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Objective Methods Results Conclusion Cognitive theories emphasize the central role of anger and anger suppression in obsessive–compulsive disorder (OCD). According to these theories, anger suppression is seen as a consequence of OCD, whereas cognitive beliefs, such as an inflated sense of responsibility, are seen as antecedent factors. To extend the findings from cross‐sectional studies, the current study investigated the temporal associations between OCD symptoms, an inflated sense of responsibility, and anger suppression. Consistent with cognitive considerations, we hypothesized that OCD symptoms mediate the association between feelings of responsibility and anger suppression. These associations were also explored in patients presenting particularly high checking‐related symptoms. Further, the stability of effects beyond controlling for depressive symptoms and medication intake was explored.A total of N = 48 patients with OCD (50% female, M = 32.46 [SD = 10.63] years of age) completed measures on obsessive beliefs, OCD symptoms, and anger suppression at three assessment points: before and after a metacognitive intervention as well as at a follow‐up 6 months later. Mediation models investigating symptom associations at these three timepoints were conducted. Exploratory analyses investigating these associations in individuals presenting high checking‐related symptoms (n = 20) and testing the stability of effects beyond controlling for depressive symptoms and medication intake were conducted.The sense of responsibility did not significantly predict the level of anger suppression. A temporal association between OCD symptoms (as assessed with the self‐report measure) and anger suppression could be evidenced, which was stable beyond controlling for depressive symptoms and medication intake. Against the expectations based on cognitive theories, the sense of responsibility did not predict OCD symptoms. No mediating effect of OCD symptoms was found.In line with cognitive viewpoints, the present study shows that higher OCD symptoms predict higher levels of anger suppression in a longitudinal design, thereby contributing to the suppression of anger. This effect seems to be independent from depressive symptoms and medication intake. The effect of sense of responsibility on OCD symptoms was less clear and could only be found in the subgroup of patients with OCD and checking‐related symptoms, who generally presented higher levels of responsibility. Overall, this is the first study demonstrating temporal associations between OCD symptoms and anger suppression. Acknowledging that anger and anger suppression may be a consequence of OCD symptoms and may also affect aspects of psychotherapy, which can ultimately inform future adjustments to psychotherapeutic treatment. [ABSTRACT FROM AUTHOR]

Background: Obsessive-compulsive disorders (OCD) are mainly treated with disorder-specific cognitive behavioral therapy using exposure and response management and/or selective serotonin reuptake inhibitors; however, a significant subgroup of patients does not sufficiently benefit from this approach. Objective: This article provides an overview of treatment-resistant OCD. Material and methods: In this narrative review the definition, causes, diagnostic and therapeutic approaches to treatment-resistant OCD are addressed. Results: Treatment resistance can be assumed in the absence of clinically relevant improvement under therapy, in the sense of a reduction of < 25% on the Yale-Brown obsessive-compulsive scale and a score of 4 (no change) on the clinical global impression-improvement scale. The number of unsuccessful treatment attempts required to establish treatment resistance is defined differently. Causative factors include misdiagnosis, a high severity, comorbid disorders, substance use, specific symptom constellations, organic causes, environmental factors, and aggravating factors in psychotherapy and pharmacotherapy. Suggestions for diagnostic and therapeutic approaches based on the German S3 guideline on OCD are presented. Conclusion: For patients with treatment resistance to first-line therapy, useful diagnostic and therapeutic recommendations are available (psychotherapeutic, psychopharmacological and neurostimulation procedures). [ABSTRACT FROM AUTHOR]

Introduction: Technology‐supported exposure and response prevention (ERP) for patients with obsessive‐compulsive disorder (OCD) as tested in clinical research, holds promise but also has limitations. The present study aims to overcome these limitations by using mixed reality for ERP (MERP). The objectives of this pilot study were to evaluate the safety, feasibility, and acceptance of MERP and to identify possible obstacles. Methods: Twenty inpatients with contamination‐related OCD were recruited and randomized to two conditions: MERP (six sessions in 3 weeks) and care as usual treatment. Patients were assessed before treatment (baseline), after the 3‐week intervention period (post), as well as 3 months after post assessment (follow‐up) regarding symptomatology (Y‐BOCS). Results: Results showed a similar reduction in symptomatology in both groups from baseline to post. Regarding safety, no clinically significant deterioration was detected in the MERP group. Patients' evaluation of the MERP was heterogeneous. The qualitative feedback provided helpful indications for further development of the software. Sense of presence was below the midpoint of the scales. Conclusion: This is the first study evaluating a MERP for patients with OCD that shows cautious evidence for the acceptance and safety of MERP. The results of the subjective evaluation suggest revisions of the software. [ABSTRACT FROM AUTHOR]

Adherence to internet-based cognitive-behavioral therapy (iCBT) is often low, possibly reducing its potential. The current study set out to test whether adherence and effects of unguided iCBT for obsessive-compulsive disorder (OCD) could be improved by varying the degree of autonomy in which modules are completed (free choice vs. fixed order). We randomized 151 individuals with OCD to either an unguided iCBT with a fixed (iCBTfixed) or a free-choice (iCBTfree+) order of the modules. We assessed participants at baseline (t0), eight weeks (t1), and 16 weeks (t2). Primary outcomes were adherence (utilization time, modules completed) and change in OCD severity (Y-BOCS). Secondary outcomes included depression, self-esteem, and treatment satisfaction. We calculated intent-to-treat (ITT) and complete case (CC) analyses. Analyses showed that both iCBT programs significantly reduced OCD severity. While groups did not differ on the ITT analyses, for the CC analyses, a greater improvement was found in the iCBTfixed in comparison to the iCBTfree+ group regarding OCD severity and quality of life, with medium effect sizes from t0 to t1 (η p 2 = 0.067–0.077). Time of utilization and number of modules completed did not differ between groups. No placebo control group, short follow-up period, self-report assessment. iCBT is effective in improving OCD. Despite similar adherence in the fixed versus the free-choice module order, the study offers tentative evidence that a fixed order of content is associated with better effects. More research on the effects of adherence on outcome is necessary. • Both unguided iCBT programs in the study reduced OCD symptom severity. • Utilization time and modules completed were not related to outcome. • Tentative evidence that a fixed order of content is associated with better effects [ABSTRACT FROM AUTHOR]

Research suggests that patients with borderline personality disorder (BPD) share a range of cognitive biases with patients with psychosis. As the disorder often manifests in dysfunctional social interactions, we assumed associated reasoning styles would be exaggerated in a social setting. For the present study, we applied the Judge-Advisor System by asking participants to provide initial estimates of a person's age and presumed hostility based on a portrait photo. Afterwards, we presented additional cues/advice in the form of responses by anonymous previous respondents. Participants could revise their estimate, seek additional advice, or make a decision. Contrary to our preregistered hypothesis, patients with BPD (n = 38) performed similarly to healthy controls (n = 30). Patients sought the same number of pieces of advice, were equally confident, and used advice in similar ways to revise their estimates. Thus, patients with BPD did trust advice. However, patients gave higher hostility ratings to the portrayed persons. In conclusion, patients with BPD showed no cognitive biases in seeking, evaluating, and integrating socially provided information. While the study implies emotional rather than cognitive biases in the disorder, cognitive biases may still prove to be useful treatment targets in order to encourage delaying and reflecting on extreme emotional responses in social interactions. [ABSTRACT FROM AUTHOR]

