Thursday January 3rd 2013 - NYBH Staff
Exploring OCD and Eating Disorders
Attempting to better understand the relationship between obsessive-compulsive disorder (OCD) and pathological eating disorders (and subsequently the dispositional characteristics common among individuals suffering from either diagnosis), researchers Vartanian & Grisham designed and carried out a study in Australia (2012). Their objective was to examine the relationship between OCD, perfectionism, and compulsive body checking. The researchers note that co-morbidity is often observed between OCD and eating disorders (ED), citing a study by Kaye, Bulik, Thornton, Barbarich, Masters, and Price Foundation Collaborative Group (2004) that demonstrated a 41% prevalence of life-time OCD in a sample of patients with eating disorders (Vartanian & Grisham, 2012).
There is an intuitive relationship between body checking in patients with eating disorders and OCD symptoms. Checking behaviors are often common in patients with a diagnosis of OCD because the checking serves to reduce anxiety temporarily, thus negatively reinforcing and perpetuating the behavior. However, body checking has actually been shown to increase body dissatisfaction (Reas, Whisenhunt, Netemeyer, & Williamson, 2002). Patients, therefore, can become intertwined in a paradoxical endeavor whereby attempts to reduce anxiety contribute to greater and more pathological body dissatisfaction—and, consequently, more severe eating disorders.
Assessing the Dispositions
Vartanian & Grisham (2012) wanted to identify precursors to clinical eating disorders first. The proposed study was to examine dispositional characteristics (specifically perfectionism and negative affect) that are common to both OCD symptoms and body checking. The researchers primarily hypothesized that perfectionism and OCD symptoms would be positively related to body checking, and subsequently that body checking would be associated with greater body dissatisfaction. Participants were recruited from a psychology course at a university in Australia, as well as community volunteers. The subjects were asked to complete several questionnaires, including Obsessive-Compulsive Inventory Revised (OCI-R) (Foa, Huppert, Leiberg, Langner, Kichic, & Hajcak, 2002); Body Checking Questionnaire (BCQ) (Reas, et al., 2002); Multidimensional Perfectionism Inventory (MPI) (Frost, Marten, Lagart, & Rosenblate, 1990); Depression, Anxiety, and Stress Scales (DASS) (Lovibond & Lovibond, 1995); Body Dissatisfaction Subscale of the Eating Disorder Inventory (EDI-BD) (Garner, Olmstead, & Polivy, 1983).
Paths to Greater Body Dissatisfaction
Consistent with the researchers’ hypothesis, both obsessive-compulsive symptoms and perfectionism showed a positive relationship with body checking. Additionally, body-checking behavior was also positively correlated with greater body dissatisfaction, indicating that checking simultaneously reduces (short term) and creates (long term) further anxiety about one’s body image. These findings have important implications for clinicians when identifying patients at risk for clinical eating disorders and in evaluation of patients presenting with symptoms of OCD and body checking.
Kaye, W. H., Bulik, C. M., Thornton, L., Barbarich, N., Masters, K., & Price Foundation Collaborative Group (2004). Comorbidity of anxiety disorders with anorexia nervosa and bulimia nervosa. American Journal of Psychiatry, 161, 2215–2221.
Foa, E. B., Huppert, J. D., Leiberg, S., Langner, R., Kichic, R., Hajcak, G., et al. (2002). The Obsessive-Compulsive Inventory: Development and evaluation of a short version. Psychological Assessment, 14, 485-496.
Frost, R. O., Marten, P., Lagart, C., & Rosenblate, R. (1990). The dimensions of perfectionism. Cognitive Therapy and Research, 14: 449–468.
Garner, D. M., Olmstead, M. P., & Polivy, J. (1983). Development and validation of a multidimensional eating disorder inventory for anorexia nervosa and bulimia. International Journal of Eating Disorders, 2, 15–34.
Lovibond, S. H. & Lovibond, P. F. (1995). Manual for the Depression Anxiety Stress Scales. Sydney: Psychology Foundation.
Reas, D. L., Whisenhunt, B. L., Netemeyer, R., & Williamson, D. A. (2002). Development of the Body Checking Questionnaire: A self-report measure of body checking behaviors. International Journal of Eating Disorders, 31, 324–333.
Vartanian, L. & Grisham, J. (2012). Obsessive-compulsive symptoms and body checking in women and men. Cognitive Therapy Resources, 36, 367-374.
Friday December 28th 2012 - NYBH Staff
Screening Kids for ADHD
A team of two researchers hypothesized that children with a diagnosis of Attention Deficit Hyperactivity Disorder (ADHD) might be more susceptible to bullying. With this as their working hypothesis, Holmberg & Hjern (2008) studied the phenomenon of bullying within the population of all fourth grade students in the Sigtuna, a Swedish municipality near Stockholm. Students were screened for ADHD in a two-step procedure. Parents and teachers were asked initially to complete a questionnaire including Connors’ 10-item scale, a tool commonly used to measure behavior related to ADHD symptoms. Children who tested positively for behavioral problems associated with ADHD (characteristics such as impulsivity and difficulties in emotional regulation) were then invited to complete a more intensive clinical evaluation by a child neurologist. After a clinical interview, each positively identified child was classified into one of four categories:
(1) Pervasive ADHD
(2) Situational ADHD
(3) Sub-threshold ADHD
(4) No ADHD
The ADHD Categories
Pervasive ADHD was reflected by children who manifested ADHD symptoms both at home and during school. Conversely, the category of situational ADHD was designated for children who manifested symptoms only in one setting or the other. The term sub-threshold ADHD was used to describe children who met between four and five criteria for an ADHD diagnosis in one or two settings. Finally, the children classified as not having ADHD were grouped with the students who had not been selected for clinical assessment. All children were then asked to report information about bullying on a survey questionnaire, administered by school nurses.
