Although research supports cognitive behaviour therapy (CBT) as the treatment of choice for childhood obsessive compulsive disorder (OCD) and recommends family involvement (e.g., AACAP, 1998; Barrett, Healey-Farrell, & March, 2004a), little is known about the role of the family in the development, maintenance, and treatment of childhood OCD. Furthermore, although significant improvements are found in treatment response, many children remain symptomatic (de Haan, 2006). Objective: The aims of the study were to examine (1) the perceptions of the family environment among family members and if child perceptions change with treatment and (2) treatment response and child and family characteristics that may predict treatment response. Gender differences were also examined. Method: This study involved 82 children (ages 8 to 17 years) receiving CBT for OCD and a concurrent parent program. Children and parents were assessed at initial, pre-, and post-treatment with questionnaires, a symptom severity interview, a family environment questionnaire, and child self-report measures of anxiety and depression. Pre-treatment data were used for the prediction of treatment response. Results: Child and parent perceptions of the family environment differ in terms of family expressiveness, with children perceiving their family as being ‘distressed.’ Although girls and boys had similar perceptions of their family environment, girls’ perceptions were more in agreement with their parents than boys. Children’s ratings of family cohesiveness were ‘normal’ at pre-treatment, and increased significantly at post-treatment; however, this was not meaningful when gender was considered. We found a similar treatment response to past research. Different characteristics were found to predict treatment response for boys and girls, with more predictors being identified for girls. Conclusions: Results emphasize the importance that families may have in the treatment of OCD and in our attempt to find predictors, as well as the need to examine boys and girls separately. This research is critical to refine and tailor treatment techniques to match child and family characteristics.

A growing literature suggests that individuals repeatedly check in part because they lack confidence in their memories for previously-completed actions. It has also been hypothesized that the cognitive distrust demonstrated by individuals with OCD extends beyond memory to related factors such as attention and perception; however, the relation between distrust in attention, perception and memory has yet to be examined. The present study examined the extent to which distrust in attention and perception relate to memory distrust and compulsive checking in participants ranging in OCD symptom severity. A measure of distrust in attention and perception was developed for this purpose. Initial psychometric results indicated that distrust in attention and perception can be measured reliably and that it is related to previously-established metacognitive factors (e.g., distrust in memory) and OCD-relevant beliefs (e.g., inflated sense of responsibility). Importantly, the present results also indicated that distrust in attention and perception contributed to checking symptoms beyond memory distrust, baseline negative mood and neuroticism, and previously-established OCD beliefs (i.e., inflated sense of responsibility). Taken together, these findings suggest that distrust in attention and perception may be an important mechanism in the persistence of compulsive checking.

A growing literature suggests that individuals repeatedly check in part because they lack confidence in their memories for previously-completed actions. It has also been hypothesized that the cognitive distrust demonstrated by individuals with OCD extends beyond memory to related factors such as attention and perception; however, the relation between distrust in attention, perception and memory has yet to be examined. The present study examined the extent to which distrust in attention and perception relate to memory distrust and compulsive checking in participants ranging in OCD symptom severity. A measure of distrust in attention and perception was developed for this purpose. Initial psychometric results indicated that distrust in attention and perception can be measured reliably and that it is related to previously-established metacognitive factors (e.g., distrust in memory) and OCD-relevant beliefs (e.g., inflated sense of responsibility). Importantly, the present results also indicated that distrust in attention and perception contributed to checking symptoms beyond memory distrust, baseline negative mood and neuroticism, and previously-established OCD beliefs (i.e., inflated sense of responsibility). Taken together, these findings suggest that distrust in attention and perception may be an important mechanism in the persistence of compulsive checking.

No description available.

Obsessive Compulsive Disorder (OCD) is a commonly diagnosed mental health condition among children and adolescents, with studies suggesting that OCD has the potential for significant disruption of academic and social performance. Subjective well-being (SWB) represents a non-traditional conceptualization of mental health within the dual factor model, wherein SWB and measures of psychopathology (e.g., problematic levels of internalizing and externalizing behaviors) provide a more comprehensive picture of mental wellness. The current study examined the nature of the relationship between clinical characteristics of pediatric OCD and SWB within school-age youth (N=65) seeking treatment from an outpatient pediatric neuropsychiatric clinic. Additionally, the potential for moderation of this relationship by various symptom-related and demographic variables was examined, as was the potential for SWB to moderate the relationship between clinical characteristics of pediatric OCD and associated impairments in academic and general functioning. Results indicated that a majority of the sample (n=58; 89.2%) met or exceeded the clinically significant threshold for OCD symptoms, while roughly half of the sample (n=33; 50.8%) endorsed significant levels of academic impairment associated with symptom onset. Subjective well being varied among participants, with levels of SWB showing a statistically significant negative relationship with obsessive thoughts, but little to no relationship with compulsive behaviors. Finally, results of multiple regression analyses failed to identify variables that effectively moderated the relationship between clinical characteristics of pediatric OCD and SWB. Similarly, SWB was not indicated as a moderator of the relationship between clinical characteristics of pediatric OCD and academic functioning. Implications of the findings and directions for future research are discussed.