Objective: Unrealistic pessimism (UP) is an aspect of overestimation of threat (OET) that has been associated with obsessive‐compulsive disorder/symptoms (OCD/OCS). During the COVID‐19 pandemic, UP may have played an important role in the course of OCD. To investigate the relationship, we conducted two longitudinal studies assuming that higher UP predicts an increase in OCS. Method: In Study 1, we investigated UP in the general population (N = 1,184) at the start of the pandemic asking about overall vulnerability to infection with SARS‐CoV‐2 and UP regarding infection and outcome of severe illness. Further, OCS status (OCS+/−) was assessed at the start of the pandemic and 3 months later. In Study 2, we investigated UP in individuals with OCD (N = 268) regarding the likelihood of getting infected, recovering, or dying from an infection with SARS‐CoV‐2 at the start of the pandemic and re‐assessed OCS 3 months later. Results: In Study 1, UP was higher in the OCS+ compared to the OCS− group, and estimates of a higher overall vulnerability for an infection predicted a decrease in OCS over time. UP regarding severe illness predicted an increase in symptoms over time. In Study 2, UP was found for a recovery and death after an infection with SARS‐CoV‐2, but not for infection itself. Conclusions: Exaggeration of one's personal vulnerability rather than OET per se seems pivotal in OCD, with UP being associated with OCD/OCS+ as well as a more negative course of symptomatology over the pandemic in a nonclinical sample. Practitioner points: Unrealistic optimism, a bias common in healthy individuals, is thought to be a coping mechanism promoting well‐being in the face of danger or uncertainty.The current study extends findings that its inversion, unrealistic pessimism, may play an important role in obsessive‐compulsive disorder and may also be involved in the development of the disorder.This study highlights the importance that prevention programs during a pandemic should include targeting unrealistic pessimism. [ABSTRACT FROM AUTHOR]

Although exposure and response prevention (ERP) is considered the gold standard for the treatment of obsessive-compulsive disorder (OCD), it is rarely used in clinical practice. Therapists' beliefs about ERP affect its utilization, as previous research suggests, but the role of therapists' cognitive biases is unclear. In particular, susceptibility to thought-action fusion (TAF) may be related to the underutilization of ERP in OCD. Therapists (N = 353) were divided into those recommending (ERP+, n = 228) and not recommending ERP (ERP-, n = 125) as treatment for an OCD case example. TAF in therapists was assessed using behavioral and self-report measures (TAFS). TAF was higher in the ERP- than the ERP+ group, with a small to moderate effect size (0.2 ≤ d ≤ 0.4). ERP- therapists showed more avoidance and neutralizing behavior and a stronger emotional response than the ERP+ therapists during the experimental task. Moreover, higher TAF as measured by the TAFS was associated at a small magnitude with lower likelihood of using ERP in the therapists' actual clinical practices. Therapists' cognitive biases should be addressed in their training in order to increase the dissemination of evidence-based treatment (i.e., ERP) and thus improve the treatment of OCD. [ABSTRACT FROM AUTHOR]

Background: There is accumulating evidence that implicit measures improve the prediction of suicidality within a 6‐month follow‐up period in psychiatric populations. Building upon these results, we set out to expand the follow‐up period and to investigate various implicit methods. Methods: Seventy‐nine inpatients completed the Beck Scale for Suicidal Ideation (BSS) and a range of implicit measures: three implicit association tests (IATs: Death; Self‐harm–Me/Others; Self‐Harm–Good/Bad) and a subliminal priming task (with separate scores for negative and positive adjectives, each indicating the association between the primes "dying" and "growing"). After 18 months, we reached n = 52 patients and reassessed suicidal ideation, plans, and attempts. Results: In a hierarchical regression, the five implicit task indices were entered after the patient's age, gender, and BSS score at baseline. The implicit scores improved prediction of BSS scores after 18 months compared to prediction based on age, gender, and BSS score at baseline alone. However, none of the implicit measures was associated with suicide plans or attempts during the follow‐up period. Conclusion: Results suggest that implicit measures can be a useful assessment tool for the prediction of suicidal ideation, even beyond the BSS. However, long‐term prediction of suicide plans or attempts using implicit measures seems limited. [ABSTRACT FROM AUTHOR]

Recent evidence favours psychological interventions explicitly targeting suicidality; however, group treatments on suicidality are rare and are assumed to have unfavourable effects. We developed two modules specifically addressing suicidality that replace two existing modules in the Metacognitive Training for Depression (D‐MCT). The aim of the current study was to examine the feasibility, safety, and acceptability of this intervention (D‐MCT/S). Forty‐eight inpatients with depression received eight sessions of D‐MCT/S over 4 weeks in addition to standard treatment. Patients were assessed before the training, 4 and 8 weeks later regarding suicidality (primary outcome: Beck Suicide Scale [BSS]), hopelessness, depression (e.g. Hamilton Depression Rating Scale [HDRS]), dysfunctional attitudes, and self‐esteem. Negative effects of the modules and subjective appraisal were assessed. Suicidality, hopelessness, and depression decreased over time. Whereas the effects on the BSS only reached trend level, a large effect was observed when the suicide item of the HDRS was used. Two of the 46 patients (4%) reported a deterioration in their symptoms, but this was not associated with the D‐MCT/S. Negative effects of the general training were rather low, and acceptability was high. In general, patients evaluated the two new modules on suicidality similarly to the established modules. However, both modules were assessed as distressing by 39% of the patients. When we addressed suicidality in the D‐MCT/S, we did not observe any contagious effects. In fact, the pilot versions of the two modules on suicidality are promising in terms of feasibility, safety, and acceptability. The results will be used to improve current shortcomings. The trial was registered with the German Clinical Trials Register (#DRKS‐ID: DRKS00010543) on 23 August 2016. [ABSTRACT FROM AUTHOR]

Das Ziel des Artikels ist es, den neuesten Stand zum effektiven Einsatz von Verhaltensexperimenten im Rahmen der Psychotherapie für Zwangsstörungen darzulegen. Dazu werden im ersten Teil die evidenzbasierten Psychotherapien zur Behandlung von Zwangsstörungen vorgestellt sowie die Probleme bei der Implementierung dieser Verfahren aufgezeigt. Dabei zeigt sich, dass trotz der guten Evidenzlage die Verfahren zu selten eingesetzt werden und so die Forschungs-Praxis-Lücke fördern. Im Anschluss werden die zugrundeliegenden Rationale zur Durchführung von Verhaltensexperimenten erläutert, in Bezug zu aktuellen Forschungsarbeiten gestellt und damit die Bedeutung von Verhaltensexperimenten in der Therapie von Zwangsstörungen unterstrichen. Daraus werden Empfehlungen für die effektive Umsetzung von Verhaltensexperimenten in der Praxis abgeleitet. Die Funktionsanalyse der zwangsspezifischen Symptomatik stellt das zentrale Element im Rahmen der Behandlung von Zwangsstörungen dar. Dabei müssen die Verhaltensexperimente an die individuell befürchtete Konsequenz bei Unterlassen von Ritualen und Sicherheitsverhalten (d.h. die furchtbasierte Überzeugung) ausgerichtet sein, um eine maximale Erwartungsverletzung zu ermöglichen. Klinische Fallbeispiele werden skizziert, anhand deren effektive Verhaltensexperimente anschaulich und praxisnah dargestellt werden. Abschließend werden noch Hinweise, Tipps und Fallstricke für Praktiker zur Durchführung von effektiven Verhaltensexperimenten beleuchtet und die Grenzen von Verhaltensexperimenten benannt. [ABSTRACT FROM AUTHOR]

