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Contemporary cognitive treatment of obsessive-compulsive disorder (OCD) dates back to 1985, and rests on the premise that infrequent unwanted intrusions are essentially universal. As such, it is not the intrusion that is the focus of treatment but rather the interpretation or appraisal placed upon the intrusion. A number of cognitive domains are thought to be key areas, including inflated responsibility, overimportance of thoughts, need to control thoughts and overestimation of threat. Cognitive treatment of OCD is idiographic owing in part to the heterogeneous nature of the disorder as well as the cognitive domains implicated in the etiology and maintenance of the disorder. Cognitive treatment of an individual with ego-dystonic sexual and aggressive intrusions is illustrated in the current manuscript. Video clips are embedded at key moments during the treatment to ideally facilitate the illustration of this complex treatment. It is hoped that the addition of video clips will aid in the dissemination of this treatment that was recently tested and found to produce large effect sizes in a recent randomized controlled trial. (Contains 2 figures and 1 table.)

Relatively little is known about the long-term durability of group treatments for obsessive-compulsive disorder (OCD) and contemporary cognitive treatments. The current study investigated the 2-year follow-up results for participants who completed randomized trials of group or individual treatment and received either cognitive therapy (CT) or exposure plus response prevention (ERP). Yale-Brown Obsessive Compulsive Scale (YBOCS) scores for individual ERP and CT were not significantly different over 2 years. However, YBOCS scores were consistently lower over time for group ERP participants than for group CT participants. With a single exception in the group treatment study, secondary cognitive and depression scores were stable, indicating that gains achieved during acute treatment were maintained over 2 years. Less than 10% of treatment completers relapsed in each of the treatment trials. Approximately 50% of the completer sample was rated as recovered at 2 years. Additionally, a tentative cross-study comparison suggests that CT was better tolerated and resulted in less dropout than did ERP. Despite the overall positive results, efficacy of OCD treatments has reached a plateau and may require a fresh perspective to move forward. (Contains 2 figures, 2 tables, and 3 footnotes.)

Over the past decade, a number of well-controlled studies have supported the validity of a cognitive model of generalized anxiety disorder (GAD) that has four main components: intolerance of uncertainty, positive beliefs about worry, negative problem orientation, and cognitive avoidance. Although these studies have shown that the model components are associated with high levels of worry in nonclinical samples and with a diagnosis of GAD in clinical samples, they have not addressed the question of whether the model components can predict the severity of GAD. Accordingly, the present study sought to determine if the model components are related to diagnostic severity, worry severity, and somatic symptom severity in a sample of 84 patients with a primary diagnosis of GAD. All model components were related to GAD severity, although positive beliefs about worry and cognitive avoidance were only modestly associated with the severity of the disorder. Intolerance of uncertainty and negative problem orientation had more robust relationships with the severity of GAD (and with worry severity, in particular). When participants were divided into Mild, Moderate, and Severe GAD groups, intolerance of uncertainty and negative problem orientation distinguished the Moderate and Severe GAD groups from the Mild GAD group, even when age, gender, and depressive symptoms were statistically controlled. Overall, the results lend further support to the validity of the model and suggest that intolerance of uncertainty and negative problem orientation are related to the severity of GAD, independently of sociodemographic and associated clinical factors. The theoretical and clinical implications of the findings are discussed.

Negative problem orientation, a dysfunctional set of attitudes related to problem-solving ability, has been implicated as a process variable in several psychological disorders, notably depression and generalized anxiety disorder (GAD). The goal of the present study was two-fold: (1) to further examine the construct validity of a new measure of negative problem orientation, the negative problem orientation questionnaire (NPOQ), through its relationship to conceptually similar variables, and (2) to investigate the specificity of negative problem orientation to worry, the cardinal feature of GAD, compared to depression. The sample consisted of 148 university students who completed six questionnaires, the NPOQ and measures of worry, depression, pessimism, self-mastery, and neuroticism. Multiple hierarchical regressions revealed that when entered in the last step following demographic information and personality variables (pessimism, self-mastery, and neuroticism), the NPOQ accounted for 5.6% of the variance in worry scores compared to 1.6% of the variance in depression scores. It was concluded that the NPOQ shows evidence of construct validity, and that the process variable of negative problem orientation appears to have greater specificity to worry than depression. Implications for the understanding of worry and GAD are discussed. Keywords: Problem-solving; Anxiety; Depression (emotion); Statistical validity; Personality measures

Negative problem orientation, a set of dysfunctional attitudes toward social problem-solving, has increasingly become an important construct in our understanding of deficits in problem-solving ability in daily life. Until recently, no measure was specifically constructed to assess negative problem orientation directly, other than as a subscale in a more global measure of problem-solving ability. The goal of the present study was to translate the French version of the Negative Problem Orientation Questionnaire (NPOQ), and to examine its psychometric properties. The sample consisted of 201 university students who completed five questionnaires assessing psychological distress, pessimism, components of problem-solving ability, and the NPOQ. A unitary factor structure was revealed, accounting for 54.8% of the variance. The NPOQ had excellent internal consistency, good test--retest reliability at 5 weeks, and demonstrated convergent and discriminant validity when measured against self-reported pessimism, depression, anxiety, and problem-solving ability. The findings suggest that the NPOQ is a measure with sound psychometric properties that will be a valuable tool in future research on problem orientation. Keywords: Problem-solving; Inventories; Statistical validity; Statistical reliability; Test construction; Psychometrics

Background: Anxiety and related disorders are among the most common mental disorders, with lifetime prevalence reportedly as high as 31%. Unfortunately, anxiety disorders are under-diagnosed and under-treated., Methods: These guidelines were developed by Canadian experts in anxiety and related disorders through a consensus process. Data on the epidemiology, diagnosis, and treatment (psychological and pharmacological) were obtained through MEDLINE, PsycINFO, and manual searches (1980-2012). Treatment strategies were rated on strength of evidence, and a clinical recommendation for each intervention was made, based on global impression of efficacy, effectiveness, and side effects, using a modified version of the periodic health examination guidelines., Results: These guidelines are presented in 10 sections, including an introduction, principles of diagnosis and management, six sections (Sections 3 through 8) on the specific anxiety-related disorders (panic disorder, agoraphobia, specific phobia, social anxiety disorder, generalized anxiety disorder, obsessive-compulsive disorder, and posttraumatic stress disorder), and two additional sections on special populations (children/adolescents, pregnant/lactating women, and the elderly) and clinical issues in patients with comorbid conditions., Conclusions: Anxiety and related disorders are very common in clinical practice, and frequently comorbid with other psychiatric and medical conditions. Optimal management requires a good understanding of the efficacy and side effect profiles of pharmacological and psychological treatments.