Biomedical subjects

David F Tolin

Publications and source records attributed to David F Tolin.

28 records · Page 2Linked to original sources

PubMed2004

Cognitive-behavioral therapy for medication nonresponders with obsessive-compulsive disorder: a wait-list-controlled open trial.

BACKGROUND: Cognitive-behavioral therapy (CBT) is generally recommended for obsessive-compulsive disorder (OCD) patients who have failed to respond to approved medications. However, few studies of the efficacy of CBT have selected patients who did not respond to medications. METHOD: We selected 20 adult OCD (DSM-IV criteria) patients with a history of inadequate response to adequate doses of multiple medications, as well as a high rate of comorbid disorders. After a 1-month wait-list period, patients received 15 sessions of outpatient CBT incorporating exposure and ritual prevention. RESULTS: OCD severity (as measured with the Yale-Brown Obsessive Compulsive Scale) decreased significantly (p <.05) after treatment, and gains appeared to have been maintained over a 6-month follow-up period. Analysis of clinical significance indicated that 53% (8/15) of treatment completers met this criterion at posttreatment and 40% (6/15) met the criterion at 6-month follow-up. The sample was characterized as having generally poor insight and putting low effort into CBT; these factors significantly (p <.05) predicted degree of improvement. CONCLUSION: CBT is a useful treatment for OCD patients who have failed to respond adequately to multiple serotonin reuptake inhibitor medications. However, these results were attenuated compared with previous trials. Patients with a long history of poor response to medication may have poor insight and/or not put sufficient effort into treatment; these factors are likely to diminish treatment outcome.

Adult↗

PubMed2003

The Anxiety Sensitivity Index - Revised: psychometric properties and factor structure in two nonclinical samples.

Anxiety sensitivity (AS) is the fear of anxiety-related sensations based on beliefs about their harmful consequences. Despite its status as the most popular measure of AS, the anxiety sensitivity index is too abbreviated to adequately measure the somatic, cognitive, and social facets of the construct. The Anxiety Sensitivity Index - Revised (ASI-R) is a revised and expanded version of the ASI that was developed to improve the assessment of AS and its dimensions. The present study was conducted to examine the psychometric properties and factor structure of the ASI-R. Two large undergraduate samples completed a psychometric assessment package that included the ASI-R and measures of anxiety, depression, and related constructs. Exploratory factor analysis revealed four lower-order ASI-R factors: (1) beliefs about the harmful consequences of somatic sensations; (2) fear of publicly observable anxiety reactions; (3) fear of cognitive dyscontrol; and (4) fear of somatic sensations without explicit consequences. These factors loaded on a single, higher-order factor. Correlations between the ASI-R factors and related variables were consistent with AS theory. Results across both samples in the present study were highly similar. The strengths and limitations of the ASI-R are discussed, and the implications of our findings for the nature and measurement of AS are considered.

Adolescent↗

PubMed2003

Intolerance of uncertainty in obsessive-compulsive disorder.

Pathological doubt, a prominent feature of obsessive-compulsive disorder (OCD), may be related to difficulty tolerating ambiguous or uncertain situations. This is thought to be particularly true of those patients with checking compulsions. Intolerance of uncertainty (IU) has been studied extensively within the domains of worry and generalized anxiety; however, it has received relatively little empirical attention in OCD patients. We administered the Intolerance of Uncertainty Scale [Personality and Individual Differences 17 (1994) 791] to 55 clinic patients with OCD, 43 of whom had checking compulsions, and 14 nonanxious controls. OC checkers showed greater IU than did OC noncheckers and NACs. The latter two groups did not differ from each other. Furthermore, both repeating and checking rituals were associated with IU. Pathological doubt may be understood not only in terms of knowledge-based constructs, but also patients' emotional reaction to feelings of uncertainty. We discuss the implications for increasing tolerance via cognitive-behavioral therapy.

Adult↗

PubMed2003

Tracking levels of psychiatric distress associated with the terrorist events of September 11, 2001: a review of the literature.

BACKGROUND: Early publicized predictions of an onslaught of psychiatric distress following the terrorist events of September 11, 2001, have not materialized, and it remains unlikely at present that the medical and insurance communities will experience a significant increase in psychiatric utilization rates secondary to September 11. A handful of research studies have begun to characterize the psychiatric impact of the events associated with the September 11 terrorist attacks. Information related to the manifestation of psychiatric distress following disasters is of particular interest to the scientific, clinical and disability insurance communities given the ongoing threat of further terrorist attacks. METHODS: A comprehensive literature search was completed to identify articles that address our current understanding of posttraumatic stress disorder (PTSD) and patterns of psychiatric distress that typically follow manmade disasters. To help in conveying such a conceptual framework, we integrated basic research relating to PTSD with epidemiological data relating to past disasters (e.g., the Oklahoma City bombing) and the events of September 11. RESULTS AND CONCLUSIONS: A critical analysis of the September 11 research literature is offered with suggestions for research that would strengthen our understanding of the manifestation of psychiatric distress associated with manmade disasters.

Humans↗

PubMed2002

Directed forgetting in obsessive-compulsive disorder: replication and extension.

