that some OCD symptom dimensions are motivated by these experiences rather than by anxiety. Most published data are correlational, using non-clinical individuals. This study sought to examine INC/NJREs in vivo in non-clinical and OCD individuals., Methods: Study 1: Ninety-three undergraduates were randomly assigned to a INC/NJREs induction (n=44) or non-induction task (n=47). Scores on self-reports assessing INC, NJREs, OCD, Anxiety, and Depression were also recorded. Study 2: Twenty adults with OCD performed the induction task and completed the same questionnaire-packet as the non-clinical participants., Results: Study 1: The induction-group scored higher on several DVs of the experimental task, as INC/NJREs and uncomfortable physical sensations predicted impulses/urges to do something. All the DVs correlated with INC, NJREs, and OCD symptoms. Anxiety was only related to suppressing difficulties of the most intense sensation. Study 2: Results were comparable to those found in non-clinical people. Induced INC/NJREs correlated with compulsions severity and were associated with ordering, washing, and hoarding symptoms. OCDs did not differ from non-clinical subjects in the number of induced INC/NJREs, but they were more disturbing, difficult to suppress, and instigated more urges to do in OCDs., Limitations: The small group of OCDs and the lack of a non-OCD clinical group kept us from drawing conclusions about the specificity of INC/NJREs to some OCD symptoms., Conclusions: Findings support the role of INC/NJREs as stimuli triggering urges and/impulses to do and their impact on OCD severity., (Copyright © 2017 Elsevier Ltd. All rights reserved.)

Background and Objectives: The presence of obsessive-compulsive disorder (OCD) can result in low quality of life, with significant impairments in social and occupational functioning. An increase in the dissemination of self-help programs has been observed in the treatment of OCD, and has provided improved accessibility to treatment. The present study examined the efficacy of self-help interventions for OCD in the context of therapeutic contact., Methods: Randomised controlled trials and quasi-experimental studies were identified through computerised database searches. Self-help format (bibliotherapy, internet-based, computerised), and therapeutic contact were examined for their effect on treatment outcomes., Results: Eighteen studies targeting self-help for OCD met inclusion criteria with 1570 participants. The average post-treatment effect size (Hedges' g) of self-help interventions on primary outcomes was .51 (95% CI: .41 to 0.61). Subgroup analysis revealed large effect sizes for minimal-contact self-help (g = 0.91, 95% CI: 0.66 to 1.17), moderate effect sizes for predominantly self-help (g = 0.68, 95% CI: 0.40 to 0.96), and small effect sizes for self-administered self-help (g = 0.33, 95% CI: .18 to 0.47)., Limitations: A large variation of treatment approaches, amount of therapeutic contact, and risk of bias within each study may account for the large magnitude in effect sizes across studies. Additionally, the long-term follow-up effects of treatment approaches were not examined., Conclusions: A growing body of literature supporting to the use of self-help treatments for OCD is evident, however, further investigation through use of randomised controlled trials is required, particularly the use of stepped care and long-term effectiveness., (Copyright © 2015 Elsevier Ltd. All rights reserved.)

As noted in this commentary, the research in this special issue presents several conceptual and methodological innovations that advance out understanding of obsessions and compulsions. The issue spans a broad range of topics from basic psychological processes such as selfhood themes, perceptions of internal states, and preference for visual symmetry to new insights into compulsions and other forms of neutralization to promising treatment approaches for special OCD symptom presentations. The implications of this research for understanding vulnerability to OCD and the role of compulsions are discussed and three methodological challenges are highlighted that require further attention by OCD researchers., (Copyright © 2015. Published by Elsevier Ltd.)

Background and Objectives: Transformation obsessions denote an under-reported symptom of Obsessive Compulsive Disorder (OCD), characterised by an excessive fear of turning into another person/object or acquiring unwanted characteristics. Relative to other OCD symptoms, little is known about the clinical presentation of transformation obsessions. The study aims to examine the clinical correlates and treatment prognosis of transformation obsessions in a paediatric OCD sample., Methods: The sample consisted of 346 youths with a primary diagnosis of OCD. Patients with and without transformation obsessions were compared in terms of demographic and clinical characteristics, and CBT outcomes., Results: 10% of the sample endorsed transformation obsessions. Patients with transformation obsessions were more likely to be boys, to be on augmented medication regimes, and to present with more severe obsessions at assessment. A factor analysis identified four major OCD symptom clusters, with transformation obsessions loading on a 'forbidden thoughts' factor alongside aggressive, sexual, and religious obsessions. No group differences in treatment outcomes were observed., Limitations: Limitations include the cross-sectional and retrospective nature of the study, the representativeness of our sample, and use of concomitant medication, among others., Conclusions: The study provides the first empirical evidence regarding phenomenological similarities and differences between paediatric OCD patients presenting with and without transformation obsessions. The findings suggest that transformation obsessions are best conceptualised as related to 'forbidden' obsessions and respond to exposure-based CBT., (Copyright © 2015 Elsevier Ltd. All rights reserved.)

