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Depressive and obsessive-compulsive (OCD) symptoms often co-occur and a number of possible explanations for this co-occurrence have been explored, including shared biological and psychosocial risk factors. Network approaches have offered a novel hypothesis for the link between depression and OCD: functional inter-relationships across the symptoms of these conditions. The few network studies in this area have relied largely on item, rather than process-level constructs, and have not examined relationships dimensionally.Network analytic methods were applied to data from 463 treatment-seeking adults with OCD. Patients completed self-report measures of OCD and depression. Factor analysis was used to derive processes (i.e., nodes) to include in the network. Networks were computed, and centrality, bridge, and stability statistics examined.Networks showed positive relations among specific OCD and depressive symptoms. Obsessions (particularly repugnant thoughts), negative affectivity, and cognitive-somatic changes (e.g., difficulty concentrating) were central to the network. Unique relations were observed between symmetry OCD symptoms and cognitive-somatic changes. No direct link between harm-related OCD symptoms and depression was observed.Our results bring together prior findings, suggesting that both negative affective and psychomotor changes are important to consider in examining the relationship between OCD and depression. Increased consideration of heterogeneity in the content of OCD symptoms is key to improving clinical conceptualizations, particularly when considering the co-occurrence of OCD with other disorders.

BACKGROUND: Obsessive-compulsive disorder (OCD) is an often disabling and chronic condition that is normally assessed using diagnostic interviews or lengthy self-report questionnaires. This makes routine screening in general health settings impractical, and as a result OCD is often under-(or mis-)recognized. The present study reports on the development of an ultra-brief version of the Obsessive-Compulsive Inventory-Child Version (OCI-CV) which may be administered routinely as a screener for pediatric OCD. METHOD: A total of 489 youth diagnosed with OCD, 259 non-clinical controls, and 299 youth with other disorders completed the OCI-CV and other indices of psychopathology. Using item analyses, we extracted five items and examined the measure’s factor structure, sensitivity and specificity, and convergent and discriminant validity. RESULTS: We extracted five items that assess different dimensions of OCD (washing, checking, ordering, obsessing, neutralizing/counting), termed the OCI-CV-5. Results revealed that the measure possesses good to excellent psychometric properties, and a cutoff off (≥2) yielded optimal sensitivity and specificity. LIMITATIONS: Participants were predominantly White. In addition, more research is needed to examine the OCI-CV-5’s test-retest reliability and sensitivity to treatment. CONCLUSIONS: The OCI-CV-5 shows promise as an ultra-brief self-report screener for identifying OCD in youth when in-depth assessment is unfeasible.

Obsessive-compulsive disorder (OCD) is among the most distressing and functionally impairing of psychological problems. This chapter describes the phenomenology of obsessions and compulsions, which are highly heterogeneous. Themes of obsessions may include contamination, aggression and violence, mistakes, sex, morality, blasphemy, and the need for order and symmetry. Compulsive rituals may take the form of excessive washing and cleaning, checking, seeking reassurance, and ordering and arranging, as well as mental maneuvers aimed at suppressing obsessional thoughts or excessive self-reassurance. The chapter also discusses the nature of so-called obsessive-compulsive related disorders (OCRDs), a collection of conditions involving repetitive behaviors that, according to some, overlap with OCD. The OCRDs include hoarding disorder, hair-pulling and skin-picking disorders, and body dysmorphic disorder (BDD). The major theoretical approaches to understanding OCD and the OCRDs are reviewed and then critically evaluated. The chapter also provides an evaluation of the basis for grouping OCD along with the putative OCRDs.

Item does not contain fulltext The Dimensional Obsessive-Compulsive Scale (DOCS) is a self-report questionnaire aimed to measure the severity of obsessive-compulsive symptoms on four thematically different symptom dimensions (contamination, responsibility for harm, unacceptable thoughts, and symmetry and completeness). The DOCS was developed in the US in response to the insufficiency of existing OCD measures. The 20-item scale is used in research and clinical settings. We translated the DOCS into Dutch and examined the psychometric properties in a clinical sample. In addition, we further examined the US version of DOCS with respect to measurement invariance between patient and non-patients and also between the US and the Dutch version of the DOCS. The analyses showed that the Dutch version is a valid and reliable version of the DOCS. Measurement invariance tests indicated that patient scores can be validly compared with non-patient scores. Therefore, the DOCS is a good instrument to monitor the development of OCD, for example, during treatment. The same result was found for the US DOCS and the Dutch DOCS, hence US scores and Dutch scores can be validly compared. With these two studies we have extended our knowledge of the DOCS, beyond the common psychometric properties. 10 p.

