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This study is the first to obtain data on the prevalence of, contributors to, and supports required for, pandemic-related distress within the residential aged care sector in Australia. A nested mixed-methods approach was used to examine aged care leaders' opinions about the impact of COVID-19 on the mental health of aged care residents and staff.A total of 288 senior staff of Australian residential aged care facilities (care managers, clinical care coordinators, and lifestyle team leaders; mean age = 52.7 years,On average, nearly half of their residents experienced loneliness (41%) and a third experienced anxiety in response to COVID-19 (33%). The most frequently noted contributors to poor mental health among residents were restrictions to recreational outings and watching news coverage relating to COVID-19. Participants emphasized the need for increased access to counseling services and improved mental health training amongst staff. Residential care staff were similarly impacted by the pandemic. More than a third of staff were reported as anxious (36%) and 20% depressed, in response to COVID-19. Staff were worried about introducing COVID-19 into their facility and were impacted by news coverage of COVID-19. Staff would feel supported by financial assistance and by increased staff-resident ratios.Senior staff perceive that the mental health of Australian aged care residents and staff was negatively impacted by the COVID-19 pandemic. The most noted contributors were identified, as was the mental health support for aged care communities.This study provides government and policymakers with clear intervention targets for supporting the sector. Clinicians can support residential aged care communities by providing on-site or telehealth counseling, and upskill and train residential aged care staff on how to respond to the emotional needs of residents in response to COVID-19.

Perinatal Obsessive-Compulsive Disorder (pOCD) refers to the onset/exacerbation of Obsessive-Compulsive Disorder (OCD) during the perinatal period. This disorder has been studied in mothers, with limited research conducted on fathers. The aim of the current study was to conduct the first systematic review of research investigating the experience of pOCD in fathers. A systematic review was conducted via electronic searches of Scopus, ProQuest, APA PsychNet, PubMed, and EBSCOhost. There were 523 articles identified and screened for eligibility, resulting in six eligible studies included in the final review. All studies reported the presence of subclinical obsessive-compulsive symptoms in fathers during the perinatal period, with the prevalence comparable to mothers. Compared to mothers, however, fathers were found to report less intrusion-related distress. Two studies reported a correlation between dysfunctional beliefs, negative appraisal of intrusions, and pOCD symptoms. Common categories of obsessive thoughts and compulsions experienced by fathers were also identified. Fathers appear susceptible to pOCD, which is consistent with the Cognitive-Behavioral Theory of OCD. Future research is recommended, therefore, to investigate clinical prevalence and severity of pOCD in fathers, particularly relative to mothers, and further investigate the role of dysfunctional beliefs in the development of pOCD.

Purpose The COVID-19 pandemic has resulted in a widespread adoption of videoconferencing as a communication medium in mental health service delivery. This review considers the empirical literature to date on using videoconferencing to deliver psychological therapy to adults presenting with mental health problems. Method Papers were identified via search of relevant databases. Quantitative and qualitative data were extracted and synthesized on uptake, feasibility, outcomes, and participant and therapist experiences. Results Videoconferencing has an established evidence base in the delivery of cognitive behavioural therapies for post-traumatic stress disorder and depression, with prolonged exposure, cognitive processing therapy, and behavioural activation non-inferior to in-person delivery. There are large trials reporting efficacy for health anxiety and bulimia nervosa compared with treatment-as-usual. Initial studies show applicability of cognitive behavioural therapies for other anxiety and eating disorders and obsessive-compulsive spectrum disorders, but there has yet to be study of use in severe and complex mental health problems. Therapists may find it more difficult to judge non-verbal behaviour, and there may be initial discomfort while adapting to videoconferencing, but client ratings of the therapeutic alliance are similar to in-person therapy, and videoconferencing may have advantages such as being less confronting. There may be useful opportunities for videoconferencing in embedding therapy delivery within the client's own environment. Conclusions Videoconferencing is an accessible and effective modality for therapy delivery. Future research needs to extend beyond testing whether videoconferencing can replicate in-person therapy delivery to consider unique therapeutic affordances of the videoconferencing modality. Practitioner points Videoconferencing is an efficacious means of delivering behavioural and cognitive therapies to adults with mental health problems. Trial evidence has established it is no less efficacious than in-person therapy for prolonged exposure, cognitive processing therapy, and behavioural activation. While therapists report nonverbal feedback being harder to judge, and clients can take time to adapt to videoconferencing, clients rate the therapeutic alliance and satisfaction similarly to therapy in-person. Videoconferencing provides opportunities to integrate therapeutic exercises within the person's day-to-day environment.

Objective: To investigate and compare patterns of temporal self-appraisal in anxiety and depression. Specifically, whether these parallel the self-enhancing perceptions of a continuous upward traje...

Over the past decade, digital mental health has been an emerging priority area for mental health practice and research (Hollis et al., 2018), with the spotlight dramatically shifting to this area s...

Objectives: The role of cognitions and beliefs in trichotillomania (TTM; hair pulling disorder) has been the subject of only limited investigation. This study aimed to develop and validate the Beliefs in TTM Scale (BiTS). Methods: A pool of 50 items based upon themes identified in previous research was administered online to 841 participants with and without self-reported problematic, non-cosmetic hair pulling behaviours. Results: Exploratory and confirmatory factor analyses conducted in randomly split-halves of the sample supported retention of 14 items comprising three factors: negative self-beliefs, low coping efficacy, and perfectionism. Conclusions: The BiTS demonstrated satisfactory psychometric properties and all three subscales significantly correlated with greater hair pulling severity. Negative self-beliefs predicted hair pulling severity over and above mood symptoms, suggesting the importance of addressing self-construals in psychological treatments for TTM. Validation in a clinician diagnosed sample is required. Practitioner points: Research supports cognitive therapies for treating trichotillomania (hair pulling disorder), although studies investigating the nature and role of cognitions and beliefs in this disorder have been lacking. This study developed and validated a self-report measure of three styles of beliefs most relevant to trichotillomania: negative self-beliefs, low coping efficacy, and perfectionism. Negative self-beliefs predicted the severity of trichotillomania symptoms over and above depression and anxiety, suggesting such cognitions may not necessarily be due to comorbidities. Future research should validate the new measure in a clinician diagnosed sample, and therapies for trichotillomania may be enhanced by targeting shame specifically.