Previous research indicates that patients with obsessive-compulsive disorder (OCD) show impaired ability to forget negative material (Behav Res Ther 34 (1996) 633). The present study was intended to replicate and extend these findings by separating emotional valence from personal relevance, using idiographic stimulus selection to control for heterogeneity of OCD concerns, and the addition of an anxious control group. We used a directed forgetting paradigm, in which participants were instructed to either remember or forget a series of words. No differences in impairment were found among the groups during a free recall test, in which they were asked to recall both "remember" and "forget" words. However, during a recognition test, OCD patients showed greater impaired forgetting for OCD-relevant words than did nonanxious and anxious controls. Valence of words did not emerge as a contributing factor to impaired forgetting.

Adult↗

PubMed2002

Religious obsessions and compulsions in a non-clinical sample: the Penn Inventory of Scrupulosity (PIOS).

The present investigation reports on the development and psychometric evaluation of the Penn Inventory of Scrupulosity (PIOS), a 19-item self-report scale measuring religious obsessive-compulsive symptoms. Factor analysis yielded a two factor solution with the first subscale measuring fears about having committed sin, and the second measuring fears concerning punishment from God. Using a sample of college students, the PIOS was shown to be internally consistent and possess good convergent and discriminant validity. Highly devout participants evidenced higher scores on both PIOS subscales, but devout Jews evidenced fewer fears of sin and punishment from God compared to devout Protestants or Catholics. The PIOS has utility both as a research and clinical tool.

Adolescent↗

PubMed2002

Emotional responding to fearful and disgusting stimuli in specific phobics.

Individuals with small animal and blood-injection-injury (BII) phobias respond to phobia-relevant stimuli with both fear and disgust. However, recent studies suggest that fear is the dominant emotional response in animal phobics whereas disgust is the primary emotional response in BII phobics. The present study examined emotional responding toward pictures of spiders, surgical procedures, and two categories of general disgust elicitors (rotting food and body products) among analogue spider phobics, BII phobics, and nonphobics. Dominant emotional responses to phobia-relevant stimuli clearly differentiated the groups. as spider phobics were more likely to be classified as primarily fearful when rating pictures of spiders (74%), whereas BII phobics were more likely to be classified as primarily disgusted when rating pictures of surgical procedures (78%). Discriminant function analyses revealed that disgust ratings, but not fear ratings, of the phobic pictures were significant predictors of phobic group membership. Both phobic groups were characterized by elevated disgust sensitivity toward video and pictorial general disgust elicitors. Implications and suggestions for continued research examining fearful and disgusting stimuli in specific phobia are outlined.

Adolescent↗

PubMed2002

Thought suppression in obsessive-compulsive disorder.

Social cognition research has indicated that attempts to suppress thoughts can lead to a paradoxical increase in the frequency of that thought. This phenomenon has been a central component of cognitive-behavioural models of obsessive-compulsive disorder (OCD); however, research has yet to demonstrate deficient thought suppression ability in OCD patients. We examined whether individuals with OCD (OCs) exhibit a deficit in the ability to suppress thoughts. In Experiment 1, attempted thought suppression led to a paradoxical increase in self-reported thoughts for OCs, but not for nonanxious controls (NACs) or anxious controls (ACs). In order to rule out self-report biases, in Experiment 2 we utilized a lexical decision paradigm that measured priming strength of a target word under thought suppression conditions. Results paralleled those of Experiment 1: OCs showed decreased lexical decision latency of the 'suppressed' thought (thought to reflect either increased priming strength or disrupted processing of nonsuppressed thoughts), thus exhibiting a paradoxical effect of thought suppression. This effect was not seen in NACs or ACs. These findings suggest that deficits in cognitive inhibitory processes may underlie the intrusive, repetitive nature of clinical obsessions.

Adolescent↗

PubMed2002

Inflated perception of responsibility for harm in OCD patients with and without checking compulsions: a replication and extension.

In a follow-up study to [J. Anxiety Disord., in press] examination of inflated perception of responsibility for harm among individuals with obsessive compulsive disorder (OCs), 22 OC checkers, 24 OC non-checkers, and 25 non-anxious controls (NACs) completed the Obsessive Compulsive Responsibility Scale (OCRS), which consisted of written descriptions of Low-Risk (LR), Moderate-Risk (MR), and High-Risk (HR) scenarios. In LR and MR scenarios, OC checkers reported greater perception of responsibility for harm and greater relief upon rectifying the situation, than did NACs. OC checkers also reported greater urges to rectify LR situations than did NACs. OC non-checkers did not differ from NACs on any of the scales. No group differences emerged for HR scenarios. The results suggest that, compared to OC non-checkers and to NACs, OC checkers have an inflated perception of responsibility for harm; and that this perception leads to a need to rectify potentially harmful situations.

Analysis of Variance↗

PubMed2002

The relationship between disgust sensitivity and avoidant behavior: studies of clinical and nonclinical samples.

Researchers have reported links between specific phobias (of small animals and blood/ injection/injury (BII)) and disgust sensitivity. Avoidance is one route by which disgust sensitivity may play a role in the etiology or maintenance of pathological fear. This paper discusses a series of three studies to examine behavior associated with disgust sensitivity. Study I examined disgust sensitivity and avoidance of disgust-evoking tasks among spider fearful and nonfearful participants. Study 2 reanalyzed previously published data on the relationship between disgust sensitivity and visual avoidance of BII stimuli and spiders. Study 3 examined disgust sensitivity in obsessive-compulsive disorder (OCD). Results indicate the trait of disgust sensitivity is a poor predictor of avoidance behavior in specific situations, but state disgust more consistently predicts avoidance, suggesting future research in specific phobia should shift emphasis toward examining the role of state disgust.

Animals↗