It is of crucial importance to identify and disseminate effective treatments for paediatric obsessive-compulsive disorder (OCD). OCD is time-consuming and distressing, and can substantially disable functioning at school, at home, and with peers (Piacentini, 2003). Children who do not receive treatment are at risk of psychological difficulties in adulthood, including continued OCD, clinical anxiety and depression, personality disorders, and social maladjustment (Wewetzer et al., 2001). Two-thirds of adult cases of OCD develop in childhood, and adults with OCD have lower employment, poorer academic achievement, and lower marital rates compared to non-OCD adults (Hollander et al., 1996; Koran, 2000; Lensi et al., 1996; Steketee, 1993). The distressing nature of OCD in childhood, accompanying psychosocial impairment and risk of future psychopathology, underscore the need to identify effective treatments. The primary aim of this thesis was to expand knowledge of evidence-based treatments for paediatric OCD. A mixed-methodology approach was employed to examine key issues in this area. The first study used meta-analytic methodology to determine the evidence supporting available treatments for paediatric OCD. An extensive literature search revealed over 100 published reports of treatments, encompassing a broad array of theoretical approaches and treatment strategies. Examples of treatments used for paediatric OCD included psychodynamic therapy, pharmacotherapy, cognitive-behavioural therapy (CBT), hypnosis, family therapy, immunotherapy, and homeopathy. / Study 1 comprised the first known meta-analysis of randomised, controlled treatment trials (RCTs) for paediatric OCD. Included studies were limited to RCTs as they are the most scientifically valid means for determining treatment efficacy and provide a more accurate estimate of treatment effect by removing error variance associated with confounding variables. The literature search identified 13 RCTs containing 10 pharmacotherapy to control comparisons (N = 1016) and 5 CBT to control comparisons (N = 161). Random effects modelling yielded statistically significant pooled effect size (ES) estimates for pharmacotherapy (ES = 0.48, 95% CI = 0.36 to 0.61, p < .00001) and CBT (ES = 1.45, 95% CI = 0.68 to 2.22, p =.002). The results support the efficacy of CBT and pharmacotherapy, and confirm these approaches as the only two evidence-based treatments for paediatric OCD. Implications and suggestions for future research are discussed. The effectiveness of CBT provided impetus to further examine this treatment. Group CBT is an understudied treatment modality among children with OCD. It was hypothesised that group CBT would possess efficacy because of the effectiveness of individual CBT for children with OCD, the demonstrated effectiveness of group CBT among adults with OCD, the practical and therapeutic advantages afforded by a group treatment approach, and the embeddedness of the approach in robust psychological theory. The aim of the second study was to evaluate the efficacy of group CBT. The study comprised the largest known conducted randomised, placebo-controlled trial of group CBT for paediatric OCD. / Twenty-two children and adolescents with a primary diagnosis of OCD were randomly assigned to a 12-week program of group CBT or a credible psychological placebo. Children were assessed at baseline, end of treatment, and at 1 month follow-up. Outcome measures included the Children’s Yale-Brown Obsessive-Compulsive Scale, global measures of OCD severity, Children’s Depression Inventory, and parent- and child-rated measures of psychosocial functioning. An intention-to-treat analysis revealed that children in the group CBT condition had statistically significantly lower levels of symptomatology at posttreatment and follow-up compared to children in the placebo condition. Analysis of clinical significance showed that 91% of children that received CBT were ‘recovered’ or ‘improved’ at follow-up, whereas 73% of children in the placebo condition were ‘unchanged’. Effect size analysis using Cohen’s d derived an effect of 1.14 and 1.20 at posttreatment and follow-up, respectively. These effects are comparable to results from studies of individual CBT. This study supported group CBT as an effective treatment modality for paediatric OCD and demonstrated that the effect extends beyond placebo and nonspecific treatment factors. In addition to treatment efficacy, the inherent worth of a treatment lies in its adoption by the relevant clinical population. Children with OCD are known to be secretive and embarrassed about symptoms, and there is often a long delay between onset of symptoms and treatment-seeking (Simonds & Elliot, 2001). An important observation during the course of conducting the RCT was that a high rate (39%) of eligible families declined participation. / This led to the question, "What barriers prevent participation in group CBT for paediatric OCD?" Qualitative methodology was employed to address this research question. Eligible families that had declined participation in the RCT were contacted and invited to participate in semi-structured interviews that explored reasons for non-participation and positive and negative perceptions of group CBT. The average time between non-participation and interview was 1.33 years (SD = 3 months). Data were collected from nine families and thematic analysis methodology was utilised to identify emergent themes. Failure to participate was predicted by practical and attitudinal barriers. Practical barriers included a lack of time, distance, severity of OCD symptoms, financial, and child physical health. Attitudinal barriers included child embarrassment about OCD symptoms, child belief that therapy would be ineffective, fear of the social aspect of the group, lack of previous success with psychology, lack of trust in strangers, parental concern about the structure of the group, denial of a problem, and ‘not being ready for it’. Attitudinal barriers more frequently predicted treatment non-participation. Positive and negative perceptions of this treatment modality were informative. Parents showed no differences in preference for individual or group CBT. An important finding was that 56% of the children had not received treatment since parental expression of interest in the group CBT program. Application of the findings to methods that promote service utilisation is discussed.