Improving our understanding of how reward and punishment are experienced by those with trichotillomania (TTM) may assist in the advancement of psychological interventions. The purpose of this study...

The delivery of videoconferencing psychotherapy (VCP) has been found to be an efficacious, acceptable and feasible treatment modality for individual therapy. However, less is known about the use of VCP for couple and family therapy (CFT). The focus of this systematic review was to examine the efficacy, feasibility and acceptability of using VCP as a treatment delivery modality for CFT. A systematic search was conducted, data relating to efficacy, feasibility and acceptability were extracted from included studies. The search returned 7,112 abstracts, with 37 papers (0.005%) included. The methods of the review were pre-registered (PROSPERO; CRD42018106137). VCP for CFT was demonstrated to be feasible and acceptable. A meta-analysis was not conducted; however, results from the included studies indicate that VCP is an efficacious delivery method for CFT. Recommendations for future research and implications regarding clinical practice are made, which may be of interest to practitioners given the COVID-19 pandemic.

Objective Accurate and reliable assessment of clinical competencies in clinical psychology training requires the use of a range of assessment methods. In addition to traditional written assignments, exams, and clinical supervisor ratings, there is a growing recognition that objective and structured performance-based exams are also required. The objective structured clinical examination (OSCE) is a well-established assessment method that involves a series of assessment stations in which students perform structured clinical tasks, mostly with simulated patients (SPs), while being independently rated by examiners. Several clinical psychology programmes in Australia have started conducting OSCE but descriptions of clinical psychology OSCE are lacking. Method In this paper, we describe the OSCE in four universities. Results Challenges, limitations, and practical issues of this form of assessment, in addition to similarities and differences between OSCE are explored. To promote best practice in the assessment of clinical competencies, we offer seven tips to clinical psychology trainers on setting up an OSCE for their programme. Conclusion The OSCE has the potential to improve the reliability, validity and authenticity of competency assessments in clinical psychology programmes. We hope these OSCE descriptions and tips will encourage programmes to introduce the OSCE and spur further research into this form of assessment. Key points (1) The objective structured clinical examination (OSCE) is a well-established assessment method that can be applied to the clinical psychology training context. (2) Four OSCE applied to clinical psychology training programs in Australia are described. (3) Seven tips are offered to promote best practice in the assessment of clinical competencies using OSCE.

Online social networking interventions have potential to support young people who experience suicidal thoughts by specifically addressing interpersonal risk factors for suicide, but may also pose a risk of harm. This uncontrolled, single-group pilot study aimed to evaluate the safety, feasibility, and acceptability of an enhanced online social networking intervention (&ldquo, Affinity&rdquo, ) among a sample of young people who experienced active suicidal ideation, and to explore potential changes in clinical outcomes and the therapeutic targets of the intervention. Twenty young people with current or recent suicidal ideation who were receiving treatment for depression at a tertiary-level mental health service were given access to Affinity for two months. Participants were assessed at baseline and 8-week follow-up, 90 percent reported clinical suicidal ideation at baseline. A priori criteria related to feasibility, safety and acceptability were satisfied. In terms of potential clinical effects, significant and reliable pre-post improvements were found on self-report outcomes including suicidal ideation. This study provides initial world-first evidence to support the use of an online intervention incorporating social networking as an adjunct to treatment for young people who experience suicidal ideation. The effectiveness of Affinity needs to be evaluated in a randomised controlled trial.

Evidence‐based psychological treatments for trichotillomania (TTM) can be effective; however, relapse is common and consumers have indicated poor satisfaction with treatment outcomes. The aim of this study was to identify participants' perspectives of critical factors associated with short‐ and long‐term recovery following their brief, intensive peer‐support retreat for TTM. A mixed methods longitudinal design was used to evaluate a 3‐day residential peer‐support retreat attended by eight women who self‐referred into the retreat. Semi‐structured interviews were conducted at post‐retreat (n = 6) and 12‐month follow‐up (n = 5). Self‐report measures of symptom severity, mood and quality of life were completed at baseline (n = 7), post‐retreat (n = 6), 6‐month follow‐up (n = 5) and 12‐month follow‐up (n = 5). An inductive thematic analysis was performed to identify themes within the interview transcripts. Quantitative outcome data was used to confirm, challenge, provide context for, and link qualitative findings within the broader literature. Quantitative outcome data demonstrated reduced TTM severity from baseline to post‐retreat. By 6‐month follow‐up, symptoms had relapsed to baseline levels. Participants' perspectives of factors associated with recovery immediately after the retreat included group‐based processes (e.g., sharing, normalisation, safety, and enhanced motivation/accountability) and individual processes (e.g., readiness for change, self‐regulation skills). The qualitative and quantitative data conveyed similar outcomes at both post‐retreat and 12‐month follow‐up. Brief, immersive peer‐support retreats for TTM may facilitate equivalent symptom reductions as longer, therapist‐delivered cognitive behavioural treatments for some individuals.