Objective Method Results Conclusion This study addresses the limitations of existing interventions for depression, such as a deficit‐oriented focus, overlooking the utilization of positive elements such as nature, and neglecting the incorporation of group effects. The present feasibility study examines FlowVR, a resource‐oriented, nature‐inspired virtual reality (VR)‐based group therapy. Previously tested individually in a pilot study for non‐clinical participants, FlowVR has demonstrated positive effects on depressive symptoms. This study assesses the impact and safety of FlowVR in a group setting within a clinical sample using a one‐armed study design.Forty‐two inpatients and day patients with depression were recruited. Before and after the FlowVR intervention period of 4 weeks (two sessions per week), depressive symptoms were assessed (Beck Depression Inventory‐II; BDI). Symptomatology (i.e., depressive symptoms), depression‐associated variables (i.e., self‐efficacy), intervention‐specific variables (feeling of flow), and VR‐specific variables (simulator sickness) were assessed before and after each session.Linear mixed effect models showed that symptomatology (depression, negative affect, current anxiety), depression‐associated constructs (self‐efficacy, motivation), and intervention‐specific variables (flow) improved over the course of the sessions. No variable deteriorated more in one session compared to any other session. The lasso regression identified five potential predictors for the change in depression (BDI‐II), yet these could not be validated in a subsequent linear regression analysis.To conclude, FlowVR had the hypothesized positive impact over the course of the sessions, showing, for example, improvements in symptomatology. The sessions have demonstrated safety with no notable deteriorations. Therefore, FlowVR is deemed safe for clinical patients and group settings. However, further research is needed to explore predictors for the change in depression. [ABSTRACT FROM AUTHOR]

Background: Prevalence estimates for body-focused repetitive behaviors (BFRBs) such as trichotillomania differ greatly across studies owing to several confounding factors (e.g. different criteria). For the present study, we recruited a diverse online sample to provide estimates for nine subtypes of BFRBs and body-focused repetitive disorders (BFRDs). Methods: The final sample comprised 1481 individuals from the general population. Several precautions were taken to recruit a diverse sample and to exclude participants with low reliability. We matched participants on gender, race, education and age range to allow unbiased interpretation. Results: While almost all participants acknowledged at least one BFRB in their lifetime (97.1%), the rate for BFRDs was 24%. Nail biting (11.4%), dermatophagia (8.7%), skin picking (8.2%), and lip-cheek biting (7.9%) were the most frequent BFRDs. Whereas men showed more lifetime BFRBs, the rate of BFRDs was higher in women than in men. Rates of BFRDs were low in older participants, especially after the age of 40. Overall, BFRBs and BFRDs were more prevalent in White than in non-White individuals. Education did not show a strong association with BFRB/BFRDs. Discussion: BFRBs are ubiquitous. More severe forms, BFRDs, manifest in approximately one out of four people. In view of the often-irreversible somatic sequelae (e.g. scars) BFRBs/BFRDs deserve greater diagnostic and therapeutic attention by clinicians working in both psychology/psychiatry and somatic medicine (especially dermatology and dentistry). [ABSTRACT FROM AUTHOR]

Objectives: The availability of treatment for depression needs to be improved. Among the barriers are the dearth of group programmes and the high demand of many programmes with regard to staff expertise. The Metacognitive Training for Depression (D‐MCT) is a new, easy‐to‐administer, cognitive behaviour‐based group intervention. In a previous 6‐month trial, D‐MCT was highly accepted by patients and efficacious compared to a control treatment. The aim of the current study was to examine whether the effects of the D‐MCT can be sustained over 3.5 years. Design: Long‐term follow‐up of a randomized controlled trial. Methods: A total of 84 patients with a confirmed diagnosis of unipolar depressive disorder were enrolled in a randomized, controlled, assessor‐blind, parallel group trial comparing two interventions added to usual care: D‐MCT and general health training (HT). Patients were reassessed 3.5 years after the interventions were terminated. Primary outcome was the Hamilton Depression Rating Scale. Self‐assessed depressive symptom severity (BDI), dysfunctional cognitive (DAS) and metacognitive (MCQ) beliefs, self‐esteem (RSE), and quality of life (WHOQOL‐BREF) served as secondary outcomes. Results: Primary intention‐to‐treat analyses using analysis of covariance showed negative results, and only secondary post‐hoc analyses utilizing latent growth modelling demonstrated superiority of D‐MCT over HT with regard to the long‐term course of depressive symptom severity and cognitive and metacognitive outcomes as well as physical and psychological quality of life. Conclusions: Findings suggest that D‐MCT may be a promising add‐on treatment for unipolar depression that should be investigated in large multi‐centre studies. Independent replications are needed. Practitioner points: Clinical implications: The current study shows tentative evidence that positive effects of the D‐MCT reported at the 6‐month follow‐up assessment were sustained over 3.5 years.Potential positive effects regard severity of depression, dysfunctional cognitive, and metacognitive beliefs as well as quality of life.If positive results are replicated with less trained therapists, D‐MCT offers the possibility of providing a simple and easy‐to‐administer CBT‐based group treatment for depression with long lasting effects. Limitations: Sample size was small; a large‐scale multi‐centre trial would be desirable to gain high statistical power with an adequate sample size and to allow the investigation of possible allegiance effects.D‐MCT was delivered as an add‐on intervention and not as a stand‐alone intervention. [ABSTRACT FROM AUTHOR]

Highlights • Many dysfunctional cognitive beliefs are transdiagnostic. • The newly developed Beliefs Questionnaire (BQ) includes cognitive beliefs that are not covered by the Obsessive Beliefs Questionnaire (OBQ). • Exaggerated Standards/Perfectionism represents a primary cognitive belief in both patients with Obsessive-compulsive disorder (OCD) and depression. • Overestimation of threat and the fear of becoming insane are rather specific to OCD. Abstract There is an ongoing debate about the specificity of dysfunctional beliefs in patients with obsessive-compulsive disorder (OCD) as some of these beliefs seem to be relevant in depressed patients as well. The present study aimed to elucidate the specificity of dysfunctional beliefs using the newly developed Beliefs Questionnaire (BQ). A combination of an online assessment and clinical interviews was carried out. One hundred thirty OCD patients (M = 38.7 years; 68% women) were compared to 85 patients with depression (M = 36.6 years; 75% women) and 220 nonclinical controls (M = 38.9 years; 71% women) on the BQ, which contains 13 items tapping cognitive beliefs. The BQ was validated against the Obsessive Beliefs Questionnaire (OBQ). Patients with OCD and depression scored higher on the BQ compared to nonclinical controls. OCD patients displayed higher values on overestimation of threat and the fear of becoming insane. Correlation between BQ and OBQ total scores was high (r = 0.751), supporting the validity of the new scale. Our results show that two beliefs are OCD-specific. However, the BQ covers mainly transdiagnostic features and should be replicated with the inclusion of an anxiety disorder sample. [ABSTRACT FROM AUTHOR]

