Treatment experiences of Latinas with current or past binge eating disorder and/or bulimia nervosa

ABSTRACT

This study utilized a female sample of 43 Latinas with a history of binge eating disorder and/or bulimia nervosa to investigate disparities in health care that may act as barriers to or correlates of treatment for these women. Results indicated that 65% of our sample sought treatment for their eating disorder. The most commonly utilized treatment providers were psychologist/therapist for individual therapy and nutritionist/dietician, while therapist-led group therapy was rated as the most helpful treatment and treatment by a physician was rated as least helpful. Participants endorsed eating disorder stigma, eating disorder shame, mental health shame, and cost of treatment as the most influential barriers to seeking or receiving treatment. Acculturation to White dominant society was associated with greater perceived treatment helpfulness. Findings from this study can be used to inform treatments for Latinas in order to potentially increase effectiveness, treatment-seeking, and recovery rates.     

Treatment utilization and barriers to treatment engagement among people with body dysmorphic symptoms

Objectives

Body dysmorphic disorder (BDD) is characterized by an excessive preoccupation with an imagined or minor appearance flaw. Many aspects of BDD remain unknown, such as rates of treatment utilization, types of treatment sought, and barriers to treatment. The present study sought to examine rates and patterns of treatment utilization as well as barriers to treatment among individuals with body dysmorphic symptoms.

Methods

The present study consists of 401 individuals with symptoms consistent with a diagnosis of BDD who completed self-reported measures of treatment utilization and barriers to treatment in an internet survey.

Results

Consistent with past research, results showed that individuals with probable BDD reported seeking non-mental health treatments for BDD (e.g., plastic surgery). Additionally, an examination of treatment barriers demonstrated significant barriers for the sample for the three domains examined: logistic and financial; stigma, shame, and discrimination; and treatment skepticism. Secondary analyses revealed a differential endorsement of treatment barriers across ethnic groups for all three barrier domains.

Conclusion

These data suggest that BDD is still an underrecognized disorder with marked barriers to treatment. Increased education and dissemination efforts are warranted.     

The impact of neuropsychological functioning on treatment outcome in pediatric obsessive–compulsive disorder

Background: Scant research has examined the effect of neuropsychological (NP) functioning on treatment outcome in pediatric obsessive–compulsive disorder (OCD). This study sought to address this gap in existing research. Methods: A total of 63 youths were included in this study and asked to complete the Rey‐Osterrieth Complex Figure (ROCF) and specific subtests of the Wechsler Intelligence Scale for Children, Third Edition (WISC‐III). Results: Analyses suggest that 5 min recall accuracy (raw score) and percent recall from the ROCF, assessed before treatment may be predictors of treatment response among children with OCD. What is more, exploratory post hoc analyses indicated that performance on these ROCF tasks is particularly relevant among youths receiving cognitive‐behavior therapy (CBT) alone. These results may be driven by executive functioning ability. Additional analyses suggest a relationship between age, symptom severity, and NP functioning on select tasks from both the ROCF and WISC‐III. Conclusions: Although alternative explanations exist, these findings suggest that poorer performance on the ROCF and, in turn, poorer response to treatment, particularly among those youths receiving CBT alone, may be due to executive functioning difficulties. Clinicians and researchers should be sensitive to this fact and may warrant modification(s) to existing treatment protocols. Limitations to this study, however, suggest the need for replication and extension of these findings in the future. Depression and Anxiety, 2010. © 2009 Wiley‐Liss, Inc.     

