Biomedical subjects

M H Freeston

Publications and source records attributed to M H Freeston.

At least 19 recordsLinked to original sources

PubMed2002

Recollections of parent-child relationships in patients with obsessive-compulsive disorder and panic disorder with agoraphobia.

OBJECTIVE: In previous studies, patients with different psychiatric conditions, as compared with matched controls, have reported that their parents were more protective and less caring towards them when they were children. However, studies investigating associations between parental behaviours and anxiety disorders have yielded inconsistent results. The aim of this study was to compare recalled parental behaviours in out-patients with obsessive-compulsive disorder (OCD), in out-patients with panic disorder with agoraphobia (PDA), and in non-anxious controls. METHOD: The sample included 43 out-patients with OCD, 38 with PDA, and 120 controls. Participants completed the Parental Bonding Instrument and the Egna Minnen Beträffande Uppfostran or Own Memories of Parental Rearing Experiences in Childhood. RESULTS: No differences were found between the two anxious groups. However, compared with the control group, anxious patients recalled their parents as more protective. CONCLUSION: Our findings suggest that child rearing practices such as overprotection may be a risk factor in the development of anxiety disorders.

Adult↗

PubMed2000

Functional and dysfunctional perfectionists: are they different on compulsive-like behaviors?

Both perfectionism and excessive responsibility have been linked to obsessive compulsive disorder (OCD). Up to now however, a greater number of studies have focused on the role of responsibility. The present study compared compulsive-like behavior of people with different styles of perfectionism. Sixteen functional perfectionists (FP) and 16 dysfunctional perfectionists (DP) were compared on three different tasks in order to explore OC type behavior such as doubting, checking and intrusions. Results show that DP participants, compared to FP participants, scored higher on an OC behavior scale, took significantly more time to complete a precision task and precipitated their decision when confronted with ambiguity. The two groups also tended to differ in their intrusive thoughts following an unsolved problem; FP participants were more preoccupied about solving the problem than about the quality of their performance, contrary to DP subjects. Results are discussed according to theoretical models of OCD.

Adult↗

PubMed2000

Differences and similarities between obsessive intrusive thoughts and worry in a non-clinical population: study 1.

Worry is the central characteristic of Generalized Anxiety Disorder (GAD) and obsessions are a central feature of Obsessive-Compulsive Disorder (OCD). There are strong similarities between these disorders: repetitive cognitive intrusions, negative emotions, difficulty dismissing the intrusion and finally, loss of mental control. Direct comparisons between obsessions and worries are almost non-existent in the literature but key distinctions have been proposed. The study attempted to specify the differences between obsessive intrusive thoughts and worry in a nonclinical population across a series of variables drawn from current models (appraisal, general descriptors and emotional reactions). 254 students participated in the study. They first identified an obsession-like intrusion and a worry and then evaluated them with the Cognitive Intrusion Questionnaire. Within-subject comparisons demonstrated significant differences on several variables: frequency, duration, percentage of verbal and image content, interference, egodystonic nature, stimuli awareness, emotions, etc. Most of these differences remained significant after controlling for frequency of thought. Discriminant analysis demonstrated a low classification error rate when using nine variables to categorize thoughts as obsessions or worries. Results generally support the differences postulated in the literature with the exception that obsessive intrusive thoughts are better controlled. The egodystonic/egosyntonic dimension emerged as an important variable in understanding obsessions and worry.

Adult↗

PubMed2000

Differences and similarities between obsessive intrusive thoughts and worry in a non-clinical population: study 2.

Differences between obsessions and worry have been clearly demonstrated on several variables [Langlois, F., Freeston, M. H., & Ladouccur, R. (2000). Differences and similarities between obsessive intrusive thoughts and worry in a non-clinical population: study 1. Behaviour Research and Therapy, 38, 157-173.]. Previous factor analysis of obsessions or worries have typically been used in developing measures for OCD and GAD symptoms. These studies generally support the distinctiveness of obsessions and worries but there have been no direct comparisons of the factor structure of obsession and worry on the same measure. This study aimed to compare the general structure of worry and obsessional intrusions. It also attempted to identify the relations between the respective factors identified in the appraisals of intrusions and the factor structures of coping strategies used in reaction to the thoughts. 254 students participated in the study. They first identified an obsession-like intrusion and a worry and then evaluated them with the Cognitive Intrusion Questionnaire. Different factor structures were obtained for worry and obsessive intrusive thoughts. However, the factor structure for the strategies used to counter the thoughts were highly similar for both types of thought. Furthermore, regression analysis identified interesting relationships between the strategies, the thought characteristics and appraisal. Thus, despite the ability to find differences between obsessive intrusive thoughts and worry, and even to accurately categorize them based on these differences, there may in fact exist common processes that are shared over much of a continuum. Sharp differences in the processes involved may only become clear in prototypical cases. The implications for models of cognitive intrusion are discussed.

