Obsessive-compulsive Disorder Symptoms Research Articles

Increases in functional connectivity between the default mode network and sensorimotor network correlate with symptomatic improvement after transcranial direct current stimulation for obsessive-compulsive disorder

BackgroundNon-invasive neuromodulation is a promising intervention for obsessive-compulsive disorder (OCD), although its neurobiological mechanisms of action are still poorly understood. Recent evidence suggests that abnormalities in the connectivity of the default mode network (DMN) and the supplementary motor area (SMA) with other brain regions and networks are involved in OCD pathophysiology. We examined if transcranial direct current stimulation (tDCS) alters these connectivity patterns and if they correlate with symptom improvement in treatment-resistant OCD. MethodsIn 23 patients from a larger clinical trial (comparing active tDCS to sham) who underwent pre- and post-treatment MRI scans, we assessed resting-state functional MRI (rs-fMRI) data. The treatment involved 30-minute daily tDCS sessions for four weeks (weekdays only), with the cathode over the SMA and the anode over the left deltoid. We conducted whole-brain connectivity analysis comparing active tDCS-treated to sham-treated patients. ResultsWe found that active tDCS, but not sham, led to connectivity increasing between the DMN and the bilateral pre/postcentral gyri (p = 0.004, FDR corrected) and temporal-auditory areas plus the SMA (p = 0.028, FDR corrected). Also, symptom improvement was directly associated with connectivity increasing between the left lateral sensorimotor network and the left precuneus (r = 0.589, p = 0.034). LimitationsLimited sample size (23 participants with resting-state neuroimaging), inability to analyze specific OCD symptom dimensions (e.g., harm, sexual/religious, symmetry/checking, cleaning/contamination). ConclusionsThese data offer novel information concerning functional connectivity changes associated with non-invasive neuromodulation interventions in OCD and can guide new brain stimulation interventions in the framework of personalized interventions.

An investigation of the experience of control through the sense of agency in people with obsessive-compulsive disorder: a review and meta-analysis.

The construct of sense of agency (SoA) has proven useful for understanding mechanisms underlying obsessive-compulsive disorder (OCD) phenomenology, especially in explaining the apparent dissociation in OCD between actual and perceived control over one's actions. Paradoxically, people with OCD appear to experience both diminished SoA (feeling unable to control their actions) and inflated SoA (having "magical" control over events). The present review investigated the extent to which the SoA is distorted in OCD, in terms of both implicit (ie, inferred from correlates and outcomes of voluntary actions) and explicit (ie, subjective judgment of one's control over an outcome) measures of SoA. Our search resulted in 15 studies that met the criteria for inclusion in a meta-analysis, where we also examined the potential moderating effects of the type of measure (explicit versus implicit) and of the actual control participants had over the outcome. We found that participants with OCD or with high levels of OCD symptoms show lower implicit measures of SoA and at the same time tend to overestimate their control in situations where they do not actually have it. Together, these findings support the hypothesized dissociation in OCD between actual and perceived control over one's actions.

Testing an Imagery Rescripting Exercise Targeting Fear of Self.

A feared possible self refers to the unwanted characteristics that a person may possess or develop. We tested an experimental paradigm to target fear of possible self using imagery rescripting. A student sample (n = 91), with moderate obsessive-compulsive disorder symptoms, engaged in written and audio-guided exercises to evoke episodic future mental imagery that represented their feared possible self. Participants were then randomized between imagery rescripting or neutral imagery control tasks. The results revealed no difference between conditions in fear of self or general obsessional beliefs following the manipulation. State anxiety and the urge to neutralize the imagery reduced more in the control condition than in the rescripting condition. These findings suggest that the current paradigm is emotionally engaging but not effective at addressing fear of self as measured. Methodological improvements such as removing a written component of the rescripting task and idiosyncratic measuring of fear of self are proposed.

