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This study evaluated COVID-19-related intrusive thoughts and associated ritualistic behaviors (CITRB). From March to May 2020, 1,118 Chinese high school students, college students, psychiatric outpatients, and community members completed a survey assessing CITRB, generalized anxiety, depression, somatization, obsessive-compulsive symptoms, and pandemic-related disruptions. Overall, participants reported mild to moderate CITRB, although certain thoughts/behaviors were more frequently endorsed, such as repeatedly telling others to take precautions against COVID-19 and checking COVID-19-related news. Being male, younger, a health-care worker, or in isolation/quarantine was associated with CITRB severity in community members. Obsessive-compulsive symptom severity, depression, somatic symptoms, and anxiety were associated with CITRB severity, although only obsessive-compulsive symptoms were uniquely associated with CITRB. This study provided evidence for the construct of CITRB, which may help mental health providers identify the nature and sources of COVID-19-related distress for some individuals as well as serve as a framework for evaluating obsessive-compulsive symptoms specific to large-scale crises. [ABSTRACT FROM AUTHOR]

Irritability is a common, impairing transdiagnostic symptom in childhood psychopathology, though it has not been comprehensively studied in pediatric obsessive-compulsive disorder (OCD). Further, the central cognitive behavioral treatment component for OCD, exposure and response prevention therapy (ERP), has been recently proposed as a treatment for irritability. This study aimed to evaluate whether certain clinical characteristics are associated with irritability in pediatric OCD and whether irritability reduces following ERP. Participants were 161 youth (ages 7-17) with OCD and a caregiver participating in a randomized controlled trial of D-cycloserine or pill placebo augmented ERP. Participants completed validated assessments during treatment. Irritability was significantly and positively associated with depressive symptoms, defiance, functional impairment, and family accommodation, but was not associated with pretreatment OCD severity, symptom dimensions, obsessive beliefs. Irritability significantly declined following treatment, with over half of youth with any pretreatment irritability experiencing clinically significant change, though this change was not related to OCD improvement. Results suggest that irritability may be a marker of psychiatric comorbidity, parental accommodation, and impairment in youth with OCD. Implications for the exposure-based treatment of irritability are discussed. [ABSTRACT FROM AUTHOR]

Although cognitive behavioral therapy (CBT) is a highly effective treatment for individuals with obsessive-compulsive disorder (OCD), a portion people with OCD do not benefit fully from CBT due to ambivalence about participating in treatment, nonadherence to exposure exercises, and dropout. This paper reviews the promising evidence for motivational interviewing (MI) as a therapeutic approach that is well suited to address these issues and potentially improve treatment outcomes. It will also provide a discussion of MI processes that may enhance CBT for OCD which can foster a collaborative relationship that integrates a patient's own goals and values into exposure planning, helps resolve ambivalence or reluctance to engage in exposure exercises and builds and supports patients' intrinsic motivation to participate in treatment. The review will conclude with a case report describing the use of pre-CBT MI for an individual with OCD. [ABSTRACT FROM AUTHOR]

Violating expectancies during exposure therapy is proposed to promote inhibitory learning and improved treatment outcomes. Because people tend to overestimate how distressing emotionally challenging situations will be, violating expectations of distress may be an intuitive way to promote treatment outcome during exposure-based cognitive-behavioral therapy (CBT). This study evaluated overpredictions of distress during exposure tasks in 33 youth with obsessive-compulsive disorder (OCD; ages 8-17) participating in CBT. Youth with more variable prediction accuracy and a higher proportion of overpredictions experienced more rapid symptom reduction, b = −0.29, p =.002. Underpredictions were less common toward the end of therapy as youth experienced less severe OCD, b = 0.12, p=.001. Findings suggest that although youth often accurately predict the intensity of exposure, overpredictions are common as well. The frequency of these overpredictions promoted treatment outcome, supporting expectancy violations as one indicator of inhibitory learning during exposure therapy. [ABSTRACT FROM AUTHOR]

Introduction: Deep brain stimulation (DBS) has emerged as an effective treatment for patients with severe treatment-refractory obsessive-compulsive disorder (OCD). Over the past two decades, several clinical trials with multiple years of follow-up have shown that DBS offers long-term symptom relief for individuals with severe OCD, though a portion of patients do not achieve an adequate response. Areas covered: This review sought to summarize the literature on the efficacy and long-term effectiveness of DBS for OCD, and to identify strategies that have the potential to improve treatment outcomes. Expert opinion: Although this literature is just emerging, a small number of DBS enhancement strategies have shown promising initial results. More posterior targets along the striatal axis and at the bed nucleus of the stria terminalis appear to offer greater symptom relief than more anterior targets. Research is also beginning to demonstrate the feasibility of maximizing treatment outcomes with target selection based on neural activation patterns during symptom provocation and clinical presentation. Finally, integrating DBS with post-surgery exposure and response prevention therapy appears to be another promising approach. Definitive conclusions about these strategies are limited by a low number of studies with small sample sizes that will require multi-site replication. [ABSTRACT FROM AUTHOR]