ADHD – Risk Factor for Bullying and Victimization
The results of the analysis by Holmberg & Hjern (2008) indicated that children with ADHD are both more likely to experience peer victimization and to bully others. The researchers noted that 24% of children diagnosed with pervasive ADHD and 25% diagnosed with situational ADHD reported bullying others. These percentages are in stark contrast to those reported by children with sub-threshold ADHD at 11% and those without ADHD at 7%. Thus, children in this fourth grade sample diagnosed with pervasive or situational ADHD reported bullying behaviors three times as often as their peers. Additionally, the researchers reported that children with situational ADHD reported being bullied most frequently, closely followed by children with pervasive and sub-threshold ADHD. The pervasive ADHD and the situational ADHD groups reported victimization up to 10 times as often as their counterparts.
Intervention and Prevention Programs
Holmberg & Hjern (2008) encourage practitioners to conduct a thorough investigation into social relationships and difficulties at school when treating children with an ADHD diagnosis. Intervention and prevention programs should be tailored to intervene at many levels including classroom training, parental training, and individual social skill training should all be incorporated as necessary.
Conners, C. K. (1969). A teacher rating scale for use in drug studies with children. American Journal of Psychiatry, 126: 884–888.
Conners, C. K. (1990) Manual for Conners Rating Scales. Toronto: Multi-Health Systems.
Holmberg, K. & Hjern, A., (2008). Bullying and attention deficit hyperactivity disorder in 10 year olds in a Swedish community. Developmental Medicine & Child Neurology, 50: 134-138.
Thursday December 27th 2012 - NYBH Staff
Prevalence of Bullying in Academic Settings
Reintegrative Shaming Theory (RST) was developed by Australian criminologist John Braithwaite to explain the shame processes used to address human errors, especially in criminal punishment, in light of the differing outcomes when shaming processes are implemented, with an emphasis on reintegration or stigmatization (1989). It is through this lens of RST that Pontzer, in recent years, examined the connection between parenting styles, personality, and the bully/victim relationship (2010). He notes the widespread presence of the phenomenon of bullying from middle school through university, highlighting research that shows 13.4% of university students admit to bullying behavior once or twice throughout university (Chapell et al., 2004) and between 5-8% of students between middle and high school reporting victimization or bullying within the last 6 months (U.S. National Household Surveys, 1993, 1999, 2001).
Origins of Bullying/Victimization
The pervasive nature of bullying has prompted researchers to uncover the lasting psychological and behavioral consequences of the experience, both for bullies and their victims. Those who are bullied may eventually suffer from low self-esteem, depression, anxiety, and increased stress. Conversely, Pontzer (2010) notes a myriad of research highlighting the link of the origin of bullying behavior to parenting styles that are harsh, neglectful, absent, and/or rejecting. Interestingly, Pontzer (2010) notes the connection between parenting and the tendency to bully. Victimization has not been studied to the same degree; however, a study by McNamara and McNamara (1997) suggests parents of victimized children may have experienced bullying themselves and consequently and unknowingly perpetuated the cycle through over-protective parenting.
Dealing with Shame
Shame is an important emotion to examine in the discourse on bullying. It is defined as an emotion experienced upon the realization that an individual’s ethical identity has been violated or threatened by that individual’s own actions (Braithwaite and Braithwaite, 2001). RST focuses on three specific tendencies for dealing with shame: 1) the tendency to acknowledge shame; 2) the tendency to displace shame; 3) the tendency to internalize shame. Each tendency represents a differing psychological coping mechanism adopted by an individual to manage the painful consequences of the experience of shame. Shame acknowledgement is the ideal management strategy; it requires an acceptance of a behavior as outside of one’s character and an endeavor to repair the damage. Shame displacement involves shifting blame from oneself to others, and shame internalization is a position of ruminating on one’s own wrongdoings and a fixation on the rejection of others.
Reintegrating and Stigmatization
Pontzer (2009) relates RST directly to parenting by highlighting two terms: Reintegrative parenting and parental stigmatization. Reintegrative parenting requires awareness of a child’s behavior and wrongdoings as well as taking opportunities to explain to a child why certain behaviors are wrong and that all may be forgiven if proper amends are made. Pontzer (2009) takes care to note that children should be consistently reminded throughout this process of their worth and acceptance by the parent. In contrast, parental stigmatization refers to parenting that is abusive. Pontzer (2009) highlights the dangers of parental stigmatization, noting that parenting that is rejecting can cause a child to imitate hostile behaviors and severely limit their capacity to experience empathy toward others.
