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The aim of this study was to examine worsening of OCD symptoms after childbirth in individuals seeking assessment or treatment of OCD. The postpartum period may make parents biologically and psychologically vulnerable to OCD symptoms. Participants included 222 parents with OCD who completed surveys through a self-help website. Most women and almost half of men with self-reported OCD reported an increase in OCD symptoms following childbirth. Retrospective report of perceived worsening of OCD symptoms after childbirth was associated with more aggressive obsessions for both men and women, in comparison to individuals whose OCD symptoms did not worsen around childbirth. Women whose OCD symptoms worsened after childbirth reported more impairment in social functioning than individuals whose symptoms did not worsen. These results highlight the need to develop a better understanding of aggressive obsessions in parents, and improve education about prevalence, content, assessment, and intervention for aggression-focused intrusive thoughts. [ABSTRACT FROM AUTHOR]

Intensive residential treatment (IRT) for obsessive-compulsive disorder (OCD) includes frequent meetings with a cognitive–behavioral therapist. We examined whether this therapeutic working alliance relates to IRT outcomes. Data came from a naturalistic sample of patients with OCD (n = 124) who received IRT at a specialty OCD clinic. Patients completed measures of OCD severity and well-being at admission and discharge. Both the patient and treating psychologist completed the Working Alliance Inventory-Short Form (WAI-SF). Alliance ratings were tested as predictors in models predicting outcomes (discharge scores adjusting for baseline and treatment duration) as well as logistic regression predicting treatment response (≥35% symptom reduction in OCD symptoms). Patient and clinician ratings of the quality of the alliance were weakly yet significantly correlated. Patient ratings of the alliance predicted outcomes, while therapist ratings did not. Moreover, greater discrepancy between patient and client ratings predicted worse outcomes. Patient ratings of the task dimension of the alliance uniquely related to responder status. Patient perceptions of the working alliance, particularly as pertaining to agreement on therapeutic tasks, related to success with IRT for OCD. Further study is needed test interventions to improve task alliance as a strategy to enhance treatment. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic prompted many mental health care providers to quickly reorganize their operations and services in an effort to continue serving their clientele while also ensuring the health and safety of their patients and staff. Over the course of five days (beginning 15 March 2020), the McLean OCD Institute at Houston (MOCDI-H) transitioned from providing three levels of care in-person to conducting intensive outpatient and traditional outpatient programming completely online. Through the teamwork of all members of the MOCDI-H staff and in collaboration with our patients and their families, we were able to develop virtual programming and make a smooth transition with minimal disruption to patient care. This article aims to describe how we facilitated our clinical transition in a quick and effective manner and became the first program within the OCD community to transition to teletherapy. An anecdotal exploration of the benefits and challenges experienced for patient care and providers is offered. Future directions and implications associated with the change from in-person sessions to teletherapy are discussed. [ABSTRACT FROM AUTHOR]

The mental well-being of athletes is a topic of continual discussion due to the rising pressures to succeed and strive for perfection. The present study surveyed 178 National Collegiate Athletic Association (NCAA) Division I collegiate athletes in order to determine risk factors associated with ritualistic and superstitious behaviors in relation to athlete burnout. Collegiate athletes completed the Athlete Burnout Questionnaire (ABQ), Sports Ritual Scale (SRS) and the anxiety subscale of the Depression, Anxiety and Stress Scale - 21 (DASS-21). Results showed anxiety as a mediator in the relationship between sport rituals and burnout, indicating that ritualistic behaviors were not detrimental to athletes unless they also reported high levels of anxiety. The added component of anxiety predisposes athletes that engage in ritualistic behaviors to burnout. Implications of this study reinforce the importance of following recommended NCAA best practices for mental health and specifically the need to educate athletes, coaches and trainers on the impact that sport ritualistic behaviors can have on collegiate athletes' well-being, specifically athletes prone to anxiety, in order to prevent burnout. [ABSTRACT FROM AUTHOR]

Body-focused repetitive behaviors (BFRBs) are recurrent behaviors targeting one or more body regions that may associate with negative outcomes. Little is known on their prevalence and correlates in psychiatric populations. This study examined the preliminary prevalence and correlates of BFRBs in 67 youth aged 9–17 years with primary anxiety-related disorders, mood disorders, or attention deficit and hyperactivity disorder (ADHD), using the Repetitive Body-focused Behavior Scale (RBBS), the Clinical Global Impressions scale, and the Behavior Assessment System for Children—2nd Edition, Behavioral & Emotional Screening System (BASC-2-BESS). Nearly half of the youth and parents reported significant child BFRBs on the RBBS. Additionally, 15% of the youth and 4.5% of the parents reported significant child distress/impairment related to BFRBs. A primary diagnosis of ADHD associated with greater parent-reported BFRB rates, number, and severity. An increased proportion of girls vs. boys presented with child-reported BFRBs and associated distress/impairment. The presence of BFRBs across the sample was associated with increased internalizing and externalizing symptom severity as measured with the BASC-2-BESS. In addition, internalizing and externalizing symptom severity positively correlated with BFRB severity. Our results suggest youth with psychiatric conditions, especially ADHD, who present with elevated symptom severity, may be particularly at-risk for concomitant BFRBs. [ABSTRACT FROM AUTHOR]