Abstract A substantial portion of people with obsessive-compulsive disorder (OCD) do not fully respond to cognitive behavioral therapy (CBT), leading clinical researchers to investigate ways to improve this treatment. The present meta-analysis evaluated 25 randomized trials that compared standard CBT with CBT plus an augmentation strategy. The combination of CBT with d-cycloserine or serotonin reuptake inhibitors was not significantly more effective than CBT alone, g = 0.043, p =.65, and g = 0.11, p =.30, respectively. Two mindfulness-based augmentations of CBT were not found to be more effective than traditional CBT, g = −0.22, p =.57. Significant beneficial effects were found when CBT was integrated with specific psychosocial augmentations, including increasing family involvement in four studies, g = 0.60, p <.001, and incorporating motivational interviewing in three studies, g = 0.77, p <.001. These augmentations were most effective in studies with patients with more severe OCD, and when delivered as separate, independent therapeutic interventions. While promising, the findings for psychosocial augmentation are based on a small number of studies and should be replicated by larger trials. These results support continued investigation of novel behavioral strategies that may "enhance" CBT. Graphical abstract fx1 Highlights • Family involvement and motivational interviewing appear to improve CBT for OCD. • Psychopharmacologic drugs have not been shown to enhance CBT for OCD. • CBT augmentations appear most promising for those with more severe symptoms. • Augmentations to CBT are most effective when delivered as separate interventions. [ABSTRACT FROM AUTHOR]

Evidence suggests that depressive symptoms tend to improve concurrently with obsessive-compulsive disorder (OCD) symptoms during cognitive behavioral therapy (CBT), despite depression not being the primary target of intervention. Studies examining the temporal or mediational relationships of OCD and depressive symptoms have indicated a bidirectional relationship, as prior levels of OCD symptoms influenced subsequent levels of depression, and vice versa. Deep transcranial magnetic stimulation (dTMS) has recently emerged as a treatment option for OCD. Whether dTMS affects depression symptoms similarly to CBT remains to be examined. The current study employed a random intercept cross-lagged panel model (RI-CLPM) to examine the relationship of OCD and depression symptoms in 94 treatment refractory patients, undergoing dTMS or sham treatment. Both OCD and depression symptoms improved significantly. However, a stable, cross-lagged relationship between the variables was not supported. Changes in one symptom domain could not be used to predict the other. The present study was conducted in a treatment refractory population, meaning the present findings may not generalize to treatment naïve patients or those with less severe OCD symptoms. It is unclear whether the study was sufficiently powered to detect the effects of interest, and this concern also meant that examining the dTMS and sham groups independently was not feasible. When treating OCD with dTMS, depression symptoms appear likely to diminish but should be monitored throughout, and additional interventions applied if needed. • dTMS has recently emerged as a treatment option for OCD. • How dTMS for OCD impacts depression symptoms remains to be examined. • We used RI-CLPM to examine the relationship between OCD and depression during dTMS. • Both OCD and depression symptoms improved significantly. • A stable, cross-lagged relationship between the variables was not supported. [ABSTRACT FROM AUTHOR]

Cognitive behavioral therapy adapted for autistic youth with anxiety and/or OCD has a strong evidence base, but few have access. A 12-week family-based, Internet-delivered cognitive behavioral therapy (iCBT) program for 7-15 year-old autistic youth with anxiety and/or OCD was developed as a potential method to address this problem. Quantitative and qualitative feedback from stakeholders (parents, youth, clinicians) was gathered on an initial draft of content before conducting a pilot trial. This feedback suggested high quality, engagement, usability, and informativeness of the material. Suggestions were incorporated into the treatment program that was tested in a pilot trial. Eight families were randomized to the iCBT program with either 1) weekly email support or 2) weekly email support plus biweekly telehealth check-ins, and seven of these families completed pre- and post-treatment assessments. An average reduction of 39% in anxiety severity scores was found, with six of the seven being classified as responders. Preliminary evidence suggests that family-based iCBT is an acceptable and promising treatment for autistic youth with anxiety and/or obsessive-compulsive disorders that should be further modified and tested in future work. • Internet-delivered CBT was developed and revised with multiple rounds of stakeholder feedback. • Two iCBT formats were tested: one with weekly emails plus biweekly video calls; one with weekly emails only. • A 39% reduction in anxiety severity was observed among seven completers (55% in the video call condition; 22% in e-mail). • Six of seven completers were considered responders. • Therapists spent 12 min/week/family in the email condition and 28 min/week/family in the video call condition. [ABSTRACT FROM AUTHOR]

This study evaluated exposure therapy processes during symptom provocation in a randomized sham-controlled trial of deep transcranial magnetic stimulation (Deep TMS) for 99 adults with obsessive-compulsive disorder (OCD). The following factors were expected to lead to more symptom improvement, particularly in active relative to sham groups: 1) progression to more hierarchy items, 2) greater distress during provocations, 3) between-session habituation, and 4) variability in distress during provocations. Participants were randomized to six weeks of daily symptom provocation plus sham or active Deep TMS of the dorsal medial prefrontal cortex and anterior cingulate cortex. Obsessive-compulsive symptoms were assessed weekly and at four-week follow-up. No significant predictors were identified though increased distress moderated outcomes (b = −.041, p =.048); those who reported more distress during provocations had an improved active vs. sham response, though there was less of a difference between active and sham for those who reported less distress. Lack of an association between other exposure processes and treatment outcome may suggest differences between Deep TMS provocations and exposure exercises. • Higher distress during provocations corresponded with greater active vs. sham Deep TMS efficacy. • No exposure processes tested during Deep TMS provocations predicted improved symptom reduction. • Symptom provocations during Deep TMS for OCD appear distinct from exposure tasks. [ABSTRACT FROM AUTHOR]

