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Psychodynamic and cognitive theories postulate a prominent role of aggressiveness in patients with obsessive-compulsive disorder (OCD). Explicit assessment of aggressiveness in OCD has yielded diverging results. The present study aimed to investigate aggressiveness in OCD using the Implicit Relational Assessment Procedure (IRAP). Patients with OCD (n = 59) were compared to non-clinical controls (NCs; n = 31) on an IRAP using self-referential statements and the explicit State-Trait Anger Expression Inventory-II (STAXI-II). During the computer-based IRAP, participants were required to respond as quickly and accurately ("correct" or "incorrect") to the relation of two presented stimuli (e.g., "I am" + "aggressive"). D IRAP -Scores for the I am aggressive trial type were significantly higher in NCs compared to the OCD sample (d = 0.73). Patients with OCD scored significantly higher on the Trait Anger scales and the Anger Expression-Out scale of the STAXI-II. The I am aggressive D IRAP -Score correlated with the overall Trait Anger scale (r = −.33, p =.001) and with the Anger Expression-In scale (r = −0.31, p =.003). Patients with OCD were more ambivalent about their own aggressiveness than NCs. These findings were in line with patients' explicit aggressiveness. • Aggressiveness can be assessed using the Implicit Relational Assessment Procedure. • Patients with OCD appear more ambivalent about their aggressiveness than controls. • Patients with checking compulsions are not especially affected by aggressiveness. [ABSTRACT FROM AUTHOR]

Despite its efficacy and effectiveness, exposure with response prevention (ERP) is underused in patients with obsessive-compulsive disorder (OCD). As this underuse of ERP may apply particularly to harm-related OCD, we investigated the theory-practice gap as well as negative beliefs and experiential avoidance as potential reasons for the underutilization of ERP with this group in a sample of trainee and qualified therapists. We assessed 339 therapists' general knowledge about ERP using a harm-related OCD case example and their utilization of ERP in clinical practice for harm-related OCD. Of the total sample, 74% of the therapists (n = 251) were CBT-oriented and 61% (n = 209) were in training. We assessed negative beliefs and experiential avoidance using the Therapist Beliefs about Exposure Scale (TBES) and the Acceptance and Action Questionnaire-II (AAQ-II). While 74% of the therapist recommended ERP for the case example, only 43% admitted to using ERP for harm-related OCD in their clinical practice. ERP affinity of therapists in theory and practice was related to fewer negative beliefs about ERP, with large effect size (η p 2 = 0.367 [CI 95% 0.285 − 0.433]) and lower experiential avoidance with small effect size (η p 2 = 0.024 [CI 95% 0.001 − 0.059]) in the total sample. We found evidence of a theory-practice gap in the treatment of harm-related OCD in a sample of trainee and qualified therapists. To ensure that patients with harm-related OCD content receive the evidence-based treatment they need, negative beliefs about ERP may represent a potential target. • Evidence for a theory-practice gap in the treatment of harm-related OCD. • 16%–36% of therapists would not treat patients with harm-related OCD. • Negative beliefs about exposure were related to the degree of ERP affinity. [ABSTRACT FROM AUTHOR]

Objective Many individuals with obsessive-compulsive disorder (OCD) do not receive proper treatment due to limited access to or active avoidance of the psychological/medical healthcare system. Self-help may alleviate some of the burden inflicted by OCD. However, the efficacy of most self-help interventions has not been tested. Research is increasingly concerned with often sophisticated Internet self-help interventions, but bibliotherapy using eBooks may reach individuals at a larger scale. The present study examined the efficacy of the myMCT (short for “my metacognitive training”), an integrative transtherapeutic self-help manual for OCD. A secondary aim was to identify factors moderating treatment response. Method A total of 70 individuals with self-reported OCD were assessed at baseline and subsequently randomized to either myMCT or a wait-list control condition. Six weeks later, post-assessment was carried out. Scores on the self-rating version of the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) served as the primary outcome. Secondary outcomes included scores on OCD symptom dimensions (Obsessive-Compulsive Inventory-Revised; OCI-R), depression (Patient Health Questionnaire for Depression; PHQ-9), and a cognitive biases questionnaire. Results The retention rate was 80% (treatment group: 74%, control group: 86%). Participants who received myMCT showed a significant decline in both obsessive and compulsive symptoms on the Y-BOCS at a large effect size relative to wait-list controls. Moreover, the myMCT intervention group showed larger decreases on the OCI-R, PHQ-9, and the cognitive biases questionnaire. Poor insight predicted a worse outcome in the treatment group. Conclusions MyMCT led to symptom improvement in individuals with OCD for both the primary and secondary outcomes at a medium to large effect size. Still, many still displayed substantial symptom severity post intervention. In a next step, it remains to be determined. whether culturally adapted translations are feasible and efficacious in nonindustrialized countries where evidence-based treatments are rarely available and self-help often represents the only treatment option. [ABSTRACT FROM AUTHOR]

