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The Role of Anxiety Sensitivity in Obsessive-Compulsive Disorder Treatment Outcome
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The Role of Anxiety Sensitivity in Obsessive-Compulsive Disorder Treatment Outcome

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Anxiety Sensitivity (AS) is the fear of bodily sensations related to anxiety due to beliefs that they are harmful. While considerable attention has focused on the link between AS and panic disorder, …

Anxiety Sensitivity (AS) is the fear of bodily sensations related to anxiety due to beliefs that they are harmful. While considerable attention has focused on the link between AS and panic disorder, less research has examined AS in OCD. Calamari and colleagues (2008) found that AS was significantly associated with OCD severity, even after controlling for cognitive risk factors. The present study examined changes in AS over the course of treatment in 337 individuals with an OCD diagnosis and Y-BOCS-SR score of 16 or higher. Multiple regression analysis demonstrated that all variables significantly decreased from admission to discharge. Adding the ASI change over treatment to the multiple regression increased variance accounted for significantly, suggesting that changes in AS may play an important role in the treatment of OCD, and that targeting AS may be beneficial. Limitations and future directions are discussed.

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  • 1. The Role of Anxiety Sensitivity in Obsessive-Compulsive Disorder Treatment Outcome Rachel C. Leonard, Ph.D., Kimberly A. Kinnear, B.S., and Bradley C. Riemann, Ph.D.Abstract Methods Results ConclusionsAnxiety Sensitivity (AS) is the fear of bodily sensations Participants Participants with a comorbid PD diagnosis had significantly higher These results suggest that changes in AS over therelated to anxiety due to beliefs that they are harmful. Participants included 320 adults between the ages of 18 admission ASI scores (M = 34.27, SD = 13.86) than those without a course of treatment may play an important role in OCDWhile considerable attention has focused on the link and 70 (M = 31.33, SD= 12.15; females = 168, 52.5%). PD diagnosis (M = 26.20, SD = 12.40), t(318) = -2.115, p = .035. symptom severity reduction. In addition to exposurebetween AS and panic disorder, less research has All participants had a primary diagnosis of OCD There were no significant differences in all other variables at and response prevention treatment, targeting ASexamined AS in OCD. Calamari and colleagues (2008) established by a psychiatrist who specializes in anxiety admission or discharge based on the presence of a comorbid through interoceptive exposures and thoughtfound that AS was significantly associated with OCD disorder diagnosis and treatment and had a Y-BOCS-SR diagnosis of PD. The mean ASI score in our sample (26.48, SD = challenging regarding the meaning of aversive physicalseverity, even after controlling for cognitive risk factors. score of 16 or higher. Comorbidity was common, with 12.51) is in line with ASI scores reported in other OCD samples sensations may be beneficial in the treatment of OCD.The present study examined changes in AS over the 71.6% of participants having at least one additional (Calamari et al., 2004; Calamari et al., 2008; Taylor et al., 1992). Limitations and Future Directionscourse of treatment in 337 individuals with an OCD diagnosis and 34.7% having at least two additional In order to examine changes over the course of treatment, residual This study has several limitations. First, data ondiagnosis and Y-BOCS-SR score of 16 or higher. diagnoses. Of note, only 11 participants (3.4% of the gain scores (RG) were calculated, which corrects for problems in specific medications prescribed to participantsMultiple regression analysis demonstrated that all sample) had a diagnosis of Panic Disorder (PD) in using raw change scores (see Steketee & Chambless, 1992). Then, throughout the course of treatment were not available.variables significantly decreased from admission to addition to OCD. we examined whether the ASI-RG or BDI-II RG significantly Second, we do not have data on individuals who diddischarge. Adding the ASI change over treatment to the Treatment interacted with the type of program (RTC or IOP) in predicting Y- not complete the BDI-II, ASI, and Y-BOCS-SR at bothmultiple regression increased variance accounted for BOCS-SR RG in order to determine whether data could be admission and discharge; therefore, it is possible thatsignificantly, suggesting that changes in AS may play an The majority of patients (n = 265, 82.8%) were in a collapsed across programs or would need to be analyzed individuals who did not complete these measures atimportant role in the treatment of OCD, and that residential treatment center (RTC), with the remaining 55 separately. This interaction was not significant; therefore, data were both time points (for instance, due to a suddentargeting AS may be beneficial. Limitations and future (17.2%) in an intensive outpatient program (IOP). collapsed across programs for all subsequent analyses. insurance denial) may be significantly different fromdirections are discussed. Participants admitted between May, 28, 2001 and Initial examination of the data using paired-samples t-tests revealed those who did. October 25, 2011 and had an average length of stay of 62.02 days (SD = 32.39, range = 6 - 231), with that scores on the ASI, BDI-II, and Y-BOCS-SR significantly Future research comparing exposure and responseIntroduction participants in the RTC program having an average decreased from admission to discharge, indicating less severe prevention plus interventions targeting AS andAnxiety Sensitivity (AS) is defined as the fear of bodily length of stay