The cognitive-behavioral model of obsessive-compulsive disorder, along with several contemporary theories, suggests that self-esteem is likely an important component of OCD psychopathology and treatment. Little research, however, has explored the association between self-esteem and OCD. The study of self-esteem is itself a complex pursuit. A comprehensive investigation of self-esteem requires consideration of state and trait aspects of this construct and a longitudinal perspective, particularly when self-esteem is studied during the course of psychological treatment. In this study, adults participating in psychological treatment for OCD provided repeated self-reports of self-esteem throughout the course of therapy. The aims of this study were to evaluate the relationship between self-esteem and severity of OCD and depressive symptoms; to examine whether temporal variability (i.e., fluctuation) in self-esteem was associated with symptom reduction; and to measure changes in self-esteem over time. Our results indicated the following: average self-esteem across treatment, variability in self-esteem, and depressive symptomatology were significantly correlated with post-treatment OCD severity; self-esteem did not affect the rate of OCD symptom change over treatment but did significantly affect the rate of depressive symptom change; self-esteem increased significantly before and after sessions, on average, and over the course of treatment. Implications and further directions are discussed. • Self-esteem increases between the beginning and end of sessions and across CBT-ERP treatment for OCD. • Improvements in self-esteem across CBT-ERP correspond with decreases in depressive symptoms. • Self-esteem and self-esteem variability correlate with OCD severity post-treatment. • Change in self-esteem does not predict rate of change in OCD symptoms during treatment. [ABSTRACT FROM AUTHOR]

Major depressive disorder (MDD) is common in youth and among the most frequent comorbid disorders in pediatric obsessive-compulsive disorder (OCD), but it is unclear whether the presence of OCD affects the symptom presentation of MDD in youth. A sample of youth with OCD and MDD (n = 124) and a sample of youth with MDD but no OCD (n = 673) completed the Patient Health Questionnaire for Adolescents (PHQ-A). The overall and symptom-level presentation of MDD were examined using group comparisons and network analysis. Youth with MDD and OCD, compared to those with MDD and no OCD, had more severe MDD (Cohen's d = 0.39) and more reported moderate to severe depression (75 % vs 61 %). When accounting for demographic variables and the overall severity of MDD, those with comorbid OCD reported lower levels of anhedonia and more severe difficulties with psychomotor retardation/agitation. No significant differences in the interconnections among symptoms emerged. Data were cross-sectional and self-reported, gold standard diagnostic tools were not used to assess OCD, and the sample size for the group with MDD and OCD was relatively small yielding low statistical power for network analysis. Youth with MDD and OCD have more severe MDD than those with MDD and no OCD and they experience more psychomotor issues and less anhedonia, which may relate to the behavioral activation characteristic of OCD. • Whether OCD affects the clinical presentation of youth depression is unknown. • We examined key features of depression in depressed youth with (n = 124) and without (n = 673) OCD. • Those with OCD had more severe depression. • Those with OCD had less anhedonia and more psychomotor difficulties. [ABSTRACT FROM AUTHOR]

• Providers report greater perceived feasibility delivering OCD treatment to individuals ages 13-to-65. • Treatment for OCD is perceived to have greater feasibility at lower-levels of symptom severity over telehealth compared to in-person delivery. • OCD providers repot greater ability to identify and address treatment interfering factors in-person relative to telehealth. Until recently, psychotherapies, including exposure and response prevention (ERP) for obsessive–compulsive disorder (OCD), have primarily been delivered in-person. The COVID-19 pandemic required OCD providers delivering ERP to quickly transition to telehealth services. While evidence supports telehealth ERP delivery, limited research has examined OCD provider perceptions about patient characteristics that are most appropriate for this modality, as well as provider abilities to identify and address factors interfering with effective telehealth ERP. In the present study, OCD therapists (N = 113) rated the feasibility of delivering telehealth ERP relative to in-person for different (1) patient age-groups, (2) levels of OCD severity, and (3) provider ability to identify and address factors interfering with ERP during in-person and telehealth ERP (e.g., cognitive avoidance, reassurance seeking, etc.). Providers reported significantly greater feasibility of delivering telehealth ERP to individuals ages 13-to-65-years relative to other age groups assessed. Greater perceived feasibility for telehealth relative to in-person ERP was reported for lower versus higher symptom severity levels. Lastly, providers felt better able to identify and address problematic factors in-person. These findings suggest that providers should practice appropriate caution when offering telehealth ERP for certain patients with OCD. Future research may examine how to address these potential limitations of telehealth ERP delivery. [ABSTRACT FROM AUTHOR]