Assessing Parenting and the Bully/Victim Relationship
Pontzer (2010), in an attempt to better understand the connection between parenting and the bully/victim relationship, conducted a study among university students in Pennsylvania. Participants were administered written questionnaires, including the revised Olweus Bully/Victim Questionnaire (Olweus, 2001), the Management of Shame State-Shame Acknowledgement and Shame Displacement (MOSS-SASD) (Ahmed, 2001), the Self Esteem Inventory (RSE) (Rosenberg, 1979), Scale of Emotional Empathy (Mehrabian & Epstein, 1972), and Children and Families Scale (McDevitt et al., 1991).
Empathy Training as Possible Treatment
The results of Pontzer’s study (2010) indicate the pervasive presence of bullying at the university level. Fifty-seven percent of individuals who reported bullying over the past couple of months also reported higher degrees of bullying throughout childhood. Further, there was a positive relationship demonstrated between being a bully and parental stigmatization and subsequent patterns of shame displacement. These findings indicate that anger and aggression might represent attempts to avoid the experience of shame. Based on this knowledge, empathy training is indicated as possibly having a great impact on bullies in treatment settings. Interestingly, participants identified as recent victims of bullying in a university setting also reported frequent victimization throughout childhood. These participants had a strong association with the variable of shame internalization and parental stigmatization, and they harbored feelings of low self-esteem, alienation, and self-blame.
Ahmed, E. (2001). Shame Management: Regulating Bullying. Shame management through reintegration (pp 211-301). Cambridge: Cambridge University Press.
Braithwaite, J. (1989). Reintegrative shaming theory. Cambridge University Press.
Braithwaite, J. & Braithwaite, V. (2001). Shame, shame management and regulation. Shame management through reintegration (pp. 1-58). Cambridge: Cambridge University Press.
Chapell, M., Caset, D., De la Cruz, C., Ferrell, J., Forman, J., Lipkin, R., et al. (2004). Bullying in college by students and teachers. Adolescence, 39, 53-64.
Mehrabian, A. & Epstein, N. (1972). A measure of emotional empathy. Journal of Personality, 40, 525-243.
McDevitt, T., Lennon, R., & Kopriva, R. J. (1991). Adolescents’ perceptions of mothers’ and fathers’ prosocial actions and empathic responses. Youth and Society, 22(3), 387-409.
McNamara, B. & McNamara, F. (1997). Keys to dealing with bullies. Hauppauge: Barron’s.
NCES. (1995). Student victimization in schools. U.S. Department of Education.
Olweus, D. (2001). General Information about the revised Olweus Bully/Victim Questionnaire, PC Program and Teacher Handbook. New York: Guildford Press.
Pontzer, D. (November 2009). A Test of Reintegrative Shaming Theory as an Explanation of Bullying Among University Students. Paper presented at the annual meeting of the American Society of Criminology, Philadelphia, PA. Retrieved from http://www.allacademic.com/meta/p379567_index.html
Pontzer, D. (2010). A theoretical test of bullying behavior: Parenting, personality, and the bully/victim relationship. Journal of Family Violence, 25, 259-273.
Rosenberg, M. (1979). Conceiving the self. New York: Basic Books Inc.
Tuesday December 4th 2012 - NYBH Staff
Approaching the Holidays
Many people face the holiday season with a sense of impending doom, because they know it usually means heightened stress and anxiety. The amped-up workload (shopping, decorating, gift wrapping, meal preparation, finding a tree, writing and mailing cards, etc.) and concerns over increased spending--on top of responsibilities of “making nice” with family members you see infrequently and trying to prevent family disputes and clashes--can mark that celebrative period with serious tension … or make your life a living hell.
A recent article in Psychology Today offers a few recommendations that can help decrease feelings of stress over the holiday season and increase sense of joy. The main ingredient to all of these is mindfulness. “Paying full whole-hearted attention” is how mindfulness is defined in this article. Key features are your being observant without being critical and being compassionate with yourself. How does this apply to stress relief? Well, one very important way is being able to acknowledge the feelings of stress or unhappiness and realizing that they will pass.
Schedule to Lower Stress
So, while the time leading up to the holidays can be quite stressful, the author suggests incorporating something for yourself into your schedule every day, while always being mindful, can be, as the author suggests, the smart and healthy way to handle the season.
The holidays can be exciting and joyful, but they can also create feelings of anger, stress, resentment, anxiety, and exhaustion. These feelings can get triggered simply by waiting in a register line to purchase gifts for your loved ones, searching for last-minute items needed for holiday preparations, or looking once more over the list of all the tasks you still need to complete.
Putting Mindfulness into the Season
To this end and also toward experiencing all the positive feelings that the holiday season can offer, the author suggests a 10-day stress-lowering recipe with mindfulness as the main ingredient.
1. Eat some chocolate, but, this time, chew slowly and pay particular attention to the wonderful flavors, textures, and aromas, instead of simply devouring it like an animal. You can call it “chocolate meditation.”
2. Go for a 15- to 30-minute walk while paying close attention to your surroundings.
3. Carry out a three-minute breathing exercise.
4. Do something pleasurable, i.e., visit a friend, make time for your favorite hobby, read a book, or do whatever you know pleases you.
5. Follow the “Intensely Frustrating Line Meditation” whenever your progress toward goals is blocked. That is, if you are forced to wait long periods, try to get in touch with, become aware of, and be mindful of the thoughts, sensations, and emotions prompted by the situation.