Objective The role of emotion regulation (ER) has been receiving increased attention in relation to various forms of psychopathology including hoarding disorder (HD). However, questionnaire designs are limited to finding associations of ER with symptoms or symptom groups, without finding out how such constructs might be involved in the disorder. Methods This study was a qualitative investigation of ER in a clinical HD sample (N = 11). Results Prominent themes provided support for ER difficulties in hoarding. In particular, difficulties with identifying and describing feelings, unhelpful attitudes toward the emotional experience, the use of avoidance-based strategies, and a perceived lack of effective ER strategies were prominent themes. Furthermore, emotional factors were identified as being associated with the onset and/or exacerbation of hoarding behavior, and possessions and acquiring behavior appeared to serve an ER function. Conclusion The current paper provides a nuanced account of the role of ER in hoarding difficulties.

Suicide is a major public health problem and is the second leading cause of death in young people worldwide. Indicating a lack of adequate treatment approaches, recent data suggest a rising suicide rate. Current approaches to suicide prevention do not sufficiently account for the specific needs of young people or the ways in which they engage with the health system, nor are they adequately theory-driven. In this paper, we review an empirically-supported theoretical model of suicide together with the latest evidence in treating young people who are at risk. We discuss the potential efficacy of social-media-based online interventions, with a particular focus on how they may be uniquely placed to target interpersonal risk factors for suicide. We highlight the risks associated with such interventions, including the potential for contagion to occur. Based on prominent theoretical models and gaps in existing treatment approaches, we propose a newly-developed, theory-driven, online social-networking-based intervention for suicide prevention in young people.

Trichotillomania (TTM) is postulated to be a disorder in which both impulsivity, motivated by reward, and compulsivity, motivated by punishment, contribute equally. Three separate studies were conducted to measure response to reward and punishment within the context of the reinforcement sensitivity theory of personality to examine whether hair-pulling behaviours could be predicted by sensitivity to reward and/or punishment. For study 1, a MANOVA was conducted to identify differences in sensitivity to reward and punishment in a cohort recruited via the internet, with hair-pulling symptoms (n = 89) and without symptoms (n = 206). For study 2, a stepwise discriminate function analysis was conducted to assess whether sensitivity to reward and punishment, along with anxiety and depression could predict group membership (in n = 25 individuals with hair-pulling symptoms and n = 25 without symptoms). Study 3 attempted to replicate the results of study 2 in a cohort of individuals who met clinical diagnostic criteria for trichotillomania (n = 22) and healthy controls (n = 22). It was concluded that both sensitivity to reward and sensitivity to punishment drive the motivation for hair-pulling in non-clinical samples. When participants met diagnostic criteria for TTM, depression and sensitivity to punishment became more important.

Hoarding disorder is a disabling condition associated with significant health risks, and social, occupational, and economic impairment. While the cognitive-behavioral model of compulsive hoarding has been successful in explaining the phenomenology of hoarding, recent research has suggested emotion regulation (ER) might play an important role in driving hoarding symptoms. To investigate this notion, two non-clinical questionnaire studies were conducted. In Study 1 (N = 199; M age = 28.43; SD = 11.42), it was found that ER difficulties and impulsivity were significantly associated with hoarding symptoms and beliefs, and significantly predicted difficulty discarding, acquisition, and total hoarding symptoms, even after controlling for relevant covariates (i.e., general depressive and non-hoarding obsessive-compulsive symptoms). The ER-hoarding relationship was partially mediated by beliefs regarding emotional attachment to possessions. Study 2 largely replicated the findings of Study 1 in an independent non-clinical study (N = 178; M age = 25.06; SD = 10.05). In addition to generally replicating the earlier findings, it was additionally found that while the use of cognitive reappraisal and expressive suppression strategies were not significantly associated with hoarding symptoms, experiential avoidance and alexithymia were both significantly associated with hoarding symptoms and beliefs, and significantly predicted hoarding symptoms after controlling for covariates. Implications are discussed.

Hair-pulling disorder (HPD) or Trichotillomania is a complex disorder with frequent relapses. Avoidance has been highlighted as an important behavioural feature in HPD. To improve our understanding of avoidance, two studies were conducted to identify the types of avoidance that may be experienced by those who pull hair. Internet questionnaires were used to collect data. Data from study one was split into two subsets. An exploratory factor analysis was conducted to identify the different types of avoidance experienced by those reporting symptoms of hair pulling (subset one, n = 278), followed by a confirmatory factor analysis (subset two, n = 295). In study two a MANOVA was conducted (n = 300) to examine whether levels of avoidance differed between controls and those with hair pulling symptoms. Participants with hair pulling symptoms had greater levels of avoidance on each of the five types: 'Avoidance of non-social goals', 'Self-concealment', 'Behavioural social avoidance', 'Avoidance of relationship problem solving' and 'Avoidance of thinking about the future'. These data expand on the current literature, which has predominantly focused on experiential avoidance. Future research will need to validate these findings in a clinical group.

Mixed findings regarding the long-term efficacy of cognitive behavior therapy (CBT) for the treatment of hoarding has led to the investigation of novel treatment approaches. “Blended” therapy, a combination of face-to-face (f2f) and online therapy, is a form of therapy that enables longer exposure to therapy in a cost-effective and accessible format. Blended therapy holds many benefits, including increased access to content, lower time commitment for clinicians, and lower costs. The aim of the present study was to develop and evaluate a “blended” treatment program for hoarding disorder (HoPE), involving 12-weeks of face-to-face group therapy, and an 8 week online therapist assisted program. A sample of 12 participants with hoarding symptomology were recruited from the Melbourne Metropolitan area, and were involved in one of two conditions; 12 weeks group therapy +8 weeks online therapy (bCBT) or 12 weeks group therapy +8 weeks waitlist +8 weeks online therapy. Questionnaires were completed at all time points. The 8-week online component consists of 8 CBT-based modules, addressing psychoeducation, goal setting, motivation, relapse prevention and other key components. No significant differences were found over time between the bCBT group and waitlist control group, however trends suggested continued improvement in overall hoarding scores for the bCBT group, when compared to the waitlist control group. There were significant differences in scores from pre-treatment to 28 weeks, suggesting that all participants who were involved in the online intervention showed continued improvement from pre-treatment to post-treatment. This study highlights the potential benefit of novel formats of treatment. Future research into the efficacy of blended therapy would prove beneficial., Highlights • The study aimed to develop and evaluate a ‘blended’ treatment program for hoarding disorder (HoPE), consisting of 12-weeks of GCBT and an 8 week online component. • Results showed significant decreases in overall hoarding severity for all participants involved in blended program • No significant differences between bCBT and waitlist control, however, bCBT group demonstrated trends suggesting continued improvement • This study highlights the potential benefit of novel formats of treatment

