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In addition to impacting the physical health of millions of Americans, the novel-coronavirus (COVID-19) pandemic is a significant psychological stressor due to both the threat of the illness itself and the mitigation strategies used to contain the spread. To facilitate understanding of the impact of COVID-19, validated measures are needed. Using a stepwise procedure in line with best-practice measurement procedures, the current report summarizes the procedures employed to create the COVID-19 Impact Battery (CIB). Two independent samples recruited via Amazon Mechanical Turk (N = 175, N = 642) and a third community sample (N = 259) were used for reliability and validity testing. Validation procedures yielded a battery consisting of three scales assessing COVID-19 related behaviors, worry, and disability. The behaviors scale contains three subscales assessing stockpiling, cleaning, and avoidance. The worry subscale also contains three subscales assessing health, financial and catastrophic concerns. In addition, we created a short version of the battery (CIB-S) to allow for more flexibility in data collection. In summary, we have provided reliability and validity information for the CIB and CIB-S, demonstrating that these measures can facilitate evaluation of the broad impact of COVID-19 on mental health functioning.

Background Anxiety sensitivity (AS) is a well-studied transdiagnostic risk construct that is believed to amplify responses to many forms of stress. The COVID-19 pandemic is a broad stressor with significant physical and social threats. In the current study, we were interested in ascertaining the degree to which AS would relate to distress and disability in the context of COVID-19. We hypothesized that AS would be associated with increased distress and disability. Moreover, we hypothesized that AS would be uniquely predictive while controlling for other relevant risk factors such as age, race, and perceived local COVID-19 infection rates. Method Participants (N = 249) were U.S. adults assessed using online data resourcing and re-assessed one month later. Results At the first time point, during the beginning phases of the COVID-19 pandemic, AS was significantly related to COVID-19 distress and disability with a moderate effect size. AS was longitudinally associated with higher COVID-19 worry and depression. Limitations Our findings are limited by the use of a relatively small online sample. Additionally, assessment of pre-pandemic and post-pandemic symptoms and functioning would be beneficial for future research. Conclusions Taken together, the current study provided evidence consistent with AS as a causal risk factor for the development of distress and depression during the COVID-19 pandemic.

Objective Accurate threat appraisal is central to survival. In the case of the coronavirus pandemic, accurate threat appraisal is difficult due to incomplete medical knowledge as well as complex social factors (e.g., mixed public health messages). The purpose of this study was to evaluate the degree to which individuals accurately perceive COVID-19 infection rates and to explore the role of COVID-19 threat perception on emotional and behavioral responses both cross sectionally and prospectively. Methods: A community sample (N = 249) was assessed using online crowdsourcing and followed for one month. COVID-19 threat appraisal was compared with actual COVID-19 infection rates and deaths at the time of data collection in each participant's county and state. It was predicted that actual versus perceived COVID-19 infection rates would only be modestly associated. Relative to actual infection rates, perceived infection rates were hypothesized to be a better predictor of COVID-related behaviors, distress, and impairment. Results: Findings indicated that relative to actual infection, perceived infection was a better predictor of COVID-related outcomes cross sectionally and longitudinally. Interestingly, actual infection rates were negatively related to behaviors cross sectionally (e.g., less stockpiling). Prospectively, these variables interacted to predict avoidance behaviors over time such that the relationship between perceived infection and avoidance was stronger as actual infection increased. Conclusions: These data suggest that perceived COVID-19 infection is significantly associated with COVID-related behaviors, distress and impairment whereas actual infection rates have a less important and perhaps even paradoxical influence on behavioral responses to the pandemic.

The direct threat posed by the 2019 novel coronavirus (COVID-19), uncertainty surrounding best safety practices, and secondary consequences of the virus have led to widespread stress and declining mental health across communities and individuals. These stresses may impact parenting behaviors, potentially leading to negative consequences for children. Controlling parenting behaviors increase in the face of perceived environmental threat and are associated with adverse mental health outcomes for children; however, determinants of parenting behaviors have not been investigated during the COVID-19 pandemic. The current study prospectively evaluated parenting behaviors during the pandemic (N=87). Results indicated that all negative affect emotions investigated were positively associated with controlling parenting behaviors. However, only COVID-related fear predicted changes in controlling parenting behaviors across timepoints. Specifically, although controlling parenting behaviors decreased in the overall sample from time 1 to time 2, higher COVID-related fear scores at time 1 predicted maintenance of high levels of controlling parenting behaviors at time 2. Additionally, this effect was specific to controlling, as opposed to more adaptive, parenting behaviors. Future studies should investigate the association between parents' COVID-related fear, controlling parenting behaviors, and adverse mental health outcomes for children in the context of the COVID-19 pandemic.