Symptom dimensions and cognitive-behavioural therapy outcome for pediatric obsessive-compulsive disorder

Objective: To examine whether obsessive‐compulsive disorder (OCD) symptom subtypes are associated with response rates to cognitive‐behavioural therapy (CBT) among pediatric patients. Method: Ninety‐two children and adolescents with OCD (range = 7–19 years) received 14 sessions of weekly or intensive (daily psychotherapy sessions) family‐based CBT. Assessments were conducted at baseline and post‐treatment. Primary outcomes included scores on the Children’s Yale‐Brown Obsessive‐Compulsive Scale (CY‐BOCS), remission status, and ratings on the Clinical Global Improvement (CGI) and Clinical Global Impression – Severity (CGI‐Severity) scales. Results: Seventy‐six per cent of study participants (n = 70) were classified as treatment responders. Patients with aggressive/checking symptoms at baseline showed a trend (P = 0.06) toward improved treatment response and exhibited greater pre/post‐treatment CGI‐Severity change than those who endorsed only non‐aggressive/checking symptoms. Step‐wise linear regression analysis indicated higher scores on the aggressive/checking dimension were predictive of treatment‐related change in the CGI‐Severity index. Regression analysis with CY‐BOCS score as the dependent variable showed no difference between OCD subtypes. Conclusion: Response to CBT in pediatric OCD patients does not differ substantially across subtypes.     

Evidence for successful implementation of exposure and response prevention in a naturalistic group format for pediatric OCD

Background: Although exposure and response prevention (ERP) is an effective treatment for youth with obsessive–compulsive disorder (OCD), the majority of studies, randomized clinical trials of individual therapy, find variability in treatment response. We evaluated the potential role of individual differences in OCD presentation, comorbid disorders, age, and gender on treatment effects. Moreover, we examined these potential effects in a group format in a naturalistic, clinic‐based sample of patients. Methods: Pediatric patients with a DSM‐IV diagnosis of OCD ( n =41) were treated with ERP in an intensive outpatient community‐based program. OCD, mood, and anxiety symptom severity was measured at baseline, during treatment, and at discharge. Trajectories and predictors of treatment outcome were measured using linear growth models. Results: We found that group‐based ERP was effective in reducing pediatric OCD symptom severity in a naturalistic treatment setting irrespective of age or gender. Furthermore, ERP was found to be effective at reducing depressive symptoms but not other anxiety symptoms. We also found inter‐individual variability in the discharge levels of contamination, symmetry, and intrusive sexual thoughts and in the rate of severity reduction of intrusive sexual thoughts. Conclusion: Group‐based ERP is an effective treatment for children and adolescents with OCD. Several factors, including symptom dimensions and comorbid psychopathology, are associated with treatment response and outcome in this pediatric population. Depression and Anxiety, 2011. © 2011 Wiley‐Liss, Inc.     

Predictors of treatment outcome in modular cognitive therapy for obsessive-compulsive disorder

Background: The present study sought to identify predictors of outcome for a comprehensive cognitive therapy (CT) developed for patients with obsessive–compulsive disorder (OCD). Methods: Treatment was delivered over 22 sessions and included standard CT methods, as well as specific strategies designed for subtypes of OCD including religious, sexual, and other obsessions. This study of 39 participants assigned to CT examined predictors of outcomes assessed on the Yale‐Brown Obsessive Compulsive Scale. A variety of baseline symptom variables were examined as well as treatment expectancy and motivation. Results: Findings indicated that participants who perceived themselves as having more severe OCD at baseline remained in treatment but more severe symptoms were marginally associated with worse outcome for those who completed therapy. Depressed and anxious mood did not predict post‐test outcome, but more Axis I comorbid diagnoses (mainly major depression and anxiety disorders), predicted more improvement, as did the presence of sexual (but not religious) OCD symptoms, and stronger motivation (but not expectancy). A small rebound in OCD symptoms at 1‐year follow‐up was significantly predicted by higher scores on personality traits, especially for schizotypal (but not obsessive–compulsive personality) traits. Conclusions: Longer treatment may be needed for those with more severe symptoms at the outset. CT may have positive effects not only on OCD symptoms but also on comorbid depressive and anxious disorders and associated underlying core beliefs. Findings are discussed in light of study limitations and research on other predictors. Depression and Anxiety, 2011. © 2011 Wiley‐Liss, Inc.     