6. Set up a mindfulness bell to help remind you to experience fully and enjoy each activity.
7. Use the “ten-finger gratitude exercise” to come to a positive appreciation for the small things in your life.
8. Practice the author’s “sounds and thoughts meditation,” which is central to mindfulness and to becoming a happier, more relaxed, and centered person. A link is provided in the article.
9. Reclaim your life. That is, if there was a point in your life where things seemed easier and simpler, recall as many activities as you can that you engaged in at that time, and make them part of your life again.
10. Visit the movies. Yes, you've probably seen movies on the big screen many times, BUT have you ever planned a trip to the movies at an established time that works best for you, without knowing what movies were playing? Why not set a time and choose a movie only when you arrive at the theater?
These are a few tips the author shares in his article for making your holidays more pleasant. Have you ever tried any of these? How likely are you to incorporate one or more into your holiday schedule? Perhaps there are other things you recall that have worked in reducing your holiday stress. Do you have any additional tips or recommended changes regarding the “recipe” offered by the author?
Penman, D. (2011, December 16). Christmas stress relief: A mindful ten day guide. Psychology Today, Retrieved from http://www.psych ologytoday.com/print/82625
Tuesday November 13th 2012 - NYBH Staff
Bullies and the DSM
The current diagnostic manual used to identify and categorize psychological disorders is the DSM-IV-TR (soon to be replaced by a fifth edition). In an attempt to better understand bullying behavior in children and the existence of psychopathology as categorized in this manual, a team of researchers designed a study. Young participants were assessed for the existence of Axis I and Axis II (Personality) disorders, and the researchers (Coolidge, DenBoer, & Segal, 2004) hypothesized that bullies would more often have diagnoses of conduct disorder, attention deficit hyperactivity disorder (ADHD), and/or oppositional defiant disorder (Axis I) than the control group. They also hypothesize certain personality disorders may be more prevalent among populations of bullies but are careful to note that the diagnosis of personality disorders (Axis II) among children is not common or encouraged. It is, however, possible, if the symptoms persist for a year and are pervasive to the child’s life (Coolidge et al., 2004).
Bullies’ Problem Behaviors
Participants identified as bullies were selected from a middle school population of students reported three or more times by teachers and administrators for one or more problem behaviors: name calling, ?ghting, relentless picking on other students, de?ance toward teachers, or getting kicked out of an in-school suspension class. The control group was selected to closely match the bully group in terms of demographical information, but participants were required to have no record of referral to the office over the past school year. Student participants and their parents were not aware of their classifications for the study and their parents were asked to complete and return their respective measures at home or in parent conferences. Parents were asked to complete the Coolidge Personality and Neuropsychological Inventory (CPNI) (Coolidge, 1998; Coolidge, Thede, Stewart, & Segal, 2002), a standardized measure of children’s and adolescents’ psychological functioning. Teachers were then asked to complete Weinhold’s survey of bullying and related behaviors as adapted from the work of Espelage (Espelage, Bosworth, & Simon, 2000).
Characteristics Related to Bullying Behavior
Results of this study (Coolidge et al., 2004) supported the investigators’ initial hypothesis that child bullies often have pathological diagnoses as co-morbidities to negative problem behaviors. Bullying behavior was found to be more often associated with Axis I disorders such as conduct disorder, oppositional de?ant disorder, ADHD, and depression, but not with anxiety, compared to controls. The portion of the CPNI that screened for depression revealed the most discriminate items (differentiating participants in the bully group from the control group) were sadness, low-self esteem, depression, and feelings of worthlessness. Coolidge et al. (2004) suggest the treatment of the aforementioned emotional deficits may produce positive behavioral changes and alleviate potential root causes of outward aggression.
The Nature of Bullies
Similarly, the researchers generated data supporting the hypothesis that child bullies are more likely to suffer from a spectrum of personality disorder characteristics: passive–aggressive, histrionic, paranoid, and dependent behaviors. According to the investigators, “These results, if replicated, show the deep-seated rejection of rules, institutions, and authority ?gures, and also show that the nature of bullies is to fail to cooperate with authority ?gures” (Coolidge et al., 2004, p. 1566). The implications of the findings are important for intervention and prevention programs and should be explored further by researchers and clinicians alike. Perhaps bullying behavior is more often the outward expression of an inner pathology in children who do not yet know other pathways to manage certain emotional and psychological deficits.
Coolidge, F., DenBoer, J., & Segal, D. (2004). Personality and neuropsychological correlates of bullying behavior. Personality and Individual Differences, 36, 1559-1569.
Coolidge, F. L. (1998). Coolidge personality and neuropsychological inventory for children (CPNI): Manual. Colorado Springs, CO: Author.
Espelage, D. L., Bosworth, K., & Simon, T. R. (2000). Examining the social context of bullying behaviors in early adolescence. Journal of Counseling and Development, 78, 326–333.
Tuesday October 30th 2012 - NYBH Staff
Concept of Empathy
In an attempt to better understand the effectiveness of empathy training as an intervention to bullying behaviors, Sahin (2012) designed an experimental study. Empathy has historically been understood as both (1) a cognitive function that allows an individual to be aware of another’s thoughts and feelings and (2) an affective reaction, or an ability to understand another’s feelings (Bernadett-Shapiro, Efrensaft, & Shapiro, 1996; Feshbach & Roe, 1968; Merrabian & Epstein, 1972). Sahin (2012) used this two-part interpretation of empathy in the creation and implementation of an empathy training program, which was prepared using research conducted by Ozbay and Sahin (2004) on the acquisition of empathetic skills in the therapeutic setting. The empathy training program was tested on an experimental group of children identified as bullies, to determine if empathic skills can be learned and employed to improve behavior.
