I am excited to share some very preliminary pilot results regarding the novel intervention strategy we have developed for this project. The intervention involves guiding patients to notice and reflect on the therapeutic value of practicing what we have termed "cognitive integrity" - that is, being actively honest with oneself. So far we have collected data from 12 patients with OCD and/or related anxiety disorders who completed our 30-minute adjunct intervention prior to one of their regularly scheduled exposure-based therapy sessions. In short, patients reported finding our adjunct intervention helpful at increasing their motivation and persistence during the subsequent exposure session. The patients' therapists also reported that the patients engaged more fully (t(11)=2.80, p=.017) and showed more willingness to experience emotional discomfort during exposure (t(11)=3.53, p=.005) following our adjunct intervention than they had in previous sessions. Patients also provided some helpful qualitative feedback on our adjunct intervention, from which we quote some anonymized excerpts below:
“I really found the advice about the importance of being honest with yourself helpful. I had some homework that I did not fully complete and I will often just claim to have completed something even if I haven’t because I want to show the appearance of making progress. This discussion made me think hard about the difference between actually accomplishing something vs. just appearing to accomplish something.”
“I think that using personal honesty when it comes to pushing as hard as possible in completing exposures can be an effective motivator. The effectiveness could vary depending on the difficulty of the exposure at hand and if there are any distractions that are diverting focus."
“I thought it was helpful to speak about the importance of recognizing passive avoidance when completing exposure tasks. While I knew [my therapist] and I were going to discuss it anyway and I have always been pretty cognizant of it, it was great to hear it an additional time to keep it at the forefront of my mind."
“I think it was helpful for me to find an example of when I struggled with doing something that made me uncomfortable, but did it anyway. Remembering how that felt, to get through the experience that I didn't want to do, should be helpful for me to encourage and motivate myself to work through the exposures that I'm doing now. And also to recognize the excuses that I made and to challenge them.”
Eugenia Gorlin, Ph.D., and Tania Lombrozo, Ph.D.
Good thinking can be cultivated by choice: Implications for epistemic responsibility and moral agency
Eugenia I. Gorlin, Ph.D., and Tania Lombrozo, Ph.D.
About This Project
The efficacy of exposure-based therapies for obsessive compulsive disorder (OCD) is among the most well-established findings in clinical psychology. Yet non-response rates are still alarmingly high, with 40% of patients either quitting early or not benefiting. This project will test two theoretically plausible predictors of OCD patients' persistence during treatment, and whether modifying one or both factors can improve treatment outcomes.
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What is the context of this research?
Obsessive compulsive disorder (OCD) symptoms affect as many as 1 in 4 people and are often extremely debilitating. The gold-standard treatment for OCD is exposure and response prevention (ERP), which involves willingly confronting situations one finds distressing (e.g., a dirty, grimy toilet) and resisting the urge to ritualize (e.g., wash one's hands) in response. ERP works extremely well for most patients who get through it successfully; yet 20% of patients drop out early, and another 20% "fail" to benefit. Thus more work is needed to understand why ERP works for some patients and not others, and to improve or tailor our treatment approaches accordingly.
What is the significance of this project?
The success of ERP hinges on patients' ability to exercise self-control in the face of powerful urges to act on their compulsions. Yet self-control is likely impaired in OCD, making this especially difficult. This project will aim to enhance ERP treatment outcomes by strengthening 2 facets of self-control: autonomous motivation (i.e., tying ERP to one's freely chosen goals and values) and working memory (i.e., keeping goal-related information active in memory during a complex task). This will be the first test of whether modifying one or both factors can improve ERP outcomes, thus paving the way to more effective treatments for this debilitating disorder.
What are the goals of the project?