Adaptation, Psychological↗

PubMed2000

On the pharmacotherapy of obsessive-compulsive disorder: is a consensus possible?

OBJECTIVE: To examine the efficacy and tolerability of clomipramine compared with the selective serotonin reuptake inhibitors (SSRIs) in the treatment of obsessive-compulsive disorder (OCD), bearing in mind the recent Expert Consensus Guidelines recommendation to use clomipramine after 2 to 3 failed SSRI trials. METHOD: The literature on the pharmacotherapy of OCD was critically examined. RESULTS: The available research evidence is not conclusive but suggests that clomipramine possesses greater anti-obsessional efficacy than do the SSRIs. In addition, when clomipramine is presented to patients in a positive way, and properly used in small initial doses with gradual increases, it seems to be tolerated as well as the SSRIs. CONCLUSION: Recently expressed opinions that clomipramine should be used to treat OCD after 2 to 3 failed SSRI trials are not supported by research evidence. Both clomipramine and the SSRIs may be used as first-line treatments for OCD.

Clomipramine↗

PubMed2000

Strategies used with intrusive thoughts: a comparison of OCD patients with anxious and community controls.

Models of intrusive thoughts attribute a key role to strategies used by people to cope with their unwanted cognitions. In an extension of previous work, the authors conducted structured interviews with 38 people with obsessive-compulsive disorder, 38 people with another anxiety disorder, and 19 healthy volunteers. The interview identified the repertoire of strategies used with the participant's most troubling thought. The 2 clinical groups reported significantly more strategies than the nonclinical group. The clinical groups also reported significantly greater intensity of the thought and their emotional response and lower efficacy for the strategies. People with OCD reported a significantly higher proportion of strategies that were specifically linked to the thought content (as distinct from nonspecific strategies that were only linked sequentially in time). The results identify both common and differential characteristics of intrusive cognition in anxiety disorders.

Adult↗

PubMed2000

Efficacy of a cognitive-behavioral treatment for generalized anxiety disorder: evaluation in a controlled clinical trial.

Recent advances in the understanding of worry have led to the development of treatments for generalized anxiety disorder (GAD). The present study tested a GAD treatment that targeted intolerance of uncertainty, erroneous beliefs about worry, poor problem orientation, and cognitive avoidance. Twenty-six primary GAD patients were randomly allocated to a treatment condition (n = 14) or a delayed treatment control condition (n = 12). Self-report, clinician, and significant other ratings assessed GAD and associated symptoms. The results show that the treatment led to statistically and clinically significant change at posttest and that gains were maintained at 6- and 12-month follow-ups. Furthermore, 20 of 26 participants (77%) no longer met GAD diagnostic criteria following treatment. With regard to the treatment's underlying model, the results show that intolerance of uncertainty significantly decreased over treatment and that gains were maintained at both follow-ups. Although nonspecific factors were not significant predictors of treatment outcome, their role in the treatment of GAD requires further investigation.

Adult↗

PubMed1999

Multiple pathways to inflated responsibility beliefs in obsessional problems: possible origins and implications for therapy and research.

The purpose of this paper is to consider the possible origins of an inflated sense of responsibility which occupies an important place in the cognitive theory of obsessive compulsive disorder (Rachman, S. (1993). Obsessions, responsibility, and guilt. Behaviour Research and Therapy, 31, 149-154. Salkovskis, P. M. (1985). Obsessional-compulsive Problems: A cognitive-behavioural analysis. Behaviour Research and Therapy, 23 (5), 571-583). Clinical experience and consideration of current cognitive conceptualisations of obsessions and obsessive compulsive disorder suggest a number of possibilities, each of which is described after a brief introduction to the concept itself. While there are reasons to believe that some general patterns can be identified, the origins of obsessional problems are best understood in terms of complex interactions specific to each individual.

Cognitive Behavioral Therapy↗

PubMed1999

Psychological factors associated with emergency room visits among asthmatic patients.

This study was designed to investigate physiological and psychological characteristics of subjects with high-frequency emergency room (ER) visits. Asthma status, psychological functioning and predispositions, psychosocial adaptation to asthma, and health behaviors were measured for 30 patients who had two or more ER visits during the last 2 years. These subjects were matched for age, sex, and corticosteroid use with 30 subjects who had no unscheduled ER visits for the same period. No significant differences were found for measures of asthma status. Among the asthma-specific variables, the number of hyperventilation-bronchoconstriction symptoms did not distinguish between the groups. High attenders reported more panic-fear symptoms, lower self-efficacy, and more perceived interference. There were no differences for measures of anxiety/depression, self-focused attention, or health locus of control. However, these variables were found to be significant predictors of panic-fear symptoms, lower self-efficacy, and more perceived interference.