Despite the high prevalence and burden of mental health disorders, the majority of affected individuals go untreated. Therefore, increased efforts have been made to develop and examine brief online interventions as a cost-effective, broadly disseminable alternative to traditional psychotherapy. In particular, recent studies have demonstrated the efficacy of online interventions targeting transdiagnostic risk factors such as anxiety sensitivity (AS), thwarted belongingness (TB), and perceived burdensomeness (PB). Although improved psychosocial functioning is an important indicator of successful treatment, no studies to our knowledge have examined the impact of brief web-based interventions on functional outcomes. The current study examined the effects of brief online interventions targeting AS, TB, and PB on occupational, social, and family life functioning in two samples (N = 74; N = 247). In Study 1, results demonstrate a significant impact of an AS treatment on social functioning at one-month follow-up, mediated by pre-to-post reductions in AS. In Study 2, results demonstrate a significant impact of a mood intervention targeting TB and PB on social functioning at one-month follow-up. The results of the current study suggest that brief online interventions may have a significant impact on functional impairment, particularly social functioning. This provides further support for the continued development and implementation of brief online interventions.

Although sexual intrusive thoughts (SITs) are often studied in combination with other intrusions, little is known about the metacognitive processes that are specific to SITs. The present study evaluated sexual versus non-SIT frequency in relation to two main factors: gender and general negative beliefs (GNB), a component of metacognition involving beliefs about the consequences of failing to control thoughts. A nonclinical sample of 286 undergraduate students completed the Revised Obsessional Intrusions Inventory-Sex Version and the Meta-Cognitions Questionnaire. Results indicated main effects for GNB and a significant interaction between gender and GNB for SITs. More specifically, frequency of SITs was significantly higher for males, as well as for participants with higher GNB. In contrast, analyses for non-SITs revealed a main effect for GNB, but no main effects for gender or a significant interaction. These findings suggest a link between high GNB and increased SIT and non-SIT frequency. Moreover, gender may function as a moderator between GNB and SIT frequency. Further characterizing the effects of gender and GNB may help in form treatments for disorders involving clinically significant SITs.

Perfectionism is frequently noted in obsessive–compulsive disorder (OCD) and some data suggest that treatment outcomes with cognitive behavioral therapy (CBT) are poorer for OCD patients with higher levels of perfectionism. However, this literature includes inconsistent findings and has thus far been limited to outpatient samples. Existing studies have also not utilized measures of perfectionism in-line with the multidimensional nature of this construct, which includes both adaptive and maladaptive forms of perfectionism. This study administered measures of multidimensional perfectionism and OCD severity at admission and discharge in a large sample (N = 154) of adult OCD patients undergoing intensive residential treatment (IRT). Results indicated that more perfectionistic patients had slightly longer treatment duration. Adjusting for treatment duration and baseline severity, pre-treatment perfectionism did not significantly predict OCD outcomes. However, all domains of perfectionism significantly improved following treatment, and changes in perfectionism significantly predicted OCD outcomes. In particular, greater reduction in maladaptive perfectionism uniquely predicted better OCD symptom outcomes. These results suggest that high initial levels of perfectionism may not prevent OCD patients from benefitting from IRT, and that reduction in perfectionism significantly accounts for OCD treatment gains. Limitations and avenues for future research are discussed.

Hoarding disorder (HD) is a persistent and severe psychiatric condition in which individuals are unable to discard possessions, which results in considerable clutter. Individuals who hoard often endorse interpersonal difficulties and social isolation. However, little research has examined mechanisms that may help to explain this relationship. One possible mechanism is hostility, which is characterized by increased sensitivity to real or perceived social threats. The current study examined the relationship between hoarding symptoms and hostility across two undergraduate samples. In study 1, unselected undergraduates (N = 195) were administered measures of hoarding symptoms, hostile interpretations, and depression and anxiety symptoms. Participants in study 2 (N = 117) were selected for reporting elevated hoarding symptoms. Study 2 participants were administered the same measures as in study 1, and were additionally randomized to an inclusion or exclusion condition in a social exclusion manipulation. Total hoarding symptoms and hostile interpretations were positively associated across both samples, even when controlling for depression and anxiety. Further, greater hoarding symptoms were associated with increased feelings of hostility in response to social exclusion in study 2. Results suggest that increased sensitivity to social threat may confer risk for hoarding. These findings add to a growing body of research implicating interpersonal factors in the development and maintenance of hoarding disorder.