Difficulty in Emotion Regulation, Metacognition, Psychiatric Symptoms, and Suicide Probability in Obsessive-Compulsive Disorder.

Although an association has been newly reported between obsessive-compulsive disorder (OCD) and an increased risk of suicide, there are only a limited number of studies investigating suicide-related factors in OCD patients. The aim of this study is to evaluate the relationship between dysfunctional metacognitive activity, difficulty in emotion regulation, anxiety, depression, somatization symptom severity, and suicide probability in OCD patients by comparing them with a control group. Difficulties in Emotion Regulation Scale, Metacognition Scale, Suicide Probability Scale, and Patient Health Questionnaire Somatic, Anxiety, and Depression Symptom Scale were administered to 70 OCD patients and 70 healthy controls. The Dimensional Obsession Compulsion Scale was administered to assess OCD symptom dimensions among OCD patients. Dysfunctional metacognition, difficulty in emotion regulation, probability of suicide, depression, anxiety, and somatization symptoms were significantly higher in OCD patients compared to the control group (P < .05). Suicide probability was found to be positively correlated with depression, difficulty in emotion regulation, impulsivity dimension, metacognition, cognitive confidence dimension, contamination, cleaning, and symmetry scores among OCD symptom dimensions (P < .05). Recognizing the factors that were found to be associated with suicide probability in individuals with OCD may be of great importance in identifying patients at higher suicide risk.

Better treatment response in people with obsessive-compulsive disorder is associated with more use of a planning-focused coping style

Background Obsessive-compulsive disorder (OCD) is a common and highly disabling mental health condition. Although effective treatments such as cognitive behavioural therapy are available, a substantial minority of patients do not respond to treatment, and those who do often experience relapse. There is an urgent need to understand more about the psychological factors involved in response to OCD treatment. Prior literature suggests that poorer treatment response may be related to higher levels of early life stress and experiential avoidance, while better treatment response may be related to positive coping styles (planning; active coping). Methods Individuals with OCD (n = 202) took part in an online survey in which they reported what OCD treatment they had received, and how their OCD symptoms at the time of the survey compared to their OCD symptoms before they had received any treatment. They also completed measures of OCD severity, early life stress, experiential avoidance, planning and active coping. Depression and anxiety were measured as control variables. Results It was found that more severe OCD symptoms were associated with higher levels of early life stress and more use of experiential avoidance, but were unrelated to planning or active coping. On the other hand, a better self-reported response to OCD treatment was associated with more use of the planning style of coping, but was not associated with early life stress, experiential avoidance or active coping. Conclusions The present study highlights planning-focused coping as a possible modifiable factor in maximising treatment response in people with OCD. Given that sustained recovery from OCD is relatively rare, research that focuses on how to maximise the benefit of existing treatments could have a significant impact on individuals living with the condition.

Psychometric Properties of Thai Version of Obsessive Belief Questionnaire (OBQ-T)

Background: Obsessive Beliefs Questionnaire (OBQ) is a valid measure for assessing obsessional beliefs, which are the main symptoms of obsessive-compulsive disorder (OCD). It is translated and assessed psychometric properties in many languages, however, no valid questionnaire for assessing the beliefs related to OCD is established in Thailand. Objective: To assess the psychometric properties of the Thai version of the Obsessive Belief Questionnaire (OBQ-T). Materials and Methods: Participants include ninety-two OCD patients who were duly informed of the details of the present study. Written consent was obtained. The Obsessive Beliefs Questionnaire-44 (OBQ-44) was translated into Thai (OBQ-T) after receiving permission. Data regarding the characteristics of the participants, the OBQ-T, the Thai self-report version of the Yale-Brown Obsessive-Compulsive Scale-Second Edition (Y-BOCSII-SR-T) severity scale, the Thai Florida Obsessive Compulsive Inventory (FOCI-T), the Patient Health Questionnaire (PHQ-9), and the Pictorial Thai Quality of Life (PTQL), were collected and analyzed. Psychometric properties of the OBQ-T were tested. Results: The OBQ-T has excellent reliability with a Cronbach’s coefficient of 0.945. It has a positive correlation with the Y-BOCS II-SR-T severity scale and the FOCI, which indicates the concurrent validity of the OBQ-T. The content validity index shows acceptable content validity. The confirmatory factor analysis (CFA) and the exploratory factor analysis (EFA) were examined, and the three-factor model is most similar to the original OBQ-44, which is composed of three factors reflecting responsibility and threat estimation, perfectionism and intolerance for uncertainty, and importance and control of thought. Conclusion: The OBQ-T has an acceptable reliability and validity for the measurement of beliefs and appraisals, which are related to the pathogenesis of obsessions. Keywords: Obsessive Compulsive Disorder, Psychometric properties, Thai, Obsessional belief questionnaire

