Academic literature on the topic 'Compulsive behavior – Treatment'

Obsessive–compulsive disorder (OCD) is a chronic and disabling psychiatric disease with a lifetime prevalence of 2–3%. People with OCD suffer from intrusive, unwanted and recurrent thoughts (obsessions) and/or repetitive ritualistic behaviors (compulsions). The aim of this study is to quantify the dimensions of ritualistic ‘compulsive-like’ behavior in quinpirole-induced behavior in rats by using T-pattern behavioral analysis. In addition, we investigated whether the behavioral effects elicited by quinpirole sensitization remained after 2 weeks of cessation of treatment. Finally, to study the neurobiological underpinnings of this ‘compulsive-like’ behavior, we investigated the effect of quinpirole treatment on the extracellular dopamine levels in the nucleus accumbens. Once established, ‘compulsive-like’ behavior is dependent upon quinpirole administration, as this behavior rapidly normalized after cessation of treatment. After a single dose of quinpirole the dopamine level decreased more in saline pre-treated animals as compared with animals given quinpirole treatment continuously. Furthermore, T-pattern analysis revealed that quinpirole-induced behavior consists, unlike OCD rituals, of a smaller behavioral repertoire. As seen in patients with OCD, quinpirole-treated animals performed these behaviors with a high rate of repetition. These findings suggest that quinpirole-induced behavior mimics only part of the compulsive behavior as shown in OCD patients.

ABSTRACTImpulsive-compulsive sexual behavior is a little studied clinical phenomenon which affects ~5% to 6% of the population. In theDiagnostic and Statistical Manual of Mental Disorders, Fourth Edition-Text Revision, it is classified as an impulse control disorder not otherwise specified or a sexual disorder not otherwise specified. It may be placed in a possible new category in theDiagnostic and Statistical Manual of Mental Disorders, Fifth Editioncalled substance and behavioral addictions.This clinical entity is reviewed and the merit of classifying it as an addiction is assessed. Information is presented regarding its diagnostic criteria, epidemiology, types of behavior it can involve, relationship to hypersexuality, comorbidities, treatment, and etiology. The data regarding this disorder and its overlap with chemical addiction is limited. If the two disorders are to be grouped together, further data are needed.

Obsessive–compulsive disorder and autism spectrum disorder commonly co-occur. Adapted cognitive behavior therapy for obsessive–compulsive disorder in adults with autism spectrum disorder has not previously been evaluated outside the United Kingdom. In this study, 19 adults with obsessive–compulsive disorder and autism spectrum disorder were treated using an adapted cognitive behavior therapy protocol that consisted of 20 sessions focused on exposure with response prevention. The primary outcome was the clinician-rated Yale–Brown Obsessive–Compulsive Scale. Participants were assessed up to 3 months after treatment. There were significant reductions on the Yale–Brown Obsessive–Compulsive Scale at post-treatment (d = 1.5), and improvements were sustained at follow-up (d = 1.2). Self-rated obsessive–compulsive disorder and depressive symptoms showed statistically significant reductions. Improvements in general functioning and quality of life were statistically non-significant. Three participants (16%) were responders at post-treatment and four (21%) were in remission from obsessive–compulsive disorder. At follow-up, three participants (16%) were responders and one (5%) was in full remission. Adapted cognitive behavior therapy for obsessive–compulsive disorder in adults with co-occurring autism spectrum disorder is associated with reductions in obsessive–compulsive symptoms and depressive symptoms. However, outcomes are modest; few patients were completely symptom free, and treatment engagement was low with few completed exposures and low adherence to homework assignments. We identify and discuss the need for further treatment refinement for this vulnerable group.