Further evidence for the efficacy of association splitting as a self-help technique for reducing obsessive thoughts

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.     

Comorbidity in hoarding disorder

Background: Hoarding Disorder (HD) is currently under consideration for inclusion as a distinct disorder in DSM‐5 (1). Few studies have examined comorbidity patterns in people who hoard, and the ones that have suffer from serious methodological shortcomings including drawing from populations already diagnosed with obsessive compulsive disorder (OCD), using outdated definitions of hoarding, and relying on inadequate assessments of hoarding. The present study is the first large‐scale study of comorbidity in a sample of people meeting recently proposed criteria for hoarding disorder (1) and relying on validated assessment procedures. Methods: We compared psychiatric comorbidity in a large HD sample (n = 217) to 96 participants meeting criteria for OCD without HD. Results: High comorbidity rates were observed for major depressive disorder (MDD) as well as acquisition‐related impulse control disorders (compulsive buying, kleptomania, and acquiring free things). Fewer than 20% of HD participants met criteria for OCD, and the rate of OCD in HD was higher for men than women. Rates of MDD and acquisition‐related impulse control disorders were higher among HD than OCD participants. No specific anxiety disorder was more frequent in HD, but social phobia was more frequent among men with HD than among men with OCD. Inattentive ADHD was diagnosed in 28% of HD participants and was significantly more frequent than among OCD participants (3%). Conclusions: These findings form important base rates for developing research and treatments for hoarding disorder. Depression and Anxiety, 2011. © 2011 Wiley‐Liss, Inc.     

ADHD prevalence and association with hoarding behaviors in childhood‐onset OCD

Background: It has been suggested that attention‐deficit hyperactivity disorder (ADHD) and obsessive–compulsive disorder (OCD), both neurodevelopmental disorders with onset in childhood, are highly comorbid, but previous studies examining ADHD and OCD comorbidity have been quite variable, partly because of inconsistency in excluding individuals with tic disorders. Similarly, ADHD has been postulated to be associated with hoarding although this potential relationship is largely methodologically unexplored. This study aimed to examine the prevalence of ADHD among individuals with childhood‐onset OCD but without comorbid tic disorders, as well as to examine the relationship between clinically significant hoarding behaviors (hoarding) and ADHD. Method: ADHD prevalence rates and the relationship between ADHD and hoarding were examined in 155 OCD‐affected individuals (114 probands and 41 relatives, age range 4–82 years) recruited for genetic studies and compared to pooled prevalence rates derived from previously published studies. Results: In total, 11.8% met criteria for definite ADHD, whereas an additional 8.6% had probable or definite ADHD (total=20.4%). In total, 41.9% of participants with ADHD also had hoarding compared to 29.2% of participants without ADHD. Hoarding was the only demographic or clinical variable independently associated with ADHD (odds ratio=9.54, P<0.0001). Conclusion: ADHD rates were elevated in this sample of individuals with childhood‐onset OCD compared to the general population rate of ADHD, and there was a strong association between ADHD and clinically significant hoarding behavior. This association is consistent with recent studies suggesting that individuals with hoarding may exhibit substantial executive functioning impairments and/or abnormalities, including attentional problems. Depression and Anxiety, 2010. © 2010 Wiley‐Liss, Inc.     

Training interpretation biases among individuals with symptoms of obsessive compulsive disorder

The current study tested the causal premise underlying cognitive models of obsessive compulsive disorder (OCD) that negative interpretations of intrusive thoughts lead to the distress and impairment associated with symptoms of OCD. Specifically, we sought to determine: (a) whether it was possible to train healthier (defined as more benign/less threatening) interpretations regarding the significance of intrusive thoughts; and (b) whether there was a link between modifying negative interpretations and subsequent emotional vulnerability to an OC stressor. A nonclinical sample of students high in OC symptoms completed either a Positive (n = 50) or Neutral (n = 50) interpretation training procedure designed to alter OC-relevant interpretations and beliefs. As expected, participants in the Positive (versus Neutral) training condition endorsed healthier OC-relevant interpretations and beliefs following training. Additionally, when controlling for baseline affect, participants in the Positive (versus Neutral) training condition reported less negative affect during the OC-stressor task (at the level of a non-significant trend) and reported less desire to perform neutralizing activities. In general, results provide some support for cognitive models of obsessions and suggest that negative interpretations of intrusive thoughts may be causally related to symptoms of OCD.     