Contamination fear and washing compulsions are among the most common symptoms of obsessive compulsive disorder (OCD). Though these symptoms have traditionally been viewed as being driven by a desire to avoid harm, recent research has highlighted the importance of feelings of incompleteness (INC) or not-just right experiences (NJREs) in this symptom dimension. However, no study to date has examined the extent to which INC/NJREs may be associated with treatment response for contamination symptoms. The current study used a multi-method approach to examine the role of INC/NJREs in treatment of contamination symptoms. Participants (n = 88) with elevated contamination symptoms, half of whom met for an OCD diagnosis, engaged in three sessions of exposure and response prevention (ERP) targeting contamination fears, and completed self-report and in vivo measures of INC/NJRES and contamination symptoms. ERP was associated with significant reductions in INC/NJREs. Further, changes in INC were associated with changes in contamination symptoms, independent of changes in harm avoidance. Greater discomfort in response to an in vivo NJRE task at pre-treatment predicted poor treatment response, though a self-report measure of INC did not predict response. These findings provide novel evidence for the importance of INC/NJREs in contamination-based OCD and its treatment.

Objectives Despite the existence of several first-line treatments for obsessive-compulsive disorder (OCD), many patients fail to experience symptom reduction and/or do not complete treatment. As a result, the field has increasingly moved towards identifying and treating malleable underlying risk factors that may in turn improve treatment efficacy. One salient underlying risk factor, anxiety sensitivity (AS) cognitive concerns, has been found to be uniquely associated with obsessive-compulsive (OC) symptom dimensions. However, no studies have yet examined whether reductions in AS cognitive concerns will lead to subsequent reductions in OC symptoms. Methods The current study attempted to fill this gap by recruiting individuals reporting elevations on both AS cognitive concerns and at least one OC symptom dimension. Participants were randomly assigned to receive either a one-session AS cognitive concerns intervention (n = 35) or a single health information control session (n = 37). AS cognitive concerns were assessed at post-intervention and one-month follow-up. Results The active intervention produced significantly greater reductions in AS cognitive concerns post-intervention than the control intervention. However, this effect was no longer significant at one-month follow-up. Further, while there was not an effect of treatment condition on OC symptoms at one-month follow-up, changes in AS cognitive concerns from baseline to post-intervention mediated changes in OC symptoms at one-month follow-up. Conclusions Findings support previous research attesting to the malleable nature of AS. Extending this research, findings provide initial support for the efficacy of AS interventions among individuals with elevated OC symptoms. Practitioner points Clinicians should consider assessing anxiety sensitivity (AS) among patients with obsessive-compulsive disorder. If elevated, clinicians should consider targeting AS as an adjunct to treatment as usual.

Background Interpersonal trauma (IPT) is one of the most commonly reported types of traumatic experiences and has the greatest likelihood of resulting in a diagnosis of posttraumatic stress disorder (PTSD). Relative to other types of trauma, victims of IPT report greater trauma-specific rumination, whereby they focus on negative consequences of the trauma on their life. Theoretical and empirical work suggest trauma-specific rumination leads to elevated posttraumatic stress symptoms (PTSS); however, there has been a dearth of research examining how trauma type may impact this association. Therefore, the current longitudinal study examined how the experience of IPT moderates the relationship between trauma-specific rumination and later PTSS. Method Participants (N = 204) enrolled in a clinical trial completed self-report measures of trauma experience, trauma-specific rumination, and PTSS at baseline and 1-month follow-up appointments. Results Results revealed that IPT moderated the relationship between baseline rumination and 1-month trauma symptoms, even after covarying for participant age and sex, treatment condition, negative affect, and number of previously experienced traumas. Further, this moderation effect was specific to the PTSD numbing cluster. Limitations Major limitations include measurement of PTSS via PCL-C rather than the PCL-5, as well as a limited sample size, precluding moderation analyses of other trauma types. Conclusions The current study provides novel findings demonstrating specificity of index trauma type in the longitudinal relationship between rumination and PTSS. Future work is needed to examine how IPT impacts the development of pathways between rumination and PTSS.

Perfectionism, a trait-like individual difference variable reflecting the tendency to set extremely high standards along with critical evaluations of one's own behavior, has long been regarded as a risk and maintenance factor for obsessive-compulsive disorder (OCD). However, research exploring the relationship between these constructs is mixed. One explanation for these equivocal findings is the heterogeneous nature of OCD. Indeed, there is increasing evidence for distinct symptom dimensions that are more homogenous than the broad OCD phenotype. The current study examined the associations between self-reported perfectionism and OCD symptom dimensions controlling for probable depression status. The sample included 67 rural veterans. Results revealed a unique association between perfectionism and the unacceptable thoughts dimension of OCD. These findings are consistent with a growing body of literature demonstrating that OCD symptom dimensions have unique underlying dysfunctional beliefs.