Empathy Training Program
Participants were selected for the experimental group, based on their answers to the Scale of Identifying Bullying/Child Form (Piskin & Ayas, 2007), administered to the population of sixth graders in Trabzon, Turkey. The control group was comprised of a random selection of students, not identified as bullies. Experimental group participants were also asked to complete Yilmaz-Yuksel’s Empathy Index for Children (2003) and proceeded from there to complete an eleven-session empathy training program. The program consisted of varying activities, interactions, and lectures, all aimed at assisting participants in identifying and relating to different emotional experiences. Homework was assigned to encourage students to actively think about and engage in emotional recognition during their everyday lives.
Changes in Empathy Level and Behavior
The results of the experiment indicated that the empathic education program was effective in reducing bullying behaviors in the sixth grade population that comprised the study (Sahin, 2012). Among students in the experimental group, bullying behaviors were decreased immediately following the experiment as well as in a 60-day follow-up study. In addition to demonstrated behavioral changes on the part of these students, there were also higher levels of empathy reported after the program. Successful empathic skill-building programs have several implications for mental health outcomes. Sahin (2012) cited studies that indicate children with high empathic skills had lower anger levels and incidents of physical and verbal violence (Robert & Strayer, 2004). Further, Sahin (2007) noted in a previous study that empathic training developed children’s empathic skills and increased self-esteem. Further investigation into the efficacy of empathy training programs in the treatment of bullying should be a priority for researchers, clinicians, and program administrators as an intervention with cascading benefits to multiple layers of a child’s development.
Bernadett-Shapiro, S., Efrensaft, D., & Shapiro, J. (1996). Father participation in childcare and the development of empathy in sons: An empirical study. Family Therapy, 23, 77–93.
Feshbach, N. D., & Roe, K. (1968). Empathy in six- and seven-year olds. Child Development, 39(1): 133–145.
Merrabian, A., & Epstein, N. (1972). A measure of emotional empathy. Journal of Personality, 40(4): 525–543.
Özbay, Y., & ?ahin, M. (2004). Emphatic atmosphere in psychological counseling and developing empathic ability. Süleyman Demirel University, The Social Sciences Review of the Faculty of Science and Literature, 11, 137–150.
Pi?kin, M., & Ayas, T. (2007). Developing the scale of identifying bully and victim/child form. Paper presented at the XVI National Congress of Educational Sciences, Tokat, September, 2007.
Robert, W., & Strayer, J. (2004). Children’s anger, emotional expressiveness, and empathy: Relations with parents’ empathy, emotional expressiveness, and parenting practices. Social Development, 13(2): 229-254.
Sahin, M. (2007) Researching the efficiency of empathy training to prevent bullying behaviors in primary schools. Unpublished Doctoral Thesis, Ataturk University, Institute of Social Sciences.
Sahin, M. (2012). An investigation into the efficiency of empathy training program on preventing bullying in primary schools. Children and Youth Services Review, 34, 1325-1330.
Y?lmaz-Yüksel, A. (2003). The Effect of Empathy Training on Primary School Children's Emphatic Ability. Unpublished Doctoral Thesis, Ankara University, Institute of Educational Sciences.
Thursday October 25th 2012 - NYBH Staff
Domains of Anxiety Disorder Symptoms
A study was recently conducted to better understand the difference in symptom severity and frequency between youth diagnosed with obsessive-compulsive disorder (OCD) and those with other anxiety disorders (ADs). The researchers hypothesized that youth with OCD would demonstrate poorer functioning across several domains: Emotional functioning, oppositionality, cognitive and attention problems, and levels of impairment (Jacob, Morelen, Suveg, Brown-Jacobsen, & Whiteside, 2012). It is noted that research examining the difference between ADs is limited; therefore, clinicians run a risk of generalizing treatment without due consideration to the specific deficits or impairments presented in each client.
Varying reasons for the aforementioned hypothesis were detailed by Jacob et al. (2012). With regard to externalizing behaviors, children with OCD may be at higher risk for disruptive or oppositional behaviors as a result of their need to complete certain rituals (Riddle, Scahill, King, & Hardin, 1990). Cognitive functioning and capacity for attention are also hypothesized to suffer as a result of symptoms related to OCD. The researchers cited a study by Barrett & Healy (2003) that indicated youth with OCD reported feeling “less cognitive control” than their peers with other AD diagnoses. The reason for this discrepancy could be attributed to the mental energy that rituals and intrusive thoughts consume in a youth with OCD.
Youths and Parents Surveyed
The resulting study included youth with a primary diagnosis of OCD and/or other ADs. Participants and one parent each were asked to complete a diagnostic interview and several questionnaires: Emotion Regulation Checklist (ERC, Shields & Cicchetti, 1997); Connor’s Parent Rating Scale-Revised-Short Version (CPRS-R:S, Connors, 2001); Child Sheehan Disability Scale-Parent Report (CSDS-P, Sheehan, 1986); Spence Children’s Anxiety Scale for Parents (SCAS-P, Spence, 1998) and Spence Children’s Anxiety Scale (SCAS, Spence 1998).