Adult↗

PubMed1998

Generalized anxiety disorder: a preliminary test of a conceptual model.

This study presents a preliminary test of a conceptual model of Generalized Anxiety Disorder (GAD) which is theoretically driven and has clear clinical implications. The model's main features are intolerance of uncertainty, beliefs about worry, poor problem orientation and cognitive avoidance, Subjects were 24 GAD patients and 20 non clinical control subjects. The results show that all main components of the model were highly related to the discriminant function and that intolerance of uncertainty was pivotal in distinguishing GAD patients from non clinical subjects. Further, the discriminant function derived from these four process variables was very effective for classifying GAD patients and non clinical subjects into their respective groups. Overall, 82% of subjects were correctly classified as 18 of 24 subjects in the GAD group and 18 of 20 subjects in the non clinical group were properly identified. The results are discussed in terms of the proposed model of GAD and its clinical implications.

Adult↗

PubMed1997

What do patients do with their obsessive thoughts?

Current models of Obsessive-Compulsive Disorder (OCD) accord a key role to neutralization in the maintenance of obsessional thoughts. Although overt compulsions are well known and have frequently been described in the literature, their cognitive equivalents have not been described to any great extent. This study systemically described the repertoire of strategies used by 29 OCD patients with dominant obsessive thoughts. Extensive repertoires were reported, characterized by low to moderate mean efficacy in removing the thoughts. The majority of strategies were not cognitive rituals nor neutralization in the narrow sense of 'attempts at putting right', even though they were effortful, intentional, and deployed in a strategic way. The results are discussed in terms of the need for a broad definition of neutralization that includes all strategies including coping strategies. Clinical implications are discussed and comprehensive response prevention is recommended for the treatment of obsessive thoughts.

Adaptation, Psychological↗

PubMed1997

Psychological characteristics of volunteers in studies on gambling.

Advertisements were published in local newspapers asking for volunteers to participate in a study on gambling. A battery of eleven questionnaires was mailed to the subjects assessing pathological gambling behavior, sociodemographic characteristics, motivation to gamble, erroneous perceptions about gambling, superstitious beliefs, depressive symptoms, social anxiety and avoidance, alcohol and drug abuse, problem-solving skills, and marital satisfaction. Subjects received $10 when they returned the questionnaires fully completed. Response rate was over 95%. Surprisingly, 29% of the respondents met the criterion for probable pathological gambling (score of 5 or more on the SOGS) and a further 16% were identified as potential pathological gamblers (scores of 3 or 4). The potential and probable pathological gamblers showed significant differences on motivational and cognitive variables related to gambling compared to those subjects who showed no signs of pathological gambling. The probable pathological gamblers reported significantly more signs of poor psychosocial functioning than the other two groups, including depressive symptoms, poor problem orientation, drug and alcohol abuse, and interpersonal conflict. The practical and theoretical implications of these results are discussed.

Journal Article↗

PubMed1997

Cognitive-behavioral treatment of obsessive thoughts: a controlled study.

Twenty-nine patients with obsessive-compulsive disorder as diagnosed in accordance with the Diagnostic and Statistical Manual of Mental Disorders (3rd ed., revised; American Psychiatric Association, 1987) who did not have overt compulsive rituals were randomly assigned to treatment and waiting-list conditions. Patients in the treatment condition received cognitive-behavioral therapy consisting of a detailed explanation of the occurrence and maintenance of obsessive thoughts, exposure to obsessive thoughts, response prevention of all neutralizing strategies, cognitive restructuring, and relapse prevention. Compared with waiting-list patients, treated patients improved significantly on measures of severity of obsessions, current functioning, self-report obsessive-compulsive symptoms, and anxiety. When waiting-list patients were subsequently treated, the combined group improved on all outcome measures. Treatment gains were maintained at 6-month follow-up. Results indicate that cognitive-behavioral therapy is effective in the treatment of patients with obsessive thoughts, a group that has often been considered resistant to treatment.

Adult↗

PubMed1997

Reconsideration of the Locke-Wallace Marital Adjustment Test: is it still relevant for the 1990s?

The Locke-Wallace Marital Adjustment Test has been in use for over thirty years despite the development of other scales. The role of the test is discussed in terms of theoretical and practical concerns in the measurement of marital satisfaction. Major criticisms are briefly reviewed and empirical questions are identified. These questions are addressed using archival data on four samples totalling 281 couples. The test possesses adequate reliability and good criterion-related validity. A single factor was identified for both men and women. Ten items discriminated in all analyses. Minor changes in the scoring procedure were suggested for two items in response to some criticisms. These changes did not affect the psychometric properties. The alternative scoring system proposed by Hunt was also evaluated and a cut-score was identified. Continued use of the test is justified in general contexts where the broadly based definition of adjustment is appropriate. More comprehensive measures of adjustment and satisfaction and simpler measures of marital quality still leave a role for this 15-item rapid assessment measure of marital adjustment.