It is well established that the transition to new parenthood is associated with the onset or worsening of obsessive-compulsive symptoms (OCS); however, less is known regarding specific risk factors associated with the development of postpartum OCS. The present prospective study examined experiential avoidance and interpretations of intrusive thoughts as predictors of the development of postpartum OCS in first-time mothers and fathers. Participants were 64 expecting parents (33 mothers and 31 partners—all fathers) who were followed from the 2nd or 3rd trimester of pregnancy into the postpartum. All completed measures of postpartum OCS, experiential avoidance, and interpretations of intrusive thoughts. Experiential avoidance and the pre-existing tendency to misinterpret intrusive thoughts were predictors of infant-related OCS in the early postpartum, but not at six months postpartum. These findings provide support for particular psychological risk factors in the development of infant-related OCS among first-time mothers and fathers. Implications for prevention and intervention are discussed.

Nearly one billion people worldwide suffer from obsessive-compulsive behaviors(1,2), yet our mechanistic understanding of these behaviors is incomplete, and effective therapeutics are unavailable. An emerging perspective characterizes obsessive-compulsive behaviors as maladaptive habit learning(3,4), which may be associated with abnormal beta-gamma neurophysiology of the orbitofrontal-striatal circuitry during reward processing(5,6). We target the orbitofrontal cortex with alternating current, personalized to the intrinsic beta-gamma frequency of the reward network, and show rapid, reversible, frequency-specific modulation of reward- but not punishment-guided choice behavior and learning, driven by increased exploration in the setting of an actor-critic architecture. Next, we demonstrate that chronic application of the procedure over 5 days robustly attenuates obsessive-compulsive behavior in a non-clinical population for 3 months, with the largest benefits for individuals with more severe symptoms. Finally, we show that convergent mechanisms underlie modulation of reward learning and reduction of obsessive-compulsive symptoms. The results contribute to neurophysiological theories of reward, learning and obsessive-compulsive behavior, suggest a unifying functional role of rhythms in the beta-gamma range, and set the groundwork for the development of personalized circuit-based therapeutics for related disorders.

Despite cross-cultural differences in obsessive-compulsive disorder (OCD) symptomology, little work has been extended in those in Mexico. To bridge this gap, the current study administered standard...

BACKGROUND: The Obsessive-Compulsive Inventory-Children’s Version (OCI-CV) was developed to assess obsessive-compulsive symptoms in youth. Recent changes in the Diagnostic and Statistical Manual (DSM-5) exclude hoarding from inclusion in the diagnosis of obsessive-compulsive disorder (OCD). Accordingly, the present study examined the reliability, validity, factorial structure, and diagnostic sensitivity of a revised version of the scale – the OCI-CV-R– that excludes items assessing hoarding. METHODS: Participant were 1047 youth, including 489 meeting DSM criteria for primary OCD, 298 clinical controls, and 260 nonclinical controls, who completed the OCI-CV and measures of obsessive-compulsive symptom severity, depression, and anxiety at various treatment and research centers. RESULTS: Findings support a five-factor structure (doubting/checking, obsessing, washing, ordering, and neutralizing), with a higher order factor. Factorial invariance was found for older (12 to 17 years) and younger (7 to 11 years) children. Internal consistency of the OCI-CV-R was acceptable, and discriminant and convergent validity were adequate and akin to that of its progenitor. Diagnostic sensitivity and specificity were found for a total score of 8 and higher. CONCLUSION: It is recommended that the OCI-CV-R replace the former version, and that this measure serve as part of a comprehensive clinical assessment of youth with OCD. Recommendations for further research with ethnically and racially diverse samples, as well as the need to establish benchmark scores are discussed.

For a number of reasons, it may be critical to involve a romantic partner or spouse in exposure and response prevention (ERP) for obsessive-compulsive disorder (OCD). Indeed, relationship stress focal to OCD is associated with greater symptom severity, a more severe course, and poor global functioning. Research also indicates that involving partners or spouses to serve as coaches for their OCD-affected partners during ERP improves the efficacy of this treatment. This chapter describes the nature and treatment of OCD, focusing on interpersonal dynamics, and outlines a couple-based ERP program for individuals with OCD who are in long-term relationships. Case examples are included to illustrate the techniques used in this program.