Abstract not available

The pivotal role of inflated responsibility beliefs in the maintenance and treatment of obsessive-compulsive disorder (OCD) has been clearly demonstrated (Rachman, 1993; Salkovskis, 1998; Shafran, 1997; van Oppen & Arntz, 1994). Yet little is known about the origins of these beliefs, their contribution to a sense of inflated responsibility or the symptoms of OCD, or the contribution of personality to inflated responsibility and to OCD, The aims of this thesis were to investigate a model of the inter-relationships among the personality dimensions of neuroticism and psychoticism, inflated responsibility and OCD, and the origins of inflated responsibility to inflated responsibility and to OCD. In order to achieve these aims, a scale was developed to assess the origins of inflated responsibility based upon the five pathways proposed by Salkovskis, Shafran, Rachman, and Freeston (1999) and the additional domains of guilt, vigilance and thought-action fusion (Shafran, Thordarson, & Rachman, 1996; Shafran, Watkins & Charman, 1996; Tallis, 1994). Eighty-four participants with OCD (age M = 43.36) and 74 control participants (age M =37.14) volunteered to participate in the two studies of this thesis. The aim of Study 1 was to develop and validate a measure of the Origins of Inflated Responsibility (OIR). The results of the first study yielded a 25-ttem scale, the Origins of Inflated Responsibility Questionnaire (OIRQ) with five independent factors: responsibility, strictness, protection from responsibility, critical incidents, and peer blame which demonstrated both internal reliability and temporal stability over a 2-week period. In Study 2, participants also completed the Responsibility Attitudes Scale (Salkovskis, Wroe, Gledhill, Morrison, Forrester, Richards, ct al. (2000) (a measure of inflated responsibility), the Padua Inventory (Sanavio, 1988) (to measure of the symptoms of OCD)y and the Eysenck Personality Inventory-Revised (Eysenck & Eysenck, 1991). Multivariatc Analysis of Variance revealed that the OCD group scored higher on all variables than the control group except for strictness where the groups were not different, and psychoticism where the OCD group scored lower. A series of Multiple Regression analyses revealed that both group and the OIR contributed to inflated responsibility (R2 = .56). When all variables, OIR, inflated responsibility and neuroticism were entered as predictors of OCD, 60% of the variance in OCD was explained however, 49% of the variance was shared by the independent variables suggesting the presence of some underlying construct. Structural Equation Modelling, where all the constructs in the model were examined simultaneously, revealed that neuroticism contributed to the OIR, inflated responsibility and OCD. The OIR were also significant predictors of inflated responsibility and indirectly through inflated responsibility predictive of OCD. The OIR also directly predicted OCD and when the total effects are considered, their contribution was greater than the total effect for inflated responsibility alone. The results of these studies provide good support for the origins of inflated responsibility proposed by Salkovskis et al. (1999), as measured by the OIRQ developed for use in the current thesis. The results also support the contribution of inflated responsibility and neuroticism, as well as the OIR, to OCD, The large amount of variance shared by the OIR, inflated responsibility and neuroticism suggest that there might be some underlying construct, perhaps of a biopsychosocial nature, that requires further investigation for its role in the onset and maintenance of OCD. The clinical relevance of these findings is discussed in terms of early prevention strategies and interventions.