Background This study investigated distinct trajectories of treatment response in a naturalistic intensive/residential treatment (IRT) program for adults with severe obsessive-compulsive disorder (OCD). We hypothesized that: (1) distinct trajectories would emerge and (2) demographic variables, psychiatric comorbidity, OCD symptom subtype, level of insight, previous exposure and response prevention (ERP) treatment, and quality of life, would differentially predict assignment to these trajectories. Methods Participants included 305 individuals with primary OCD admitted for IRT. Results Two trajectories emerged over the course of the first eight weeks of treatment, with the vast majority of participants demonstrating treatment response. The first trajectory (96%, n = 292) showed a negative, linear treatment response (a.k.a. “linear responders”) and more severe OCD symptoms at admission. The second trajectory (4%, n = 13) had less severe OCD symptoms at admission and did not exhibit a significant overall change in symptoms over the course of treatment. More specifically, this second trajectory or “u-shaped responders” show a non-significant linear response through week four of treatment, followed by slightly increased symptoms in week five. Assignment to these classes was not differentially predicted by hypothesized predictor variables. Limitations Our final model had inconsistent fit indices and small class prevalance of the u-shaped responder group; therefore, model selection was based on both fit indices and substantive meaning. Conclusions This study emprically derived two distinct trajectories of OCD symptom severity over the course of IRT. These findings have the potential to refine IRT for patients with severe OCD, and to potentially guide future investigation into the optimal delivery of ERP treatment for OCD generally.

Posttraumatic stress disorder (PTSD) symptoms are positively related to suicide risk among firefighters. One mechanism that may account for this relationship is anxiety sensitivity (AS) cognitive concerns-the fear that cognitive symptoms of anxiety will have catastrophic consequences. We sought to replicate the mediating effect of AS cognitive concerns on the relationship between PTSD symptoms and suicide risk among 214 trauma-exposed male firefighters with non-zero suicide risk. Bootstrap mediation analyses tested AS cognitive concerns as a statistical mediator of PTSD symptoms (total and symptoms clusters scores) and suicide risk, controlling for depression symptoms and relevant demographic variables. AS cognitive concerns statistically mediated the relationship between PTSD symptoms (total score, as well as intrusion, avoidance, and arousal-reactivity symptoms clusters) and suicide risk; however, the reverse was also true. AS cognitive concerns may confer risk for suicide among trauma-exposed firefighters. Firefighters may benefit from AS-specific interventions, which are shown to reduce PTSD symptoms and suicidality.

Overview: Hoarding Disorder (HD) is characterized by extreme attachment to one's possessions. Despite a number of studies showing that this attachment may partially be driven by interpersonal dysfunction, few have identified specific factors underlying these interpersonal issues and object attachment (OA) within HD. To address this, we investigated Fear of Intimacy (FOI) which has not been researched in its relation to HD. We predicted that FOI would positively correlate with OA and hoarding symptoms, and FOI would have a significant indirect effect on hoarding symptoms via OA. Method Participants (N = 116) with elevated scores on the Saving Inventory–Revised were recruited to complete a battery of measures. Results Controlling for depression, anxiety, and stress FOI and OA were positively correlated with hoarding symptoms and each other, with mixed results depending on the hoarding measure used. The indirect effect of FOI on hoarding symptoms through OA was significant. Discussion This is the first study to establish FOI as a related factor of HD and show that this relationship might be partially accounted for by OA. These findings provide initial support for a theoretical understanding of HD whereby FOIFOI may predict or maintain the disorder partly due to its relationship with OOA.

Background A growing body of literature indicates that exposure to interpersonal trauma contributes to the onset or exacerbation of hoarding symptoms. However, little research has explored psychosocial factors that may help to explain the relationship between interpersonal trauma and hoarding symptoms. One outcome of trauma exposure that may be associated with hoarding symptoms is aggression, defined as the tendency to experience and express hostility and anger, and to engage in aggressive behavior. Therefore, the current study examined the relationship between hoarding and aggression, as well as the mediating role of aggression in the relationship between exposure to interpersonal trauma and hoarding symptoms. Methods Community participants (n = 258) completed a battery of questionnaires assessing trauma exposure, hoarding symptoms, aggression, and negative affect. Results Results revealed that when accounting for negative affect, hoarding symptoms were associated with greater aggression, and the relationship between exposure to interpersonal trauma and hoarding symptoms was mediated by aggression. Specificity analyses indicated that depression symptoms and emotion dysregulation did not mediate the relationship between interpersonal trauma exposure and hoarding, providing further support for the importance of aggression. Limitations Findings should be interpreted in light of limitations, including the use of cross-sectional and self-report data, and a general community sample. Conclusions Taken together, our findings suggest that interpersonal processes, such as aggression toward others, may be associated with increased hoarding symptoms.