The cognitive model of obsessions (Rachman, 1997, 1998) proposes the escalation from normal intrusive thought into clinical obsession begins with the appraisal of thoughts as being significant or dangerous. The cognitive theory of obsessions also posits through targeting and dismantling maladaptive thought related beliefs and thought control strategies, one can reduce the frequency of and discomfort associated with obsessive thoughts. The current study first set out to obtain additional empirical support for the proposed relationship between maladaptive thought related beliefs, thought management strategies, and obsessive thinking. Next, this study explored the potential impact of targeting and altering maladaptive thought related beliefs and thought management strategies, through mindfulness-based training (thought acceptance), in comparison to relaxation-based training (thought control). Finally, this study assessed which, if any, participant characteristics were associated with positively responding to mindfulness training. Results highlighted the strong relationship between maladaptive thought related beliefs, thought management strategies and obsessive thinking, with mindfulness mediating the relationship between maladaptive thought related beliefs and obsessive thinking. Research results also lend support for the potential efficacy of both mindfulness as well as relaxation based training, for the treatment of obsessive thinking. Participants assigned to both conditions exhibited decreased obsessive thinking as well increased positive mood state and decreased maladaptive thought related beliefs. Process related analysis uncovered a significant relationship between decreased maladaptive thought related beliefs and decreased obsessive thinking for the mindfulness condition, providing initial evidence for changes in meta-cognitive beliefs as an active ingredient in mindfulness training. In contrast, a significant relationship between decreased maladaptive thought related beliefs and decreased obsessive thinking was not found for the relaxation condition. Finally, when assessing participant characteristics associated with positively responding to mindfulness training, level of obsessive thinking predicted self reporting to have obtained a significant benefit from engaging in mindfulness training, with study participants experiencing higher levels of obsessive thinking interpreting the mindfulness intervention as more beneficial than study participants who experienced lower levels of obsessive thinking. These findings offer initial evidence that mindfulness training may be a useful treatment approach, in targeting and altering maladaptive thought related beliefs, for the treatment of obsessive thinking. / text

Trichotillomania (TTM) is currently classified as an impulse disorder in the DSM-IV, but there is a growing consensus amongst researchers that trichotillomania should be placed on the putative QCD-related disorders spectrum. QCD and TTM have been compared in many fields including neurobiology, phenomenology and epidemiology. Studies of cognition in QCD and TTM typically focus on automatic thoughts and underlying assumptions and there is a paucity of research into enduring cognitive structures, or schemas, associated with the two disorders. This thesis reviews the available evidence regarding the relationship between QCD and TTM. The Young Schema Questionnaire (YSQ) was used to measure 15 maladaptive schemas in 96 QCD patients, 34 TTM patients, and 94 controls. In the comparison between QCD and TTM it was found that depression has a major impact on the profile of schemas in QCD. When controlling for depression a few differences in schema profile were found between QCD and TTM, though the schema enmeshment emerged as significant in both disorders. These findings are discussed in the light of the debate around the classification of trichotillomania in the psychiatric nomenclature. / Thesis (M.A.)-University of Natal, Pietermaritzburg, 2003.