<p>Despite the prominence of cognitive theories of anxiety disorders, which posit that thoughts can affect the expression of psychopathology, empirical investigation of the origins of such thoughts is scant. In the study of obsessive-compulsive disorder (OCD), a number of cognitive factors, deemed obsessive beliefs, have been identified as correlates of the disorder. Although both parenting behaviors and obsessive beliefs have demonstrated associations with obsessive-compulsive symptoms, research exploring the relations between all three of these constructs has been heretofore limited. Moreover, given the moral content of some obsessions and compulsions (e.g. praying, harm prevention techniques), it is possible that specific moral socialization techniques serve to promote obsessive beliefs. This study investigated parenting, obsessive beliefs, moral socialization and obsessive-compulsive symptoms in a large non-clinical sample (N=288). Thirty-four students who were measured as relatively high or low on obsessive beliefs subsequently completed an additional procedure in which they were interviewed about moral socialization. Results provided support for a model in which obsessive beliefs served as a mediator of the relations between parenting behaviors and symptom levels. Adding self-conscious emotions to the model as a covariate significantly improved overall fit statistics. With respect to moral socialization, few differences emerged in the moral socialization histories of individuals relatively high or low on obsessive beliefs. However, those in the high obsessive beliefs group were more likely to report relationship-centered discipline (i.e. the parent using damage to the parent-child relationship as a vehicle for punishment) than those in the low obsessive beliefs group.</p> / Dissertation

The current coginitive models of the Obsessive-Compulsive Disorder (OCD) symptoms focuses on the different cognitive factors. Like other nonspecific and noncognitive variables, these factors may also function as vulnerability factors. However, they have been mostly studied separately and majority of the findings in the literature come from the Western samples. Accordingly, the studies examining these factors together and the impact of the culture in these studies are sparse in number. The present study suggested a comprehensive cognitive model for OCD symptoms, including several distal and proximal vulnerability factors. It was aimed to adapt three instruments to examine the interrelationships among the vulnerability factors and OCD symptoms in different cultures. Relevant ten instruments were administered to the university students from Turkey and Canada. The analyses showed that Turkish versions of three instruments had satisfactory psychometric properties for Turkish students. These analyses also revealed some cross-cultural similarities and differences in these factors and OCD symptoms. Neuroticism, age, introversion, OCD beliefs on responsibility/threat estimation, perfectionism/certainty and thought-action fusion in likelihood dimension were found to be associated with the OCD symptoms in both Turkish and Canadian samples. The relational paths between non-specific, appraisal and control factors, and OCD symptoms were also significant in both samples. However, religiousness was only significant factor in OCD symptoms and contributed to several belief and control factors toward these symptoms, only for Turkish subjects. The analyses of the religiousness differences indicated that psychological fusion in general and in morality was more related to the religiosity for Canadian Christians. Besides, Turkish students seemed to utilize worry more for OCD symptoms / whereas, Canadian participants used self-punishment. These common and unique patterns of the relationships were discussed within relevant findings about characteristics of the religion and culture.

The purpose of the present study was to examine the underlying mechanism of memory distrust as a function of repeated checking in a nonclinical student sample. Recent literature proposes that repeated checking increases familiarity with the material checked. Then, familiarity makes the recollections less vivid and detailed. Afterwards, this condition promotes distrust in memory. Before the experimental phase of the study, Padua Inventory- Washington State University Revision (PI-WSUR) and demographic information form were applied to the 381 students (232 female, 149 male) university students. Then, 84 students were selected according to their PI-WSUR scores. The students scored half standard deviation below the mean of the group were assigned to the low OCD group (N= 42) and the students scored half standard deviation above the mean were assigned to the high OCD group (N= 42). In the experimental phase of the study, an interactive computer animation was developed to test repeated checking behavior. Before the experiment, participants were randomly assigned to two groups: primed with feedback group and primed with no feedback group. In the experiment, participants were all asked to carry out checking rituals on a virtual gas ring. Each participant performed turning on, turning off and checking processes for 15 trials. However, half of the participants in the primed with feedback group were given feedback indicating that the checking activity was successful and complete and half of the participants in the primed with no feedback group were not given any feedback. The data are analyzed by 2 (Group: Low OCD group - High OCD Group) X 2 (Feedback condition: Primed with Feedback Group - Primed with no Feedback Group) Between Subjects ANOVA. Results showed that participants in the primed with feedback group had significantly higher scores on both memory confidence for the last checking trial of the gas rings and overall outcome confidence for all fifteen checking trials than participants in the primed with no feedback group. There was no significant group main effect and interaction effect (group x feedback condition) for the level of memory confidence and overall outcome confidence. There were also no significant group and feedback condition main effects and interaction effect for the level of vividness and detail of the recollections of the last checking behavior. Results are discussed in the light of the related literature.

Title from title page of PDF (University of Missouri--St. Louis, viewed February 23, 2010). Includes bibliographical references (p. 53-60).