Background and Objectives: Cognitive proposals about the mediating role of misinterpretations, emotional reactions, and control strategies in the escalation of obsessional intrusive thoughts (OIT) to clinical obsessions have received only partial support. This study aims to examine these variables, taking into account the obsession/OIT contents and the severity of the obsessive-compulsive disorder (OCD)., Methods: After identifying their most upsetting OIT/obsession, 61 OCD patients and 61 non-clinical individuals assessed the associated distress, interference and appraisals, and the strategies used to control the obsession/OIT., Results: Compared with the nonclinical subjects, OCD individuals scored higher on all variables. The obsession's severity was associated with high disturbance, interference and dysfunctional appraisals, whereas the compulsion's severity was related to specific control strategies. Different obsessional contents produced similar emotional disturbance and interference. However, obsessional contents influence the amount of adscription to different dysfunctional appraisals and the frequency of use of several control strategies., Limitations: Our conclusions are limited by the scarce number of patients representing the various obsessive contents, specially order., Conclusions: Overall, superstitious obsessions were more dysfunctionally appraised than the other obsessional contents, inducing both covert and overt neutralizing strategies, whereas contamination obsessions were less dysfunctionally appraised., (Copyright © 2013 Elsevier Ltd. All rights reserved.)

Background and Objectives: To optimize the effectiveness of cognitive-behavior therapy (CBT) for each individual patient, it is important to discern whether different intervention techniques may be differentially effective. One factor influencing the differential effectiveness of CBT intervention techniques may be the patient's preferred learning style, and whether this is 'matched' to the intervention., Method: The current study uses a retrospective analysis to examine whether the impact of two common CBT interventions (thought records and behavioral experiments) is greater when the intervention is either matched or mismatched to the individual's learning style., Results: Results from this study give some indication that greater belief change is achieved when the intervention technique is matched to participants' learning style, than when intervention techniques are mismatched to learning style., Limitations: Conclusions are limited by the retrospective nature of the analysis and the limited dose of the intervention in non-clinical participants., Conclusions: Results suggest that further investigation of the impact of matching the patient's learning style to CBT intervention techniques is warranted, using clinical samples with higher dose interventions., (Copyright © 2012 Elsevier Ltd. All rights reserved.)

Background and Objectives: Previous research has found that a high impact of possibility based information during reasoning prevents the resolution of doubt among those with Obsessive-Compulsive Disorder (OCD). It was expected that the ability of those with OCD to resolve obsessional doubt would improve following Inference Based Treatment (IBT)., Methods: The ability to resolve doubt, including the relative impact of reality and possibility based information, was measured before and after treatment with the Inference Processes Task in a group of 35 participants diagnosed with OCD., Results: Results confirmed that IBT improved the participants' ability to resolve obsessional doubt. Those who improved their ability to resolve doubt showed a significantly better treatment outcome. Improvements appeared mostly due to a lowered impact of possibility based information following treatment., Limitations: The study did not include a control condition although results clearly indicate that the ability to resolve obsessional is closely linked to the most relevant quantifiers of treatment outcome. In addition, relatively small sample sizes prevented more powerful multiple comparisons between groups., Conclusions: Results suggest treatment implications and the relevance of dissolving the tenacity of obsessional doubt in OCD., (Copyright © 2011 Elsevier Ltd. All rights reserved.)

