Book Summary: Psychopathology & Psychotherapy: DSM-5 Diagnosis, Case Conceptualization, and Treatment, Third Edition differs from other psychopathology and abnormal psychology books. While other books focus on describing diagnostic conditions, this book focus on the critical link between psychopathology and psychotherapy. More specifically, it links diagnostic evaluation, case conceptualization, and treatment selection to psychotherapy practice. Research affirms that knowledge and awareness of these links is essential in planning and providing highly effective psychotherapy. This third edition incorporates detailed case conceptualizations and treatment considerations for the DSM-5 diagnoses most commonly seen in everyday clinical practice. Extensive case studies illustrate the diagnostic, case conceptualization, and treatment process in a way that makes it come alive. Written by practicing clinicians with expertise in specific disorders, this book will be an invaluable resource to both novice and experienced clinicians.

Den vård som har starkast evidens vid behandling av tvångssyndrom, Obsessive Compulsive Disorder (OCD), är kognitiv beteendeterapi (KBT), innehållande exponering och responsprevention. Idag är tillgången till denna vård begränsad främst på grund av för få behandlare. Tidigare forskning pekar på att personer med OCD kan bli hjälpta av mindre terapeutintensiva behandlingar. Att leverera vård stegvis med ökande behandlingsintensitet; Stepped Care, kan vara ett sätt att öka tillgängligheten av KBT. Denna pilotstudie har undersökt Stepped Care för OCD i form av tre steg, på Ångestenheten, Karolinska Universitetssjukhuset. Det primära syftet har varit att bidra till kunskapsinsamlingen kring Stepped Care vid OCD. Sammanlagt 19 vuxna patienter ingår i pilotstudien. 8 blev förbättrade efter självhjälp, 5 efter gruppbehandling, 2 efter individualterapi samt 4 bortfall. Av dessa behöll 7 av självhjälps-, 3 av grupp- och ingen av individualpatienterna sina framsteg vid en uppföljning 12 veckor efter avslutad behandling. Totalt tog behandlingen 244 terapeuttimmar i anspråk, vilket är mer än en halvering mot traditionell individualbehandling. Resultaten tyder på att Stepped Care är ett intressant alternativ för att effektivisera och öka tillgängligheten av vård för OCD-patienter.

Obsessive-compulsive disorder (OCD) is a significantly impairing anxiety disorder for which the most successful treatment, cognitive behaviour therapy, has 50-60% success rates, taking into account treatment refusals and dropout rates (Fisher & Wells, 2005). Thus, factors that contribute to the persistence of OCD and interfere with treatment are likely being overlooked. Indeed, Mancini and Gangemi (2004) have proposed that individuals with OCD have greater fear of guilt than others; that is, they dread being judged as guilty for not having done everything in their power to prevent some negative outcome. This fear of guilt fuels obsessions and compulsions as individuals attempt to prevent, avoid, or neutralise the feared guilt. However, few studies have explored fear of guilt in OCD, and no scales exist to measure this construct. The role of fear of guilt in OCD was therefore examined across two studies. Study 1 explored the core features of fear of guilt in OCD, as well as the validity and reliability of the Fear of Guilt Scale (FOGS), a measure developed specifically to assess levels of trait fear of guilt in OCD. Results indicate that the FOGS is a valid and reliable, two-factor measure, and greater FOGS scores significantly predict more severe OCD symptoms among nonclinical participants. Study 2 aimed to determine whether fear of guilt evokes caution and feelings of doubt during the decision-making process, thereby making it more difficult to know when to stop and explaining perseveratory behaviour, such as compulsions in OCD. Findings suggest that greater fear of guilt does not predict more time taken or information needed to make decisions, but higher fear of guilt predicts feelings of uncertainty when deliberating, as indicated by ratings of greater difficulty making decisions, lower confidence in having made the right decisions, and less satisfaction with decisions made. Implications of these findings and the role that fear of guilt may play in the development and persistence of OCD are discussed.