Family accommodation of symptoms conflicts with the primary goals of cognitive-behavioral therapy for pediatric obsessive-compulsive disorder (OCD) and can be an obstacle to positive outcomes. This study examined a structural equation model of parent and child variables related to family accommodation using a sample of 65 parent-child dyads recruited from a university-based clinic. Additionally, parents' motivations for engaging in accommodation were explored. Results generally supported the hypothesized model. Family accommodation mediated the relationship between OCD symptom severity and parent-rated functional impairment, child internalizing problems mediated the relationship between parent anxiety and family accommodation, and parent empathy and consideration of future consequences interacted to predict accommodation. Child externalizing problems significantly influenced family accommodation but neither of these two variables was affected by parent depression. Excessive reassurance seeking and cleaning/washing compulsions were relatively likely to be accommodated. Implications for clinical practice and directions for future research are discussed.

myo-lnositol (mIns), a natural component of the human diet and essential precursor of several signalling pathways, including that of G protein-coupled receptors, has also been shown to be effective in the treatment of psychiatric disorders such as depression, obsessive compulsive disorder and panic disorder. Most likely since mlns is a simple isomer of glucose, no serious side effects have been reported with its use, even at high oral doses of mlns. Previous studies suggest that the therapeutic action of mlns may include reduced serotonin 5HTzA and muscarinic acetylcholine receptor function. An important signal transduction system that may possibly be involved in the mechanism of action of antidepressants is phosphoinositide (PI) turnover. In this signalling system PI-phospholipase C (PLCpl), that is implicated in the in the mechanism of action of antidepressants and anxiolytics, is activated. The mechanism of action of mlns, however, still remains elusive and needs further investigation. In this study a possible modulatory role of 24-hour pre-treatment of human neuroblastoma cell line (SH-SY5Y) with mlns on mRNA levels and protein expression of phospholipase C-p1 (PLCP1) and glycogen synthase kinase 3P (GSK3p) was investigated. The effects of mlns were also compared to that of other prototype antidepressants, such as fluoxetine (a selective serotonin reuptake inhibitor), imipramine (a tricyclic antidepressant), lithium and another drug with potential antidepressant effects, sildenafil (phosphodiesterase 5-type (PDE5) inhibitor). Real-time reverse transcription Polymerase Chain Reaction (RTPCR) was performed in order to investigate the mRNA levels, while protein expression in membranes and the cytosol fraction of cells were quantified with Western blots. The expression of PLCPl was decreased after pre-treatments with imipramine or myoinositol in combination with fluoxetine. In addition, sildenafil alone or in combination with myo-inositol, also decreased the expression of membrane-bound PLCp1. However, a 24- hour pre-treatment with lithium did not alter PLCPl expression significantly. Determined mRNA levels for the expression of PLCPl were consistent in these findings, except for the inhibition of the mRNA for the expression of PLCPl also after lithium treatment. The reduced PLCpl mRNA levels after lithium pre-treatment may suggest the involvement of posttranscriptional modification (or delayed translational effects) of PLCpl after lithium treatment. The data from the current study suggest that antidepressant action may include downregulation of PLCPl expression and that modulators of the nitric oxidecGMP pathway (e.g. sildenafil as a PDE5 inhibitor) may exhibit similar properties. / Thesis (M.Sc. (Pharmacology))--North-West University, Potchefstroom Campus, 2005.

This qualitative study was aimed at examining which therapeutic attitudes and procedures it is possible to find regarding obsessive-compulsive disorder (OCD), to see if there are any specific factors that crystallizes as particularly important for this disorder. A total of ten therapists with different background and experiences concerning OCD participated in the study where semi-structured interviews was used to collect the data. To analyze the data thematic analysis was used. Three main-themes grew from the analysis, which were all related to the study’s overall purpose. The first main-theme was general therapeutic attitudes. Under this theme, there are two sub-themes, personal characteristics of the therapist and degree of knowledge. The second main-theme, therapeutic approaches regarding OCD, also includes two sub-themes, degree of therapeutic distinctiveness and specific treatment interventions. The third main-theme was the treatment results components. This theme also includes two sub-themes, therapeutic factors and choice of method. In the participants’ stories about which therapeutic attitudes and procedures that are important regarding the treatment of people suffering from OCD, several factors became visible. These are connected to a general therapeutic attitude across diagnosis, such as warmth, empathy, and the ability to form an alliance, in addition to several therapeutic factors which are important to OCD specifically, such as experience and maturity, and being creative. The participants also emphasizes to a large degree ERP as the first choice in regards to treatment. Specifically for this study is that one participant emphasizes ACT as the preferred treatment intervention, where ERP did not result in a satisfactory treatment outcome.