Objective Exposure and response prevention (ERP) is an effective treatment for individuals with obsessive–compulsive disorder (OCD), yet a substantial number of individuals with OCD do not fully respond to this intervention. Based on emerging experimental and clinical research on acceptance, this study sought to explore whether willingness to experience unpleasant thoughts, emotions, and bodily sensations during ERP was associated with improved treatment response. Methods Two hundred eighty-eight adults with OCD receiving residential ERP provided self-rated willingness and other exposure-related variables during each daily coached ERP session. Obsessive–compulsive and depressive symptom severity was assessed every week. Multilevel modeling was used to study the impact of willingness on treatment outcome during the first 6 weeks of residential care. Results Data indicated that individuals with higher willingness during ERP reported faster symptom reduction during residential treatment, even when controlling for length of stay, psychopharmacological intervention, depression, adherence, and rituals performed during ERP. These results appear to have both statistical and clinical significance. Conclusions Willingness to fully experience unpleasant and unwanted thoughts, emotions, and bodily sensations during exposures appears to be a marker of successful exposure therapy in adults with OCD. Future research should examine how willingness may enhance extinction learning during ERP.

Few studies have examined indices of change in treatment for obsessive compulsive disorder (OCD). The current study evaluated within- and between-session trajectories of fear, disgust, and urge to wash in exposure and response prevention (ERP) for contamination-based OCD and tested whether change in these indices were associated with treatment outcomes. Forty-one participants (75.6% female) engaged in three sessions of ERP for contamination OCD. Participants provided ratings of fear, disgust, and urge to wash during each session, and contamination symptoms were assessed at pre- and post-treatment and two-week follow-up. Fear, disgust, and urge to wash all significantly decreased both within and between sessions. Both fear and disgust declined significantly faster than urge to wash within session, though declines in fear and disgust did not significantly differ from each other. Within-session changes in fear were significantly associated with reduced symptoms at post-treatment, whereas within-session changes in disgust were associated with symptoms at two-week follow-up. The current study highlights the roles of fear and disgust in the context of ERP as unique indicators of treatment outcome for contamination-based OCD. Only within-session fear was uniquely associated with treatment outcome at post, while within-session disgust predicted outcome at follow-up. Theoretical and clinical implications are discussed.

Background and objectives Hoarding disorder (HD) is a debilitating mental illness characterized by extreme difficulty parting with possessions and clutter that can result in dangerous living conditions. One hypothesis about why individuals with HD save possessions is that they possess a pathological attachment to their belongings, which may serve to compensate for unfulfilling interpersonal relationships. However, there is a dearth of empirical work examining this. The current study examined the impact of an experimental manipulation of social exclusion on attachment to possessions and saving behaviors in a sample of individuals with elevated hoarding symptoms. Methods Participants (n = 117) were selected for scoring above the non-clinical mean on a measure of hoarding symptoms. Participants were randomized to either be included or excluded in a game of Cyberball. They completed a behavioral discarding task and object attachment measure before and after completion of the game. Results Study condition was unrelated to in vivo attachment to possessions and saving behaviors during the discarding task. However, a post hoc mediation model showed that greater feelings of rejection, regardless of condition, were associated with greater in vivo attachment to possessions and subsequent number of items saved during the lab task. Limitations Limitations include the use of a non-clinical and homogeneous sample. Conclusions Taken together, individuals prone to feelings of rejection may be at risk for developing HD as they may use possessions to cope with interpersonal stress. Results will be discussed in light of implications for theoretical models and potential treatment targets in HD.

This review highlights recent research regarding gender differences in OCD, with a focus on prevalence, course of illness, symptom presentation, comorbidity, and treatment response. Overall, findings remain mixed. OCD may be more common among males in childhood, but is more common among females in adolescence and adulthood. Males tend to report an earlier age of onset and present with symptoms related to blasphemous thoughts. Females often describe symptom onset as occurring during or after puberty or pregnancy and present with symptoms related to contamination and/or aggressive obsessions. Females also tend to report significantly higher depression and anxiety. There are no reported gender differences in treatment outcome. Gender may play a role in the onset, presentation, and impact of OCD symptoms. However, more work is needed to account for differences across studies, with one promising future direction being the study of reproductive hormones.