The purpose of this quantitative study has been to investigate teenager’s perception of obsessions and compulsive acts. Teenager’s perceptions and experiences as well as connections between the taboos surrounding the topic and the perception have been examined. The study has taken in to consider gender perspective, in regards to certain topics. As a result the differences and similarities between male and females’ perspective, regarding the topic, have been highlighted. Thus, our sample group contained teenagers, as a vital part has been to highlight their perspective. The teenagers that have been participating in the study have been in school year 9, meaning ages fifteen to sixteen. Altogether a total of eighty-eight students have taken part in the study, split between two schools, one based in a middle sized county and one in a small size county, both based in Sweden. The study has used a survey as a data collection model. The students, in the sample group, have answered a questionnaire which surrounds the topic. The answers have generated some interesting results and by the means of labelling theory and the notion of taboo, the results have been analysed. The study has established how labelling, stigmatization and taboo can be seen as cohesive with teenager’s perception. With relation to earlier studies and the results, our reasoning surrounding information and its significant function is highlighted.

Recent theories posit that cognitive factors explain the development and maintenance of contamination fears associated with obsessive compulsive disorder (OCD). Few studies to date have aimed to establish causality or temporal precedence for cognitions predicting OCD-relevant distress and avoidance. The current study used a prospective design to assess threat appraisals, personality traits, and obsessive compulsive symptoms in an unselected sample of university students and community members (N = 105) several days prior to a contamination behavioural approach task (BAT) in a public washroom. Results of the hierarchical regressions demonstrated that prospective danger appraisals significantly predicted both disgust and avoidance on the BAT, even when controlling for neuroticism, disgust sensitivity, and OCD symptoms. In contrast, looming germ spread appraisals and responsibility appraisals were not significant predictors of the BAT. Results from in vivo distress ratings and implicit reaction time data indicated that disgust is more strongly associated with contaminants compared with anxiety. The findings of this research suggest that psychological treatment for contamination concerns should include monitoring of disgust as a process and outcome variable in exposure paradigms, and focus on reappraisal of danger estimates related to disease in cognitive paradigms.

Obsessive-compulsive disorder (OCD) is a significantly impairing anxiety disorder for which the most successful treatment, cognitive behaviour therapy, has 50-60% success rates, taking into account treatment refusals and dropout rates (Fisher & Wells, 2005). Thus, factors that contribute to the persistence of OCD and interfere with treatment are likely being overlooked. Indeed, Mancini and Gangemi (2004) have proposed that individuals with OCD have greater fear of guilt than others; that is, they dread being judged as guilty for not having done everything in their power to prevent some negative outcome. This fear of guilt fuels obsessions and compulsions as individuals attempt to prevent, avoid, or neutralise the feared guilt. However, few studies have explored fear of guilt in OCD, and no scales exist to measure this construct. The role of fear of guilt in OCD was therefore examined across two studies. Study 1 explored the core features of fear of guilt in OCD, as well as the validity and reliability of the Fear of Guilt Scale (FOGS), a measure developed specifically to assess levels of trait fear of guilt in OCD. Results indicate that the FOGS is a valid and reliable, two-factor measure, and greater FOGS scores significantly predict more severe OCD symptoms among nonclinical participants. Study 2 aimed to determine whether fear of guilt evokes caution and feelings of doubt during the decision-making process, thereby making it more difficult to know when to stop and explaining perseveratory behaviour, such as compulsions in OCD. Findings suggest that greater fear of guilt does not predict more time taken or information needed to make decisions, but higher fear of guilt predicts feelings of uncertainty when deliberating, as indicated by ratings of greater difficulty making decisions, lower confidence in having made the right decisions, and less satisfaction with decisions made. Implications of these findings and the role that fear of guilt may play in the development and persistence of OCD are discussed.