To work on the client's cognitions is central to cognitive-behavioral therapy (CBT). No matter what wave (or generation) of approaches we are looking at. In this introduction to the current special issue, the different approaches presented in the issue are briefly outlined and common features are highlighted. [ABSTRACT FROM AUTHOR]

Studies have confirmed the efficacy of the cognitive intervention Association Splitting (AS) in obsessive-compulsive disorder (OCD) when applied as a self-help technique. AS aims to alter symptom-provoking automated cognitive networks of OC-related stimuli by building new or strengthening established but weak neutral associations. The aim of this study was to investigate the acceptance and benefits of therapist-assisted AS as an add-on to cognitive behavioral therapy (CBT). One hundred and nine patients with OCD who were undergoing CBT were randomly assigned to either AS or cognitive remediation (CR). Both groups were assessed at baseline, 4 weeks and 6 months later. The primary measure was the Yale-Brown Obsessive Compulsive Scale. Although patients’ acceptance of AS was good, AS was not better than CR regarding overall symptom severity. However, a larger decrease was found from baseline to 6 months follow-up in AS regarding avoidance. Moreover, subsidiary analyses excluding control patients who had obtained information about AS indicated its superiority. Because superiority of AS was found in post hoc analyses excluding control patients who had obtained information on AS, we suggest that contagion effects deserve consideration. [ABSTRACT FROM AUTHOR]

There is much room for improvement in the treatment of obsessive-compulsive disorder (OCD). The current study introduces a newly developed version of Metacognitive Training for OCD (MCT-OCD), inspired by the self-help intervention myMCT as well as by MCT group programs for other disorders. The current study examines the acceptability of the training. Forty-four patients with OCD received four sessions of MCTOCD in addition to inpatient treatment. At post assessment, patients provided a subjective appraisal of the training. Analyses revealed high acceptability and added value of the MCT-OCD. The current, preliminary version of the MCT-OCD is promising in terms of patient acceptance. Results will be used to improve current shortcomings of the training and to develop a more comprehensive MCT-OCD. [ABSTRACT FROM AUTHOR]

Background: Our understanding of how patients perceive and evaluate treatment for depression is scarce. Because dropout rates are high among individuals in treatment for depression, it is necessary to expand the focus of research to patients' perspectives on the treatment they receive. The aim of the two studies presented was to evaluate patient acceptance of Metacognitive Training for Depression (D-MCT), a highly standardized group intervention.Methods: Acceptability was evaluated in an open case series (Study 1, N = 70) and a randomized controlled trial (RCT; Study 2, N = 84). In both studies, participants rated their subjective appraisal on a 15-item questionnaire after administration of eight D-MCT modules. In Study 1, a subsample of patients also evaluated modules individually after each session. In Study 2, ratings were compared to an active control intervention (walking and psychoeducation sessions), and assessment was repeated at 6-months follow-up.Results: High rates of acceptance of the D-MCT were demonstrated in both studies immediately after treatment (post-assessment). In addition, the RCT showed better evaluations for the D-MCT than for the control condition at post-assessment as well as at 6-months follow-up. Weekly session evaluations in Study 1 indicated good acceptance for individual modules.Limitations: Evaluations could only be obtained from completers; blinding of patients and therapists was not possible.Conclusions: Results of the two studies suggest that D-MCT represents a promising group treatment in terms of patient acceptance and provide an example of how patients' feedback may be used to improve treatment. [ABSTRACT FROM AUTHOR]

Background and Objectives: Many individuals with anxiety disorders do not receive professional treatment. Internet interventions have shown to be effective in the treatment of anxiety. The present randomized controlled trial was designed to examine the effectiveness of a short-term (4-week) Internet intervention in treating panic disorder, agoraphobia, social anxiety disorder, and specific phobias ('ConfID'). We addressed the questions of whether this transdiagnostic program would affect these disorders to varying degrees and whether there would be moderators of effectiveness.Methods: Adults who were recruited in online forums for anxiety underwent an online baseline assessment (N = 179) and were randomized either to the intervention group (ConfID) or the control group (care as usual). Online post-assessment took place 4 weeks later. The primary outcome was assessed with the Beck Anxiety Inventory (BAI); the secondary outcomes targeted the disorder-specific symptoms, depression, and somatization.Results: Participants in the intervention group showed a significantly stronger anxiety reduction compared to participants receiving care as usual (small-to-medium effect size between groups in intention-to-treat analysis). The treatment effect was similar for the different disorders and was moderated by participants' attitudes towards Internet interventions. Secondary outcomes yielded effect sizes in the medium range.Limitations: Moderate treatment adherence, lack of measures beyond online self-reports, and unavailability of long-term results.Conclusions: The study provides further evidence that transdiagnostic Internet interventions are promising in reducing the existing treatment gap in individuals with panic disorder and phobias. Results extend previous findings by showing that significant effects can also be reached by comprehensive short-term programs and that the effects might be moderated by participants' attitudes towards Internet interventions. [ABSTRACT FROM AUTHOR]

Background and Objectives: Post-traumatic stress disorder (PTSD) is accompanied by altered autobiographical memories (AM) of the traumatic incident itself as well as of non-trauma-related events. Several studies have shown that trauma-exposed individuals developing PTSD have a reduced capacity to access specific past events that are not related to the traumatic event compared to those who do not develop PTSD. However, one study including a group of elderly adults did not find significant differences in AM between PTSD and non-PTSD participants. The present study investigated whether PTSD is associated with impaired AM of trauma-related and non-trauma-related memories in the elderly.Method: Forty-four elderly participants, displaced during childhood from former German territories after the end of World War II (WWII), were examined. This group comprised 19 participants with and 25 participants without PTSD. These participants were compared to 23 non-traumatized non-displaced elderly participants.Results: PTSD, non-PTSD and non-traumatized participants do not differ significantly in their ability to recall specific memories of their past. Moreover, participants with PTSD did not recall more trauma-related memories than non-PTSD participants.Limitations: The traumatized participants reached for assessment might represent the most resilient individuals, which might constrain generalizability of our results to other trauma populations.Conclusions: This study confirms preliminary evidence that PTSD is not associated with AM impairment in the elderly. We suggest that aging may alter the relationship between trauma and AM impairment in traumatized participants with PTSD, which need to be confirmed by longitudinal studies. [ABSTRACT FROM AUTHOR]

The present study examined potential transgenerational effects of trauma on autobiographical memory in adult offspring of elderly participants with and without PTSD symptoms who were exposed to an early trauma during childhood. As traumatization is associated with reduced memory specificity for past events, we hypothesized that offspring of traumatized parents might be exposed to a less elaborative narrative style, which, in turn, might result in less specific autobiographical memories in the offspring. Results show that autobiographical memory specificity did not differ significantly between adult offspring of traumatized elderly participants with PTSD symptoms, without PTSD symptoms, and non-traumatized elderly participants. [ABSTRACT FROM AUTHOR]

The authors discuss a study comparing metacognitive training for depression (D-MCT) and health training (HT). Topics covered include the development of D-MCT as a cognitive behavioral therapy-based group intervention, improvement in depressive symptoms through D-MCT, and the persistence of residual symptoms. Also mentioned are overall treatment satisfaction and the long-term goal of improving dissemination of effective treatments for depression.