Background Hoarding disorder (HD) is a common and debilitating disorder characterized by an accumulation of and failure to discard one's possessions. The identification and examination of underlying factors that may contribute to hoarding symptoms are needed to elucidate the nature of the disorder and refine existing treatments. Two transdiagnostic vulnerability factors that have been associated with hoarding symptoms are distress intolerance (DI) and intolerance of uncertainty (IU). Objectives This study examined the relationships between DI, IU, and symptoms of hoarding in two samples consisting of outpatients and individuals recruited from Amazon's Mechanical Turk. We hypothesized that DI and IU would show unique and interactive associations with hoarding symptoms. Results Across both samples, DI and IU were significantly associated with hoarding symptoms. However, DI and IU did not interact in their prediction of symptoms, and only IU remained a significant predictor, when accounting for relevant covariates. Conclusions Results suggest that IU is a robust predictor of hoarding symptoms and may be a promising and novel treatment target for HD.

Insomnia symptoms are associated with smoking and may interfere with smoking cessation. Specifically, studies have shown that smoking-related sleep problems are associated with long-term smoking relapse, and longer sleep duration is associated with successful smoking cessation. However, it is currently unclear whether pre- or post-quit insomnia symptoms are associated with smoking cessation outcomes. As such, the current study aimed to extend previous findings by using a measure of insomnia symptoms as a predictor of smoking cessation failure by Month 3 following smoking cessation treatment. Additionally, we examined whether post-quit insomnia symptoms predicted cessation outcomes. Results indicated that pre-, but not post-quit insomnia, predicted smoking cessation failure by 3-month post-cessation, after covarying for depressive symptoms, anxiety sensitivity, alcohol use disorder severity, treatment condition, and number of cigarettes per day. These findings add to the literature on insomnia symp...

Prior research has shown that difficulties in emotion regulation is associated with overall levels of posttraumatic stress symptoms (PTSS). However, it is currently unclear which facets of difficulties in emotion regulation (e.g., lack of emotion regulation strategies, impulse control problems, non-acceptance of emotional responses) are associated with specific PTSS clusters. This information may be valuable in refining treatment approaches in PTSS. The aim of the current study was to use structural equation modeling to test the relationships between Difficulties in Emotion Regulation Scale (DERS) subfactors and PTSS in a trauma-exposed community sample (N = 746). Results indicated that impulse control difficulties were most consistently associated across PTSS clusters (i.e., re-experiencing, avoidance, and hyperarousal), while lack of emotion regulation strategies and emotional clarity were uniquely associated with numbing symptoms, after covarying for neuroticism. However, other facets of difficulties in emotion regulation (i.e., non-acceptance of emotional responses and difficulties engaging in goal-directed behavior while upset) were not associated with PTSS. These findings provide further support for the role of difficulties in emotion regulation in specific PTSS clusters. Additionally, they suggest that impulse control problems may be important in the development of most PTSS and thus most beneficial to target clinically, while lack of emotional clarity and effective emotion regulation strategies may be specific to numbing symptoms.

OBJECTIVES A prior study found that over 50% of treatment-seeking individuals who hoard incur at least one psychiatric work impairment day (i.e., they are unable to work or are less effective at work due to poor mental health) each month. The aim of the current study was to assess work-related variables associated with workplace impairment in a non-treatment-seeking sample. DESIGN Cross-sectional. Self-report questionnaires were administered via Amazon's Mechanical Turk. METHODS One hundred and eighty-five employed individuals who reported elevated hoarding symptoms completed questionnaires regarding hoarding symptoms, work engagement, psychiatric work impairment, work control, attention and concentration difficulties at work, and quality of workplace relationships. RESULTS Greater workplace control and higher quality workplace relationships were associated with greater work engagement. Greater hoarding symptoms and attention difficulties at work were associated with more psychiatric work impairment days. Work engagement statistically mediated the association between the quality of workplace relationships and work impairment, though mediation was also significant when reversing the mediating and outcome variables. CONCLUSIONS Among a community sample of employed individuals, greater hoarding symptoms were associated with greater psychiatric work impairment. Work-related variables, such as co-worker relationships and attention difficulties, contributed additional variance above that accounted for by hoarding symptoms. There were significant associations between co-worker relationships, work engagement, and workplace impairment, though the direction of the mediation model is unclear. Future research should examine factors associated with unemployment in hoarding disorder. PRACTITIONER POINTS Clinicians should be aware that greater hoarding severity directly contributes to greater workplace impairment. Clinicians should consider prioritizing the reduction in clutter in living areas that impact one's daily activities and subsequent ability to attend work. Clinicians should assess and treat workplace impairment by helping individuals achieve greater control at work, developing higher quality interpersonal relationships, and improving their attentional abilities.