Dette er den første behandlingsstudien som undersøker langtidseffekten (seks måneder) av intensiv inneliggende ERP-behandling gitt til et stort utvalg pasienter med tvangslidelse (obsessive-compulsive disorder, OCD) (N=108). Sekstitre prosent av pasientene hadde komorbiditet. OCD-alvorlighet (Yale-Brown Obsessive-Compulsive Scale, Y-BOCS; Obsessive-Compulsive Inventory-Revised, OCI-R) og depresjonsalvorlighet (Beck Depression Inventory, BDI) ble kartlagt ved oppstart, avslutning og oppfølging. Etter behandling viste 69.4% klinisk signifikant endring (CSC) på Y-BOCS, og 74% viste CSC på OCI-R. Nedgangen på BDI var også signifikant. Effektstørrelsene for Y-BOCS, OCI-R og BDI var store, både ved avslutning og ved oppfølging. Ved oppfølging viste pasientene en oppsving i symptomer, men endringen var ikke signifikant. Trettiåtte prosent var fortsatt syke eller hadde fått tilbakefall, mens det gikk bra for resten av utvalget. Alvorlighetsgrad av OCD-symptomer og klinikervurdert depresjon var relatert til tilbakefall, men tilbakefall var ikke signifikant relatert til depresjonsgrad, generalisert angstlidelse (GAD), sosial fobi, sivilstatus eller arbeidsstatus. Studien replikerer tidligere funn som har vist at ERP har god effekt på OCD-symptomer og foreslår videre at også intensiv inneliggende ERP kan være effektiv. En viktig implikasjon av studien er at depresjon og alvorlighetsgrad av OCD representerer større risiko for tilbakefall, og at intervensjoner for å adressere disse må utforskes.

Recent theories posit that cognitive factors explain the development and maintenance of contamination fears associated with obsessive compulsive disorder (OCD). Few studies to date have aimed to establish causality or temporal precedence for cognitions predicting OCD-relevant distress and avoidance. The current study used a prospective design to assess threat appraisals, personality traits, and obsessive compulsive symptoms in an unselected sample of university students and community members (N = 105) several days prior to a contamination behavioural approach task (BAT) in a public washroom. Results of the hierarchical regressions demonstrated that prospective danger appraisals significantly predicted both disgust and avoidance on the BAT, even when controlling for neuroticism, disgust sensitivity, and OCD symptoms. In contrast, looming germ spread appraisals and responsibility appraisals were not significant predictors of the BAT. Results from in vivo distress ratings and implicit reaction time data indicated that disgust is more strongly associated with contaminants compared with anxiety. The findings of this research suggest that psychological treatment for contamination concerns should include monitoring of disgust as a process and outcome variable in exposure paradigms, and focus on reappraisal of danger estimates related to disease in cognitive paradigms.

According to the cognitive model, Obsessive-compulsive disorder (OCD) is maintained by various belief factors such as an inflated sense of responsibility, perfectionism and an overestimation about the importance of thoughts. Despite much support for this hypothesis, there is a lack of understanding about the role of self-concept in the maintenance or treatment of OCD. Guidano and Liotti (1983) suggest that individuals who are ambivalent about their self-worth, personal morality and lovability use perfectionistic and obsessive compulsive behaviours to continuously restore self-esteem. This thesis develops a model of OCD that integrates self-ambivalence in the cognitive model of OCD. (For complete abstract open document)

Recent theories posit that cognitive factors explain the development and maintenance of contamination fears associated with obsessive compulsive disorder (OCD). Few studies to date have aimed to establish causality or temporal precedence for cognitions predicting OCD-relevant distress and avoidance. The current study used a prospective design to assess threat appraisals, personality traits, and obsessive compulsive symptoms in an unselected sample of university students and community members (N = 105) several days prior to a contamination behavioural approach task (BAT) in a public washroom. Results of the hierarchical regressions demonstrated that prospective danger appraisals significantly predicted both disgust and avoidance on the BAT, even when controlling for neuroticism, disgust sensitivity, and OCD symptoms. In contrast, looming germ spread appraisals and responsibility appraisals were not significant predictors of the BAT. Results from in vivo distress ratings and implicit reaction time data indicated that disgust is more strongly associated with contaminants compared with anxiety. The findings of this research suggest that psychological treatment for contamination concerns should include monitoring of disgust as a process and outcome variable in exposure paradigms, and focus on reappraisal of danger estimates related to disease in cognitive paradigms. / Arts, Faculty of / Psychology, Department of / Graduate