Limitations No clinical control group was recruited; no inter-rater reliability was assessed for the association task. Conclusions Further evidence for biased associative networks in OCD was found. Associations of individually chosen cue words proved to be modifiable by therapy. [ABSTRACT FROM AUTHOR]

Background: Identifying predictors of treatment outcome can guide treatment selection and optimize use of resources. In patients affected by obsessive-compulsive disorder (OCD), perfectionism has emerged as one possible predictor, with some data suggesting that cognitive-behavioral therapy outcomes are poorer for more perfectionistic patients. Findings so far are inconsistent, however, and research has yet to be extended to newer treatment approaches. Methods: We administered measures of concern over mistakes, clinical perfectionism, as well as OCD and depression symptom severity to a sample of OCD patients in out-patient group treatments (N = 61), namely, metacognitive training (MCT-OCD) or mindfulness-based cognitive therapy (MBCT) for OCD. Hierarchical data over time was submitted to multi-level analysis. Results: Neither concern over mistakes nor clinical perfectionism at baseline predicted OCD symptoms across time points. However, concern over mistakes at baseline did significantly predict comorbid depressive symptoms. Furthermore, exploratory analysis revealed change in clinical perfectionism during treatment as a predictor of OCD symptoms at follow-up. Conclusion: These results suggest that initial concern over mistakes may not prevent patients with OCD from benefitting from third-wave treatments. Change in clinical perfectionism may present a putative process of therapeutic change. Limitations and avenues for future research are discussed. [ABSTRACT FROM AUTHOR]

Abstract: The aim of the present study was to investigate neuropsychological performance in an untried trauma sample of older adults displaced during childhood at the end of World War II (WWII) with and without posttraumatic stress disorder (PTSD) as well as transgenerational effects of trauma and PTSD on their offspring. Displaced older adults with (n=20) and without PTSD (n=24) and nondisplaced healthy individuals (n=11) as well as one of their respective offspring were assessed with a large battery of cognitive tests (primarily targeting memory functioning). No evidence for deficits in neuropsychological performance was found in the aging group of displaced people with PTSD. Moreover, no group difference emerged in the offspring groups. Findings may be interpreted as first evidence for a rather resilient PTSD group of older adults that is available for assessment 60 years after displacement. [Copyright &y& Elsevier]

IntroductionThe aim of the present study was to investigate (meta)cognitive beliefs related to posttraumatic stress disorder (PTSD) in a sample of individuals displaced as children at the end of the Second World War as well as transgenerational effects of trauma and PTSD on the offspring. MethodsDisplaced individuals with (n=20) and without PTSD (n=24) and nondisplaced healthy controls (n=11), as well as one of their adult offspring, were assessed with the Metacognitions Questionnaire (MCQ-30). Older adults, formerly displaced in childhood, were additionally assessed with the Posttraumatic Cognitions Inventory (PTCI). ResultsDysfunctional beliefs (MCQ-30, PTCI) were particularly pronounced in formerly displaced individuals with PTSD, but not in the offspring generation. ConclusionsThe findings suggest that in an aging group of displaced individuals with PTSD dysfunctional beliefs are associated with the disorder. Bias modification may help to attenuate symptomatology. No evidence was found for a transgenerational effect. [ABSTRACT FROM PUBLISHER]

Background: In the European Union, over 2000 suicides on railway premises were reported in 2020. Identifying individuals' behavioral and location patterns just before they die or attempt to die by train suicide (ITS) is critical for effective prevention of suicides by train. We conducted a naturalistic study using a newly developed instrument for the assessment of fatalities in rail traffic that used information from on‐site video cameras. Methods: A total of 56 case files and surveillance recordings of ITS prior to their suicide or suicide attempt were compared to 46 surveillance recordings of matched regular train passengers (RTP) before they boarded their trains. Groups were compared on individuals' behavior as well as location and contextual parameters. Results: ITS performed unusual movement patterns more frequently, carried luggage less often, stayed on the platform longer, and let more trains pass relative to RTP. Conclusions: If this study is replicated with a larger sample, artificial intelligence could be used to detect suspicious/unusual (movement) patterns in order to prevent train suicide. Social awareness campaigns that foster the identification of people in distress at train stations in combination with lower thresholds for the use of emergency devices on platforms may help to detect potential train suicides and reduce their incidence. [ABSTRACT FROM AUTHOR]

Abstract: Deficits in memory and cognitive inhibition have been proposed as underlying mechanisms of obsessive–compulsive disorder (OCD). To test this hypothesis, an emotional variant of the retrieval-induced forgetting (RIF) paradigm was constructed which investigates whether repeated retrieval of previously learned material (Rp+) leads to enhanced forgetting of related but nonretrieved material (Rp−) in comparison to unrelated material (NRp). Paradigm (involving OCD-relevant, neutral and negative material) was presented to 21 participants with OCD and 22 healthy controls. To compare personally relevant stimuli across groups, salience ratings of the material were included. RIF was not reduced in OCD per se. Tentative evidence was found for a weakened RIF effect for personally salient OCD-relevant material in OCD patients in comparison to healthy controls. [Copyright &y& Elsevier]

Background: Despite improved treatment options, many people with obsessive-compulsive disorder (OCD) do not seek or even actively avoid therapy due to shame or fear of stigmatization. Self-help treatment is increasingly acknowledged as a means to 'treat the untreated' and to motivate patients for face-to-face psychotherapy. Our group has gathered preliminary evidence for the efficacy of a novel self-help approach entitled association splitting (AS) aimed at the reduction of obsessions. Methods: For this study, a total of 46 participants with a likely diagnosis of OCD were randomly allocated to either AS or a waitlist control (WL). Treatment consisted of the self-study of a manual sent via e-mail. At baseline and four weeks later symptoms were assessed online using the self-report version of the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS), the Obsessive-Compulsive Inventory-Revised (OCI-R), and the Beck Depression Inventory (BDI). Results: A total of 74% of the initial sample took part in the re-assessment. Results were in accordance with prior uncontrolled data indicating that AS is a feasible approach leading to a symptom decline of approximately 25% on the Y-BOCS. The technique also exerted a positive effect on depression (BDI) and the OCI-R subscale obsessive thoughts. Conclusions: The study confirms the feasibility and efficacy of AS for a subgroup of patients with OCD. Ongoing studies explore whether short-term effects are maintained over time and whether therapist-guided therapy may enhance the efficacy of AS. Depression and Anxiety, 2011. © 2011 Wiley-Liss, Inc. [ABSTRACT FROM AUTHOR]

Abstract: The Psychiatric Symptom Rating Scales (PSYRATS) have demonstrated their usefulness for the dimensional assessment of hallucinations and delusions. However, there is no evaluated German version of the PSYRATS to date. Also, in spite of theoretical conceptions about “detaching” effects of antipsychotics, there are few consolidated findings about how core symptomatic aspects of schizophrenia change during antipsychotic treatment. The present study aimed to fill this gap. A total of 40 schizophrenic voice-hearers were interviewed three times during the course of six months using a newly developed German version of the PSYRATS with very good psychometric properties. At the same time, psychopathology was assessed with the Positive and Negative Syndrome Scale (PANSS). In the longitudinal course, a general symptomatic decrease became apparent only for auditory hallucinations but not for delusions. Specifically, the loudness of the hallucinated voices as well as the associated distress decreased early, while other aspects of the hallucinations took more time to fade. In this study, the PSYRATS proved to be a valuable tool for measuring the change of specific symptom dimensions. However, our results only partially supported the notion of a general detachment from symptoms due to psychiatric treatment. [Copyright &y& Elsevier]