Adaptation, Psychological↗

PubMed1995

Inflated responsibility in obsessive compulsive disorder: validation of an operational definition.

An excessive sense of responsibility has been identified in obsessive-compulsive disorder (OCD) where patients evaluate their thoughts in terms of the harm they could cause to themselves or others. In a new definition, responsibility was defined as the belief that one possesses pivotal power to provoke or prevent subjective crucial negative outcomes. In order to empirically test the validity of this definition, two studies used a semi-idiographic design to evaluate responsibility across ambiguous situations related to major OCD themes like contamination, verification, somatic concerns, loss of control, making errors, sexuality and magical thinking. In the first study, 397 volunteer adults participated in the experiment. For each situation, subjects briefly described a possible negative outcome and then rated this outcome on four dimensions: (1) probability; (2) severity; (3) influence; and (4) pivotal influence, using a 9-point Likert scale. Finally Ss rated perceived responsibility and personal relevance. Highly relevant situations were retained for the final analysis. Regression analysis suggested that influence and pivotal influence were better predictors of responsibility ratings than probability and severity. The second study examined the effect of the order of the questions on the responsibility ratings. A first group of Ss (n = 85) answered the Responsibility Questionnaire (RQ) in the original order, while a second group (n = 53) rated responsibility before the other ratings. Regression analysis showed that although proportion of variance explained diminished when the order was reversed, pivotal influence was still the best predictor of responsibility. Results are discussed in terms of current models of OCD and implications for future research and cognitive treatment are identified.

Adolescent↗

PubMed1995

Perfectionism, responsibility and obsessive-compulsive symptoms.

Although both perfectionism and responsibility have been associated with OCD at a theoretical level, responsibility has been the focus of a number of recent articles. This study was conducted in order to empirically test the relative importance of perfectionism and responsibility in Obsessive-Compulsive symptoms. Perfectionism and two measures of responsibility showed moderate correlations with Obsessive-Compulsive symptoms. A hierarchical regression analysis revealed that although responsibility accounted for more variance, perfectionism was still a significant predictor of Obsessive-Compulsive symptoms, once responsibility had been partialled out. These results suggest that although responsibility is related to OC symptoms, perfectionism is also independently associated. While responsibility has received much attention lately from OCD theorists and clinicians, perfectionism may also play a significant if underestimated role in some OC patients. The results are discussed in terms of their implications for current cognitive models and treatment procedures that give responsibility a central role in OCD. A new definition of perfectionism is also proposed.

Adult↗

PubMed1995

Experimental manipulations of responsibility: an analogue test for models of obsessive-compulsive disorder.

Several authors attribute excessive responsibility a predominant role in Obsessive-Compulsive Disorder (OCD) [Salkovskis, P. M. (1985) Behaviour Research and Therapy, 23, 571-583; Rachman, S. (1993) Behaviour Research and Therapy, 31, 149-154; van Oppen, P. & Arntz, A. (1994) Behaviour Research and Therapy, 32, 79-87]. The present studies aimed at demonstrating the link between different levels of perceived responsibility and checking behaviors by experimentally manipulating responsibility in non-clinical Ss. In the first study, a sound recognition task was used to compare checking behaviors in Ss with high (HR) and low (LR) perceived responsibility. Only one variable was significantly different, Ss from the HR group reporting more anxiety during the task than Ss from the LR group. Results did not support a link between responsibility and checking behavior. In a second study HR and LR Ss were compared on a manual classification task. Subjects from the HR group hesitated and checked more, and reported more preoccupation with errors and anxiety during the task than Ss from the LR group. Since perceived severity of the outcome was the most variable affected by the manipulation, the implications for current models of OCD are discussed and an alternative explanation is attempted. Finally, clinical implications are examined and suggestions are made for future directions of research.

Adult↗

PubMed1995

Cognitive-behavioral treatment of obsessions.

Three patients with obsessive-compulsive disorder whose major complaints were obsessional thoughts with cognitive neutralization as opposed to overt rituals were treated with a cognitive-behavioral package. Cognitive neutralization involves both cognitive rituals and a variety of less ritualized coping strategies all designed to remove the thought and decrease discomfort. In a departure from earlier case studies, the patients were treated in a multiple baseline design across subjects. All three patients reported decreased discomfort and improved their professional and/or interpersonal functioning. Gains were maintained at follow-up (8 to 11 months).

Adaptation, Psychological↗