Obsessive Compulsive Disorder (OCD) is classified as an anxiety disorder characterized by distressing persistent unwanted ideas or impulses (obsessions) and urges and/or compulsion to do something to relieve the associated anxiety caused by the obsession. The thematic content of the obsessions are highly variable, ranging from symmetry, contamination to aggressive concerns. Compulsions tend to be linked to the obsessions, but can also be idiosyncratic to the intrusive thought. According to the cognitive model, Obsessive-compulsive disorder (OCD) is maintained by various belief factors such as an inflated sense of responsibility, overestimation of threat and the over-control of thoughts. Despite much support for this hypothesis, there is a lack of specificity. This series of studies sought to determine the relationship between a number of cognitive beliefs and appraisal processes and obsessive-compulsive symptoms. This thesis presents the results of three studies. The first study was designed to investigate the hypothesis that certain beliefs are more prevalent in OCD, compared with other anxiety disorders. The second study expands on earlier findings by examining whether the six metacognitive beliefs proposed by the Obsessive Compulsive Cognitions Working Group, (OCCWG; 1997, 2001, & 2003) correlate with specific symptom-based OCD subtypes. The final study addresses some of the methodological weaknesses inherent in retrospective self-report measures by replicating the study using experimental techniques. Most importantly, this research was conducted from within the theoretical framework of Rachman (1993) and Salkovskis (1989) models which emphasise the misinterpretation of significance of the intrusive thoughts. The first study explored the relationship between thought-action fusion (TAF) and inflated responsibility beliefs across individuals diagnosed with obsessive compulsive disorder (OCD), an anxiety disorder other than OCD (anxious controls; AC), and a non-anxious control group (NAC). It was hypothesized that the OCD group would evidence significantly higher inflated responsibility and TAF scores, compared to the AC and NAC groups. In this study, non-clinical and clinical participants were recruited for research. The non-clinical group was comprised of undergraduate students (n = 22: mean age = 26.8; SD = 9.2). The clinical groups included 20 participants with OCD as their primary diagnosis (mean age = 32.1; SD = 11.9) and 21 individuals diagnosed with another anxiety disorder (mean age = 32.2; SD = 10.9). To measure inflated responsibility beliefs and thought action fusion, self-report questionnaires were administered to the participants. The results of this study demonstrated that inflated responsibility beliefs, while present in other anxiety disorders, were significantly higher in participants with OCD, even after controlling for depressed mood and TAF levels. No group differences emerged between the OCD and anxious groups on measures of TAF. Thus, it can be tentatively concluded that inflated responsibility beliefs may have a more robust relationship with OCD than TAF beliefs, which appear to act as a general vulnerability factor occurring along a continuum of anxiety disorders. The second study examined the associations between the six OCD-related beliefs: control of thoughts, importance of thoughts, responsibility, intolerance of uncertainty, overestimation of threat and perfectionism and five empirically derived OCD subgroups. Clinical participants with a primary diagnosis with OCD (n = 67: mean age = 38.0; SD = 11.7) were recruited over a period of two years from the Anxiety Disorders Unit. Participant responses were cluster analysed to form five stable groups: aggressive obsessions-checking compulsions (n = 22: mean age = 26.8; SD = 9.2); contamination obsessions-cleaning compulsions (n = 22: mean age = 26.8; SD = 9.2); symmetry concerns-ordering/arranging compulsions (n = 22: mean age = 26.8; SD = 9.2); hoarding obsessions-hoarding compulsions (n = 22: mean age = 26.8; SD = 9.2); and miscellaneous obsessions -miscellaneous compulsions (n = 22: mean age = 26.8; SD = 9.2). The second found that intolerance of uncertainty was significantly related to the contamination subgroup. While responsibility and threat estimation beliefs were higher in the aggressive-checking subgroup, these differences did not reach statistical significance. No other significant results were found, however, there was a non-significant trend for perfectionism beliefs to be higher in symmetry-ordering and hoarding subgroup. Following the results of this study, questions remained about whether the lack of significant findings reflected the generality of these beliefs or were due to methodological differences. This led to the development of the final study presented in this thesis. The purpose of the final study was to investigate whether the second study was limited by the method of assessment (e.g. self-report questionnaires). This study was unique, as it was the first of its kind to experimentally manipulate all six beliefs in empirically derived OCD subtypes. Twenty participants (mean age = 45.0; SD = 11.0) were chosen from the second study to form the following priori groups: contamination (n = 4: mean age = 44.5; SD = 9.5); aggressive (n = 6: mean age = 46.5; SD = 7.2); hoarding (n = 4: mean age = 47.2; SD = 6.9); and symmetry (n = 6: mean age = 41.8; SD = 17.4). Six behavioural experiments designed to reflect one of the six OCCWG beliefs were specifically developed and administered to the groups. Baseline scores were obtained using self-report questionnaires. The study found strong support for the use of experimental paradigms over self-report measures, as several significant interactions between cognitive beliefs and OCD symptom-based subtypes were found. Specifically, the hoarding subgroup evidenced significantly higher overall thought action fusion scores compared to those in the contamination group. The symmetry subgroup exhibited significantly higher anxiety than the aggressive group during the perfectionism task and demonstrated significantly higher scores on several items measuring perfectionism compared to the contamination group. Finally, over-estimation of threat beliefs was significantly higher in the contamination thoughts. No statistically significant group differences were found for controllability of thoughts, responsibility and intolerance of uncertainty. In conclusion, these studies collectively showed that in some cases of OCD certain beliefs appear highly applicable, whereas in others they are not. This finding may explain why some OCD patients have poor treatment outcomes as the beliefs and appraisals were highly variable across groups. These findings are of both theoretical and clinical significance because they add to the growing understanding that OCD may consist of distinct clusters of symptoms with different underlying motivations and beliefs. This finding is of clinical significance because treatment guidelines for OCD can become more specific, factoring into the therapy situation these underlying beliefs and appraisal processes. Lastly, the findings regarding inflated responsibility deserve special mention, given the significance of this construct in contemporary cognitive models. The results of the present studies were mixed with regard to responsibility as only the first study found a significant result. It appears that, like the other belief domains proposed by the OCCWG, responsibility may not be specific to all types of OCD and current cognitive models may benefit was shifting the emphasis to other belief domains.

Thesis (Ph. D.)--University of Nevada, Reno, 2007. / "August, 2007." Includes bibliographical references (leaves 81-100). Online version available on the World Wide Web.

Thesis (Ph.D.)--Tufts University, 2004. / Adviser: Lee Edelman. Submitted to the Dept. of English. Includes bibliographical references (leaves 155-162). Access restricted to members of the Tufts University community. Also available via the World Wide Web;