Obsessive-compulsive disorder among African Americans and blacks of Caribbean descent: results from the National Survey of American Life

Background: There is limited research regarding the nature and prevalence of obsessive‐compulsive disorder (OCD) among various racial and ethnic subpopulations within the United States, including African Americans and blacks of Caribbean descent. Although heterogeneity within the black population in the United States has largely been ignored, notable differences exist between blacks of Caribbean descent and African Americans with respect to ethnicity, national heritage, and living circumstances. This is the first comprehensive examination of OCD among African Americans and blacks of Caribbean descent. Methods: Data from the National Survey of American Life, a national household probability sample of African Americans and Caribbean blacks in the United States, were used to examine rates of OCD among these groups. Results: Lifetime and 12‐month OCD prevalence estimates were very similar for African Americans and Caribbean blacks. Persistence of OCD and rates of co‐occurring psychiatric disorders were very high and also similar between African American and Caribbean black respondents. Both groups had high levels of overall mental illness severity and functional impairment. Use of services was low for both groups, particularly in specialty mental health settings. Use of anti‐obsessional medications was also rare, especially among the Caribbean black OCD population. Conclusions: OCD among African Americans and Caribbean blacks is very persistent, often accompanied by other psychiatric disorders, and is associated with high overall mental illness severity and functional impairment. It is also likely that very few blacks in the United States with OCD are receiving evidence‐based treatment and thus considerable effort is needed to bring treatment to these groups. Depression and Anxiety, 2008. Published 2008 Wiley‐Liss, Inc.     

THE MORE IT IS NEEDED,THE LESS IT IS WANTED: ATTITUDES TOWARD FACE‐TO‐FACE INTERVENTION AMONG DEPRESSED PATIENTS UNDERGOING ONLINE TREATMENT

Many individuals suffering from depression do not actively seek treatment. Self‐help strategies represent low‐threshold treatment options that are particularly relevant for milder cases. The present study addressed two important issues: (1) we examined depressed individuals’ motives and attitudes that may represent barriers to face‐to‐face treatment; (2) we examined if the participation in an online treatment program facilitates or compromises their willingness to undergo face‐to‐face treatment. We recruited 210 participants with depression for a trial on the efficacy of an online treatment program for depression. Participants were randomly allocated either to a self‐help treatment (Deprexis) or to a wait‐list control group. All participants filled out a newly developed 42‐item questionnaire called Psychotherapy Expectations, Concerns, and Hopes Inventory (PECHI). The scale measures attitudes toward face‐to‐face treatment and was administered at baseline and 8 weeks later. Principal component analysis of the PECHI revealed five dimensions: hope for symptomatic improvement, fear of poor alliance with the therapist, skill acquisition, skepticism and resentment of psychotherapy, and self‐stigma. Attitudes toward treatment were stable over time and neither modulated by group status nor by self‐reported or objective symptom decline. Correlation analyses revealed that current levels of depression and well‐being were potent predictors of attitudes toward treatment, suggesting that when the patient feels more depressed, doubts about the effectiveness of therapy emerge more strongly. To conclude, results suggest that Deprexis neither promotes nor reduces negative attitudes toward psychotherapy, nor does it increase barriers to enter face‐to‐face treatments. An alarming paradox emerged: when a depressed person is in greatest need of help, motivation to seek face‐to‐face treatment is lowest. Depression and Anxiety 00:1‐11, 2012. © 2012 Wiley Periodicals, Inc.     