Psychoeducation for Parents Needed
The results of the study affirmed the researchers’ hypothesis that youth with OCD suffer greater deficits in functioning than their peers with other AD diagnoses. Consistent with studies indicating youth with OCD use ineffective coping strategies for distressing emotions, the research by Jacob et al. (2012) indicated youth with OCD demonstrated lower levels of emotion regulation. Similarly, youth with OCD also displayed “more oppositional behavior than youth with other ADs” (Jacob et al., 2012, p. 233). These findings highlight the need for further psychoeducation for parents surrounding the symptoms of OCD and better management strategies for defiant or disruptive behavior. Lastly, children with OCD also “demonstrated more cognitive problems/inattention than the non-OCD sample” (Jacob et al., 2012, p. 235).
Need for Greater Insight into Distinctions
The researchers stress the importance of future research distinguishing all ADs from one another in terms of symptomology and of severity of symptoms to “facilitate a more in-depth understanding of their similarities and differences” (p. 235).
Connors, K. (2001). Connors’ Rating Scales-Revised: Technical Manual. North Tonawanda, New York: Multi-Health Systems.
Jacob, M., Morelen, D., Suveg, C., Brown-Jacobsen, A., Whiteside, S. (2012). Emotional, behavioral, and cognitive factors that differentiate obsessive-compulsive disorder and other anxiety disorders in youth. Anxiety, Stress, & Coping, 25 (2), 229-237.
Sheehan, D. (1996). The anxiety disease. New York: Bantam Books.
Shields, A., & Cicchetti, D. (1997). Emotion regulation among school-age children: The development and validation of a new criterion Q-sort scale. Developmental Psychology, 33, 906-916.
Spence, S. (1998). A measure of anxiety symptoms among children. Behavior Research and Therapy, 36, 545-566.
Wednesday October 17th 2012 - NYBH Staff
Focused vs. Open Monitoring Attention
Meditation encompasses a wide variety of practices performed with the ultimate goal of achieving a heightened sense of well-being. Studies have shown that long-term meditation practitioners can actually alter the structure and function of their brains by means of this practice. In particular, Davidson and Lutz (2008) studied the effects that focused attention (FA) and open monitoring attention (OM) had on brains. FA refers to the practice of voluntarily focusing attention on a chosen object in a sustained fashion. OM meditation involves non-reactively observing the content of experience from moment to moment, primarily as a means to recognize the nature of emotional and cognitive patterns.
A keyword for understanding these processes is neuroplasticity, which describes brain changes that occur due to experience. Meditation, like other forms of skill acquisition, can prompt plastic changes in the brain. Specifically, the study carried out by Davidson and Lutz (2008) looked at variations in patterns of brain function, changes in the cortical evoked responses to visual stimuli related to the impact of meditation on attention, and alterations in amplitude and synchrony of high-frequency oscillations that probably play an important role in connectivity among widespread circuitry in the brain.
Maintaining Attentional Focus
What the researchers found—first, and in particular—was that FA meditation training diminishes the necessary effort to maintain attentional focus (Davidson, R., & Lutz, A., 2008). It is important to note that this pattern was stronger for long-term practitioners. Interestingly, this pattern seems to be similar to that of any new skill acquisition, such as language acquisition—illustrated by the famous learning curve that is u-shaped.
Further, through brain imaging technology, the amygdalae of expert FA meditators were shown to be less activated than those of novices when presented with emotional sounds. The amygdala of the human brain is part of the limbic system and causes the release of stress hormones prompting, among other things, the “fight-or-flight” response. The finding, therefore, suggested that the advanced levels of concentration commonly seen in expert meditators decrease emotionally reactive behaviors that usually conflict or interfere with the stability of concentration.
OM meditation specifically was found to decrease elaborative stimulus processing (Davidson, R., & Lutz, A., 2008). What might this indicate in terms of our practice of meditation as well as in terms of our daily lives? It means that these individuals (OM meditators) are more effective in attending moment-to-moment to the stream of stimuli present and as a result are less likely to stay stuck on one stimulus. Not only is this observed when engaged in meditation, but also it is suggested to be a long-term effect that is present when not meditating.
Particular Benefits of Meditation
The investigators concluded from their results that attention is a trainable skill and FA meditation seems to enhance this possibility. Furthermore, they believe the findings demonstrated that OM meditation can help reduce the “neural noise” we are typically faced with and therefore help us to be more effective in attending to the stream of more important stimuli present.
Question about Meditation
There are many more ways people feel that the practice of meditation helps them. If you are a practitioner, tell us how it has improved your life or how it helps you on a regular basis, and please mention the kind of meditation in which you engage.
Davidson, R., & Lutz, A. (2008). Buddha’s brain: Neuroplasticity and meditation [In the spotlight]. IEEE Signal Processing Magazine 25(1), 176–174.