Es wird von einer 46-jährigen Patientin mit Zwangssymptomatik berichtet, die im Rahmen einer stationären multimodalen Verhaltenstherapie (mit Fokus auf Expositions-Reaktions-Management) an einem zusätzlichen Behandlungsangebot namens «Assoziationsspaltung» teilnahm. Hierbei handelt es sich um eine neue Methode zur Reduktion von Zwangsgedanken, deren Wirksamkeit derzeit in einer von der Deutschen Forschungsgemeinschaft (DFG) finanzierten Studie evaluiert wird. Die Methode basiert auf dem kognitiven Prinzip der Assoziationsauffächerung (fan effect) und zielt auf die Ausbildung und Stärkung neutraler Assoziationen zu zwangsrelevanten angstauslösenden Kognitionen ab. Mithilfe der Technik sollen zwangsrelevante Verknüpfungen geschwächt und infolgedessen Zwangsgedanken reduziert werden. Exemplarisch am Fall einer Patientin mit Waschzwang, dem Befürchtungen vor Verkeimung und Verschmutzung zugrunde liegen, wird das Verfahren Assoziationsspaltung eingeführt und der Therapieverlauf nebst Messdaten zu 3 Zeitpunkten dargestellt. Copyright © 2011 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

Abstract: An attentional bias for trauma-related stimuli has been demonstrated in individuals with posttraumatic stress disorder (PTSD). However, few studies have investigated how biological relatives of individuals with PTSD process trauma-relevant information. To investigate whether parental PTSD is associated with an attentional bias for trauma-related stimuli in adult offspring, we compared performance of individuals displaced after World War II with (n =22) and without PTSD (n =24) to a non-displaced healthy control group (n =11) and their respective offspring as to their processing of trauma-related stimuli in an emotional Stroop task. Evidence for biased information processing was neither found in individuals with PTSD nor their offspring. Possible explanations for the findings and implications for future studies are discussed. [Copyright &y& Elsevier]

Background: Obsessive compulsive disorder (OCD) is a chronic and disabling disorder. It profoundly compromises various aspects of patients' everyday life, thus affecting their quality of life (QoL). Using generic instruments, several studies have confirmed severely impaired health-related QoL in patients diagnosed with OCD. However, there has been a dearth of research on illness-specific QoL. Aims: The present study aimed to further investigate subjective QoL in individuals with OCD with a focus on illness-specific aspects. Method: To assess subjective QoL in a broad OCD sample, an internet survey was conducted with 123 participants with obsessive-compulsive symptoms. The survey comprised both a generic (WHOQOL-BREF) and a novel self-developed OCD-specific QoLmeasure (QoLOC). Psychopathology was determined with diagnostic standard instruments (self-report forms of: Y-BOCS, OCI-R, BDI-SF). Results: Regression analyses confirmed depression as the best predictor for decreased QoL. In addition, participants reported high despair resulting from OCD-related problems that differed across symptom subtypes. An exploratory factor analysis suggested four domains of OCD-specific problems tapped by the QoLOC: (1) depressiveness in association with OCD; (2) constraints in activities due to OCD symptoms or avoidance; (3) problems with partner and/or family due to OCD symptoms or avoidance; (4) self-concept/ coping of own illness. Conclusions: Results produced a comprehensive picture of QoL impairments and their relation to psychopathology in a representative OCD sample. Illness-specific concerns should be further addressed in QoL research in OCD because such problems are not sufficiently mirrored in generic QoL measures. [ABSTRACT FROM AUTHOR]

Abstract: It has been proposed that the organization of the worst moment in traumatic memories (“hotspots”) is of particular importance for the development of PTSD. However, current knowledge regarding the organization and content of worst moments is incomplete. In the present study, trauma survivors with (n =25) and without PTSD (n =54) were asked to indicate the worst moment of their trauma and to give a detailed narrative of the traumatic event. The worst moment and the remaining narrative were analyzed separately with regard to organization and emotional content. Results indicated that worst moments of trauma survivors with PTSD differed from the remaining narrative and from worst moments described by trauma survivors without PTSD in that they were characterized by more unfinished thoughts, more use of the present tense and lower levels of cognitive processing. However, hypotheses regarding differentiating emotional content were not supported. Implications for our theoretical understanding of PTSD and potential therapeutic interventions are discussed. [Copyright &y& Elsevier]

Abstract: Building upon semantic network models, it is proposed that individuals with obsessive-compulsive disorder (OCD) process ambiguous words (e.g., homographs such as cancer) preferably in the context of the OC meaning (i.e., illness) and connect them to a lesser degree to other (neutral) cognitions (e.g., animal). To investigate this assumption, a new task was designed requiring participants to generate up to five associations for different cue words. Cue words were either emotionally neutral, negative or OC-relevant. Two thirds of the items were homographs, while the rest was unambiguous. Twenty-five OCD and 21 healthy participants were recruited via internet. Analyses reveal that OCD participants produced significantly more negative and OC-relevant associations than controls, supporting the assumption of biased associative networks in OCD. The findings support the use of psychological interventions such as Association Splitting that aim at restructuring associative networks in OCD by broadening the semantic scope of OC cognitions. [Copyright &y& Elsevier]

Abstract: There is an ongoing debate whether or not patients with post-traumatic stress disorder (PTSD) are more prone to produce false memories. The present study investigated this question using a visual variant of the Deese–Roediger–McDermott (DRM) paradigm, additionally addressing underlying mechanisms of false memory production (e.g., depression, dissociation, emotional valence, arousal). The visual paradigm was administered to 48 traumatized individuals with (n =20) and without PTSD (n =28) and 28 non-traumatized controls. Groups did not differ with regard to memory performance and memory confidence. False memories were correlated with depression. We recommend that future studies employ trauma-related material to further explore memory aberrations in PTSD. [Copyright &y& Elsevier]

Disorganized trauma memory seems to play an important role in the pathogenesis of posttraumatic stress disorder (PTSD). However, it is unclear whether memory organization of nonautobingraphical material (i.e., sequence memory) is also impaired in PTSD. A novel task designed to assess nonautobiographicel memory for content and order information was adraministered to trauma survivors with (n = 26) and without PTSD (n = 55) as well as to nontraumatized healthy adults (n = 30). In addition, traumatized participants were asked to give a detailed narrative of the traumatic event and an unpleasant autobin- graphical event. Transcripts of both types of narratives were analyzed with regard to disorganization. Results indicated that trauma memories were more disorganized than memories of an unpleasant event in the PTSD group in comparison with the non-PTSD group. However. no differences were found for memory organization of nonautobiographical material among trauma survivors with and without PTSD and nontraumatized controls. With regard to memory accuracy of nonautobiographical material, group differences were more strongly associated with trauma exposure than with PTSD. [ABSTRACT FROM AUTHOR]