Prevalence and clinical characteristics of mental rituals in a longitudinal clinical sample of obsessive-compulsive disorder

Background: Obsessive–compulsive disorder (OCD) is a chronic and debilitating anxiety disorder associated with significant impairment in quality of life and functioning. Research examining the differences in clinical correlates and treatment response associated with different obsessions in OCD has yielded important findings underscoring the heterogeneous nature of this disorder. To date, most of this research has focused on differences associated with primary obsessions, and little attention has been paid to the clinical utility of studying how compulsive symptoms affect clinical course. Virtually no systematic research has explored the clinical characteristics of one understudied symptom presentation, mental rituals, and what impact this primary symptom has on severity and course of illness. Mental rituals, or compulsions without overt signs, represent unique clinical challenges but often go understudied for numerous methodological and clinical reasons. Methods: In this study, we explored the impact of primary mental rituals on clinical severity and chronicity in a large, longitudinal sample of OCD patients (N = 225) over 4 years. Results: Mental rituals were a primary presenting symptom for a sizable percentage of the sample (12.9%). Primary mental rituals were associated with greater clinical severity and lower functioning at intake, as well as a more chronic course of illness, as participants with primary mental rituals spent nearly 1 year longer in full DSM‐IV criteria episodes over the 4‐year follow‐up interval than OCD patients without mental rituals. Conclusions: These results suggest that mental rituals are uniquely impairing and highlight the need for further empirical exploration and consideration in treatment. Depression and Anxiety, 2011. © 2011 Wiley‐Liss, Inc.     

Comparative outcomes among the problem areas of interpersonal psychotherapy for depression

Background: Although interpersonal psychotherapy (IPT) is an efficacious treatment for acute depression, the relative efficacy of treatment in each of the four IPT problem areas (grief, role transitions, role disputes, interpersonal deficits) has received little attention. We evaluated the specificity of IPT by comparing treatment success among patients whose psychotherapy focused on each problem area. Moreover, we sought to understand how the patient characteristics and interpersonal problems most closely linked to the onset of a patient's current depression contributed to IPT success. Methods: Patients meeting DSM‐IV criteria for an episode of major depressive disorder ( n =182) were treated with weekly IPT. Remission was defined as an average Hamilton Rating Scale for Depression 17‐item score of 7 or below over 3 weeks. Personality disorders were diagnosed using the Structured Clinical Interview for DSM‐IV Personality Disorders. Results: Contrary to our prediction that patients whose treatment was focused on interpersonal deficits would take longer to remit, survival analyses indicated that patients receiving treatment focused on each of the four problem areas did not differ in their times to remission. Nor were patients in the interpersonal deficits group more likely to have an Axis II diagnosis. Patients whose treatment focused on role transitions remitted faster than those whose treatment focused on role disputes, after controlling for covariates. Conclusion: With skillful use of IPT strategies and tactics and with careful medication management where appropriate, patients in this study whose treatment focused on each problem area were treated with equal success by trained IPT clinicians. Depression and Anxiety, 2010. © 2010 Wiley‐Liss, Inc.     

Stepped care versus standard cognitive-behavioral therapy for obsessive-compulsive disorder: a preliminary study of efficacy and costs