Trichotillomania (hair pulling disorder; HPD) is associated with high rates of comorbidity, functional impairment, shame, and isolation. Many people with HPD rarely discuss their condition with others, and in turn, can avoid seeking face-to-face treatment. Internet-delivered cognitive-behavioural therapy (iCBT) has significant potential to provide effective and accessible treatment. However, poor engagement with iCBT is a common limitation, leading to calls for collaboration between program developers and consumers to ensure a user-centered design. The current study explored the needs and preferences for an iCBT program for HPD using an online survey. Participants were 111 adults (Mage = 31.57, SD = 9.09; 97.3% female) with self-reported HPD symptoms. The majority of participants reported a preference for a 6–10 week therapist-assisted program that encourages active engagement, provides personalised feedback, and features the capacity for self-monitoring. Psychoeducation and strategies for coping with distressing emotions and hairpulling urges, support with identifying triggers, and changing negative self-talk were also desired. Relationships between iCBT uptake barriers and participant characteristics were also explored. Overall, the findings suggest that adults with HPD symptoms are accepting of iCBT programs and have specific preferences and expectations for such interventions. Recommendations for co-design and development of internet interventions for HPD are discussed.

Although not recognized as a discrete psychiatric disorder, compulsive buying (CB) is a widespread psychological problem characterized by a preoccupation with shopping and impulses to purchase that are experienced as irresistible and chronic, leading to distress and significant impairment. Social psychological frameworks for CB highlight the link between CB and materialistic value endorsement and individuals’ motives to compensate for a perceived deficiency in self-concept. Alternatively, cognitive frameworks for CB focus on the role of beliefs about possessions (e.g. perceiving goods as “essential” and “unique,” and buying opportunities as “occasions not to be missed”) in order to explain CB. Both models also strongly implicate the role of mood in CB phenomena. Strong links have been found between materialism, mood, and CB. The relevance of self and cognitions to CB has also been supported, albeit fewer studies have examined such links.

Objectives: Existing models of trichotillomania (TTM; hair pulling disorder) rely heavily on a biological predisposition or biological pathogenesis of the disorder, but fail to capture the specific neuropsychological mechanisms involved. The present systematic review aims to scope existing neuropsychological studies of TTM to explore gaps in current models. Methods: A systematic literature search was conducted to detect all published primary studies using neuropsychological and neuroimaging measures in a cohort of individuals experiencing TTM. Studies addressing neuropsychological function were divided into domains. Findings from imaging studies were considered within brain regions and across methodology. Results: Thirty studies with a combined 591 participants with TTM, 372 healthy controls and 225 participants in other types of control group were included. Sixteen studies investigated neuropsychological parameters, and 14 studies pursued neuroimaging technologies. Available studies that used neuropsychological assessments and reported a statistically significant difference between those with TTM and controls ranged in effect size from 0.25 to 1.58. All domains except verbal ability and visual ability reported a deficit. In neuroimaging studies, several structural and functional brain changes were reported that might be of significance to TTM. Only tentative conclusions can be made due to the use of multiple methodologies across studies, a major limitation to meaningful interpretations. Conclusions: Positive neuropsychological and neuroimaging results require replication, preferably with multi-site studies using standardized methodology. Increased standardized testing and analyses across the literature, as a whole, would improve the utility and interpretability of knowledge in this field. (JINS, 2018, 24, 188–205)

Background Trichotillomania (hair-pulling disorder) is a debilitating and distressing disorder associated with great secrecy and shame. A lack of understanding regarding interventions for Trichotillomania contributes to poor routine outcomes for the disorder. Method This systematic review and meta-analysis assessed the efficacy of behaviourally based psychological interventions and pharmacological interventions for trichotillomania compared to a range of control groups. Participants were adults who have been diagnosed with trichotillomania. A systematic search was conducted of the Cochrane library, EBSCOhost, MEDLINE before 1966, and Google Scholar for relevant randomised controlled trials. Results Of the total 462 records identified, 12 studies were included in the quantitative synthesis, and nine studies were included in meta-analyses. Conclusions Analyses revealed that—from medication approaches—fluoxetine was not found to be efficacious. However, N-acetyl cysteine, clomipramine, and olanzapine showed potential for the treatment of trichotillomania. Regarding psychotherapy, behaviour therapy showed superior efficacy when compared to a passive control group. However, when behaviour therapy was compared to an active control group (progressive muscle relaxation, supportive therapy), both conditions showed similar efficacy in treating trichotillomania. It was concluded that the psychological mechanisms in trichotillomania may be more complex than the behavioural model indicates. Implications and limitations are discussed.