Our goal is to test 2 novel factors that we think may affect patients' ability to stick with, and ultimately benefit from, ERP treatment: their self-reported level of autonomous motivation for treatment, and their performance on a computerized working memory task. We will first test these factors in 100 OCD patients just starting ERP treatment at either a residential or outpatient facility. We will then randomly assign patients to either working memory (WM) training, motivation enhancement (ME), combination (WM+ME), or a placebo control (with "training" on an unrelated task), and will compare their effects on ERP adherence and symptom reduction over treatment.
The participant compensation funds will allow us to compensate patients for their time and energy in completing our assessment procedures, which will be crucial to recruiting and retaining our target sample of 100 participants.
The software licenses will allow us to run our study tasks at the treatment facility where patients will already be receiving care (e.g., McLean Hospital). Specifically, we need e-Prime to run our Operation Span working memory task, Inquisit 4 for the Monetary Choice delay-of-gratification task, and MATLAB for the Effort Discounting task (which measures participants' subjective appraisals of the costliness of effort).
The part-time research assistant compensation funds will allow us to hire a research assistant who is "blind" to intervention condition (unlike the primary investigator) and can travel to the study site at least 1x/week to administer the assessment measures for our study.
The laptop will give us more flexibility to run subjects on-site.
Meet the Team
After a brief stint as an opera singer in training at the New England Conservatory, I realized that my creative proclivities were better channeled into the art and science of improving human psychological well-being. In 2008 I graduated summa cum laude from Tufts University with a Bachelor of Science in psychology and philosophy, and went on to gain additional experience as a research assistant and clinical interviewer in the Massachusetts General Hospital psychiatry department. In 2010 I began my doctoral studies in clinical psychology at the University of Virginia (UVA) under the mentorship of Dr. Bethany Teachman. There, I developed a program of research examining how cognitive and motivational mental processes interactively contribute to anxiety and related emotional disorders. My experimental research in these areas has yielded 10 peer-reviewed publications, a book chapter, and 14 talks and presentations at professional conferences. For my dissertation research I developed and tested a novel intervention strategy that promoted post-failure reengagement in goal-pursuit by targeting both motivational and cognitive mechanisms of rumination. I went on to complete my clinical psychology residency at the Alpert Medical School of Brown University, where I worked with Drs. Mark Zimmerman and Kristy Dalrymple on research examining the psychosocial and psychiatric profiles of adults with cognitive deficits (specifically ADHD). Currently I am completing a postdoctoral fellowship under Dr. Michael Otto’s mentorship at Boston University, where I am conducting evidence-based psychotherapy at the Center for Anxiety and Related Disorders (CARD) and continuing to develop my own independent research program. My ultimate mission is to creatively bridge clinical science and practice to offer more innovative, individually tailored psychological treatments.
Michael W. Otto
I am a Professor in the Department of Psychological and Brain Sciences at Boston University. I have had a major career focus on developing and validating new psychosocial treatments for anxiety, mood, psychotic, and substance use disorders, with a particular focus on treatment refractory populations. This includes a translational research agenda investigating brain-behavior relationships in therapeutic learning. My focus on hard-to-treat conditions and principles underlying behavior-change failures led me to an additional focus on health behavior promotion, including investigations of addictive behaviors, medication adherence, sleep, and exercise. Across these health behaviors, I have been concerned with cognitive, attention, and affective factors that derail adaptive behaviors, and the factors that can rescue these processes. I also investigate exercise as an intervention for affective and addictive disorders, as well as for cognitive enhancement. I have over 400 publications spanning these research interests, and have been identified as a “top producer” in the clinical empirical literature, and an ISI Highly Cited Researcher. I am a Past President of the Association of Behavioral and Cognitive Therapies, and am currently President of Division 12 of the American Psychological Association.
Nothing posted yet.
Note: We plan to run this project at two local treatment facilities - the Center for Anxiety and Related Disorders (CARD) at Boston University and the Obsessive Compulsive Disorder Institute (OCDI) at McLean Hospital. Both facilities have excellent reputations for the evidence-based treatment of anxiety disorders, including OCD, and clinicians at both institutions have expressed a strong interest in collaborating on this research.
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