Background: Exposure and response prevention (ERP) for obsessive–compulsive disorder (OCD) is underutilized, in part because of costs and time requirements. This study extends pilot work investigating the use of a stepped care ERP administration, in which patients are first given a low‐intensity, low‐cost treatment and the more costly intervention is reserved for those who do not respond to the first intervention. Methods: Thirty adults with OCD were randomized to receive stepped care ERP or standard ERP. Those receiving stepped care started with three sessions over 6 weeks of low‐intensity counseling with ERP bibliotherapy; patients failing to meet strict responder criteria after 6 weeks were given the more traditional treatment of therapist‐administered ERP (17 sessions twice weekly). Those receiving standard ERP received the therapist‐administered ERP with no lower‐intensity lead‐in. Results: The two treatments were equally efficacious, with 67% of stepped care completers and 50% of standard treatment completers meeting criteria for clinically significant change at posttreatment. Similarly, no differences in client satisfaction ratings were obtained between the two groups. Examination of treatment costs, however, revealed that stepped care resulted in significantly lower costs to patients and third‐party payers than did standard ERP, with large effect sizes. Conclusions: These results suggest that stepped care ERP can significantly reduce treatment costs, without evidence of diminished treatment efficacy or patient satisfaction. Additional research is needed to determine the long‐term efficacy and costs of stepped care for OCD, and to examine the financial and therapeutic impact of implementing stepped care in community settings. Depression and Anxiety 0:1–10, 2011. © 2011 Wiley‐Liss, Inc.     

Potential use of Internet‐based screening for anxiety disorders: a pilot study

Background: The Internet is a widely used resource for obtaining health information. Internet users are able to obtain anonymous information on diagnoses and treatment, seek confirmatory information, and are able to self‐diagnose. We posted a self‐report diagnostic screening questionnaire for DSM‐IV anxiety and mood disorders (MACSCREEN) on our clinic website. Method: Three hundred and two individuals completed the MACSREEN. For those who qualified for a DSM‐IV disorder, self‐report symptom severity measures were completed for the specified disorder: Quick Inventory of Depressive Symptomatology, self‐report, Social Phobia Inventory, GAD‐7, Davidson Trauma Scale, Panic and Agoraphobia Scale, and Yale/Brown Obsessive Compulsive Scale, self‐report. Cutoff scores for each self‐report measure were used to evaluate clinically significant symptom severity. Respondents were also asked to complete a series of questions regarding their use of the Internet for health information. Results: The mean age of the MACSCREEN sample was 35.2 years (±13.9), where the majority (67.2%) were female. The most frequently diagnosed conditions were social phobia (51.0%), major depressive disorder (32.4%), and generalized anxiety disorder (25.5%). Sixty‐five percent of the sample met criteria for at least one disorder. Most respondents reported completing the MACSCREEN, as they were concerned they had an anxiety problem (62.3%). The majority of respondents reported seeking health information concerning specific symptoms they were experiencing (54.6%) and were planning to use the information to seek further assessment (60.3%). Conclusion: Individuals with clinically significant disorder appear to be using the Internet to self‐diagnose and seek additional information. Depression and Anxiety, 2010. © 2010 Wiley‐Liss, Inc.     

The Netherlands Obsessive Compulsive Disorder Association (NOCDA) study: design and rationale of a longitudinal naturalistic study of the course of OCD and clinical characteristics of the sample at baseline

In half of Obsessive Compulsive Disorder (OCD) patients the disorder runs a chronic course despite treatment. The factors determining this unfavourable outcome remain unknown. The Netherlands Obsessive Compulsive Disorder Association (NOCDA) study is a multicentre naturalistic cohort study of the biological, psychological and social determinants of chronicity in a clinical sample. Recruitment of OCD patients took place in mental health organizations. Its design is a six‐year longitudinal cohort study among a representative clinical sample of 419 OCD patients. All five measurements within this six‐year period involved validated semi‐structured interviews and self‐report questionnaires which gathered information on the severity of OCD and its co‐morbidity as well as information on general wellbeing, quality of life, daily activities, medical consumption and key psychological and social factors. The baseline measurements also include DNA and blood sampling and data on demographic and personality variables. The current paper presents the design and rationale of the study, as well as data on baseline sample characteristics. Demographic characteristics and co‐morbidity ratings in the NOCDA sample closely resemble other OCD study samples. Lifetime co‐morbid Axis I disorders are present in the majority of OCD patients, with high current and lifetime co‐morbidity ratings for affective disorders (23.4% and 63.7%, respectively) and anxiety disorders other than OCD (36% current and 46.5% lifetime). Copyright © 2012 John Wiley & Sons, Ltd.     