Alone together: the role of existential concerns in symptoms of relationship obsessive-compulsive disorder

ABSTRACT Objective Emerging research has identified the relevance of existential concerns in various subtypes and dimensions of obsessive-compulsive disorder (OCD). However, at present, no studies have examined these concerns in relation to relationship OCD (ROCD). Method The current study examined the association between ROCD symptoms and all five existential concerns (i.e., isolation, identity, meaninglessness, guilt, and death). Data was obtained from a sample of undergraduate university students in Sydney, Australia (N = 353), Mage = 20.95 years. Participants completed a number of scales including measures of ROCD symptoms, attitudes to relationships, and existential concerns. Results The results revealed significant positive correlations between all five existential concerns and ROCD symptoms. In particular, the correlations found for Isolation and Identity concerns were significantly larger than those found for Meaninglessness, Guilt, and Death. Notably, the relationships between ROCD symptoms and all five existential concerns remained significant after controlling for quality of current relationship, catastrophic beliefs about relationships, and neuroticism. Conclusions The current findings highlight the need to consider existential issues in conceptualising ROCD. Clinical implications are discussed.

Acceptability of internet-delivered cognitive behavioural therapy for adults with symptoms of obsessive-compulsive disorder: A meta-analysis.

Obsessive-compulsive disorder (OCD) is a chronic mental health disorder. Internet-delivered cognitive behaviour therapy (ICBT) is demonstrated to be effective for OCD; however little is known about the acceptability of the treatment. Therefore the aim of this study was to examine the acceptability of ICBT for adults with OCD symptoms using a meta-analytic approach. Seventeen studies (N = 1661; Mage range = 28-41 years; 58%-93% female) were included in this analysis. The random effects pooled estimates indicated that 16.3% (95% CI: 9.8%-25.7%) of participants did not commence the treatment once they were enrolled in the study, 27.6% (95% CI: 19.0%-38.2%) did not complete the treatment, and 27.0% (95% CI: 18.2%-38.0%) did not complete the post-treatment questionnaires of the study. The mean score on the Client Satisfaction Questionnaire ranged from 22.4 to 26.5. Overall, pooled estimates indicated that 81.6% (95% CI: 76.1%-86.0%) of participants were satisfied with the ICBT intervention and 84.7% (95% CI: 72.8%-92.0%) indicated that they would recommend the treatment to a friend. Some of the acceptability moderator analyses indicated that self-guided ICBT interventions had lower levels of acceptability compared with clinician-guided interventions. However, given low power, these results should be considered preliminary. This study has important implications in the dissemination of ICBT for OCD.