Little is known about the predictors of outcome from intensive residential treatment of OCD. This study aimed to examine age, gender, and baseline OCD severity, as well as measures of comorbid anxiety and depressive, internalizing/externalizing, and inattention symptoms, as predictors of treatment outcome in adolescents receiving intensive residential treatment for OCD. The sample comprised 314 adolescents aged 13–17 years with treatment-resistant OCD and a Children's Yale–Brown Obsessive–Compulsive Scale Self-Report (CY-BOCS-SR) total score ≥16. Bivariate and multiple regression models were used to evaluate the predictors of continuous OCD severity outcome and treatment response. Results of the bivariate regression analyses of predictors demonstrated that length of treatment, pre-treatment OCD severity, and symptoms of anxiety and depression significantly predicted post-treatment OCD severity, while only symptoms of depression and anxiety predicted treatment response. When including all predictors in the same model, only baseline OCD severity remained a significant predictor of post-treatment OCD severity, and none of the assessed variables significantly predicted treatment response. Results indicate that low pre-treatment OCD severity predicts lower OCD severity following treatment, although it did not predict treatment response. [ABSTRACT FROM AUTHOR]

Patient behaviors that may interfere with the process and outcome of therapy have been examined in the context of dialectical behavior therapy, but no measures exist to systematically characterize patient (or caregiver) treatment interfering behaviors (TIBs) in cognitive behavioral therapy (CBT) for anxiety disorders and obsessive-compulsive disorder (OCD). Accordingly, the primary aims of this study were to develop preliminary measures of TIBs, asking clinicians who provide CBT for anxiety disorders and/or OCD to adults and/or children to retrospectively reflect on the presence of TIBs in a recent patient (or caregiver of a child patient). These measures assessed the presence of 27 adult patient and 34 caregiver behaviors that may have interfered with treatment. Clinicians were also asked to rate their perception of treatment outcome (i.e. patient symptom improvement). Clinicians' ratings of overall interference with treatment were correlated with their perception of improvement, such that more treatment interference was associated with less symptom reduction. Interference with exposure completion, the process of therapy sessions, and attendance to therapy sessions emerged as potentially important behaviors to assess for in anxiety disorder/OCD treatment. Implications and directions for future research are discussed. [ABSTRACT FROM AUTHOR]

The article introduces various topics covered in the issue including obsessive compulsive disorder (OCD) and its symptoms, the overlap of symptoms between post-traumatic stress disorder, and the need for interventions around suicidal OCD patients and strategies for dealing with life stressors.

Obsessive Compulsive Disorder (OCD) is a neurobiological illness characterized by unwanted thoughts and/or images followed by repetitive rituals. About 5 million Americans live with Obsessive Compulsive Disorder. OCD is a manageable illness when proper interventions are utilized. Treatment for OCD is limited due to the lack of adequately trained professionals and the high costs of treatment. Cognitive behavioral therapy (CBT) in conjunction with exposure with response prevention (ERP) is the most effective intervention modality available for OCD. To address the treatment gap, an online, interactive self-help website was developed for those living with OCD without access to an effective intervention. This report will explore development of the OCD Challenge website and future implications of its use. [ABSTRACT FROM AUTHOR]

The Bergen Four Day Treatment (B4DT) is a concentrated treatment for OCD that has demonstrated promising effectiveness in Nordic country samples. The B4DT is delivered over four days and provides individual treatment in a group context. The effectiveness of the B4DT for OCD has not been tested outside Nordic countries. The current pilot study evaluated the feasibility and the potential effectiveness of B4DT in a different culture and health-care system in the United States. Findings from 48 adults with OCD who completed the B4DT indicated that OCD, anxiety, and depression symptom severity significantly decreased from pre- to post-treatment, and gains were maintained at six month follow-up. The Yale-Brown Obsessive Compulsive Scale scores were reduced from moderate to subclinical; specifically, the average scores of 27.0 (pre-treatment) fell to 11.7 (post-treatment), 12.7 (3-month follow-up), and 13.7 (6-month follow-up). The B4DT was rated as highly acceptable by the US patients. Over 95% of the patients stated that they would recommend the treatment to a friend. These findings provide the first preliminary evidence for the generalizability of the B4DT to patients outside Nordic countries. Cultural and context-dependent issues that affected this dissemination pilot study are discussed in addition to future clinical and research directions. [ABSTRACT FROM AUTHOR]

Objective: Anger attacks have been observed in patients with obsessive-compulsive disorder (OCD), often triggered by obsessional triggers. However, few studies have reported the clinical characteristics and correlates of anger attacks among Chinese patients with OCD., Methods: A total of 90 adults with a primary diagnosis of OCD, ranging from 15 to 78 years old, participated in the study. Participants were administered the Rage Outbursts and Anger Rating Scale (ROARS), Yale-Brown Obsessive-Compulsive Scale-Second Edition, and Brown Assessment of Beliefs Scale by a trained clinician. Patients completed the Obsessive-Compulsive Inventory-Revised and Depression Anxiety Stress Scale-21., Results: A total of 31.3% of participants reported anger outbursts in the past week, and ROARS scores had no significant correlation with age, duration of illness, OCD severity, depression, or stress. However, ROARS scores were negatively related to education level, and positively related to obsessing symptoms and anxiety., Conclusions: These data suggest that anger attacks are relatively common in Chinese patients with OCD. The severity of anger attacks is related to educational level, obsessing symptoms, and anxiety, which may be a latent variable reflecting executive functioning and emotion regulation skills.

Competing Interests: Competing interests: EAS receives research support from NIH and the International OCD Foundation. He has received royalties from Elsevier Publications, Springer Publications, American Psychological Association, Wiley, Inc, and Lawrence Erlbaum. He has served as a consultant for Rijuin Hospital, China and Levo Pharmaceuticals. He is on the Speaker’s Bureau and Scientific Advisory Board for the International OCD Foundation. EM is on the board of directors for the International OCD Foundation and the Peace of Mind Foundation. All other authors have no conflicts of interest to declare.