The current study tested the causal premise underlying cognitive models of obsessive compulsive disorder (OCD) that negative interpretations of intrusive thoughts lead to the distress and impairment associated with symptoms of OCD. Specifically, we sought to determine: (a) whether it was possible to train healthier (defined as more benign/less threatening) interpretations regarding the significance of intrusive thoughts; and (b) whether there was a link between modifying negative interpretations and subsequent emotional vulnerability to an OC stressor. A nonclinical sample of students high in OC symptoms completed either a Positive (n = 50) or Neutral (n = 50) interpretation training procedure designed to alter OC-relevant interpretations and beliefs. As expected, participants in the Positive (versus Neutral) training condition endorsed healthier OC-relevant interpretations and beliefs following training. Additionally, when controlling for baseline affect, participants in the Positive (versus Neutral) training condition reported less negative affect during the OC-stressor task (at the level of a non-significant trend) and reported less desire to perform neutralizing activities. In general, results provide some support for cognitive models of obsessions and suggest that negative interpretations of intrusive thoughts may be causally related to symptoms of OCD., (Published by Elsevier Ltd.)

Meridian-tapping (MT) is a body-oriented therapeutic technique which among other psychological problems targets anxiety disorders. Despite bold claims by some of its advocates that it brings lasting success in the vast majority of patients with anxiety disorders, solid empirical evidence for its effectiveness is scarce and its theoretical foundations are refuted by many scientists. The present study tested the effectiveness of a published MT self-help approach for obsessive-compulsive disorder (OCD). Following a baseline assessment over the internet including standard outcome measures for OCD (Y-BOCS, OCI-R) and depression (BDI-SF), 70 participants with OCD were randomly allocated to MT or to progressive muscle relaxation (PMR). Four weeks after the dispatch of the self-help manuals (including video demonstrations of the technique), participants were requested to take part in a post assessment. Whereas subjects found MT more helpful than PMR in retrospect (39% versus 19%) and would continue to use it in the future (72% versus 48%) there was no evidence for a stronger decline of OCD symptoms under MT on any of the psychometric measures. Moreover, Y-BOCS scores did not significantly change across time for both interventions. The present study does not support bold claims about the effectiveness of MT as a stand-alone technique. Cognitive-behavioral therapy remains the treatment of choice for OCD. While self-help MT may enhance the well-being of a subgroup of participants, its potential for OCD appears to be small. Exaggerated success claims on the effectiveness of MT in conjunction with degrading appraisals of conventional psychotherapy as made by some of its leading figures may in our view foster fatalism in patients not experiencing major symptom relief by MT., (Copyright © 2010 Elsevier Ltd. All rights reserved.)

Treatment of OCD is effective, even for the most chronic and severe cases. It has been difficult to identify predictors of treatment outcome, with little work aimed at predicting treatment outcome in severe OCD. We examined the ability of a range of demographic and psychopathology variables to predict treatment outcome in a cohort of 52 inpatients and a second group of 62 community outpatients with severe, treatment-refractory OCD. Despite both cohorts showing significant improvement in OCD symptoms, reliable predictors were difficult to identify, and were different in the two cohorts. In the inpatient group, marital status was a significant predictor, with those who were married or cohabiting showing better outcome that those not currently in a relationship. This relationship was not observed in the community treatment group. Initial symptom severity was also found to be a significant predictor, but only in the community treatment group, where higher initial severity was associated with greater reduction in symptoms during treatment. Further research examining a wider range of predictors may assist in identifying those factors which predict outcome in severe OCD.

Research supporting the metacognitive model of OCD (Wells, A. (2000). Emotional disorders and metacognitions: Innovative cognitive therapy. West Sussex, UK: John Wiley & Sons; Wells, A. (1997). Cognitive therapy of anxiety disorders: A practice manual and conceptual guide. Chichester, UK: John Wiley and Sons) is beginning to accumulate Metacognitive Therapy (MCT) aims to teach clients to shift to a 'metacognitive mode' and incorporates cognitive strategies and behavioural experiments, with the aim of modifying maladaptive metacognitive beliefs rather than the content of anxious beliefs themselves. The current paper reports on a preliminary study, applying MCT in a clinical group setting with eight adults suffering from a variety of OCD presentations. Promising results indicate a larger randomised controlled trial, with recovery achieved for seven of the eight participants on the Yale-Brown Obsessive-Compulsive Scale at 3-month follow-up. All participants demonstrated improvement on measures of OCD symptom severity and metacognitions.