Emotion regulation difficulties in trichotillomania (TTM) have been documented in past studies. However, the potential conflation of relationships due to comorbid affective symptoms means that the relationship between TTM symptoms and emotion regulation constructs requires further investigation. In addition, the relationship between different hair pulling styles (focused vs. automatic) and emotion regulation constructs has received only limited empirical attention. This study investigated relationships between emotion regulation constructs and TTM, controlling for depression, in 20 adults with self-reported TTM symptoms compared to 43 non-symptomatic participants. All participants completed structured clinical interviews. The results revealed that individuals who endorsed TTM symptoms had significantly more difficulties regulating emotions and poorer distress tolerance compared to the non-symptomatic group, even after controlling for depression. While automatic hair-pulling was not associated with any emotion regulation constructs, focused hair-pulling yielded moderate-to-strong significant correlations with several emotion regulation facets. These findings support suggestions that emotion dysregulation is core to the phenomenology of TTM (specifically, the focused hair-pulling style) and is not simply a result of comorbid depression. Future research is required to examine the impact of comorbid depression on treatment outcomes, and to determine the clinical utility of differentiating between focused and automatic hair-pulling styles.

The study aim was to test whether a 12-week publically rebated group programme, based upon Steketee and Frost's Cognitive Behavioural Therapy-based hoarding treatment, would be efficacious in a community-based setting. Over a 3-year period, 77 participants with clinically significant hoarding were recruited into 12 group programmes. All completed treatment; however, as this was a community-based naturalistic study, only 41 completed the post-treatment assessment. Treatment included psychoeducation about hoarding, skills training for organization and decision making, direct in-session exposure to sorting and discarding, and cognitive and behavioural techniques to support out-of-session sorting and discarding, and nonacquiring. Self-report measures used to assess treatment effect were the Savings Inventory—Revised (SI-R), Savings Cognition Inventory, and the Depression, Anxiety and Stress Scales. Pre-post analyses indicated that after 12 weeks of treatment, hoarding symptoms as measured on the SI-R had reduced significantly, with large effect sizes reported in total and across all subscales. Moderate effect sizes were also reported for hoarding-related beliefs (emotional attachment and responsibility) and depressive symptoms. Of the 41 participants who completed post-treatment questionnaires, 14 (34%) were conservatively calculated to have clinically significant change, which is considerable given the brevity of the programme judged against the typical length of the disorder. The main limitation of the study was the moderate assessment completion rate, given its naturalistic setting. This study demonstrated that a 12-week group treatment for hoarding disorders was effective in reducing hoarding and depressive symptoms in an Australian clinical cohort and provides evidence for use of this treatment approach in a community setting. Copyright © 2016 John Wiley & Sons, Ltd. Key Practitioner Message A 12-week group programme delivered in a community setting was effective for helping with hoarding symptoms with a large effect size. Hoarding beliefs (emotional attachment and responsibility) and depression were reduced, with moderate effect sizes. A third of all participants who completed post-treatment questionnaires experienced clinically significant change. Suggests that hoarding CBT treatment can be effectively translated into real-world settings and into a brief 12-session format, albeit the study had a moderate assessment completion rate.

Difficulties in cognitive flexibility-the ability to adapt effectively to changes in the environment and/or changing task demands-have been reported in anorexia nervosa (AN). However, findings are inconsistent across studies and it remains unclear which specific aspects of cognitive flexibility patients with AN may struggle with. This systematic review aimed to synthesise existing research on cognitive flexibility in AN and clarify differences between patients with acute AN, patients who are weight-restored and patients who are fully recovered from AN. Electronic databases were searched through to January 2020. 3,310 papers were screened and 70 papers were included in the final review. Although adults with acute AN performed worse in perceptual flexibility tasks and self-report measures compared to HCs, they did not exhibit deficits across all domains of cognitive flexibility. Adolescents with acute AN did not differ to HCs in performance on neurocognitive tasks despite self-reporting poorer cognitive flexibility. Overall, significant differences in cognitive flexibility between acute and recovered participants was not evident, though, the findings are limited by a modest number of studies. Recovered participants performed poorer than HCs in some neurocognitive measures, however, results were inconsistent across studies. These results have implications for the assessment of cognitive flexibility in AN and targeted treatment approaches.

Background and objectives Following observations in the literature that obsessions often contain or imply negative evaluative information about the self, Aardema et al. (2013) recently developed a measure of feared-self relevant to OCD. The current study aimed to provide further examination of the relevance of such feared self-beliefs to obsessive compulsive processes – in particular whether they partially underlie doubt in OCD-relevant situations. Method Nonclinical participants (N = 463; 291 females; M age = 25.17, SD = 7.47), were presented with three vignettes, related to washing, checking and non-OCD relevant themes, which assessed doubt through providing alternating sensory and possibility-based information. Results Higher levels of OCD symptoms and feared-self beliefs both significantly predicted both higher baseline levels of doubt and greater fluctuation in levels of doubt in both the contamination and checking scenarios, and to a much lesser extent in the control scenario. Feared-self beliefs did not predict fluctuation in doubt over-and-above OCD symptoms, consistent with a mediation model. Limitations The main limitation was the use of a non-clinical sample, although this allowed sufficient participant numbers to test hypotheses. Conclusions The findings provided further experimental support for reasoning processes in OCD, and suggested that feared self-beliefs may make individuals vulnerable to experiencing doubt. Additionally, these results suggested that individuals with high OCD symptoms and those with high feared self-beliefs are unable to recognise the improbable nature of possibility-based statements. Implications for treatment and theory are discussed.

The literature concerning obsessive-compulsive disorder (OCD) indicates that obsessions frequently imply negative evaluative beliefs regarding the self. The construct of the feared self has been used to describe the set of harmful attributes an individual worries they may possess. This study aimed to partially replicate previous research that demonstrated a relationship between feared-self beliefs and obsessional doubt in OCD-relevant contexts. The relationship between perceptions of personal responsibility and associated levels of doubt was also examined. Nonclinical participants (N = 221; 155 female; Mage = 26.4, SD = 9.2) were presented with vignettes related to checking and non OCD-relevant themes, which quantified doubt through the presentation of alternating reality-based (i.e., sensory) and possibility-based information. Of the total sample, 112 participants were randomly allocated to a personally relevant condition (in which the action implied in the vignettes was completed by the reader), and 109...