Obsessive-compulsive disorder (OCD) was once considered a rare and untreatable condition. Over the past half-century, however, a dramatic surge in research has led not only to a clearer understanding of this problem but also to the realization that it is fairly common and impairing, afflicting up to about 3% of the population. When the prevalence and functional impairment are considered together with the anxiety and distress that individuals with this OCD experience, one recognizes that this condition represents a significant public health concern. With this in mind, the present volume focuses on advances and emerging clinical implications in the field of OCD and related disorders with respect to assessment, treatment, treatment augmentation, and basic science.

Intolerance of Uncertainty (IU) is a key construct in the development and maintenance of obsessive-compulsive disorder (OCD). Recent research has examined the Beads Task as a behavioral measure of IU in which an incorrect decision is tied to an aversive outcome. The current study aimed to increase ecological validity of the Beads Task as an analog for decisional uncertainty in OCD. Specifically, we investigated whether the aversive outcome's “victim” impacted associations between IU and distress during decision-making. Undergraduates (N = 85) completed the Beads Task either alone or with a confederate partner. They were told that errors on the task would either lead to themselves (solo condition) or their “partner” (partner condition) having to complete the Cold Pressor Task (CPT). As hypothesized, participants in the partner condition experienced the Beads Task as significantly more distressing and important than those in the solo condition. Furthermore, self-report prospective IU was associated with distress about harm befalling oneself and perceived importance of the decision (solo condition), whereas inhibitory IU was associated with distress about harm befalling others (partner condition). Clinical implications for addressing uncertainty using exposure and response prevention, and future research of decision-making in the context of responsibility for harm are discussed.

Exposure and response prevention (ERP) and behavioral activation (BA) are effective treatments for obsessive-compulsive disorder (OCD) and depression, respectively. Patients with OCD often exhibit depression; furthermore, ERP for OCD is associated with reduced depressive symptoms. To our knowledge, no study has examined whether ERP itself functions to behaviorally activate patients with concurrent OCD and depressive symptoms. This prospective study was designed to test the hypotheses that (a) OCD exposure hierarchy completion, increased BA, and depressive symptom reduction would all be related, and (b) pre- to posttreatment changes in BA would mediate the direct effect of OCD hierarchy completion on posttreatment depressive symptoms, even after controlling for pretreatment depressive symptoms, pretreatment BA, pre- to posttreatment reductions in OCD symptoms, treatment duration, and antidepressant medication use. Patients (N = 90) with a primary diagnosis of OCD who received residential ERP for OCD completed a self-report battery at pre- and posttreatment. Exposure hierarchy completion, increases in BA, and decreases in depression were all significantly correlated (rs ranged .33 to .44). The effect of hierarchy completion on posttreatment depressive symptoms was fully mediated by pre- to posttreatment changes in BA. Findings highlight the potential for ERP to exert antidepressant effects by behaviorally activating patients. Limitations, clinical implications, and future directions are discussed.

Fear-based disorders (FBDs) occur in an interpersonal context as relatives (e.g., partners, parents) often accommodate symptoms. Symptom accommodation, which is ubiquitous and reinforces FBD behavior, is associated with increased FBD symptom severity and interferes with treatment. Accordingly, reducing accommodation represents a crucial aim for intervention. We describe a brief, manualized group intervention to decrease symptom accommodation and caregiver burden among cohabitating relatives of individuals with FBDs. The intervention is the first to date that (a) jointly includes parents and partners to target symptom accommodation, and (b) uses a transdiagnostic group treatment approach. We also provide preliminary empirical support for this group-based intervention among adult relatives (N = 20) that participated in the five weekly intervention sessions and completed assessments at baseline, posttreatment, and 1-month follow-up (1MFU). Preliminary results suggest that the group intervention is feasible and acceptable. Completers (n = 18) exhibited significant reductions in symptom accommodation and self-reported burden between baseline and 1MFU. The discussion identifies study limitations and future directions.

Many individuals with obsessive-compulsive disorder (OCD) also meet criteria for additional diagnoses. Among the most common co-occurring diagnoses are mood disorders—especially depression. This article focuses on the comorbidity between OCD and major depression. After discussing nature of OCD and depression, the rates and clinical impact of depression on OCD, the conceptualization, assessment, and treatment of OCD when it appears along with depression is covered in detail. The derivation and implementation of a cognitive-behavioral treatment program specifically for depressed OCD patients is described and illustrated using a case example.