Abstract: Recent neuroimaging studies have consistently ascribed the orbito-frontal cortex (OFC) a pivotal role in the pathogenesis of obsessive-compulsive disorder (OCD). Cognitive tests presumed sensitive to this region, such as the Object Alternation Task (OAT), are considered important tools to verify this assumption and to investigate the impact of cortical dysfunction on behavior. The aim of the present study was to assess if patients with OCD show enhanced perseveration errors on the OAT relative to healthy controls taking into account several potential moderators, especially comorbid depression and OCD subtype. Thirty-five OCD patients and 18 healthy controls underwent the OAT as well as the Trail-Making Tests (TMT) A and B. In line with prior studies, OCD patients were slowed on both TMT tasks. In contrast, samples performed similarly on the OAT. While the latter finding does not invalidate the assumption that the OFC is affected in OCD, dysfunctions involving this region may be more subtle than often claimed and likely encompass only a small subset of functional domains hosted in the OFC. [Copyright &y& Elsevier]

The outbreak of the COVID-19 pandemic has particularly affected people with obsessive-compulsive disorder (OCD). Exacerbation of obsessive-compulsive symptoms (OCS) has been suspected for those with contamination-related OCD (C-OCD). However, the course of OCS over the ongoing pandemic remains unclear. We assessed 268 participants with OCD (n = 184 with C-OCD) in an online survey at the beginning of the pandemic in Germany, reassessing 179 participants (66.8%, 104 C-OCD) three months later. We assessed severity of OCD (OCI-R), depression (PHQ-9), experiential avoidance, as well as functional and dysfunctional beliefs. Overall, OCS and depressive symptoms did not substantially change over time. However, when people with and without C-OCD were compared, symptoms improved in patients without C-OCD (nC-OCD) but remained stable in patients with C-OCD over time. Symptom improvement was associated with male gender, higher initial OCI-R, and nC-OCD. Experiential avoidance and beliefs at the beginning of the pandemic did not generally predict change in OCS. People with OCD, particularly those with nC-OCD, showed tentative signs for signs of adapting, whereas distress in those with C-OCD remained at a high level, underlining the burden for these patients. Clinicians should be informed about how to maintain effective treatment for C-OCD during a pandemic. • Change in symptomatology over the course of the pandemic was related to subtype. • Symptomatology improved in contamination-unrelated OCD (nC-OCD). • Symptomatology remained at a similar level in contamination-related OCD. • Protective factors were male gender, higher initial symptomatology, and nC-OCD. [ABSTRACT FROM AUTHOR]

The role of heightened arousal has been previously discussed as a contributor to neurocognitive impairment in posttraumatic stress disorder (PTSD). To investigate whether psychological effects (distraction, re-location of resources) elicited by the evocation of traumatic memories impact on subsequent cognitive performance in PTSD, two parallel versions of a working memory task were administered to 33 trauma-exposed participants (15 with and 18 without PTSD). Between first and second working memory assessment a trauma-related interview was conducted including the narration of the trauma. Levels of working memory impairment in PTSD patients remained unchanged. This study provides preliminary evidence that neurocognitive impairment is not secondary to psychological effects induced by the evocation of traumatic memories. Nevertheless, it is recommended that future PTSD research should devote more care to the order in which trauma-related and other dependent variables such as cognitive tests are presented to participants. Depression and Anxiety 25:175–179, 2008. © 2008 Wiley-Liss, Inc. [ABSTRACT FROM AUTHOR]

Although there is evidence for memory impairment in posttraumatic stress disorder (PTSD), it remains unclear whether memory impairment is confined to verbal material or whether memory for nonverbal material is also affected. We examined verbal and nonverbal memory for free recall and recognition in 40 patients with PTSD and 40 healthy controls. Analyses showed that patients with PTSD displayed attenuated memory performance for both short- and long-term recall, which was not further moderated by type of material. The influence of attention, verbal intelligence, and depression was investigated. Our findings suggest that both verbal and nonverbal memory are compromised in PTSD. [ABSTRACT FROM AUTHOR]

Patients with severe or treatment-refractory obsessive–compulsive disorder (OCD) often need an extensive treatment which cannot be provided by outpatient care. Therefore, we aimed to estimate the effects and their moderators of inpatient, residential, or day-patient treatment on obsessive–compulsive symptoms in patients with OCD. PubMed, PsycINFO, and Web of Science were systematically screened according to the PRISMA guidelines. Studies were selected if they were conducted in an inpatient, residential, or day-patient treatment setting, were using a number of pre-defined instruments for assessing OCD symptom severity, and had a sample size of at least 20 patients. We identified 43 eligible studies in which inpatient, residential, or day-patient treatment was administered. The means and standard deviations at admission, discharge, and—if available—at follow-up were extracted. All treatment programs included cognitive-behavioral treatment with exposure and response prevention. Only one study reported to not have used psychopharmacological medication. Obsessive–compulsive symptoms decreased from admission to discharge with large effect sizes (g = −1.59, 95%CI [−1.76; −1.41]) and did not change from discharge to follow-up (g = 0.06, 95%CI [−0.09; 0.21]). Length of stay, age, sex, and region did not explain heterogeneity across the studies but instrument used did: effects were larger for clinician-rated interviews than for self-report measures. Persons with OCD can achieve considerable symptom reductions when undertaking inpatient, residential, or day-patient treatment and effects are—on average—maintained after discharge. [ABSTRACT FROM AUTHOR]

• The majority of people with OCD were negatively affected by the COVID-19 pandemic • Negative effects were more pronounced in people with washing compulsion • Worsening of OCD was associated with reduced mobility and interpersonal conflicts • Dysfunctional hygiene-related beliefs were related to greater symptom progression The COVID-19 pandemic has prompted global measures to prevent infection. Experts assume that it is particularly affecting people with obsessive-compulsive disorder (OCD), especially those with washing compulsions. Data, however, are currently lacking. 394 participants with OCD (n = 223 washers) participated in an online survey. Change in severity of OCD symptoms, reasons participants reported for the change (e.g., reduced mobility, reduced availability of cleaning products, economic factors, interpersonal conflicts), as well as participants' beliefs and experience associated with COVID-19 were assessed. 72 % of the participants reported an increase in OCD. This increase was significantly stronger in washers compared to non-washers. The worsening of symptoms was primarily associated with reduced mobility and interpersonal conflicts. Dysfunctional hygiene-related beliefs were significantly higher in washers than non-washers and were associated with greater symptom progression. Washers were more confident than non-washers about providing other people with helpful advice related to infection preventions. Washers, however, received more negative feedback from others in response to the advice they provided than non-washers. The majority of participants with OCD were negatively affected by the COVID-19 pandemic, and the negative effects were more pronounced in washers than in non-washers. Rapid interventions for OCD should be implemented to prevent long-term deterioration. [ABSTRACT FROM AUTHOR]