of 63.48 days (SD = 32.16, range = 8 - symptom severity. traditional exposure and response prevention that doessensations related to anxiety due to beliefs that these 231) and participants in the IOP program having an not target AS within a sample of individuals with OCDsensations are harmful (Reiss, Peterson, Gursky, & average length of stay of 31.43 sessions (SD = 18.37, but not panic disorder may yield additional insights intoMcNally, 1986). While considerable research attention range = 3.43 – 81.14 sessions). Treatment in both the role of AS in OCD treatment response.has focused on the link between high levels of AS and programs primarily consisted of exposure and responsepanic disorder (e.g., McNally, 2002), less research has prevention (ERP), with cognitive restructuring and Referencesbeen conducted examining the role of AS in OCD. medication management. Of note, participants were not Baer, L., Brown-Beasley, M.W., Sorce, J., & Henriques, A. (1993). Computer-assisted telephone administration of a structuredSupport for a link between AS and OCD includes excluded based on acquired dosage of treatment; interview for obsessive-compulsive disorder. American Journal offindings that AS, as measured by the Anxiety Sensitivity therefore, the data presented includes individuals who Psychiatry, 150, 1737-1738.Index (ASI; Reiss, Peterson, Gursky, & McNally, 1986) or terminated treatment prematurely. Beck, A.T., Steer, R.A., & Brown, G.K. (1996). Manual for the Beck Depression Inventory, 2nd ed. San Antonio, TX: The Psychologicalthe Anxiety Sensitivity Index – Revised (ASI-R; Taylor & Measures Corporation.Cox, 1998), is elevated in individuals with OCD Calamari, J.E., Rector, N.A., Woodard, J.L., Cohen, R.J., & Chik, H.M.compared to nonclinical controls (Deacon & Abramowitz, Y-BOCS-SR (Baer, Brown-Beasley, Sorce, & Henriques, (2008). Anxiety sensitivity and obsessive-compulsive disorder.2006; Taylor, Koch, & McNally, 1992). Individuals with 1993). The Y-BOCS-SR consists of 10 items rated from 0 Assessment, 15(3), 351-363. to 4 for a total score ranging from 0 to 40, with higher Calamari, J. E., Wiegartz, P. S., Riemann, B. C., Jones, R. M., Greer, A.,OCD may also have elevated AS in some areas (i.e., Jacobi, D. M., et al. (2004). Obsessive-compulsive disorderphysical concerns, mental dyscontrol) compared to scores representing greater OCD symptom severity. Baer subtypes: An attempted replication and an extension of a symptom-individuals with non-panic disorder anxiety diagnoses and colleagues (1993) found that scores on the self- In order to more fully examine these relationships, multiple based taxonomy. Behaviour Research and Therapy, 42, 647-670.(Zinbarg, Barlow, & Brown, 1997). Recently, Calamari, report Y-BOCS highly correlate with the interview version, regression analysis was conducted with the BDI-II RG entered in Deacon, B. J., & Abramowitz, J. S. (2006). A pilot study of two-day cognitive-behavioral treatment for panic disorder. BehaviourRector, Woodard, Cohen, and Chik (2008) examined AS and that the Y-BOCS-SR has acceptable internal Step 1 to control for depressive symptoms, and the ASI RG entered Research and Therapy, 44, 807-817.in an OCD sample and found that AS was significantly consistency within OCD samples and has acceptable in step 2. Adding the ASI RG increased variance accounted for from Reiss, S., Peterson, R.A., Gursky, D.M., & McNally, R.J. (1986). Anxietyassociated with OCD symptom severity, even after test-retest reliability. 34.6% to 40.2%, which was a significant change, F change (1, 316) sensitivity, anxiety frequency, and the prediction of fearfulness. Behavior Research and Therapy, 24, 1-8.controlling for other cognitive risk factors. They ASI (Reiss, Peterson, Gursky, & McNally, 1986). The ASI = 29.55, p < .001. Results indicated that, controlling for changes in McNally, R. J. (2002). Anxiety sensitivity and panic disorder. Biologicalsuggested that future studies investigate the potential is a 16 item self-report checklist measuring anxiety BDI-II scores, changes in ASI scores over the course of treatment Psychiatry, 52, 938-946.mediating role of AS over the course of treatment. sensitivity severity. Items are rated from 0-4, with total significantly predicted changes in Y-BOCS-SR scores. Results from Steketee, G., & Chambless, D. L. (1992). Methodological issues in the final step of the regression equation are presented below. prediction of treatment outcome. Clinical Psychology Review, 12,Therefore, the present study sought to examine changes scores ranging from 0-64, where higher scores indicate 387-400.in AS over the course of treatment in individuals with a greater anxiety sensitivity. Taylor, S., & Cox, B. J. (1998). An expanded Anxiety Sensitivity Index: R2 β T p Evidence for a hierarchic structure in a clinical sample. Journal ofdiagnosis of OCD and a Yale-Brown Obsessive- Beck Depression Inventory-II (BDI-II; Beck, Steer, & Anxiety Disorders, 12, 463– 484.Compulsive Scale Severity Rating, Self Report (Y- Brown, 1996). The BDI-II is a 21 item measure of severity DV: Y-BOCS- .402 Taylor, S., Koch, W.J., & McNally, R.J. (1992). How does anxiety SR RGBOCS-SR; Baer, Brown-Beasley, Sorce, & Henriques, of depressive symptoms. Items are rated from 0-4, with sensitivity vary across the anxiety disorders? Journal of Anxiety1993) score of 16 or higher. total scores ranging from 0-63. Higher scores indicate BDI-II RG .481 10.080 < .001 Disorders, 6, 249-259. Zinbarg, R., Barlow, D. H. & Brown, T. (1997). The hierarchical structure greater depression severity. ASI RG .260 5.436 < .001 and general factor saturation of the Anxiety Sensitivity Index: Evidence and implications. Psychological Assessment, 9, 277-284. Rogers Memorial Hospital | Wisconsin | 800-767-4411 | rogershospital.org

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