Externally orienting cues improve cognitive control in OCD

Background and objectivesAn executive overload model of obsessive-compulsive disorder (OCD) posits that broad difficulties with executive functioning in OCD result from an overload on the executive system by obsessive thoughts. It implies that, if individuals with OCD “snap out” of their obsessive thoughts, their performance on neurocognitive tasks will improve. MethodsWe test this prediction using the revised Attention Network Test, ANT-R, and distinct subsamples of data from unmedicated OCD and healthy controls (HC). ANT-R includes Simon and Flanker tasks; in both, incongruent trials take longer to resolve (‘conflict costs’). On some trials, a warning cue helps participants to respond faster (‘alerting benefits’). In OCD (N = 34) and HC (N = 46), matched on age, IQ, and sex, we tested (1) the effect of OCD on alerting benefits, and (2) the effect of OCD on warning cue related reductions in conflict costs. In a distinct subsample of OCD (N = 32) and HC (N = 51), we assessed whether alerting benefits and cue-related reductions in conflict costs are associated differently with different OCD symptoms. ResultsA warning cue can help individuals with OCD more than HC to improve performance on Simon and Flanker tasks. This effect is positively associated with severity of contamination symptoms. LimitationsThis study did not directly assess how distracted participants are by obsessive thoughts. It relied on the ANT-R subtraction measures. Symptom severity was assessed using self-report measures. ConclusionsDifficulties in resolving conflict during decision-making in OCD can be modulated by a warning cue presented immediately before an attentional task.

Effectiveness of One Videoconference-Based Exposure and Response Prevention Session at Home in Adjunction to Inpatient Treatment in Persons With Obsessive-Compulsive Disorder: Nonrandomized Study.

Therapist-guided exposure and response prevention (ERP) for the treatment of obsessive-compulsive disorder (OCD) is frequently conducted within clinical settings but rarely at places where patients are usually confronted with OCD symptom-provoking situations in daily life (eg, at home). This study aimed to investigate patients' views on 1 ERP session at home via videoconference and its impact on treatment outcome. A total of 64 inpatients with OCD received 1 session of therapist-guided videoconference-based ERP at home in adjunction to a multimodal inpatient treatment between 2015 and 2020. Compared with 64 age- and sex-matched controls who received a multimodal inpatient treatment without 1 session of videoconference-based ERP at home, patients who received 1 session of videoconference-based ERP in adjunction to a multimodal inpatient treatment showed stronger reductions in OCD symptom severity from admission to discharge. Before the videoconference-based ERP session, patients reported high rationale credibility and treatment expectancy. After the videoconference-based ERP session, patients reported medium-to-high positive mood as well as depth and smoothness of the session, and they perceived the working alliance as high. Results highlight the importance of administering therapist-guided ERP sessions in patients' natural environment to enhance treatment response in OCD. Videoconference-based ERP as add-on to treatment as usual is, therefore, a promising approach to facilitate the application of ERP in patients' natural environment and foster the generalization of ERP conducted in clinical settings.

Contamination-Focussed Vignettes as an Analogue of Infectious Pandemics: An Experimental Validation using the State Disgust and Anxiety Responses in OCD.

Despite infectious pandemics proving particularly detrimental to those with Obsessive-Compulsive Disorder (OCD), the investigation of analogous experimental paradigms is lacking. To address this gap, we conducted two studies employing vignettes that depicted contamination-related situations commonly experienced during a pandemic (e.g., Coughing into hands and failing to use hand sanitizer). We manipulated the salience of these vignettes across three levels: high contamination, low contamination, and a neutral control condition. Our examination of state anxiety and disgust responses in all participants revealed the successful manipulation of the vignettes' impact. Specifically, individuals with more severe OCD symptoms reported significantly higher levels of state disgust and anxiety for both high and low contamination vignettes, in contrast to the group with lower symptom severity. No significant differences were observed in the neutral vignette condition between the high- and low-scoring groups. Interestingly, for those with higher OCD symptoms, high salience contamination-focused vignettes resulted in similarly elevated state disgust and anxiety, regardless of whether the vignettes were situated in public (Study 1) or domestic (Study 2) settings. This suggests that the heightened sensitivity to contamination-related scenarios observed in individuals with OCD symptoms in the present study is not confined to a specific context. These findings support the use of contamination-focused vignettes as analogues for studying infectious pandemics and provide valuable insights into OCD models, interventions, and future research.