Repetitive behaviors are observed in autism spectrum disorder and obsessive-compulsive disorder. Clinically, obsessive-compulsive disorder obsessions are thought to drive repetitive or ritualistic behavior designed to neutralize subjective distress, while restricted and repetitive behaviors are theorized to be reward- or sensory-driven. Both behaviors are notably heterogeneous and often assessed with parent- or clinician-report, highlighting the need for multi-informant, multi-method approaches. We evaluated the relationship between parent- and child self-reported obsessive-compulsive disorder symptoms with parent-reported and clinician-indexed restricted and repetitive behaviors among 92 youth with autism spectrum disorder (ages 7–17 years). Regression analyses controlling for the social communication and interaction component of parent-reported autism spectrum disorder symptoms indicated child self-reported, but not parent-reported, symptoms of obsessive-compulsive disorder were associated with clinician-observed restricted and repetitive behaviors. Although both parent- and child self-reported obsessive-compulsive disorder symptoms were associated with parent-reported restricted and repetitive behaviors, the overlap between parent-reports of obsessive-compulsive disorder symptoms and restricted and repetitive behaviors were likely driven by their shared method of parent-reported measurement. Results suggest that children experience restricted and repetitive behaviors in ways that more closely resemble traditional obsessive-compulsive disorder-like compulsions, whereas their parents view such behaviors as symptoms of autism spectrum disorder. These findings provide guidance for better understanding, distinguishing, and ultimately treating obsessive-compulsive disorder behavior in youth with autism spectrum disorder and introduce new conceptualizations of the phenotypic overlap between these conditions. Lay abstract Youth with autism spectrum disorder often exhibit symptoms of obsessive-compulsive disorder; however, it can be difficult for parents and clinicians to tell the difference between the restricted and repetitive behaviors often seen in autism spectrum disorder and symptoms of obsessive-compulsive disorder. This difficulty in distinguishing symptoms may arise from the fact that these symptoms appear the same to observers but are typically differentiated based on whether the motivation for the behavior is to reduce stress (restricted and repetitive behaviors) or whether the behavior itself is stressful (obsessive-compulsive disorder). It is important to know the difference between these two symptoms as it may impact the treatment prescribed. The goal of this study was to better determine the difference between restricted and repetitive behaviors and symptoms of obsessive-compulsive disorder in youth with autism spectrum disorder. It was found that although parents and clinicians had trouble differentiating between the two, the children were able to provide insight as to their own motivations for behavior, and thus whether they were restricted and repetitive behaviors or symptoms of obsessive-compulsive disorder. It was also found that children may actually have subjective negative experiences when engaging in restricted and repetitive behaviors, which complicates their classification. These results provide guidance for better understanding, distinguishing, and ultimately treating obsessive-compulsive disorder behavior in youth with autism spectrum disorder.

AbstractThe management of patients with compulsive sexual behavior requires an understanding of the profile of the sexually compulsive or addicted patient. This article summarizes patient characteristics and their implications for treatment. Data from a study of the recovery of 957 patients who had problematic, sexually excessive behavior are presented. Spanning 5 years, the study shows six distinct stages patients experienced and the clinical activities that were most useful to them. A trajectory of a typical diagnosis and treatment path is provided, as well as important resources for physicians and patients.

The purpose of this study was to compare the impact of twelve weeks of instruction in two university-level educational approaches to self management (hatha yoga (EXSCI 119) and the current fitness/wellness core course (PEFWL 101) ) on the problematic behaviors of excessive smoking, dysfunctional eating and excessive alcohol consumption. Some theories of addiction, notably those of Peele and Clemmens, suggest that increased awareness, such as that promoted by hatha yoga, may be valuable to the alteration of the addictive process. The quantitative analysis utilized the stages and processes of change questionnaires developed by many researchers associated with the University of Rhode Island team led by James 0. Prochaska. Analysis of the data did not show any statistical difference between the two approaches. A secondary qualitative analysis suggests that hatha yoga students thought differently about themselves and their experience following their yoga class.
Fisher Institute for Wellness

Problem gambling is best understood from a biopsychosocial perspective, whereby multifaceted biological, psychological, and socio-environmental factors interact in ways that may lead to individual risk. Reinforcement contingencies and operant conditioning appear to play particularly important etiological roles. Theoretically, operant conditioning approaches should therefore comprise particularly effective treatment strategies. While operant conditioning in the form of contingency management is known to be an effective treatment for alcohol and substance abuse, it has never been applied by clinical practitioners in community-based treatment for problem gambling. The present pilot study explored the utility of adding concrete reward contingencies to community outpatient treatment, from the perspectives of clinical effectiveness and client/counsellor experiences. At 3-month follow-up, clinical outcomes compared well to typical treatment outcomes, and treatment retention appeared to be superior. Participating clients perceived concrete rewards to be moderately effective in the change process, while active therapist acceptance of this technique appeared to be limited.
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The purpose of this thesis was to investigate the feasibility of a treatment for hypersexual disorder (HD) by calculating and reporting the results with pre-collected data from a research project at ANOVA/Karolinska Universitetssjukhuset. The treatment was a cognitive behavioral group therapy (CBGT) developed for HD administered in a 7-session group setting with a sample of HD-diagnosed women (n = 16). Feasibility was explored through symptom change of hypersexuality, sexual compulsivity, psychological distress, and depression. Symptom change in relationship to treatment attendance was also explored. In this thesis, the results are considered in a broader context, discussing theoretical issues concerning women’s sexuality in relation to hypersexual problems and medicalization of hypersexual behaviors.   The treatment was shown to be feasible. Significant decrease was found on all measures. Attendance rate significantly correlated with a decrease in depressive symptoms, but not on other measures. Women’s sexuality might differ from men’s, but the treatment, which was first evaluated for men, is still feasible for women. Treatment for hypersexual problems in women and hypersexual problems in women in general have been understudied, which makes this study an important contribution to the research field. Further treatment studies could potentially investigate whether specific alterations based on gender and sexual orientation could be needed for further development of the treatment. There are issues concerning medicalization of hypersexual behaviors which should be considered when addressing the phenomenon, such as the influence of moral and cultural factors on the understanding of hypersexuality. Still, there is need for treatment for hypersexual behaviors experienced as problematic, and having these problems addressed within the medical and scientific field has potential for being beneficial and is preferred to having them left to alternative, unregulated health care providers.

