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Using the Dimensional Obsessive-Compulsive Scale to Predict OCD Symptom Severity Following Treatment

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Rachel C. Leonard, Ph.D.1, Bradley C. Riemann, Ph.D.1, and Jonathan S. Abramowitz, Ph.D.2

The DOCS (Abramowitz et al., 2010) was recently developed to assess OCD symptom dimensions, including: a) contamination-related obsessions and cleaning compulsions; b) obsessions regarding doubt about responsibility for making mistakes or causing harm, with checking and reassurance-seeking rituals; c) obsessions regarding need for completeness, symmetry, or exactness with ordering and arranging rituals; and d) obsessional intrusive thoughts regarding unwanted violent, sexual, or religious content with covert mental rituals or neutralizing rituals. To date, ways in which DOCS dimensions predict symptom improvement have not yet been examined. Therefore, the present study examined how DOCS scores at admission to an intensive outpatient or residential treatment program predict discharge Y-BOCS (Goodman et al., 1989). Results indicated that DOCS Responsibility for Harm and Mistakes and Symmetry/Ordering dimensions predicted discharge Y-BOCS scores, while DOCS Contamination and Unacceptable Thoughts dimensions did not. These results suggest that responsibility for harm and mistakes and symmetry/ordering symptoms may be particularly important targets of treatment.

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  • Transcript of "Using the Dimensional Obsessive-Compulsive Scale to Predict OCD Symptom Severity Following Treatment "