Cognitive-behavior therapy and exposure and response prevention are the most effective psychological treatments for obsessive-compulsive disorder (OCD). However, these approaches often produce variable results with the majority of treated individuals remaining symptomatic. This study evaluated a new form of cognitive therapy based on Wells' metacognitive model of OCD. Treatment efficacy was assessed using single case methodology in 4 consecutively referred individuals. At post-treatment, all participants made clinically significant change on a range of standardized outcome measures and these gains were largely maintained through to 6-month follow-up. Metacognitive therapy could be an effective and time efficient treatment for OCD.

The present study was undertaken to estimate the effect of exposure plus response-prevention (E/RP), delivered alone intensively over 5-weeks and without concomitant pharmacotherapy, for children and adolescents with OCD. Twenty children and adolescents with OCD, not receiving medication for this condition, were randomized to E/RP or a wait-list condition. Statistically and clinically significant symptomatic improvement was found in the E/RP group compared with controls, with improvement maintained at follow-up an average of 14 weeks later. Effect size in the main intention-to-treat analysis was 1.23 and in the secondary per protocol analysis was 1.64. This study lends further support to the view that E/RP is an effective treatment for childhood OCD.

Mental imagery is increasingly considered to be an important feature in anxiety disorders. The aim of this study was to investigate the prevalence and characteristics of mental images in obsessive compulsive disorder (OCD) and their possible association with earlier adverse events. A consecutive sample of 37 patients with OCD admitted to a specialist unit was interviewed using a semi-structured interview. Thirty (81%) patients with OCD reported mental images. Most images were either memories of earlier adverse events (n=10 or 34%) or were associated with them (n=13 or 45%). Patients with mental images had more obsessive compulsive symptoms, responsibility beliefs and anxiety than those without. Previous research has shown that patients with OCD and comorbid posttraumatic stress disorder might not benefit as much from standard behavioural treatment as those without. Consequently, additional therapeutic interventions such as imaginal reliving and restructuring of meaning or imagery modification of traumatic memories might be helpful in OCD patients with mental images that are linked to earlier adverse events.

Predictors of improvement in obsessive-compulsive symptoms (Y-BOCS) in a randomized clinical trial with adult obsessive-compulsive disorder outpatients were examined. Results of multiple regression analyses revealed that a positive helping alliance was significantly predictive of posttreatment Y-BOCS. Treatment expectancy and high motivation to change were not significantly related to posttreatment outcome. None of the predictors were significantly related to Y-BOCS levels at 12-month follow-up, but positive alliance showed a trend to significance.

Cognitive-behavioural models of obsessive-compulsive disorder (OCD) implicate thought suppression as a key factor in the development and persistence of the disorder. There is now more than a decade of research on thought suppression and its effects as they pertain to OCD. This paper briefly reports on initial thought suppression research and then offers a detailed review of recent thought suppression research that has directly examined the role of suppression in OCD. Theoretical and methodological issues in using thought suppression paradigms to understand OCD are discussed. It is concluded that this body of work continues to yield inconsistent findings with respect to the effects of suppression on thought frequency, although there are some consistent findings that suggest that suppression is driven by negative thought appraisal and is associated in turn with greater OCD symptomatology. Thus, there is support in this work for key tenets of cognitive-behavioural models of OCD. Suggestions for future research directions are offered.

The cognitive bias of "Thought Action Fusion" (TAF) has received significant research attention in the past decade. The review addresses the assessment of TAF, its place in cognitive theories of obsessional difficulties, and the evidence demonstrating that TAF is relevant to disorders beyond Obsessive Compulsive Disorder (OCD). Data on the components of TAF, its extension to positive outcomes and its role in the aetiology, maintenance and treatment of OCD are reviewed. It is concluded that the moral form of TAF is less robust than the likelihood form and that scales may be best used as a starting point in identifying beliefs and conducting experimental investigations. It is also suggested that the scales be amended to include harm avoidance, which would also increase their clinical utility.

This article describes the main characteristics and technical features of a novel psychotherapeutic strategy, well-being therapy. This paper outlines the background of its development, the structure of well-being therapy, its key concepts and technical aspects. Well-being therapy is based on Ryff's multidimensional model of psychological well-being, encompassing six dimensions: autonomy, personal growth, environmental mastery, purpose in life, positive relations and self-acceptance. The goal of this therapy is improving the patients' levels of psychological well-being according to these dimensions, using cognitive-behavioral techniques. It may be applied as a relapse-preventive strategy in the residual phase of affective (mood and anxiety) disorders, as an additional ingredient of cognitive-behavioral packages, in patients with affective disorders who failed to respond to standard pharmacological or psychotherapeutic treatments and in body image disturbances. The clinical studies supporting its efficacy are illustrated.