Tuesday October 16th 2012 - NYBH Staff
What is Known about Pain and OCD
A few years ago, a study of a sample of individuals diagnosed with obsessive-compulsive disorder (OCD) showed a 22.4% prevalence of self-harming behaviors du Toit, van Kradenburg, Niehaus, and Stein (2001). Despite the prevalence demonstrated, there were still, until recently, no studies reported that examined the relationship between pain and OCD. Thus, another group of researchers decided this was an area that should be explored, so they conducted a study in the attempt to better understand the correlates between the two phenomena. Prompted by the aforementioned 2001 study, Hezel, Riemann, and McNally examine the relationship between OCD (as well as other disorders on the obsessive-compulsive spectrum, such as compulsive non-suicidal self-injury) and the experience of physical pain (2012).
Pain Tolerance and Pain Endurance
The researchers note historical studies indicating that individuals suffering from emotional distress, most specifically chronic guilt, often have higher pain tolerance and pain endurance than their peers. For purposes of their study, they define pain tolerance as, “The time it takes before the pain becomes intolerable, prompting the person to demand termination of the stimulus” (Hezel et al., 2012, p. 982). Similarly, pain endurance is defined as the amount of time the person continues to bear the stimulus after he or she first identifies it as painful. Historical studies suggest that individuals with low self-worth and negative self-thoughts were at the highest risk for performing non-suicidal self-injury (NSSI); the self harming behavior is hypothesized to be used as a mechanism for regulating negative emotions (Hooley, Ho, Slater, and Lockshin, 2010).
Measures of Pain and Emotions
In their current study, Hezel et al. (2012) hypothesized that participants with OCD would have a higher pain tolerance, would endure the pain for greater lengths of time, and would thereby experience emotional relief (self-punishment) from the heightened experience of physical pain. Participants were recruited from an OCD clinic in the Midwest and control group participants were recruited through advertisements on Craigslist. The State Shame and Guilt Scale (SSGS) was used to measure moral, self-referential emotions of shame, guilt, and pride (Marschall, Sanftner, and Tagney, 1994). The Yale Brown Obsessive-Compulsive Scale (Y-BOC) was also used to measure OCD symptom severity. To assess participants’ pain tolerance and pain endurance, Hooley and Delgado’s (2001) portable pressure algometer was used. The device causes constant and increasing pressure to participants’ fingers, and though no tissue damage occurs, is akin to the feeling of a dull butter knife on an individuals’ skin. All subjects in this study were directed to tell researchers when pain was first noticed and, again, when it became intense enough that the subject wanted the algometer removed.
Emotional and Physical Pain
The study under discussion produced findings that are, for the most part, in line with the researchers’ hypotheses. Those participants with OCD, for example, were found to be unusually tolerant of physical pain--regardless of the nature or severity of their symptoms (Hezel et al, 2012, p. 984). Through the use of the Distress Tolerance Scale (DTS) the researchers also noted that those with low scores on the DTS also exhibited a higher pain tolerance. These results suggest that individuals who struggle to experience emotional pain are able to endure physical pain to a much greater extent; in effect the physical pain distracts from emotional pain.
Control of the Pain
Two comments in particular made by participants about pain experienced in the study were noted by the researchers. One of the patients indicated that the pain “felt good” and the other, “In all the craziness of my OCD, pain is a constant. It’s one thing that you can count on” (p. 985). Sadly, patients with OCD seemingly struggle to control negative and aversive thoughts in their lives and may take comfort in the ability to control some component of aversive stimuli, such as exposure to physical pain (Hezel et al., 2012).
du Toit, P. L., van Kradenburg, J., Niehaus, D., & Stein, D. J. (2001). Comparison of obsessive-compulsive disorder patients with and without comorbid putative obsessive-compulsive spectrum disorders using a structured clinical interview. Comparative Psychiatry, 42(4), 291-300.
Goodman, W. K., Price, L. H., Rasmussen, S. A., Mazure, C., Delgado, P., Heninger, G. R., et al. (1989). The Yale-Brown obsessive-compulsive scale II. Validity. Archives of General Psychiatry, 46, 1012-1016.
Hezel, D., Riemann, B., McNally, R. (2012) Emotional distress and pain tolerance in obsessive-compulsive disorder. Journal of Behavior Therapy and Experimental Psychiatry, 43, 981-987.
Hooley, J. M., & Delgado, M. L. (2001). Pain insensitivity in the relatives of schizophrenia patients. Schizophrenia Research, 47, 265-273.
Hooley, J. M., Ho, D. T., Slater, J., & Lockshin, A. (2010). Pain perception and non-suicidal self-injury: A laboratory investigation. Personality Disorders: Theory, Research, and Treatment, 1, 170-179.
Simons, J. S., & Gaher, R. M. (2005). The distress tolerance scale: Development and validation of a self-report measure. Motivation and Emotion, 29, 83-102.
Mental Contamination of Obsessive Compulsive Disorder OCD Treated with Cognitive Behavior Therapy-CBT
Monday October 8th 2012 - NYBH Staff
Case Study of Mental Contamination Obsessions
Mental contamination refers to a “phenomenon whereby people experience feelings of contamination from a non-physical contaminant” (Warnock-Parkes, Salkovskis, & Rachman, 2012, p. 383). A good many patients with obsessive-compulsive disorder (OCD) report this symptom. OCD affects between 1%-2.5% of the population, with contamination concerns and the related compulsion to wash excessively in a reported 38-50% of people diagnosed with the disorder (Torres et al., 2006; Rachman & Hodgson, 1980; Foa et al., 1995; Foa et al., 1998). Recently, a team of researchers shared valuable insights about the treatment of mental contamination with a single case study of a 40 year old male, by the alias of David, suffering from severe obsessions of mental contamination that resulted in a 20 year period of unemployment and restricted living (Warnock-Parkes et al., 2012).