The 18-item Obsessive-Compulsive Inventory-Revised (OCI-R) is a widely used self-report measure of Obsessive-Compulsive Disorder (OCD) symptoms, yet its factor structure does not converge with contemporary dimensional models of OCD symptoms. In addition to assessing the four core OCD dimensions, the OCI-R includes hoarding and neutralizing factors. However, since its publication, hoarding has been designated as a separate disorder, and there are concerns about the neutralizing factor's reliability and validity. The aim of this study was to evaluate a syndromally valid modification of the OCI-R. Adult samples of individuals diagnosed with OCD (n = 1087), anxiety related disorders (n = 1306), and unselected community volunteers (n = 423) completed the OCI-R and measures of anxiety and mood. Analyses excluded the 3 OCI-R hoarding items and suggested the removal of the 3 neutralizing items. Internal consistency, sensitivity and specificity to OCD clinical status, test-retest reliability, sensitivity to treatment, and convergent and discriminant validity were evaluated for the resultant 12-item scale (termed the OCI-12). The OCI-12 evidenced good to excellent psychometric properties. Clinical norms, severity benchmarks, and a clinical cutoff score were computed. In conclusion, the OCI-12 represents a syndromally valid update of the OCI-R with comparable psychometric properties and superior sensitivity and specificity.

Anxiety sensitivity (AS), the fear of anxiety-related physiological sensations, is a predictor of posttraumatic stress symptoms (PTSS) following a traumatic event, yet there is limited research on the relationship between AS and PTSS among sexual assault survivors. The present study was designed to test the hypothesis that AS would emerge as a statistical predictor of PTSS dimensions among community members and undergraduate students endorsing lifetime exposure to sexual trauma. Adults endorsing a history of sexual assault (N = 52) completed an online battery, including self-report measures of AS, general distress, dysfunctional trauma-related beliefs (i.e., posttraumatic cognitions), and PTSS. Although AS was associated with PTSS dimensions at the bivariate level (rs ranged .68–82), AS did not emerge as a significant unique predictor of PTSS dimensions in linear regression analyses after controlling for general distress and posttraumatic cognitions. In fact, general distress was the only significant statistical predictor of PTSS total and dimension scores (ps < 01). Study implications, limitations, and future directions are discussed.

COVID-19 presents significant social, economic, and medical challenges. Because COVID-19 has already begun to precipitate huge increases in mental health problems, clinical psychological science must assert a leadership role in guiding a national response to this secondary crisis. In this article, COVID-19 is conceptualized as a unique, compounding, multidimensional stressor that will create a vast need for intervention and necessitate new paradigms for mental health service delivery and training. Urgent challenge areas across developmental periods are discussed, followed by a review of psychological symptoms that likely will increase in prevalence and require innovative solutions in both science and practice. Implications for new research directions, clinical approaches, and policy issues are discussed to highlight the opportunities for clinical psychological science to emerge as an updated, contemporary field capable of addressing the burden of mental illness and distress in the wake of COVID-19 and beyond. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Cognitive biases, such as thought–action fusion (TAF), play a crucial role in the cognitive-behavioral model of obsessional symptoms and have been shown to prospectively increase the risk of developing such symptoms. Much less research, however, has examined factors that might lead to the development of the cognitive biases themselves. This study aimed to replicate and extend existing work on correlates of moral (thinking about something is the moral equivalent of the corresponding action) and likelihood (thinking about a particular event increases the probability that this event will occur) TAF. A large sample of unscreened participants (N = 407) completed a measure of TAF, as well as measures of religiosity, motivation for religion, parental psychological control, and parental guilt induction. Results indicated that religion-related variables predicted the moral TAF, whereas parenting strategies were associated with likelihood TAF. Intrinsic motivation for religion also mediated the relationship between religiosity and moral TAF. Findings are discussed in terms of developmental psychopathology and limitations are addressed.