Trichotillomania (TTM) is characterised by the removal of one's hair, causing hair loss. Phenomenological research on TTM has investigated its associated behavioural and affective factors. Few studies have investigated the possible role of cognitions and beliefs, despite emerging support for cognitive therapies in treating this disorder. This study aimed to explore and describe the cognitions and beliefs that contribute to the onset and maintenance of hairpulling in TTM. Eight women with TTM participated in semi-structured, in-depth interviews to explore their experience of cognitions and beliefs before, during and after typical hairpulling episodes. Interviews were analysed using the qualitative method of Interpretative Phenomenological Analysis. Six superordinate themes of beliefs were identified as important: negative self-beliefs, control beliefs, beliefs about coping, beliefs about negative emotions, permission-giving beliefs, and perfectionism. These preliminary findings suggest that cognitions may play an important role in TTM phenomenology. Future quantitative research on the role of cognitions and beliefs in TTM in larger samples has the potential to advance cognitive-behavioural models and treatments of this poorly understood disorder.

This study aimed to test which particular facets of emotion regulation (ER) are most linked to symptoms of hoarding disorder, and whether beliefs about emotional attachment to possessions (EA) mediate this relationship. A non-clinical sample of 150 participants (108 females) completed questionnaires of emotional tolerance (distress tolerance, anxiety sensitivity, negative urgency - impulsivity when experiencing negative emotions), depressed mood, hoarding, and beliefs about emotional attachment to possessions. While all emotional tolerance measures related to hoarding, when considered together and controlling for depression and age, anxiety sensitivity and urgency were the significant predictors. Anxiety sensitivity was fully mediated, and urgency partially mediated, via beliefs regarding emotional attachment to possessions. These findings provide further support for (1) the importance of anxiety sensitivity and negative urgency for hoarding symptoms, and (2) the view that individuals with HD symptoms may rely on items for emotion regulation, leading to stronger beliefs that items are integral to emotional wellbeing.

In a recent study conducted at Swinburne University of Technology, researchers examined the challenges involved in coordinating, undertaking, and supervising clinical psychology placements within V...

The most recent DSM saw a reclassification of obsessive-compulsive disorder (OCD) as the prototypical disorder within a separate grouping that also includes hoarding disorder, body dysmorphic disorder (BDD), trichotillomania (TTM; hair pulling disorder), and skin-picking disorder (American Psychiatric Association [APA], 2013). This followed a long-standing debate over whether there is a spectrum of disorders sharing etiological underpinnings or phenomenology with OCD (Abramowitz, McKay, & Taylor, 2011; Moulding, Nedeljkovic, & Kyrios, 2011). While much research has highlighted the role of self in the symptomatology and treatment of OCD per se (see Ahern & Kyrios, Chapter 12 in this volume; Aardema et al., 2013; Bhar & Kyrios, 2007; Doron, Moulding, Kyrios, & Nedeljkovic, 2008; Moulding, Aardema, & O'Connor, 2014), less has considered the role of selfin the OCD spectrum. This chapter aims to address this gap - specifically with reference to hoarding disorder, BDD, and TTM.

Objectives. Obsessive compulsive disorder (OCD) is one of the most disabling and highly prevalent anxiety disorders (ADs). Current cognitive models of OCD implicate views about the self and world in the maintenance of the disorder. However, little research has focused on issues that may lead to vulnerability to such views. In particular, a person's attachment insecurities (attachment anxiety, avoidance) may be important risk factors increasing the likelihood of such non-adaptive perceptions (Doron & Kyrios, 2005). Design. Participants meeting criteria for OCD were compared with cohorts meeting criteria for other ADs and healthy controls on a range of measures including adult attachment, OC symptoms, cognitions, and mood. Methods. Diagnosis of the clinical groups was established using the Anxiety Disorders Interview Schedule for DSM-IV (Brown, Di Nardo, & Barlow, 1994). The clinical relevance of attachment insecurities was ascertained by comparing their prevalence in an OCD sample (N= 30), an ADs sample (N= 20), and a community sample (N= 32). Results. Attachment anxiety was significantly higher in individuals with OCD, even when controlling for depression. Conclusions. Addressing attachment anxiety in individuals presenting with OCD may be important for enhancing therapeutic outcomes. However, findings are based on cross-sectional data that preclude conclusions relating to causal influence.

Previous research has suggested that individuals with OCD show compromised performance on tests assessing visuospatial and executive processes. This study aimed to further examine such findings by investigating the relationship between OCD symptom improvement following cognitive-behavioral therapy and changes in neuropsychological performance in individuals with OCD (n = 26), compared to test-retest control participants (n = 10). Successful treatment of OCD led to improvements relative to the control group on neuropsychological tasks measuring spatial working memory. Neuroscientific models of OCD consider such findings to be consistent with possible cortical dysfunction in OCD. However, a significant limitation of the study is in its inability to discount alternative explanations for this finding, such as the influence of changes in beliefs. Implications are discussed.

Background: Cognitive models of body dysmorphic disorder (BDD) suggest that beliefs and evaluations related to self-concept are central to the maintenance of the disorder, but such beliefs have received little empirical attention. This study examined the relative importance of contingent self-worth and self-ambivalence to BDD symptoms in comparison to their importance to obsessive–compulsive disorder and social phobia symptoms. Method: The sample comprised 194 non-clinical participants (female, N = 148; males, N = 46) with a mean age of 24.70 years (standard deviation = 9.34). Participants were asked to complete a battery of self-report questionnaires. Results: While significant relationships were found between the self-beliefs and symptoms of all three disorders, some specificity was found in the relationships. Conclusions: Self-worth based upon appearance was most important in BDD, while contingent self-worth based on the approval of others was important in social phobia. Self-ambivalence was associated with each disorder. Implications and limitations are discussed.