    1. 1. Using the Dimensional Obsessive-Compulsive Scale to Predict OCD Symptom Severity Following Treatment Rachel C. Leonard, Ph.D.1, Bradley C. Riemann, Ph.D.1, and Jonathan S. Abramowitz, Ph.D.2 1 Rogers Memorial Hospital, Oconomowoc, WI 2 University of North Carolina, Chapel Hill, NCAbstract Methods Results ConclusionsThe DOCS (Abramowitz et al., 2010) was recently developed Participants In order to determine whether data from the IOP and Although all variables decreased from admission toto assess OCD symptom dimensions, including: a) Participants included 159 individuals (males = 82) in an residential programs could be collapsed, we first examined discharge, only DOCS Responsibility for Harm andcontamination-related obsessions and cleaning compulsions; intensive outpatient program (IOP; n = 35, 22.0%) or interactions between the DOCS subscale scores and Mistakes and DOCS Symmetry/Ordering significantlyb) obsessions regarding doubt about responsibility for making residential treatment program (n = 124, 78.0%) for OCD. treatment program in predicting discharge Y-BOCS-SR predicted OCD severity at discharge. This suggests thatmistakes or causing harm, with checking and reassurance- scores. None of the interaction terms were significant; Responsibility for Harm and Mistakes and Participants had an average age of 30.88 years (SD =seeking rituals; c) obsessions regarding need for therefore, data from the two programs were collapsed for all Symmetry/Ordering may be particularly important targets 12.00, range = 18 - 70). The majority of participants werecompleteness, symmetry, or exactness with ordering and subsequent analyses. of treatment. It is also possible that therapists providing Caucasian (89.3%), followed by Hispanic (5.0%), Africanarranging rituals; and d) obsessional intrusive thoughts the treatment in this study were more successful inregarding unwanted violent, sexual, or religious content with American (1.9%), Asian (1.9%), and American Indian (0.6%) Data regarding admission and discharge scores are with missing data on 2 participants. All participants had a presented below. targeting contamination symptoms than othercovert mental rituals or neutralizing rituals. To date, ways in primary diagnosis of OCD, a score of 16 or higher on the presentations or that symptoms within these dimensionswhich DOCS dimensions predict symptom improvement have self-report version of the Y-BOCS (Baer, Brown-Beasley, Measure Admission Discharge Test of were better captured by the Y-BOCS than symptoms fromnot yet been examined. Therefore, the present study Sorce, & Henriques, 1993), and completed the measures of Significance the Contamination and Unacceptable Thoughtsexamined how DOCS scores at admission to an intensive interest at admission and a completed self-report Y-BOCS M (SD) M (SD) t(df), p dimensions.outpatient or residential treatment program predict discharge Y-BOCS-SR 26.98 (5.47) 15.75 (7.03) 19.11(158),Y-BOCS (Goodman et al., 1989). Results indicated that at discharge. Most participants (81.8%) had at least one <.001 Limitations and Future DirectionsDOCS Responsibility for Harm and Mistakes and Symmetry/ additional diagnosis. One hundred eleven participants were DOCS 7.39 (6.53) 3.36 (3.83) 10.48(152), This study has several limitations. First, 111 individualsOrdering dimensions predicted discharge Y-BOCS scores, excluded due to not having completed all measures of Contamination <.001 were not included in the analyses due to havingwhile DOCS Contamination and Unacceptable Thoughts interest. Of note, participants were not excluded based on DOCS 7.34 (6.18) 3.56 (4.08) 9.29(150), <.001 incomplete data. It is possible that these individuals differdimensions did not. These results suggest that responsibility acquired dosage of treatment; therefore, the data presented Responsibility for Harm and significantly from those included in the study, andfor harm and mistakes and symmetry/ordering symptoms includes individuals who terminated treatment prematurely. Mistakes therefore the results could have been affected by this.may be particularly important targets of treatment. Treatment DOCS 10.21 (5.89) 5.59 (4.86) 10.73(151), Further, although there are advantages to conductingIntroduction Participants admitted between May 19, 2008 and January Unacceptable Thoughts <.001 research in more naturalistic settings, this sample wasDue to the heterogeneity in OCD symptom presentations, 11, 2012 and had an average length of stay of 67.29 days complex in terms of comorbidity and severity, and DOCS Symmetry/ 7.18 (5.52) 3.69 (3.80) 9.29(151), <.001researchers have attempted to identify meaningful (SD = 32.12, range = 8 – 166 days), with participants in the received a variety of psychiatric medications. Therefore, Orderingsymptom dimensions or subtypes underlying the disorder. RTC program having an average length of stay of 66.50 future research using more tightly controlled methodologyIdentified symptom dimensions differ with respect to days (SD = 31.42) and participants in the IOP program and a larger sample size may be beneficial. In order to more fully examine these relationships, acomorbidity profiles, neural mechanisms, and rates of having an average length of stay of 40.05 sessions (SD = regression analysis was conducted with admission DOCStreatment response (e.g., Mataix-Cols, Rosario-Campos, 19.88). Treatment in both programs primarily consisted of exposure and response prevention (ERP), with cognitive subscale scores as the predictor variables and discharge Y- References& Leckman, 2005; McKay et al., 2004). It has been BOCS-SR score as the outcome variable. DOCS subscalesomewhat difficult, however, to compare extant research restructuring and medication management. Most Abramowitz, J. S., Deacon, B., Olatunji, B. O., Wheaton, M. G., scores accounted for from 11 % of the variance in discharge Berman, N. C., Losardo, D. L., et al. (2010). Assessment ofdue to the variation in symptom dimensions that have participants (72.3%) were taking at least one psychiatric Y-BOCS-SR scores. Results indicated that admission DOCS obsessive-compulsive symptoms: development andbeen identified and methods used to assess them. To medication, which included antidepressants (63.5% of the Responsibility for Harm and Mistakes and evaluation of the dimensional obsessive-compulsive scale.address this problem, Abramowitz and colleagues (2010) sample), anti-anxiety medications (40.3%), antipsychotics Symmetry/Ordering significantly predicted discharge Y- Psychological Assessment, 22, 180-198.recently developed the Dimensional Obsessive- (27.7%), mood stabilizers (16.4%), and stimulants (9.4%). BOCS-SR scores. Results from the regression equation are Baer, L., Brown-Beasley, M., Sorce, J., & Henriques, A. I.Compulsive Scale (DOCS), which assesses the presence Measures presented below. (1993). Computer-assisted telephone administration of aand severity of the most replicated symptom dimensions, R2 β t p structured interview for obsessive-compulsive disorder. Beck Depression Inventory-II (BDI-II; Beck, Steer, & Brown, American Journal of Psychiatry, 150, 1737-1738.including obsessions and functionally related avoidance 1996). The BDI-II is a 21 item measure of severity of Beck, A. T., Steer, R. A., & Brown, G. K. (1996). Manual for thepatterns and compulsions on each dimension. The four DV: Discharge Y-BOCS-SR .110 .001 depressive symptoms. Items are rated from 0-4, with total BDI-II. San Antonio, TX: Psychological Corporation.dimensions, or subscales, include a) contamination- scores ranging from 0-63. Higher scores indicate greaterrelated obsessions and cleaning compulsions, b) Admission DOCS .023 .277 ns Goodman, W. K., Price, L. H., Rasmussen, S. A., Mazure, C., depression severity. Delgado, P., Heninger, G. R., & Charney, D. S. (1989). Theobsessions regarding doubt about responsibility for Contaminationmaking a mistake or causing harm, c) obsessions DOCS (Abramowitz et al., 2010). The DOCS is a 20-item Yale-Brown Obsessive-Compulsive Scale: Development, Admission DOCS .187 2.110 .036 use, reliability, and validity. Archives of General Psychiatry,regarding a need for completeness, symmetry, or self-report measure of severity along the four symptom Responsibility for Harm and 46, 1006-1016.exactness with ordering and arranging rituals, and d) dimensions: a) Contamination, b) Responsibility for Harm Mistakes and Mistakes, c) Symmetry/Ordering, and d) Unacceptable Mataix-Cols, D., Rosario-Campos, M. C., & Leckman, J. F.obsessional intrusive thoughts regarding unwanted (2005). A multidimensional model of obsessive-compulsive Admission DOCS .067 0.815 nsviolent, sexual, or religious content with covert mental Thoughts. Scores on each subscale range from 0 – 20. Unacceptable Thoughts disorder. American Journal of Psychiatry, 162, 228-238.rituals or rituals meant to neutralize the obsessive Y-BOCS-SR (Baer et al., 1993). The Y-BOCS-SR consists McKay, D., Abramowitz, J. S., Calamari, J. E., Kyrios, M., Admission DOCS .172 2.043 .043thoughts. Although the DOCS has demonstrated of 10 items rated from 0 to 4 for a total score ranging from 0 Radomsky, A., Sookman, D. et al. (2004). A critical Symmetry/sensitivity to change over the course of treatment, was in to 40, with higher scores representing greater OCD Ordering evaluation of obsessive-compulsive disorder subtypes:which DOCS dimensions relate to treatment outcome symptom severity. Baer and colleagues (1993) found that Symptoms versus mechanisms. Clinical Psychologyhave not yet been examined. Therefore, the present scores on the self-report Y-BOCS highly correlate with the Review, 24, 283-313.study examined how DOCS symptom dimensions at interview version, and that the Y-BOCS-SR has acceptableadmission relate to OCD symptom severity at discharge internal consistency within OCD samples and hasfollowing treatment. We predicted that all four DOCS acceptable test-retest reliability.subscales would significantly predict OCD symptomseverity at discharge. Rogers Memorial Hospital | Wisconsin | 800-767-4411 | rogershospital.org
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