Increased functional connectivity between the default mode and salience networks in unmedicated adults with obsessive‐compulsive disorder

Deficits in attention have been implicated in Obsessive‐Compulsive Disorder (OCD), yet their neurobiological bases are poorly understood. In unmedicated adults with OCD (n = 30) and healthy controls (n = 32), they used resting state functional connectivity MRI (rs‐fcMRI) to examine functional connectivity between two neural networks associated with attentional processes: the default mode network (DMN) and the salience network (SN). They then used path analyses to examine putative relationships across three variables of interest: DMN‐SN connectivity, attention, and OCD symptoms. In the OCD compared with healthy control participants, there was significantly reduced inverse connectivity between the anterior medial prefrontal cortex (amPFC) and the anterior insular cortex, regions within the DMN and SN, respectively. In OCD, reduced inverse DMN‐SN connectivity was associated with both increased OCD symptom severity and decreased sustained attention. Path analyses were consistent with a potential mechanistic explanation: OCD symptoms are associated with an imbalance in DMN‐SN networks that subserve attentional processes and this effect of OCD on DMN‐SN connectivity is associated with decreased sustained attention. This work builds upon a growing literature suggesting that reduced inverse DMN‐SN connectivity may represent a trans‐diagnostic marker of attentional processes and suggests a potential mechanistic account of the relationship between OCD and attention. Reduced inverse DMN‐SN connectivity may be an important target for treatment development to improve attention in individuals with OCD. Hum Brain Mapp 38:678–687, 2017. © 2016 Wiley Periodicals, Inc.     

Ethnic differences in antidepressant response: a prospective multi‐site clinical trial

Background: Although depression is a highly prevalent condition that occurs in all ethnic groups, the influence of ethnicity on treatment response still remains unclear. Methods: A prospective 8‐week, open‐label clinical trial comparing the efficacy and side effects of citalopram (CIT) with dose escalation (20–60 mg/day) was performed in African‐Americans and Caucasians with nonpsychotic major depression. The intent‐to‐treat sample consisted of 301 participants (169 African‐Americans and 132 Caucasians). Results: Although African‐Americans were more socially disadvantaged and had a more severe depression, outcomes between the groups were similar. Remission rates were approximately 50% in both groups and about 2/3 of participants met response criteria. Retention was greater than 75% in both groups, with no differences in dropout rate. There were no differences in the number of completers, number of visits made, final dose of CIT, or in side effect profiles. Conclusions: These results confirm the growing body of evidence, including recent studies using measurement‐based care, that patients from minority groups have outcomes that are similar to those of Caucasians. The provision of measurement‐based care and encouragement of patient participation can reduce ethnic differences in response to treatment for depression. Depression and Anxiety, 2010. © 2009 Wiley‐Liss, Inc.     

Distress tolerance and obsessions: an integrative analysis

Background: Recent research implicates a potential relationship between poor distress tolerance (DT) and obsessive–compulsive disorder (OCD) and obsessions in particular, though this evidence has been largely indirect. We sought to examine the incremental and specific associations between DT and obsessions using multiple methodologies. Methods: We conducted three separate studies using independent nonclinical samples (total N =558) that involved cross‐sectional (Study 1) and prospective self‐report designs (Study 2), as well as the use of an in vivo neutralization task (Study 3). Results: Poor DT was specifically associated with obsessing but not other OCD symptoms, even when covarying for several theoretically relevant constructs. Further, poor DT was predictive of residual change in obsessing symptoms 1‐month later. Poor DT was also associated with neutralization in response to an OCD‐like intrusion and postneutralization period anxiety. Conclusions: These consistent findings provide support for an important relationship between DT and obsessions and suggest that interventions targeting DT may have special benefit for the treatment of obsessions. Depression and Anxiety, 2011. © 2011 Wiley‐Liss, Inc.