Generalised anxiety disorder (GAD) is the most significant and common of the anxiety disorders. Intolerance of uncertainty (IU) and negative metacognitive beliefs are two prominent cognitive factors in models of GAD, however only one study to date has examined the relative contribution of these factors. Therefore, this study aimed to investigate and compare these cognitive factors in their prediction of GAD symptoms, and also to examine possible developmental influences on GAD by examining the link between symptoms and the parentification style of childrearing. In this analogue study, 119 non-clinical participants (M age 22.90 years; 95 females, 24 males) completed measures of these constructs. Results indicated that both IU and negative beliefs about worry significantly related to GAD symptoms, however, the degree to which they predicted GAD symptoms did not significantly differ. Although a weak but significant relationship was found between parentification and GAD, this relationship did not remain significant after controlling for depression. Implications and limitations are discussed.

Obsessive-compulsive disorder (OCD) is one of the most disabling and highly prevalent anxiety disorders. Cognitive models implicate maladaptive beliefs such as inflated sense of responsibility, perfectionism, importance/control of thoughts in the maintenance of the disorder, but little research has investigated factors that may lead to these beliefs. This paper investigated whether a dysfunctional attachment system may be one such factor, by examining how adult attachment orientations (dimensions of attachment anxiety and avoidance) relate to OCD-related cognitions, OCD symptoms, and depression. Using structural equation modeling in a student sample (N = 446), the present study found evidence for a mediational model, where attachment dimensions contributed to OCD symptoms via OCD-related cognitions, while controlling for depression. The paper discusses the association between adult attachment orientations and OCD symptoms in the context of current cognitive-behavioral theories of OCD.

Although control-related cognitions have often been implicated in discussions of obsessive compulsive disorder (OCD), empirical investigations of the relationship between control constructs and OCD symptoms have been relatively limited. This article investigated the hypothesis that OCD symptoms may be linked with a higher desire for control (DC), but a lower sense of control (SC) over the self and environment, leading to motivation for compulsive symptoms. It also investigated whether this effect was direct, or mediated through other OCD-related cognitions. This hypothesis was investigated in a nonclinical population, using path analyses controlling for depression. It was found that higher levels of DC and lower levels of SC were associated with higher levels of OCD-related beliefs, and with symptoms via higher OCD-related beliefs. SC was also directly linked with higher OCD symptoms. Control beliefs regarding both the internal (emotions) and external (threat) environment were related to OCD symptoms. Implications for therapy and research are discussed.

Research in non-clinical samples has suggested that control beliefs, specifically desire for control and sense of control, may play a role in Obsessive--Compulsive Disorder. The present study extends a previous research design to clinical participants [Moulding, R., Kyrios, M., & Doron, G. (2007). Obsessive-compulsive behaviours in specific situations: The relative influence of appraisals of control, responsibility and threat. Behaviour Research and Therapy, 45, 1693-1702]. In this study, clinical participants with OCD-checking symptoms (n=16), anxiety disorders (n=17) and community controls (n=27) were presented with four hypothetical scenarios. Using a manipulation paradigm, the relationship between control appraisals and other OCD-relevant constructs (threat, responsibility) was examined. As in the non-clinical study, desire for control was moderately affected by responsibility and threat manipulations, while sense of control was not affected by these manipulations. Individuals with OCD recorded higher desire for control and lower sense of control relative to community controls, and a higher desire for control than the anxiety group, suggesting some specificity to OCD. A possible interactive model of control, threat and responsibility is discussed.

Previous studies have implicated beliefs about one's memory (i.e., meta-memory), in maintaining the symptoms of obsessive–compulsive disorder (OCD), particularly with respect to checking rituals. However, most research has focused on task- or situation-specific perceptions about memory performance. Expanding on this research, we undertook two studies with analogue and clinical cohorts to examine the relationship between general ‘trait’ beliefs about memory and related processes and OCD symptoms. Trait meta-memory as measured in the current study was conceptualised as a multi-dimensional construct encompassing a range of beliefs about memory and related processes including confidence in one's general memory abilities, decision-making abilities, concentration and attention, as well as perfectionistic standards regarding one's memory. Meta-memory factors were associated with OCD symptoms, predicting OCD symptoms over-and-above mood and other OCD-relevant cognitions. Meta-memory factors were found to be particularly relevant to checking symptoms. Implications for theory and research are discussed.