Exposure and response prevention (ERP) is the most effective psychological treatment for unwanted, intrusive thoughts associated with obsessive-compulsive disorder (OCD). However, the procedures involved in ERP (i.e., exposure) are challenging, provoke high levels of anxiety, and may contribute to treatment refusal and dropout (Franklin & Foa, 1998). To address this problem, researchers have begun to evaluate alternative treatments for OCD, such as Acceptance and Commitment Therapy (ACT). Despite the value of both techniques, little is known about the differential impact of these strategies. This study examined the relative effects of a single session of ACT or exposure for obsessional thoughts. There were 56 under- graduate participants with obsessional thoughts randomly assigned to receive a brief interven- tion with the core components of exposure, ACT, or an expressive writing control condition. Obsessional symptoms and related process variables were assessed at baseline and at 1-week follow-up. There were no statistical differences in believability or acceptability of the 3 condi- tions. Significant reductions in obsessional severity, behavioral tests of distress and willingness to experience intrusive thoughts, and negative appraisals of intrusive thoughts occurred in all conditions, but no differences were found between these conditions. Furthermore, changes in dysfunctional beliefs, but not in willingness to experience intrusive thoughts, predicted changes in obsessional symptoms in both the ACT and exposure conditions.Keywords: OCD; exposure; ACT; obsessionsAlthough obsessive-compulsive disorder (OCD) affects 2%-3% of adults (Karno, Golding, Sorenson, & Burnam, 1988), research shows that 80%-90% of the population at large experiences unwanted, negative intrusive "obsession-like" thoughts (Rachman & de Silva, 1978). Although such "normal obsessions" are less frequent and intense relative to their clinical counterparts, they are similar in content and form to clinical obsessions. That is, they can be unwanted and/or unacceptable personally relevant images, impulses, or doubts (e.g., the thought of stabbing a loved one, the image of having sex with one's sibling). Furthermore, many individuals who do not have OCD report experiencing distress associated with such intrusive thoughts, and they attempt to resist these thoughts as do people with OCD (Ladouceur et al., 2000).The most espoused psychological model of obsessional problems, which is derived from Beck's (1976) cognitive model of emotion, posits that obsessions develop when unwanted intru- sive thoughts are catastrophically misinterpreted (Rachman, 1997) as overly important or threat- ening. This misinterpretation evokes anxiety and a preoccupation with the thought; for example, one might believe that an unwanted thought of harming a loved one is actually indicative of deep-seated violent tendencies or that merely having this thought makes the corresponding event more likely. Misinterpreting unwanted, intrusive thoughts in this way not only leads to distress and preoccupation but also provokes "safety behaviors" (i.e., rituals, reassurance-seeking, avoid- ance) that maintain the misinterpretations (Rachman, 1997).This model has implications for treatment, specifically that reducing obsessional problems requires correcting the misinterpretations about unwanted thoughts. One technique shown to produce such change is therapeutic exposure, which involves confronting feared stimuli until the associated anxiety/distress is reduced (Abramowitz, Deacon, & Whiteside, 2011). One par- ticular form of exposure-imaginai exposure (IE)-has been used to specifically address obses- sional problems. IE involves deliberately confronting anxiety-provoking intrusive thoughts (e.g., by writing and reading them over and over while resisting urges to perform safety behaviors) and not only teaches individuals that their distress will decrease in the presence of such thoughts but also teaches them to correct misinterpretations associated with these thoughts (Abramowitz et al. …