Meta-analyses conclude that individuals with obsessive-compulsive disorder (OCD) share neurocognitive deficits. The aim of the present study was to examine the impact of attitude towards neuropsychological assessment, symptoms during assessment, and performance motivation on test results in OCD. Thirty OCD and 30 nonclinical individuals were assessed with a comprehensive battery of neuropsychological tests. Before and after testing, participants completed the newly developed Momentary Influences, Attitudes and Motivation Impact on Cognitive Performance Scale (MIAMI). The experimenter rated the patients’ momentary influences, attitude, motivation, and OC behavior during testing. Patients with OCD performed worse than controls on five out of ten outcome measures. Patients were more fearful about the test outcome and complained about more negative influences during testing than controls did. The MIAMI total score mediated the relationship between group and speed. When the MIAMI score was entered as a covariate, group differences for speed were nonsignificant. No group differences emerged between patients high on motivation and those with few negative momentary influences (as assessed by the experimenter) compared to controls. OCD patients and controls differ greatly with regard to attitude towards testing and momentary influences, which likely represents a substantial source of secondary malperformance in patients. Consequently, we call for greater caution when interpreting group differences in neuropsychological studies on OCD. Contextual and motivational variables need to be controlled for. It is also necessary to avoid general and potentially stigmatizing inferences if group differences are due to malperformance in only a subgroup of patients. [ABSTRACT FROM AUTHOR]

Objective: To assess the association of subjective quality of life as measured by the Subjective Well-being under Neuroleptic Treatment questionnaire (SWN-K) with neuropsychological functioning; to address interactions with the SWN-K domain mental functioning as a measure of subjective cognitive dysfunction; and to examine the interaction of subjective well-being and psychopathology ratings. Methods: Forty-five patients diagnosed with schizophrenia spectrum disorder (SSD) were assessed regarding subjective well-being (SWN-K), neuropsychological impairment, and psychopathology (Brief Psychiatric Rating Scale; BPRS). Results: After controlling for multiple comparisons, SWN-K total score showed significant positive correlations with concentration/attention (r = .498), working memory (r = .537), verbal memory (r = .522), and global cognition (r = .459). No correlations of SWN mental functioning and neuropsychological impairment remained significant after Bonferroni correction. Correlations between SWN-K subscales and neuropsychological functioning were generally positive, indicating higher subjective well-being in patients with better neurocognition. In multivariate analyses, global cognition was a significant predictor (p = .011), accounting for 19.7% of SWN total score variance. Adding BPRS total score as predictor (p = .054) explained an additional 6.9% of SWN-K variance. Linear regression analyses with SWN-K mental functioning as dependent variable did not yield statistically significant models. Conclusion: Subjective well-being and objective neuropsychological functioning show only moderate associations and can be seen as largely independent parameters. In particular, subjective mental functioning cannot serve as a proxy for objective neuropsychological testing. [ABSTRACT FROM AUTHOR]

Abstract: Online surveys are gaining increasing momentum in clinical research. Ease of recruitment and low cost are two of the biggest advantages of Internet studies. There are, however, concerns about their reliability and validity. The present study compared the psychometric properties of self-report instruments measuring obsessive-compulsive disorder (OCD) across three samples: (1) participants with a confirmed diagnosis of OCD (n=66), (2) participants with a probable diagnosis of OCD (n=86) and (3) clinical experts on OCD and students who were asked to pretend to have OCD (n=121). Psychometric indices of the Yale-Brown Obsessive Compulsive Score (Y-BOCS) and the Obsessive Compulsive Inventory (OCI-R) served as indicators for reliability and validity. Both patient samples revealed good retest reliability scores and good correlations between Y-BOCS and OCI-R scores. In contrast, the expert group showed poor retest reliabilities and mixed results for the intercorrelations between OCI-R and Y-BOCS scores. Simulators display a marked tendency to over-report symptoms on the OCI-R. Good psychometric properties of online studies may serve as a proxy for the validity of diagnoses. [Copyright &y& Elsevier]

Background: The assessment of Quality of Life (QoL) is an important tool for elucidating target symptoms that are particularly bothersome to patients. The present study was designed to explore predictors of decreased QoL in obsessive-compulsive disorder (OCD) patients and to explore which aspects of QoL are most affected in OCD. Furthermore, the study investigated changes in QoL after treatment and the association between QoL change scores with symptomatic outcome. In line with prior research, it wag expected that low QoL in OCD patients would be most pronounced for the emotional and social aspects of the construct. Methods: Seventy-nine OCD patients were initially recruited. Patients were assessed with the SF-36 both before and after treatment. Norm values were derived from the general population to characterize status of impairment. OCD patients were contrasted with published SF-36 scores from 2 OCD samples as well as a newly recruited psychiatric and healthy control sample. Results: Correlations with QoL were most pronounced for depression severity and number of OCD symptoms. Apart from low social and emotional QoL in the majority of patients, a large subgroup also reported lower physical well-being. Decreased scores on this subscale were mainly associated with length of illness, depression, and number of compulsions. Overall, QoL was significantly improved in therapy responders relative to nonresponders. Conclusions: The results largely correspond to previous findings showing that OCD patients sham severely compromised well-being. Somewhat unexpected from previous research, QoL deficits were not restricted to emotional and social aspects of QoL but extended to somatic domains. The present results suggest that clinicians should thoroughly explore for depression as well as physical impairments in OCD patients, which, when present, may be additionally targeted to achieve comprehensive treatment success. [ABSTRACT FROM AUTHOR]