Cognitive-behavioral models of obsessive-compulsive disorder (OCD) assign a central role to specific beliefs and coping strategies in the development, maintenance and exacerbation of obsessive-compulsive (OC) symptoms. These models also implicate perceptions of self and the world in the development and maintenance of OC phenomena (e.g., overestimation of threat, sociotropy, ambivalent or sensitive sense of self, looming vulnerability), although such self and world domains have not always been emphasized in recent research. Following recent recommendations (Doron & Kyrios, 2005), the present study undertook a multifaceted investigation of self and world perceptions in a nonclinical sample, using a coherent worldview framework (Janoff-Bulman, 1989, 1991). Beliefs regarding the self and the world were found to predict OC symptom severity over and above beliefs outlined in traditional cognitive-behavioral models of OCD. Self and world beliefs were also related to other OC-relevant beliefs. Implications of these findings for theory and treatment of OCD are discussed. Keywords: cognitive theory; obsessive compulsive disorder; cognition; self; worldview; internal representations Cognitive theory associates vulnerability to psychopathology with the tendency to misappraise situations or events. Such misappraisals are predicated on the enduring and maladaptive nature of individuals' cognitive-affective structures, or schemas. For instance, while Beck (1976) described depression as resulting from a triad of negative views of self, the world, and the future, others have invoked terms such as "internal working models" of self and other and assumptions about the world in their explanations of a range of disorders (e.g., Bowlby, 1973; Guidano & Liotti, 1983; Janoff-Bulman, 1991). However, few researchers have investigated the relationship between such broad structures and beliefs and vulnerability to the symptoms of obsessive-compulsive disorder (OCD; e.g., Bhar & Kyrios, 2000; Guidano & Liotti, 1983; Sookman, Pinard, & Beauchemin, 1994). OCD is one of the most incapacitating of the anxiety disorders (World Health Organization, 1996). It is characterized by the occurrence of unwanted and disturbing intrusive thoughts, images, or impulses (obsessions) and compulsive acts/rituals aimed at reducing distress or preventing feared events from occurring (American Psychiatric Association, 1994). Cognitive-behavioral models are based on findings that clinical and nonclinical populations experience similar intrusive thoughts, images, or urges and associated cognitions (de Silva & Rachman, 1998; Salkovskis, 1985). While nonclinical populations experience intrusions, people presenting with OCD display extreme reactions to such intrusions resulting in obsessive-compulsive (OC) symptoms. Such extreme reactions are associated with a range of dysfunctional beliefs and maladaptive appraisals that also lead to ineffective strategies in the management of intrusions. Cognitive-behavioral research by the Obsessive Compulsive Cognitions Working Group (OCCWG, 1997) has focused on six main belief domains underlying these appraisals: responsibility, overimportance of thoughts, the need to control thoughts, overestimation of threat, intolerance for uncertainty, and perfectionism. These beliefs have been found to be associated with OCD, although a considerable amount of the variance of OCD symptoms remains unexplained (e.g., OCCWG, 2005; for reviews, see Clark, 2004; Frost & Steketee, 2002). Implicit within these OC-relevant cognitive domains are beliefs about one's surrounding world (e.g., possible presence of danger) and about oneself (e.g., being personally responsible for preventing harm). A variety of variables related to self and worldviews have been linked with OC phenomena (e.g., sensitive sense of self, ambivalent sense of self, and magical thinking). However, a systematic examination of such self and worldview constructs in OCD is yet to be undertaken. …

Obsessive-compulsive disorder is a highly disabling anxiety disorder, characterized by occurrence of intrusive and unwanted thoughts (obsessions), which lead to performance of repetitive compulsions and/or rituals in order to reduce distress. Recently, it has been proposed that obsessions may be divided into two categories, termed autogenous and reactive obsessions [Lee, H.-J., & Kwon, S.-M. (2003). Two different types of obsessions: autogenous obsessions and reactive obsessions. Behavior Research and Therapy, 41, 11-29]. In this study, we aimed to further validate this subtyping of obsessions, and to investigate the cognitive and emotional correlates of the subtypes. Evidence was found for the division, using a confirmatory factor analysis in an analogue sample (N=372). It was found that frequency of reactive obsessions related more strongly to distress caused by overt OC symptoms (e.g., washing, checking), whereas frequency of autogenous obsessions related to distress from impulses of harm. Compared to autogenous obsessions, frequency of reactive obsessions correlated more strongly with all OC-related beliefs. Few differences were found between autogenous and reactive obsessions with respect to depression, anxiety, and view about self (self-ambivalence, self-esteem). It is suggested that existing OC-belief measures are more relevant to reactive obsessions. Implications for theory and treatment are discussed.

This chapter discusses the cross-cultural understanding of the obsessive compulsive and spectrum disorders. Epidemiological studies suggest a reasonably consistent prevalence of OCD around the world. The role of other culturally influenced factors in the presentation of OCD is also considered (i.e., religiosity, superstition, and beliefs), with religion considered particularly important in the presentation of OCD, although not in its prevalence per se. Treatment effect sizes across countries and within minority cultures from Western countries are outlined. The influence of cultural factors on help-seeking behaviors, assessment, misdiagnosis, and treatment are considered. Limitations of the literature base are discussed, particularly the lack of non-Western studies of treatment effects, and the low evidence base for the spectrum disorders.

The role of meta-memory and meta-cognition in obsessive-compulsive disorder (OCD) symptoms and checking was examined in a student sample, using the memory and cognitive confidence scale (MACCS; Nedeljkovic, M., & Kyrios, M. (2007). Confidence in memory and other cognitive processes in obsessive-compulsive disorder. Behaviour Research and Therapy, 45, 2899-2914). Confirmatory factor analysis supported the MACCS's previously reported structure, and hierarchical regression supported its relationship to OCD symptom severity over-and-above depression and other OCD-related beliefs. Specifically, general confidence in memory was found to be a unique predictor of overall OCD severity. Implications for theory and research are discussed.

Aspects of self-concept have been implicated in recent cognitive theories of obsessive compulsive disorder (OCD). It has been proposed that OCD is associated with perceptions of incompetence in self-domains considered important by the individual. A previous study in nonclinical individuals found that such "sensitivity of self" in the areas of job competence, morality and social acceptability was associated with elevated OCD symptoms and related beliefs. This study examined whether self-sensitivity is related to higher OCD symptoms and cognitions in individuals with OCD, and whether such self-sensitivity is specific to OCD versus other anxiety disorders. Clinical samples with OCD (N=30), other anxiety disorders (N=20) and a community control sample (N=32) participated in the study. It was found that in the OCD group, sensitivity in moral domains, but not job competence or social acceptability, was associated with higher levels of OCD symptoms and OCD-related beliefs. Sensitivity in the domains of morality and job competence was found in the OCD cohort, whereas individuals with other anxiety disorders did not show such sensitivity, suggesting some specificity of relationships to OCD. Implications for theory and therapy are discussed.