Maximizing translational value in models of compulsive behavior: A commentary on Pickenhan et al. (2024).

In this issue of Cognitive, Affective, and Behavioral Neuroscience, Pickenhan et al. (2024) discuss the need for translational studies to understand features underlying obsessive-compulsive disorder (OCD). They highlight the translational value of the observing-response task (ORT) for modeling functional and maladaptive checking behaviors, a common symptom of OCD.

A Cross-Sectional Study of How Harm Avoidance, Incompleteness and Intolerance of Uncertainty Contribute to Obsessive–Compulsive Disorder in University Students

Research suggests that certain cognitive factors increase the likelihood of developing and maintaining obsessive–compulsive disorder (OCD). Such factors that are often associated with OCD are harm avoidance (HA), incompleteness (INC), and intolerance of uncertainty (IU). The present study aimed to examine the associations of intolerance of uncertainty, incompleteness, and harm avoidance with dimensions of obsessive–compulsive symptoms. Participants were 1128 university students (Mage = 19.42 St.d. = 2.02). Results showed that all subscales of the OCI-R correlated significantly with HA, INC, and IU, confirming the findings of previous studies. HA and INC appear to predict OC symptoms in a significant way. IU appears to correlate and improve the models, although to a lesser degree. The present findings contribute to our better understanding of the relationship between OCD symptoms and underlying cognitive variables and the nature of OCD heterogeneity.

Reduced sleep quality defines a subtype of obsessive-compulsive disorder with lower Glx levels in the resting thalamus and worse response inhibition

BackgroundThe aim of this study was to investigate the differences between resting and active thalamic neurometabolite levels and inhibitory function in obsessive compulsive disorder (OCD) patients with poor sleep quality (PSQ was defined as Pittsburgh Sleep Quality Index >5 and sleep efficiency ≤85%) compared to OCD patients with good sleep quality (GSQ) and healthy controls (HCs), as well as the relationship of these indices to obsessive compulsive symptoms. MethodsFunctional magnetic resonance spectroscopy (fMRS) was used to measure resting and active thalamic neurometabolite levels in 72 subjects (20 HCs and 38 OCD patients included in study analysis). Response inhibition function was measured by the Go-Nogo task before and during MRS recording. Subjective sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI). The symptoms of OCD, anxiety and depression were evaluated using relevant clinical scales. ResultsOCD patients exhibited significantly reduced Glx/Cr levels in the resting thalamus. The levels of resting thalamic Glu/Cr and Glx/Cr in OCD patients with PSQ were significantly lowest. OCD patients had significantly lower correct rates on Go tasks, higher error rates on Nogo tasks, and longer error average response times (EART) to the Nogo task. OCD patients with PSQ demonstrated the highest Nogo task error rate and the longest EART to Nogo task. Furthermore, PSQI scores exhibited negative correlations with Glu/Cr and Glx/Cr in the resting thalamus. ConclusionOCD patients with PSQ demonstrated reduced levels of thalamic resting Glx and more pronounced response inhibitory function impairment. Aberrant neurometabolite levels in critical brain regions, coupled with heightened response inhibition function deficits, may be a neurobiological basis for the PSQ that OCD patients generally exhibit.

Inflammation in obsessive-compulsive disorder: A literature review and hypothesis-based potential of transcranial photobiomodulation.