Individuals with obsessive–compulsive disorder (OCD) often use maladaptive strategies to control intrusive thoughts (e.g., thought suppression) that may paradoxically increase their frequency. Exposure and response prevention (ERP) treatment has been associated with decreased use of these disadvantageous strategies and increased use of advantageous ones. This study examines changes in thought control strategies among patients with severe OCD receiving ERP in an intensive residential setting. Thought suppression has also been associated with suicidality; thus, we tested whether suicide risk moderated changes in thought control from admission to discharge. Consistent with prior research, patients reported decreased use of worry and punishment, and increased use of distraction and social control. Suicide risk moderated changes in the use of distraction, such that high risk patients employed this strategy less frequently at admission, but no group differences remained at discharge. Additionally, only high risk patients increased their use of distraction over treatment. Furthermore, increased use of distraction and decreased use of self-punishment predicted reduced symptoms at discharge. These findings suggest that OCD patients at high risk for suicide may particularly benefit from interventions that facilitate focused distraction from intrusive thoughts. Further, dispositional use of distraction and self-punishment strategies may be worthwhile targets in the treatment of OCD.

The most common symptom of obsessive-compulsive disorder (OCD) is contamination fear. Feelings of contamination can be provoked through contact with a physical contaminant, referred to as contact contamination (CC), as well as in the absence of one, referred to as mental contamination (MC). Prior research indicates that CC and MC are distinct, and MC may interfere with treatment for CC. However, no study to date has examined how MC may be associated with responses to physical contaminants and treatment response for CC. This study examined the relationships between CC and MC in a sample of individuals with elevated contamination symptoms (N = 88), half of whom met diagnostic criteria for OCD. Participants engaged in three sessions of exposure and response prevention (ERP) for CC and completed self-report measures and behavioral tasks assessing CC and MC at pretreatment, posttreatment, and follow-up. As hypothesized, at pretreatment, MC was positively associated with reactivity to physical contaminants, even after participants washed their hands. ERP for CC was associated with unique changes in CC and MC across self-report and behavioral measures, and greater pretreatment MC predicted greater posttreatment CC, though this effect was evident in only one of two CC measures. Additionally, specificity analyses indicated changes in MC were independent of changes in disgust propensity, a related construct. Pretreatment disgust propensity also predicted treatment outcome, though the addition of pretreatment disgust propensity as a covariate reduced the relationship between pretreatment MC and posttreatment CC to nonsignificance. Results suggest MC plays an important role in the manifestation and treatment of CC symptoms and may represent a manifestation of disgust proneness. Theoretical and clinical implications are discussed.

Cyberchondria refers to a clinical phenomenon in which repeated Internet searches regarding medical information result in excessive concerns about physical health. Cyberchondria is positively associated with symptoms of health anxiety, though it remains unclear as to whether cyberchondria poses a unique public burden. The current study replicated previous findings regarding the relationship between cyberchondria and health anxiety, and extended those findings to examine the extent to which health anxiety and cyberchondria may be differentially associated with public health outcomes, including impairment, quality of life, and service utilization. Community participants (N = 462) recruited via online crowdsourcing completed a battery of self-report questionnaires assessing cyberchondria, health anxiety, and measures of public health outcomes, including the WHOQOL and SDS. Bifactor latent variable modeling indicated that cyberchondria was closely related to, yet importantly distinct from, health anxiety. Moreover, when accounting for overlap with health anxiety, cyberchondria was associated with increased functional impairment and healthcare utilization. Results provide further support for the identification of cyberchondria as a distinct set of clinical symptoms that may pose a significant public health burden. Future research should determine ways in which to treat and/or prevent symptoms.

Hoarding disorder (HD) is a severe and persistent mental illness characterized by extreme difficulty parting with possessions and considerable clutter that can result in dangerous living conditions. HD poses a considerable public health burden; however, treatment for HD remains relatively limited, as many individuals do not respond to treatment and/or do not maintain treatment gains, suggesting there are important factors not being adequately addressed. In particular, one area that is not well-understood nor well-integrated into cognitive behavioral models is the pathological attachment individuals with HD hold to their possessions. The current review delineates existing work regarding attachment in HD and integrates findings regarding attachment into existing cognitive behavioral models of HD. We use attachment theory as a foundation by which to examine HD and better understand the dysfunctional relationships seen in those who hoard. We propose that both maladaptive cognitions and dysfunctional attachments to people and possessions jointly underlie saving behaviors characteristic of the disorder. The hypotheses put forth in this theory may help to advance our knowledge of HD, identify potential factors that can be targeted in intervention and prevention efforts, and provide important future directions for empirical work.