This study was designed to test the hypothesis that comorbidity mediates the relationship between expressed emotion, perceived criticism (PC), and treatment outcome in anxiety disorders. Although comorbid major depression and Axis II traits were related to poor outcome in agoraphobic and obsessive-compulsive outpatients, these variables did not prove to be mediators of drop-out or treatment outcome. A secondary aim was to examine whether PC predicted change in symptoms of depression. Even when posttreatment anxiety severity and comorbidity were controlled, PC accounted for a significant proportion of the variance in change on the Symptom Checklist-90-R depression scale.

Although a common problem encountered by mental health specialists, there are few published descriptions of behavior therapy intervention for childhood stealing. The present case study addresses the behavioral treatment of stealing exhibited by a child in a pubic school setting. A functional assessment suggested that the behavior was maintained by the social attention it elicited from school personnel and parents. Using an hypothesis-driven model of treatment formulation, intervention consisted of eliminating multiple sources of attention in an extinction paradigm. Intervention was associated with a systematic reduction in stealing and results were maintained through a 12-month follow-up. Issues related to functionally determined treatment of behavior disorders are discussed.

African Americans with obessive-compulsive disorder are underrepresented in behavioral treatment outcome studies. This paper consists of a clinical discussion of issues arising during the treatment with exposure plus response prevention of two African-American women with obessive-compulsive disorder. Clinical issues, such as excessive shame, insanity fears, and a sense of uniqueness, complicated the treatment process. However, both clients made significant improvement as assessed by behavioral testing, target ratings and the Yale-Brown Obsessive-Compulsive Scale.

The present study illustrates a case of obsessive-compulsive disorder (OCD) with schizotypal personality treated by social skills training. Prior research suggests that OCD with schizotypal personality predicts poor treatment outcome using exposure-based treatments. Following social skills treatment and at 6-month follow-up, the patient had considerable obsessive-compulsive symptom reduction, although he was still symptomatic for OCD, anxiety and depression. Controlled trails are indicated to illuminate the specific contributions of this approach for OCD with schizotypal personality disorder.

Abel's (1993) review of treatments for obsessive compulsive disorder (OCD) indicated that both behavioral treatment (exposure with response prevention, and biological treatment (specific serotonin reuptake inhibiting drugs) are effective. It was recognized that having both available for patients is preferable because there would be situations where one treatment is more appropriate than the other. One indication for using drugs would be where situational constraints do not allow for effective exposure treatment. We present a case study of a microbiology technician with AIDS-related OCD who had an excellent response to the administration of fluoxetine without relapse when the drug was discontinued.

Coprophagia is seen, though uncommonly, in psychiatric hospitals among adult patients with diffuse brain disease and in individuals with subaverage intelligence. We describe here a case of coprophagia in an adult with normal cognitive functioning. Thorough assessment revealed that this coprophagia was a manifestation of obsessive-compulsive disorder. The problem behavior responded to a behavioral treatment program comprising exposure and response prevention.

Subjects with obsessive compulsive disorder, bulimia nervosa, or trichotillomania selected cues which elicited or worsened their symptoms from a 339 item list. Principal components analysis suggested a four-component solution. Each disorder was significantly associated with one of these components. Diagnostic assignment based on component scores yielded 85% correct classification. The diagnostic groups did not differ on a negative feeling state component. The results indicate that both disorder-specific and generic components exist. This approach has potential for defining clinical subtypes, studying the interaction of feeling states and environmental cues in evoking symptoms, and designing treatment strategies.

Obsessive compulsive disorder (OCD) is a prevalent form of psychopathology in the elderly, yet limited evaluation of the disorder in this age group has occurred. We review the literature and describe a case of OCD effectively treated in an 80-year-old man. Case study reports suggest that elderly persons are responsive to selective serotonin uptake inhibitors, although medication selection and dosage may need to be adjusted as a result of the medical conditions sometimes present in the elderly. Elderly persons appear able to benefit from exposure and response prevention, although behavioral intervention has not been frequently used. We describe here the first case report where exposure and response prevention procedures were successfully used and this intervention was not confounded with psychopharmacologic treatment.