Obsessive-compulsive disorder (OCD) is a disabling neuropsychiatric disorder that affects about 2%-3% of the global population. Despite the availability of several treatments, many patients with OCD do not respond adequately, highlighting the need for new therapeutic approaches. Recent studies have associated various inflammatory processes with the pathogenesis of OCD, including alterations in peripheral immune cells, alterations in cytokine levels, and neuroinflammation. These findings suggest that inflammation could be a promising target for intervention. Transcranial photobiomodulation (t-PBM) with near-infrared light is a noninvasive neuromodulation technique that has shown potential for several neuropsychiatric disorders. However, its efficacy in OCD remains to be fully explored. This study aimed to review the literature on inflammation in OCD, detailing associations with T-cell populations, monocytes, NLRP3 inflammasome components, microglial activation, and elevated proinflammatory cytokines such as TNF-α, CRP, IL-1β, and IL-6. We also examined the hypothesis-based potential of t-PBM in targeting these inflammatory pathways of OCD, focusing on mechanisms such as modulation of oxidative stress, regulation of immune cell function, reduction of proinflammatory cytokine levels, deactivation of neurotoxic microglia, and upregulation of BDNF gene expression. Our review suggests that t-PBM could be a promising, noninvasive intervention for OCD, with the potential to modulate underlying inflammatory processes. Future research should focus on randomized clinical trials to assess t-PBM's efficacy and optimal treatment parameters in OCD. Biomarker analyses and neuroimaging studies will be important in understanding the relationship between inflammatory modulation and OCD symptom improvement following t-PBM sessions.

The Effect of Brainwave Synchronization Using Binaural Beats on Improving Working Memory and Reducing the Severity of Symptoms in Women With Obsessive-compulsive Disorder.

Binaural beats are one of the new methods of brainwave synchronization. However, there is little knowledge about its clinical applications. The positive effect of this method on executive functions, such as attention and working memory, in the γ band has been mainly confirmed in healthy individuals. Still, its effectiveness on disorders such as obsessive-compulsive disorder (OCD), with a prominent cognitive profile, has not been established. Therefore, the present study was conducted to examine the effect of binaural beats on working memory and the severity of OCD symptoms in the γ band in the affected women. Twenty-nine OCD women aged 25-40 years referring to psychological clinics in Tehran City, Iran, were selected by convenience sampling. After completing the symptom checklist 90 (SCL90) and the Yale-Brown severity scale (SS), the participants were given the Wechsler memory scale (WMS) digit repetition subtests. Then, they were randomly assigned to the experimental (n=15) and control (n=14) groups. The audio file of the binaural beats in the γ band was provided to the experimental group. The participants in the control group listened to the normal (no-wave) audio file. Both groups listened to the audio files for two weeks, three times a week, for 30 minutes each time. The Yale-Brown SS and digit repetition in post-test and one-month follow-up periods were obtained from both groups. According to the results, the severity of OCD symptoms was significantly reduced in the post-test and follow-up stages by the γ binaural beats (P<0.05). Also, the working memory function was improved, although it was not statistically significant (P>0.05). The results of this study show that binaural beats can be used as a complementary treatment to reduce the severity of OCD symptoms. Also, it seems that the patients' working memory is strengthened with this method.

Feeling more confident to encounter negative emotions: The mediating role of distress tolerance on the relationship between self-efficacy and outcomes of exposure and response prevention for OCD

BackgroundWhile exposure and response prevention (ERP) is the first-line treatment for obsessive-compulsive disorder (OCD), up to half of patients do not effectively respond. In an effort to better understand the mechanisms behind ERP, the inhibitory learning model emphasizes the roles of increasing perceived self-efficacy and distress tolerance. While self-efficacy and distress tolerance have separately been shown to predict OCD symptoms and treatment outcomes, no studies have assessed their joint effects in ERP. The current study examined distress tolerance as a mediator of the relationship between self-efficacy and ERP outcomes. MethodsPatients in an intensive ERP-based treatment program (N = 116) completed weekly self-report measures. ResultsOver the course of treatment, as OCD symptoms reduced, self-efficacy and distress tolerance both significantly increased. Importantly, increases in self-efficacy and distress tolerance mediated each other in explaining symptom reduction, suggesting a possible bi-directional effect. LimitationsThe temporal relationship between changes in self-efficacy and distress tolerance is worthy of further investigation. In addition, the current sample had limited racial diversity and might not be representative of patients receiving lower levels of care. Findings merit replication to be ascertained of their reliability. ConclusionsFindings suggest that during ERP, patients gain confidence in their abilities both to cope with general challenges and to withstand distress, potentially helping them engage with exposures and overcome initial fears. These findings provide support for the inhibitory learning model and highlight the mechanistic roles of self-efficacy and distress tolerance in ERP. Clinical implications to target both in treatment are discussed.

