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Evidence-based practice suggests that clinicians should integrate the best available research with clinical judgment and patient values. Treatment of religious patients with scrupulosity provides a paradigmatic example of such integration. The purpose of this study is to describe potential adaptations to make exposure and response prevention, the first-line treatment for obsessive-compulsive disorder, acceptable and consistent with the values of members of the Ultra-Orthodox Jewish community. We believe that understanding these challenges will enhance the clinician's ability to increase patient motivation and participation in therapy and thereby provide more effective treatment for these and other religious patients. Keywords: cognitive-behavioral therapy; evidence-based practice; obsessive-compulsive disorder; religion; scrupulosity; values

Two studies examined the psychometric properties of the Obsessive Compulsive Inventory--Revised (OCI-R; Psychol. Assessment 14 (2002) 485) in a nonclinical student sample. In Study 1, we investigated the factor structure and internal consistency of the OCI-R using a sample of 395 undergraduate students. At a second testing session 1 month later, 178 students completed the OCI-R. Test retest reliability was examined using data from 94 students who completed the OCI-R in both sessions. Convergent validity was also assessed with the Maudsley Obsessive--Compulsive Inventory (MOCI). In Study 2, we further investigated the convergent and divergent validity of the OCI-R using a new sample of 221 students who completed a battery of measures of obsessive--compulsive symptoms, worry, and depression. There was a significant order effect for both the OCI-R and the MOCI: means of each measure were significantly lower when presented second. Despite the order effect, statistical analyses indicated that the OCI-R has adequate test-retest reliability for the full scale and subscale scores, solid factor structure, and high internal consistency. Convergent validity with other measures of obsessive-compulsive symptoms was moderate to excellent, and divergent validity was good. The results indicate that the OCI-R is a short, psychometrically sound self-report measure of obsessive--compulsive symptoms. Keywords: OCI; OCD; Scale; Assessment; Nonclinical sample; Obsessive-compulsive

Objectives: We examined patterns in alliance development in cognitive behavioral therapy (CBT) for social anxiety disorder (SAD) compared to attention bias modification (ABM). We focused on the occurrence of sawtooth patterns (increases within‐ and decreases between‐sessions) and sudden gains and their association with outcome. Methods: Clients received CBT (n = 33) or ABM (n = 17). Client‐rated alliance was measured before and after each session. Self‐reported and clinician‐rated anxiety were measured weekly and monthly, respectively. Results: The alliance increased in CBT in a sawtooth pattern and did not change in ABM. When examining individual clients, sawtooths were more common in CBT (61% clients) than in ABM (6%) and predicted worse outcome in CBT. Sudden gains were equally frequent (CBT, 18%; ABM, 18%) and did not predict outcome. Conclusion: The alliance in CBT is dynamic and important for outcome. Sawtooths are common in CBT and may mark worse outcome. [ABSTRACT FROM AUTHOR]

The present investigation reports on the development and psychometric evaluation of the Penn Inventory of Scrupulosity (PIOS), a 19-item self-report scale measuring religious obsessive-compulsive symptoms. Factor analysis yielded a two factor solution with the first subscale measuring fears about having committed sin, and the second measuring fears concerning punishment from God. Using a sample of college students, the PIOS was shown to be internally consistent and possess good convergent and discriminant validity. Highly devout participants evidenced higher scores on both PIOS subscales, but devout Jews evidenced fewer fears of sin and punishment from God compared to devout Protestants or Catholics. The PIOS has utility both as a research and clinical tool. Keywords: Scrupulosity; Obsessive--compulsive disorder; Religion; Factor analysis

Objective: There is substantial research examining insight in psychotic disorders and in some nonpsychotic disorders. However, there has been little attention given to many nonpsychotic disorders. Research on insight in psychosis distinguishes between cognitive and clinical insight. In most studies examining insight in nonpsychotic disorders, definitions and assessments of insight vary significantly. The purpose of this review is to suggest a definition of insight in nonpsychotic disorders such that it can be used across different disorders. Method: We systematically review the extant literature of insight in nonpsychotic disorders and analyze the assessments used in order to determine how well they capture these two types of insight. Then, we discuss how these two constructs can provide better understanding of the phenomenology of insight in nonpsychotic disorders. Results: The systematic search resulted in 99 articles. These articles used 17 different methods of measuring insight, containing 127 questions. Results of the content analysis of items suggested that measures of insight used in nonpsychotic disorders do not distinguish between cognitive and clinical insight, but that most questions (90%) can indeed be reliably differentiated. Conclusion: We provide a multidimensional model of cognitive and clinical insight in nonpsychotic disorders, emphasizing the complexity of assessment and the importance of accurately defining insight. Such definitions have important theoretical and clinical implications, offering a better understanding of the concept of insight in nonpsychotic disorders. [ABSTRACT FROM AUTHOR]

The Pathological Narcissism Inventory (PNI) is a popular measure and the first to attempt to tap into both grandiose and vulnerable narcissism (GN/VN). However, data have raised questions as to whether it appropriately formulates GN and differentiates it from VN. In this study, we examined the Brief-PNI's structure and construct validity, by using a novel model based on the theoretical notion of GN and VN sharing core features. Participants (N = 1,061) completed the Brief-PNI, and psychological distress and social avoidance questionnaires. Results showed a better fit and differentiation of GN and VN for a model with cross-loading of shared first-order factors on GN and VN, compared with the traditional PNI structure. We concluded that the Brief-PNI can offer an appropriate formulation and differentiation of VN and GN, provided that their shared variance is considered. [ABSTRACT FROM AUTHOR]