Identifying components of modularized psychological interventions that contribute to symptom reduction is essential to improving depression treatment. In a secondary analysis of a randomized controlled trial (RCT), session-specific effects of Metacognitive Training-Silver, a group intervention for older adults with depression, were investigated. Thirty-eight older adults with major depressive disorder or dysthymia participated in up to eight sessions of MCT-Silver. A clinical assessment of depressive symptoms (Hamilton Depression Rating Scale) as well as additional interviews and questionnaires administered as part of the RCT were completed at pre- and post-intervention. Depressive symptoms, negative (meta)cognitive beliefs, emotion regulation strategies and attitudes toward aging were assessed pre- and post-session. The rate of change in each variable per module, elevation following the module in which the variable was addressed, and the rate of change post module were examined via linear mixed models. Clinician-rated depressive symptoms were significantly reduced from pre- to post-intervention (Cohens d = 1.31). Self-reported depression and negative mental filter measured within sessions improved significantly over treatment, whereas black-and-white thinking improved after module #3 (Should Statements, All or Nothing Thinking and Acceptance). Module-specific within-session effects were found for overgeneralization (module #1: Mental Filter) and rumination (module #6: Rumination and Social Withdrawal). Improvement in mental filter in module #1 was significantly associated with depression reduction. This study provides initial evidence that MCT-Silver partially meets its aims of reducing depression and specific cognitive variables within and across sessions. Improvement of the instrument used to measure change may improve detection of module-specific effects. Trial registration: NCT03691402. [ABSTRACT FROM AUTHOR]

The Metacognitive Training for Depression (D-MCT) is a highly structured group therapy that has been shown to be effective in reducing depressive symptoms. First evidence suggests that need for control represents a mechanism of change. However, more research is needed to evaluate the mode of action of each module and identify predictors of treatment response. Two sequential studies (one naturalistic pilot study [study I, N = 45] and one randomized controlled trial [study II, N = 32]) were conducted to evaluate the session-specific effects and predictors of D-MCT in patients with depression. The D-MCT was conducted over eight weeks, and patients answered a questionnaire on dysfunctional beliefs (e.g., negative filter) and depressive symptoms (e.g., lack of energy, self-esteem) before and after each session. Linear mixed-effects models showed that several dysfunctional beliefs and symptoms improved over the course of the treatment; three modules were able to evoke within-session effects, but no between-session effects were found. The improvement in lack of energy in one module was identified as a relevant predictor in study I via lasso regression but was not replicated in study II. Exploratory analyses revealed further predictors that warrant replication in future studies. The identified predictors were inconclusive when the two studies were compared, which may be explained by the different instruments administered. Even so, the results may be used to revise questionnaires and improve the intervention. [ABSTRACT FROM AUTHOR]

Over the last decade, psychotherapeutic interventions labelled "metacognitive" have been developed. These include the Metacognitive Therapy by Wells, the Metacognitive Reflection and Insight Therapy, and the Metacognitive Training. Overlap regarding the name and blurry conceptual boundaries sometimes make it difficult to classify and distinguish these new approaches in comparison to old ones. The aim of this article is to give an overview of the term "metacognition", to classify metacognitive approaches in relation to classic cognitive behavioral therapy, and to present the above-mentioned metacognitive interventions. Finally, the metacognitive training for depression (D-MCT), as an example of a metacognitive training, is presented in more detail and current developments in D-MCT are reported (additional modules on suicidality, special versions for older people and for the target group of refugees). [ABSTRACT FROM AUTHOR]

Up to 79 % of older adults with depression do not receive treatments commensurate with guideline recommendations. Metacognitive Training-Silver (MCT-Silver) is a low-intensity group training, which aims to reduce depressive symptoms by targeting (meta)cognitive beliefs. A randomized controlled trial comparing MCT-Silver (n = 41) to cognitive remediation (n = 39) was conducted with older adults with major depressive disorder and/or dysthymia. Clinician-rated depression (Hamilton Depression Rating Scale [HDRS, primary outcome]), self-reported depression (Beck Depression Inventory-II [BDI-II]), negative cognitive beliefs, positive metacognitive beliefs, rumination, health status, quality of life, and neurocognitive functioning were assessed at baseline, eight weeks (post) and three months (follow-up). Both groups demonstrated moderate to large reductions in depression. No superior effects of MCT-Silver on clinician-rated depression (HDRS) were detected. MCT-Silver led to greater reductions in self-reported depression and rumination at post- and follow-up. Despite this, scores at post- and follow-up assessments were similar for both groups. MCT-Silver's effect on depressive symptoms was moderated by baseline rumination, positive metacognitive beliefs and previous treatment experience. MCT-Silver was evaluated as superior according to patient appraisals. Conclusions are limited by divergent findings on measures of depression and that the study was conducted during the COVID-19 pandemic. Whereas no superior effect of MCT-Silver was found for the primary outcome, there was a significant effect of MCT-Silver for self-reported depression and rumination. Patients endorsing rumination and positive metacognitive beliefs as well as those without previous psychological treatment may benefit more from MCT-Silver. • We evaluated the efficacy of metacognitive training for depression in later life (MCT-Silver). • 80 patients were randomized to MCT-Silver or a cognitive remediation (CR) group. • MCT-Silver demonstrated statistically significant effects beyond CR on self-reported depression and rumination. • Despite statistically significant effects, total scores at post- and follow-up were similar between groups. [ABSTRACT FROM AUTHOR]

Internet‐based cognitive‐behavioural interventions (iCBT) are a valuable alternative to face‐to‐face psychotherapy. An unguided iCBT program has shown to be efficacious for patients with obsessive‐compulsive disorder (OCD). However, the modules' mode of action is not well understood, which is the objective of the present study. Twenty‐five patients with OCD who participated at the iCBT program for 8 weeks answered a questionnaire on their self‐efficacy, motivation, expected increase in health competence and experiential avoidance before and after each module and were included in the present analyses. Linear mixed‐effects models demonstrated that patients' expected increase in health competence improved over the course of the treatment. No within‐module‐specific effect was found. The iCBT program was able to improve patients' expected health competence. However, all other variables did not change. The iCBT program should be revised by focusing more strongly on the integration of the content to reduce experiential avoidance and to improve motivation. [ABSTRACT FROM AUTHOR]

It is essential to understand the effects of specific therapy elements (i.e., mechanisms of change) to optimize the efficacy of available treatments. There are, however, existing challenges in the assessment and analysis of constructs of interest. The present study aims to improve research on the effects of specific therapy elements using the example of the Metacognitive Training for Obsessive‐Compulsive Disorder (MCT‐OCD) intervention. Specifically, we introduce an innovative analytical method to identify predictors of treatment outcome and expand the assessment of common factors (e.g., coping expectations). A sample of 50 day‐ and inpatients with OCD was assessed before and after participation in an 8‐week MCT‐OCD programme. We investigated within‐session change in scores on revised questionnaires administered before and after each session. Linear mixed models (for session‐effects) and lasso regression (for prediction analyses) were used to analyse data. The revised assessments and data analyses showed greater improvement in dysfunctional (meta‐)cognitive beliefs over the time of the intervention and within sessions compared to previous MCT‐OCD studies. Some predictors, for example, improvement in coping expectation after the module on overestimation of threat for treatment outcome, were identified. The present study contributed to a better understanding of how to assess and analyse data of a modular intervention and demonstrated the strengths and weaknesses of different analytic approaches. Moreover, the analyses provided a deeper understanding of the specific effects and mechanisms of change of MCT‐OCD modules, which can be refined and examined in future studies. [ABSTRACT FROM AUTHOR]