Research consistently demonstrates that individuals with anxiety symptoms exhibit attentional biases toward threatening stimuli using various computer-based tasks. However, the presence of attentional biases across obsessive-compulsive symptom presentations has been mixed and requires clarification. This study was the first to use the dot probe paradigm to investigate the association between scrupulosity symptoms (obsessions and compulsions having to do with religion and morality) and selective attention to scrupulosity-relevant lexical stimuli. Contrary to hypotheses, individuals with higher levels of scrupulosity did not selectively attend (i.e., have faster reaction times) to scrupulosity-specific threat words (e.g., hell) more so than to general threat or neutral words. Various potential explanations for these null findings, as well as directions for future research, are discussed.Keywords: attention bias; religiosity; obsessive-compulsive disorderScrupulosity is a presentation of obsessive-compulsive disorder (OCD) involving obsessions and compulsions having to do with religion and morality (Abramowitz, 2001, 2008; Abramowitz & Jacoby, 2014; Huppert & Siev, 2010). Specifically, individuals with scrupulosity experience unwanted intrusive thoughts (i.e., obsessions) associated with the possibility that they have committed a moral or religious transgression (e.g., "Did I commit a sin without realizing it?"); intrusive blasphemous thoughts or images (e.g., images of the devil); doubts that one may not be faithful, moral, or pious enough (e.g., "Am I truly a Christian?"); concerns that one didn't perform a religious prayer or ceremony correctly (e.g., "Did I really confess all of my sins at confession?"); and fears of eternal damnation (e.g., "Am I going to hell?"). These intrusions are experienced as highly distressing and are accompanied by the drive to perform compulsive rituals-such as excessive prayer, re-reading Bible verses until they are read "perfectly," and repeatedly seeking reassurance from religious figures or loved ones about religious topics-that function to reduce anxiety. Individuals with scrupulosity also often avoid situations and stimuli that trigger obsessional thoughts and distress.Cognitive behavioral models of scrupulosity propose that one maintaining factor of this problem is attentional biases for threat (Abramowitz & Jacoby, 2014), which refers to the preferential processing of danger-related stimuli over neutral stimuli when both types of stimuli are competing for processing priority (MacLeod, Mathews, & Tata, 1986). For example, consider the case of Rebecca, a Catholic woman with scrupulosity whose obsessional doubts include uncertainty over whether she has fully confessed all of her sins at confession. Hypervigilant for cues related to confession, sin, and hell, Rebecca has become exquisitely sensitive to these words and notices every time they appear or whenever someone uses them (and even words that sound similar; e.g., being greeted by someone saying "Hello"). She also has difficulty disengaging her attention from these intrusive words and starts to ruminate about whether she has committed a sin that she has not confessed and if God is going to punish her by damning her to hell. Her anxiety steadily increases until she feels she can no longer tolerate the discomfort. To make herself feel better, she often makes excuses to leave these situations and return to church, confess any possible perceived sins, and reduce her anxiety.Research on anxiety, more generally consistently demonstrates-using various experimental paradigms-that individuals with anxiety symptoms exhibit attentional biases toward threatening stimuli (for a meta-analytic review, see Bar-Haim, Lamy, Pergamin, Bakermans-Kranenburg, & van IJzendoorn, 2007). The dot probe task (MacLeod et al., 1986) is one such paradigm, in which participants are asked to indicate as quickly as possible which letter (i. …

Anxiety and related disorders (ARDs) occur in an interpersonal context. Individuals with ARDs respond well to individual cognitive behavioral therapy (CBT); however, there is room for improvement. As such, family members may be included to “enhance” treatment outcomes, yet findings from studies examining family involvement in CBT for ARDs are equivocal. The present paper (a) identifies methodological considerations for explaining inconsistent outcomes among CBT for ARDs with family involvement, and (b) reviews factors that affect outcomes of CBT for ARDs with family involvement including levels of involvement in treatment (e.g., number, duration, and spacing of sessions) and characteristics of who is involved in treatment (e.g., family member cognitions and cultural factors). Limitations of the literature and recommendations for future research are discussed. Researchers should focus on conducting studies that can test not whether but for whom and how family involvement can contribute to improved outcomes above and beyond individual CBT for ARDs.

Exposure and response prevention (ERP) for obsessive-compulsive disorder (OCD) is often highly effective, yet some patients experience relapses following a seemingly successful course of treatment. In this article we describe the conceptual basis of ERP, and then present a client who relapsed after seemingly achieving substantial improvement following 11 sessions of ERP. Likely reasons for the relapse and strategies for enhancing ERP to achieve better long-term treatment outcomes are discussed from the perspective of acceptance and commitment therapy (ACT). These strategies mainly apply to the implementation of situational (in vivo) and imaginal exposure therapy, but also include suggestions for optimizing the use of cognitive therapy for OCD.

COVID-19 presents humanity with one of the greatest health and economic crises of the 21st Century. Because COVID-19 has already begun to precipitate a huge increase in mental health problems, we believe that clinical science must also play a leadership role in guiding a national response to this secondary crisis. In this article, we explain why COVID-19 is a game-changer, as a unique, compounding, multi-dimensional stressor that will create a vast need for intervention, and necessitate new paradigms for mental health service delivery and training. We highlight the most urgent challenge areas for clinical science, including managing potential spikes in depression, anxiety, and suicide, and address the unique COVID-19-related needs across the lifespan and the challenges that COVID-19 places on families and relationships. Clinical science also will need to address the mental health of medical care workers, mitigate health disparities, and address stigma among the most vulnerable as the pandemic unfolds. For each challenge area, we suggest research directions, clinical approaches, and policy issues that need to be considered. We then discuss how to enable multi-level deployment of potential solutions and how clinical science must itself adapt to identify and deliver these solutions. We conclude by highlighting new areas for clinical science discovery and additional funding needs. Advances in clinical science implementation—propelled by COVID-19—will likely endure long beyond the pandemic.