Concerns with Contamination
Interestingly, the researchers highlight the important connection between common contamination concerns and the contemporary culture in which they manifest. For example, contamination obsessions became much more common after the discovery of germs in the late 1800s and subsequently shifted to radiation concerns after World War II. More recently, contamination concerns are related to illnesses such as HIV/AIDS (Warnock-Parkes et al., 2012). The prevalence and severity of contamination based concerns heightens the necessity for clinicians to understand effective treatment strategies. Warnock-Parkes et al. (2012) glean their treatment strategy from Rachman’s 2006 and 2010 research studies into treatment differentiation for mental contamination versus other OCD symptoms.
Role of Emotions
Mental contamination concerns differ from contact contamination concerns (contamination obsessions about items that can contaminate) in terms of effective treatment. Mental contamination obsessions tend to induce more pervasive feelings of contamination and are typically connected to specific emotional reactions as well (Rachman, 2006). Rachman (2006) highlights the important theme of betrayal/violation often present for individuals suffering this symptom; this corresponds to the discrepancy between contamination-inducing subjects. Mental contamination is most often induced by a person or group of people than by a substance (Rachman, 2006).
Personal Events Affect Contamination Obsessions
In David’s case, feelings of contamination were induced by thinking about the government, brown envelopes, and his ex-wife. David’s history revealed that symptoms first started after a traumatic divorce with his ex-wife, an action taken after David found out his wife had cheated on him several times. He was taken to court for custody of their children and delivered frequent official government mail (in brown envelopes) including devastating materials such as divorce papers. David’s reports of feeling contaminated and “like rubbish” merely by thinking about the government or his ex-wife make much more sense within the context of his personal narrative.
Two different courses of action were attempted by Warnock-Parkes et al. (2012) during David’s treatment: high quality cognitive behavioral therapy (CBT) and cognitive therapy focused on mental contamination (CTMC). Before treatment, he was administered several assessment scales to measure OCD symptoms, anxiety and depression, work and social adjustment, and level on contamination subscale. First, David attended six sessions of high-quality CBT with a well regarded therapist, after which point he disengaged and reported not to have found the treatment helpful. David was then referred on to option two, CTMC, consisting of 13 sessions of treatment focused on seven key steps (Warnock-Parkes et al., 2012, p. 388):
1. Extended assessment and formulation
2. Psychoeducation and socialization to the mental contamination model
3. Motivation to change and goal setting
4. Cognitive work on key appraisals, including imagery re-scripting
5. Behavioral experiments using exposure and response prevention therapy (ERP) and stimulus discrimination
6. Reclaiming life following OCD
7. Relapse prevention and booster sessions
The result of CTMC for the treatment of David’s mental contamination concerns eliminated David’s reported excessive washing due to contamination obsessions. David also reported improved familial relationships and ability to tolerate mail/brown packages into his home. He was able to use local facilities that otherwise would have greatly concerned him for contamination, like government centers.
Tailored Cognitive Interventions
This case study is believed by the research team to accomplish several things. Chiefly, it accurately illustrates Rachman’s proposals about the necessity of addressing mental contamination by targeting the underlying and historical issues through a series of specifically tailored cognitive interventions such as imagery re-scripting (Warnock-Parkes et al., 2012). These interventions aim, over time, to affect how a patient appraises historical memories and current activators, or how he/she evaluates people or events that trigger said memories and activate the instinct to re-live emotional traumas. The researchers hope a more targeted treatment for those suffering from mental contamination will yield significant symptom reduction, greatly benefitting the large percentage of patients with OCD who currently drop out of treatment relatively early with little to no improvement.
Foa, E. B., Kozak, M. J., Goodman, W.K., Hollander, E., Jenike, M. A., & Rasmussen, S. A. (1995). DSM-IV field trial: Obsessive-compulsive disorder scale. American Journal of Psychiatry, 152(1), 90-96.
Foa, E. B., Kozak, M. J., Salkovskis, P. M., Coles, M. E., & Amir, N. (1998). The validation of a new obsessive-compulsive disorder scale: The Obsessive-Compulsive Inventory. Psychological Assessment, 10(3), 206-214.
Rachman, S. (2006). The fear of contamination: Assessment and treatment. Oxford: Oxford University Press.
Rachman, S. (2010). Betrayal: A psychological analysis. Behavior Research and Therapy, 48, 304-311.
Torres, A., Prince, M., Bebbington, P., Bhugra, D., Brugha, T., Farrell, M., et al. (2006). Obsessive-compulsive disorder: prevalence, comorbidity, impact, and help-seeking in the British National Psychiatric Morbidity Survey of 2000. American Journal of Psychiatry, 163, 1978-1985.
Warnock-Parkes, E., Salkovskis, P., Rachman, J. (2012). When the problem is beneath the surface in OCD: The cognitive treatment of a case of pure mental contamination. Behavioral and Cognitive Psychotherapy, 40, 383-399.