Less than half of help-seeking individuals with obsessive-compulsive disorder (OCD) receive evidence-based treatment recommended by guidelines. Metacognitive Group Training for OCD (MCT-OCD) aims to fill the treatment gap, until evidence-based treatment is available as it is easy to administer even by less trained personnel and highly standardized, which facilitates preparation and thus, dissemination. An assessor-blind randomized controlled trial comparing the MCT-OCD (n = 39) to a care as usual control condition (n = 40) was conducted. The Yale-Brown Obsessive Compulsive Scale (Y-BOCS) represented the primary outcome. Secondary outcomes targeted treatment processes. Patients were reassessed eight weeks (post) after baseline and three months (follow-up) after post. In the MCT-OCD group, OC symptoms declined more than in the control group from baseline to post with a moderate effect (η p 2 = 0.078) in the complete cases sample. Decrease in compulsions and dysfunctional metacognitions was larger in the MCT-OCD than the control group from baseline to post and from baseline to follow-up (compulsions only). Acceptability of the MCT-OCD was good. The results demonstrate that the MCT-OCD is a promising add-on treatment for reducing OC symptoms and dysfunctional metacognitions. Its easy dissemination enables a large number of patients with OCD to be treated. • The Metacognitive Training for OCD (MCT-OCD) reduced patients' OC symptoms. • The MCT-OCD showed good acceptability. • The MCT-OCD is a highly standardized intervention, which may narrow treatment gap. [ABSTRACT FROM AUTHOR]

Sex differences (e.g., regarding age at onset and content of symptoms) suggest a potential role of sex hormones in the prenatal etiopathogenesis of obsessive-compulsive disorder (OCD). To investigate whether these hormones are associated with OCD, the study used the 2D:4D digit ratio as phenotypic marker of prenatal sex hormone exposure. The study included 43 patients with OCD, 35 patients with depression, and 36 nonclinical controls. Diagnostic groups did not differ with regard to 2D:4D. In men with OCD, analyses showed a negative association between 2D:4D and OC symptom severity after controlling for depression. Moreover, a positive relationship between 2D:4D and the symptom dimension "washing" and a negative with "checking" was found in men, a positive association with age at onset in women (nonsignificant after correction for multiple testing). Future research should further pursue the hypothesis of a disturbed balance of sex hormones as a factor in the etiopathogenesis of OCD. • 2D:4D and OCD symptoms were examined for the first time. • Masculinized 2D:4D is related to OC symptoms in men. • "Simple" comparisons of 2D:4D ratios between groups are rather unreliable. • Testosterone has a potential early, prenatal influence in the development of OCD. [ABSTRACT FROM AUTHOR]

Background: Web-based interventions have been shown to be effective for the treatment of depression. However, interventions are often complex and include a variety of elements, making it difficult to identify the most effective component(s).Objective: The aim of this pilot study was to shed light on mechanisms in the online treatment of depression by comparing a single-module, fully automated intervention for depression (internet-based behavioral activation [iBA]) to a nonoverlapping active control intervention and a nonactive control group.Methods: We assessed 104 people with at least mild depressive symptoms (Patient Health Questionnaire-9, >4) via the internet at baseline (t0) and 2 weeks (t1) and 4 weeks (t2) later. After the t0 assessment, participants were randomly allocated to one of three groups: (1) iBA (n=37), (2) active control using a brief internet-based mindfulness intervention (iMBI, n=32), or (3) care as usual (CAU, n=35). The primary outcome was improvement in depressive symptoms, as measured using the Patient Health Questionnaire-9. Secondary parameters included changes in activity, dysfunctional attitudes, and quality of life.Results: While groups did not differ regarding the change in depression from t0 to t1 (ηp2=.007, P=.746) or t0 to t2 (ηp2=.008, P=.735), iBA was associated with a larger decrease in dysfunctional attitudes from t0 to t2 in comparison to CAU (ηp2=.053, P=.04) and a larger increase in activity from t0 to t1 than the pooled control groups (ηp2=.060, P=.02). A change in depression from t0 to t2 was mediated by a change in activity from t0 to t1. At t1, 22% (6/27) of the participants in the iBA group and 12% (3/25) of the participants in the iMBI group indicated that they did not use the intervention.Conclusions: Although we did not find support for the short-term efficacy of the single-module iBA regarding depression, long-term effects are still conceivable, potentially initiated by changes in secondary outcomes. Future studies should use a longer intervention and follow-up interval.Trial Registration: DKRS (#DRKS00011562). [ABSTRACT FROM AUTHOR]