The cognitive-behavioral treatment of a 24-year-old woman with moderately severe obsessional ruminations is described. The case demonstrates both the effectiveness and limitations of exposure with response prevention techniques for obsessive-compulsive disorder. The client's response raises questions about the clinical utility of viewing obsessions exclusively as conditioned anxiety stimuli. In addition, the case shows that cognitions related to control rather than appraisals of responsibility were instrumental in initiating neutralising activity. Further modification of the current cognitive-behavioural hypotheses regarding obsessions is recommended.

The most common effective treatments for obsessive-compulsive disorder include clomipramine, fluoxetine, and exposure-based behavior therapy. A meta-analysis was conducted on the results from 25 appropriate treatment studies (1975-1991). All three treatments were significantly effective for most of the outcome variables (overall severity, anxiety, depression). Exposure was not significantly effective for reducing depressed mood. More treatment outcome studies are needed before a clearly superior treatment or combination of treatments can be statistically determined.

Flooding and response prevention have been widely used in the treatment of adult obsessive compulsive disorder but have been overlooked in favor of less restrictive procedures when treating children. The present case investigates the utility of these procedures in an adolescent with severe compulsive handwashing. Treatments were introduced hierarchically to minimize subject distress; graded exposure decreased the frequency of handwashing, but flooding was required to eliminate the compulsion. Guidelines for the ethical use of flooding and exposure therapies with children are offered.

The case involved a thirteen-year-old girl with a history of different urological disorders who since the age of four showed several rituals associated with micturition as well as progressively intense urinary retention. Micturition occupied 2 to 12 hours a day. Treatment consists of systematic desensitization through imagery and in vivo together with progressive response prevention of ritualized behaviours. Cognitive therapy and parent counselling is also used. Normality is attained after 7 weeks treatment and maintained at 18 months follow-up. Psychiatric diagnosis is simple phobia to micturition.

This paper reports on the treatment of a 14-year-old boy with severe obsessive-compulsive disorder. Baseline measures indicated that two checking behaviors were of extreme frequency. Personal discomfort was severe and parental ratings of anxiety and depression were high. Treatment employed an alternating design of response prevention and cognitive therapy. Parent and client ratings of levels of anxiety and depression were taken daily in addition to frequency levels of the compulsive behaviors. The treatment procedures over 24 sessions eliminated the compulsive behaviors and reduced self-reported anxiety. The study is unique in demonstrating that the cognitive therapy had a significant influence in diminishing the obsessive-compulsive behaviors.

A 67-yr-old woman with a 45-yr history of obsessive-compulsive problems related to fear of contamination was treated rapidly by a multi-component intervention. Questionnaire data following treatment showed the patient to be free of obsessive-compulsive complaints, and these were corroborated by behavioral observations. Follow-up probes conducted 6, 12 and 18 months later revealed continued maintenance of treatment gains. Patient-therapist contact time totalled 6 hr, about one-third of the time employed by Marks for exposure and response prevention, indicating the cost-effectiveness of a multi-component treatment intervention.

An 11-year-old girl with a severe and recalcitrant case of trichotillomania was successfully treated with a modified habit reversal procedure. Erosion estimates and serial photographic assessment methods were used to document client progress over a one-year period. Treatment effects were socially validated by attractiveness ratings of 20 same-aged children. Results extend the use of habit reversal procedures to a severe case and address the need for reliable and valid assessment procedures as well as extended follow-up.

Frequent but primarily unobserved hairpulling, by a 3-yr-old girl was followed by a differential reinforcement procedure, attention-reflection, and punishment of thumbsucking, a possibly covarying behavior. Initially, attention-reflection reduced the hairpulling, but not to a clinically significant level. Dramatic decreases in hairpulling were achieved when thumbsucking was punished by application of a "bad tasting" substance. A brief reversal supports the contention that the two behaviors were correlated and suggests that behaviors may be controlled by targeting observable covariants.

Trichotillomania was treated in a developmentally normal three-year-old by punishing thumb sucking. A behavioral analysis indicated a chain of behaviors that began with hair pulling and terminated in thumb sucking. The parents punished the thumb sucking by applying a bad tasting substance to the thumb. Both hair pulling and thumb sucking were rapidly eliminated. The child remained symptom free at 40 month follow-up. This study represents the third time trichotillomania has been treated in a preschooler indirectly by targeting finger sucking as the behavior to change. The significance of treating trichotillomania indirectly is discussed.