Obsessive-compulsive disorder (OCD) is a notably heterogeneous disorder. As such, there has been increased interest in subtyping OCD into homogeneous entities using biological characteristics such as sex. Whereas there is large consensus in the literature regarding sex differences in the phenotypic expression of OCD, there are numerous disadvantages to how OCD has been previously measured and assessed. The present investigation explored potential sex differences in OCD symptoms using the Dimensional Obsessive Compulsive Scale (DOCS), a redesigned measure that more reliably assesses the four most commonly replicated OCD symptom dimensions. A large sample of community participants with elevated levels of OCD symptoms (N = 297) was recruited from an online crowdsourcing marketplace. Surprisingly, no differences in means were observed across sexes. However, results did reveal sex differences when examining relations between OCD dimensions. In particular, correlations between the OCD symptom dimensions were stronger in males compared to females. The common perception of OCD as a heterogeneous disorder may hold for females more so than for males. Future research should seek to replicate these findings using multimethod approaches including clinical, behavioral, and neuroimaging assessments.

Objective This study aimed to develop and validate the Distress Tolerance Scale-Short Form (DTS-SF), a modification of the original Distress Tolerance Scale, in a severe/complex sample of individuals with obsessive compulsive disorder (OCD). Currently, there are multiple self-report measurements of distress tolerance (DT), highlighting the need for a more refined measure. Method Participants included 222 individuals with a primary diagnosis of OCD (57% male, average age = 31) seeking intensive/residential treatment. Participants completed surveys at admission, discharge, and each week. Results An exploratory factor analysis revealed a one-factor solution representing overall DT ability. The DTS-SF was found to be sensitive to treatment effects. Appropriate associations between the DTS-SF and other measures were also found, with lower DT associated with greater OCD and depression severity and lower reported quality of life. Conclusion The DTS-SF was found to be a valid and reliable measure with high clinical utility for quickly and accurately measuring DT.

Background Intolerance of uncertainty (IU) has been associated with post-traumatic stress symptoms (PTSS) in the literature. However, no research to date has investigated the relationship between IU and PTSS within a clinical trauma-exposed sample, which is an important next step in the literature and crucial for the generalizability of these findings. Therefore, the current study hypothesized that IU would be related to increased PTSS within a clinical sample of trauma-exposed individuals. Further, we hypothesized that IU would be related to elevated PTSS after accounting for anxiety sensitivity (AS) and negative affect (NA), two known correlates of PTSS. Finally, we examined the relations between IU and the PTSS clusters (i.e., avoidance, emotional numbing, hyperarousal, and re-experiencing) while covarying for AS and NA. Methods Participants included community adults (n = 126) presenting at an outpatient clinic. All participants had previously experienced a traumatic event as defined by the DSM-5 PTSD Criterion A. Methods Results revealed that IU was significantly associated with increased PTSS above and beyond AS and NA. Further, results indicated that IU was significantly related to the avoidance, hyperarousal, and emotional numbing PTSS clusters, even after covarying for AS and NA. IU was not significantly associated with the PTSS re-experiencing cluster once AS and NA were taken into account. Conclusions Our results expand upon the extant literature by demonstrating that IU is associated with PTSS above and beyond AS and NA within a clinical trauma-exposed sample. These findings are discussed in terms of promising directions for future research and treatment strategies.

Intensive residential treatment (IRT) is effective for severe, treatment-resistant obsessive-compulsive disorder (OCD). We sought to characterize predictors and course of response to IRT.Admission, monthly, and discharge data were collected on individuals receiving IRT. We examined the association between baseline characteristics and percent change in OCD symptoms as measured by the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) using linear regression. We compared baseline characteristics of IRT responders (≥35% reduction in Y-BOCS) versus non-responders, and of patients who did versus those who did not achieve wellness (Y-BOCS ≤ 12) using non-parametric tests. To examine the course of OCD severity over time, we used linear mixed-effects models with randomly varying intercepts and slopes.We evaluated 281 individuals admitted to an IRT program. Greater baseline Y-BOCS scores were associated with a significantly greater percent reduction in Y-BOCS scores (β = -1.49 ([95% confidence interval: -2.06 to -0.93]; P .001)). IRT responders showed significantly greater baseline Y-BOCS scores than non-responders (mean (SD) 28 (5.2) vs. 25.6 (5.8); P = .003) and lower past-year alcohol use scores than non-responders (1.4 (1.9) vs. 2.1 (2.2); P = .01). Participants who achieved wellness displayed lower hoarding factor scores than those who did not (5 (4.6) vs. 9.53 (6.3); P = .03). OCD symptoms declined rapidly over the first month but more slowly over the remaining two months.Higher baseline OCD severity, lower past-year alcohol use, and fewer hoarding symptoms predicted better response to IRT. IRT yielded an initial rapid reduction in OCD symptoms, followed by a slower decline after the first month.