Obsessive-compulsive disorder (OCD) is associated with substantial impairment across a number of life domains. Recently increased interest has been focused on the bi-directional relationship between OCD and family processes, particularly a subset of family reactions to OCD symptoms that are termed "accommodation." Accommodation consists of any changes in family members' behavior aimed at preventing or reducing the patient's rituals or their distress related to OCD symptoms. For example, family members may provide patients with supplies they need to ritualize (e.g., extra soap), or may engage in rituals themselves (e.g., excessive washing). Previous research has indicated high levels of accommodation are associated with more severe OCD symptoms and functional impairment on the part of patients, and may interfere with the first line psychosocial treatment for OCD, a form of cognitive behavior therapy (CBT) consisting of exposure (to cues provoking obsessions) and ritual prevention (ERP). Thus, the aims of this research project were to develop and test a brief intervention focused on reducing accommodation in the family members of adult OCD patients with the aim of facilitating the implementation of ERP. Eighteen patient and family member dyads participated in the study. All patients received a course of standard individual ERP for OCD. Family members were randomized to either the intervention group or a control group that did not receive any intervention. The goals of the two-session intervention were to identify current accommodation behaviors and provide alternative ways of responding to OCD symptoms. Patients and family members were assessed at baseline and regularly throughout the 25-week study. Results revealed that the intervention successfully reduced accommodation with a large effect size. Patients whose family members received the intervention showed greater levels of symptom reduction than patients whose family members had not. Hierarchical regression analyses revealed that change in family accommodation from baseline accounted for a significant amount of variance in later OCD symptoms. These results suggest that this intervention successfully enhanced the outcomes of standard CBT including ERP for adults with OCD. The findings support further exploration of this intervention in larger samples and in other diagnostic groups where accommodation is likely to occur.

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Guidelines for conducting effective exposure treatment with anxious youth emphasize content (e.g., preparation for and processing of the exposure) and process (e.g., collaboration and youth involvement) variables as important elements of exposure task sessions, but there is a paucity of research examining these guidelines. Using multiple regression, this study evaluated the extent to which independent observers' ratings of process (i.e., collaboration and youth involvement) and content variables (i.e., preparation for and processing after the exposure task) were predictive of treatment outcome in a sample of 61 anxiety-disordered youth. Results indicated that collaboration between the youth and therapist significantly predicted improvement in treatment outcome as measured by youth-, parent-, and teacher-reports. Youth involvement in exposure task sessions predicted improved outcome as measured by teacher-report. Contrary to expectation, preparation for exposure did not predict outcome, but post-event processing of the exposure task was significantly predictive of clinician-rated diagnostic outcome. Exploratory analyses suggest that treatment responders were more likely to be assigned between-session exposure tasks as "homework" and were more likely to be rewarded for their efforts in session. Treatment implications and future directions are discussed. / Psychology

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The current study extended earlier findings about the RealVictory program by using a larger sample and by examining Victory Seeker phone use in more detail. Using a sample of 144 juveniles, it was found that as the number of calls answered increased, the likelihood of a rearrest and the number of rearrests decreased slightly but the differences were not statistically significant. However, as the number of calls increased, the likelihood of a felony rearrest decreased significantly and the total number of felony arrests decreased significantly. These findings suggest that Victory Seeker may be a useful tool to reinforce and provide follow-up after treatment.

Thesis (Ph.D.)--Boston University / Although meta-analytic studies support the efficacy of cognitive-behavioral therapy for social anxiety disorder, a proportion of patients drop out of treatment or fail to benefit. Research to date has explored patient- and treatment-specific predictors of poor treatment response, including comorbid depression, but has not evaluated variables related to the patient's social environment. Expressed emotion (EE), an index of critical, hostile, and overprotective attitudes expressed by a significant other toward an individual with a psychiatric or medical condition, has been found to predict psychiatric relapse and poor treatment outcome in a wide range of disorders. Because EE and a closely related construct, perceived criticism, have been shown to predict treatment outcome and course in anxiety and mood disorders, it was expected that EE and perceived criticism would also predict treatment outcome in social anxiety disorder. Forty patients undergoing 12-session group cognitive-behavioral therapy for social anxiety disorder completed questionnaires about their symptoms of social anxiety and depression, and levels of perceived criticism, before and after treatment. Each participant designated one significant other who was then assessed for EE using the Camberwell Family Interview, a semi-structured interview method. Results indicate that higher initial severity of social anxiety and lower levels of perceived criticism predicted treatment dropout. There was also a trend for participants with a significant other rated as high in emotional overinvolvement, one of the EE-subscales, to show less change on a composite measure of anxiety symptoms. Comorbid depression and critical EE were associated with pretreatment severity of social anxiety but not outcome. These findings add to an increasing body of literature showing that the manifestation of significant others' EE, and EE's effect on clinical outcome, can vary as a function of the identified patient's diagnosis. For socially anxious individuals, perceiving criticism in the social environment may provide an important impetus for seeking and adhering to treatment, whereas significant others' overprotective behavior may negatively impact their ability to benefit from treatment. Further research replicating these findings, clarifYing the mechanisms and developing supplemental interventions, are important future directions.

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<p>Cognitive Behavioral Therapy (CBT) is recognized as an evidenced-based psychological treatment for Generalized Anxiety Disorder (GAD). Despite proven efficacy of CBT (i.e., large effect sizes), not everyone responds. One promising alternative approach is Mindfulness-based therapy, which has been shown to be effective in preliminary research in GAD. The purpose of this study was to directly compare a brief (1 hour) Mindfulness to CBT intervention to determine efficacy in reducing excessive worry and associated anxiety symptoms in a GAD population. Forty-five participants with a principal diagnosis of GAD were assessed by the Structured Clinical Interview for DSM Disorders (SCID-IV) and randomly assigned to one of three conditions: Mindfulness, CBT, or Information (control condition). Following the intervention, all participants completed daily practice for one week. Assessment consisted of self-report measures of worry and factors associated with GAD symptoms pre-and post-intervention. Overall findings did not support the main hypothesis that the brief interventions (Mindfulness and CBT) would be associated with a significant reduction in worry compared to the control group. However, group differences on factors associated with GAD were found. Individuals in the CBT condition reported a significant reduction in current level of general anxiety symptoms compared to the Mindfulness and Information conditions. Individuals in both CBT and Mindfulness conditions reported a significant reduction in current stress symptoms compared to the Information condition. In addition the CBT condition also demonstrated a trend for reduction in symptoms of depression compared to both Mindfulness and Information conditions. In summary, although a more intensive intervention may be needed to affect chronic worry, the CBT intervention was associated with greater benefit then the mindfulness intervention and may be useful as a brief pre-treatment intervention for individuals on a waitlist for standard treatment.</p> / Master of Science (MSc)