Improv Intervention for Obsessive-Compulsive Symptoms: A Pilot Study from Turkey

ABSTRACT Improvisation is a form of theater with no predetermined script. All actors create a flow based on two core principles: “Yes, and…” and “No mistakes,” referring to accepting what the partner offers unconditionally, and embracing all contributions to creating content without judgment. This pilot study investigated whether 12 weeks of improv intervention can help alleviate individuals’ obsessive-compulsive disorder symptoms. A questionnaire package was given to participants to complete at three different points. The results showed statistically significant decreases in participants’ OCD, depression, and anxiety scores from pretest to posttest measurements. By its very nature, improv intervention may help create an atmosphere full of unpredictability and invite participants to be a part of it. In improv, participants are encouraged to take risks, be in the moment, and trust each other to manage challenges. This paper will also present a discussion of possible mechanisms of change to explain the effects of improv.

The effectiveness and acceptability of the Bergen 4-day treatment for adolescents with OCD: a replication and extension.

B4DT is a concentrated treatment format with prolonged sessions of exposure and ritual prevention (ERP) delivered over four consecutive days. Two previous open trials demonstrated promising results of the Bergen 4-day treatment (B4DT) for adolescents with obsessive-compulsive disorder (OCD). The aim of the current study was to replicate the initial results with a new sample of adolescents and different therapists at different sites across Norway. Forty-three youths participated in treatment program. At pretreatment, posttreatment, and the three-month follow-up, OCD symptoms were assessed using the CY-BOCS interview, while the GAD-7 and PHQ-9 were administered to rate general anxiety symptoms and depressive symptoms. Acceptability and patient satisfaction with the treatment were rated with the CSQ-8. All symptoms were significantly reduced at posttreatment and follow-up. At posttreatment, 36 patients (85.71%) were defined as responders, while 29 patients (69.05%) achieved remission. At the three-month follow-up, 36 patients (92.3%) were defined as responders, while 33 patients (84.62%) were in remission. CSQ-8 scores indicated that the patients were highly satisfied with the treatment. The B4DT was successfully replicated in a new sample at different sites across Norway, which indicates that this treatment is generalizable, effective and acceptable to adolescents with OCD.

Exploring the relationship between context and obsessions in individuals with obsessive-compulsive disorder symptoms: a narrative review.

Obsessions in obsessive-compulsive disorder (OCD) have long been proposed to differ from intrusive thoughts in unaffected individuals based on appraisal of the thoughts. However, more recent research indicates that cognitive processes behind obsessions may differ significantly from those in healthy individuals concerning their contextual relationship. This narrative literature review summarizes current evidence for the role of context-relatedness for obsessions in OCD and intrusive thoughts in affected and unaffected individuals. The review encompasses a total of five studies, two of which include individuals diagnosed with OCD (one study also includes a group of unaffected control individuals), while the other three studies investigate the relationship between OCD symptoms and context in unaffected individuals. As assessed by mainly self-reports, the review examines the connection between thoughts and their context, shedding light on how the repetition and automaticity of thoughts, as well as their detachment from context over time contribute to defining obsessions in contrast to intrusive thoughts. However, the link with context depends on the content of the obsessions. We propose the term "decontextualization of thoughts" to describe the phenomenon that obsessions gradually lose their connection with external context during the development of OCD. Future research should investigate whether this hypothesis can be supported by experimental evidence and identify whether this shift might be more likely a cause or a consequence of the disorder.