Serious illnesses such as Ebola are often highly publicized in the mass media and can be associated with varying levels of anxiety and compensatory safety behavior (e.g., avoidance of air travel). The present study investigated psychological processes associated with Ebola-related anxiety and safety behaviors during the outbreak in late 2014. Between October 30 and December 3, 2014, which encompassed the peak of concerns and of the media’s attention to this particular outbreak, 107 university students completed a battery of measures assessing fear of Ebola, performance of safety behaviors, factual knowledge of the virus, and psychological variables hypothesized to predict Ebola-related fear. We found that while our sample was generally not very fearful of contracting Ebola, the fear of this disease was correlated with general distress, contamination cognitions, disgust sensitivity, body vigilance, and anxiety sensitivity-related physical concerns. Regression analyses further indicated that anxiety sensitivity related to physical concerns and the tendency to overestimate the severity of contamination were unique predictors of both Ebola fear and associated safety behaviors. Implications for how concerns over serious illness outbreaks can be conceptualized and clinically managed are discussed.

Spirituality and religion (S/R) commonly emerge as themes in obsessive-compulsive disorder (OCD), including intrusive thoughts about sin, blasphemous images, and excessive fears of punishment from God. To relieve the distress associated with these thoughts, individuals with OCD may pray, seek reassurance from clergy members, or engage in inappropriate confession behaviors in a manner that exceeds, and in some cases contravenes, their religious or cultural norms. Research does not suggest that S/R causes or even predicts greater levels of OCD on the whole, rather when religious individuals develop OCD their symptoms tend to take on religious themes. However, research also suggests that the presence of religious obsessions and compulsions predicts poorer outcomes in OCD treatment. This may be explained by limited knowledge among clinicians about religious symptom presentations, as well as difficulty differentiating symptoms from normative religious practices. Accordingly, this chapter reviews the scientific literature on S/R and OCD, and presents a cognitive-behavioral framework for understanding S/R in the context of OCD assessment and treatment.

Key Points Question Does D-cycloserine potentiate the effect of concentrated exposure and response prevention in difficult-to-treat obsessive-compulsive disorder? Findings In this randomized clinical trial of 163 participants, D-cycloserine did not significantly affect treatment outcomes. Most patients responded to the concentrated exposure and response prevention treatment, and nearly 50% were recovered at 1-year follow-up. Meaning In this study, concentrated exposure and response prevention treatment was effective for patients with difficult-to-treat obsessive-compulsive disorder, but adding D-cycloserine did not potentiate the treatment., This randomized clinical trial evaluates whether D-cycloserine potentiates the effect of concentrated exposure and response prevention among patients with difficult-to-treat obsessive-compulsive disorder., Importance Evidence is lacking for viable treatment options for patients with difficult-to-treat obsessive-compulsive disorder (OCD). It has been suggested that D-cycloserine (DCS) could potentiate the effect of exposure and response prevention (ERP) treatment, but the hypothesis has not been tested among patients with difficult-to-treat OCD. Objective To evaluate whether DCS potentiates the effect of concentrated ERP among patients with difficult-to-treat OCD. Design, Setting, and Participants The study was a randomized placebo-controlled triple-masked study with a 12-month follow-up. Participants were adult outpatients with difficult-to-treat OCD. A total of 220 potential participants were referred, of whom 36 did not meet inclusion criteria and 21 declined to participate. Patients had either relapsed after (n = 100) or not responded to (n = 63) previous ERP treatment. A total of 9 specialized OCD teams within the public health care system in Norway participated, giving national coverage. An expert team of therapists from the coordinating site delivered treatment. Inclusion of patients started in January 2016 and ended in August 2017. Data analysis was conducted February to September 2019. Interventions All patients received individual, concentrated ERP treatment delivered during 4 consecutive days in a group setting (the Bergen 4-day treatment format) combined with 100 mg DCS, 250 mg DCS, or placebo. Main outcomes and Measures Change in symptoms of OCD and change in diagnostic status. Secondary outcomes measures included self-reported symptoms of OCD, anxiety, depression, and quality of life. Results The total sample of 163 patients had a mean (SD) age of 34.5 (10.9) years, and most were women (117 [71.8%]). They had experienced OCD for a mean (SD) of 16.2 (10.2) years. A total of 65 patients (39.9%) were randomized to receive 100 mg DCS, 67 (41.1%) to 250 mg of DCS, and 31 (19.0%) to placebo. Overall, 91 (56.5%) achieved remission at posttreatment, while 70 (47.9%) did so at the 12-month follow-up. There was no significant difference in remission rates among groups. There was a significant reduction in symptoms at 12 months, and within-group effect sizes ranged from 3.01 (95% CI, 2.38-3.63) for the group receiving 250 mg DCS to 3.49 (95% CI, 2.78-4.18) for the group receiving 100 mg DCS (all P

This chapter focuses on the phenomenology of obsessive–compulsive disorder symptoms that develop or worsen perinatally. The content of obsessions and nature of the compulsions during this period are generally related to the protection of an unborn or newborn child and most commonly involve contamination fears during pregnancy and intrusive thoughts about harm during the postpartum period. Comorbid depressive symptoms are often present as well. Perinatal OCD symptoms are maintained by the misinterpretation of intrusive thoughts as highly significant and meaningful, overestimates of threat and responsibility for preventing harm, compulsive rituals, and avoidance of fear cues. Although research has documented an increased risk of OCD during pregnancy and the postpartum period, perinatal OCD is understudied and underrecognized relative to depression and psychosis.

The unwillingness to remain in contact with obsessions and anxiety (i.e., experiential avoidance, EA) may explain how normally occurring unwanted intrusive thoughts develop into clinical obsessions as seen in obsessive-compulsive disorder (OCD). Studies examining the relationship between EA and OC symptoms are mixed, potentially because the existing self-report measure of EA (i.e., the Acceptance and Action Questionnaire, AAQ-II) is a general measure that does not adequately capture EA specific to obsessions and compulsions. Thus, we aimed to develop and evaluate an OC-specific version of the AAQ-II. First, we used exploratory factor analysis to empirically reduce an initial pool of 49 items (adapted from original AAQ-II items to reference “intrusive thoughts”) to 13 items. A two-factor solution (Valued Action and Willingness) provided the best fit to the data, accounting for 60.57% of the variance. Second, the reduced AAQ-OC was administered, along with other self-report measures, to an independent sample of adults. The AAQ-OC subscales evidenced good internal consistency as well as convergent, discriminant, and incremental validity. Future work examining the psychometric properties of the AAQ-OC in a clinical sample, as well as the measure's treatment sensitivity are needed.

Objective: We investigated the diagnostic efficiency and clinical utility of the Dimensional Obsessive–Compulsive Scale (DOCS) and subscales for distinguishing obsessive–compulsive disorder (OCD) from anxiety disorders (ADs). Method: A total of 369 participants (167 male, Mage = 29.61 years) diagnosed with DSM-IV OCD or AD, recruited from specialty clinics across the United States, completed clinical interviews and self-report questionnaires, including the DOCS. Receiver operating characteristic analyses and diagnostic likelihood ratios (DiLRs) determined discriminative validity and provided clinical utility. Logistic regressions tested for incremental validity in the DOCS-total scale and subscales in predicting OCD status. Results: The DOCS-total scale and Contamination subscale performed best in differentiating between OCD and AD diagnosis (DOCS-total: Area under curve [AUC] = .75, p < .001; Contamination: AUC = .70, p < .001) as compared with the other subscales. At high scores (DOCS-total: 28+, Contamination: 6+), Contamination was more effective than the DOCS-total in differentiating OCD from ADs, with high scores in Contamination quadrupling OCD odds and DOCS-total by about threefold (Contamination DiLR+ = 4.04, DOCS-total DiLR+ = 2.82). At low scores (DOCS-total: 0-9, Contamination: 0-2), the converse was true, with low scores in Contamination cutting OCD odds by half and DOCS-total by one fifths (Contamination DiLR− = 0.52, DOCS-total DiLR− = 0.23). Conclusion: At high scores, the Contamination subscale is the most helpful subscale to differentiate OCD and ADs. For low scores, the DOCS-total scale performs the best among the scales.