The purpose of this study was to determine what influence scheduled phone contacts would have on the extent of follow-through of continuing care recommednations by participants after treatment. Continuing care recommendations associated with ongoing sobriety include going to another level of care (individual therapy, group therapy, outpatient treatment), attending twelve-step meetings and communicating with a sponsor. Continuing care recommendations are typically written and referred to as a continuing care plan.

The present scoping review of the literature was conducted to analyze all studies of assessment and treatment approaches for individuals diagnosed with obsessive compulsive disorder (OCD) and intellectual disabilities (ID). Search terms were used to identify articles published in behavioral journals. The criteria for the articles reviewed included articles that were peer-reviewed and empirical articles. Online search engines used contained information from the Journal of Applied Behavior Analysis, Journal of Experimental Analysis, The Psychological Record, Behavior Analysis in Practice, The Analysis of Verbal Behavior, and The Behavior Analysis. Key words used in the procedural method of searching for information included obsessive compulsive disorder, OCD, obsessions, compulsions, obsessive hand washing, ordering, checking, praying, counting, repetition, delusional beliefs, grandiose thoughts, controlled thoughts, hoarding, anxiety, panic, fears, germs, look feel sound just right, contamination, and excessive worries. The findings included total of 13,785 articles. After screening for duplication and relevant citations, 13 scoping reviews were identified as meeting eligibility criteria. The present paper reviewed what articles were available with respect to assessments and treatments among individuals with obsessive compulsive disorders and individuals with intellectual disabilities. The result of this study was that one article was found meeting the criteria of assessments and treatments among individuals with obsessive compulsive disorder and intellectual disabilities. The indication, as a result of this study, is that the current literature for assessments and treatments of the symptoms of obsessive compulsive disorders and intellectual disabilities is lacking, and future research is indicated.

O transtorno obsessivo-compulsivo (TOC) possui freqüentemente curso crônico, incapacitando cerca de 10% dos seus portadores. Os sintomas interferem de forma acentuada na vida do paciente, alterando suas rotinas e causando incompreensão dos familiares e daqueles que convivem com ele. A terapia cognitivo-comportamental em grupo (TCCG) é um tratamento eficaz, reduzindo os sintomas do TOC em mais de 70% dos portadores, sendo que ao redor de 27% obtêm remissão completa dos sintomas. Entretanto, cerca de 30% não obtêm nenhuma melhora. Conhecer as razões pelas quais esses pacientes não melhoram e identificar os fatores preditores associados ao aproveitamento ou não da terapia poderia auxiliar em uma melhor compreensão do TOC, numa melhor indicação do tratamento e no desenvolvimento de estratégias que incrementem sua eficácia. O presente estudo foi realizado com 181 pacientes com TOC, que cumpriram um programa de TCCG de 12 sessões semanais de 2 horas, entre outubro de 1999 e dezembro de 2006, no Programa de Transtornos de Ansiedade (PROTAN) do Hospital de Clínicas de Porto Alegre (HCPA), Universidade Federal do Rio Grande do Sul (UFRGS) e tinha como objetivo verificar, em pacientes portadores de TOC, a existência de fatores preditores da resposta à TCCG.Os pacientes foram avaliados antes, durante e ao final do tratamento com os seguintes instrumentos: Y-BOCS, Y-BOCS chek-list, CGI, WHOQOL-BREF. Foi utilizada uma entrevista clínica estruturada com a finalidade de colher dados sobre os sintomas do paciente, histórico da doença, tratamentos anteriores e estabelecimento do diagnóstico do TOC de acordo com o DSM-IV-TR. Também foram coletados dados demográficos, socioeconômicos, status ocupacional, uso de medicação e critérios deinclusão na pesquisa. A entrevista foi complementada pelo MINI (International Neuropsychiatric Interview) para verificar a presença de comorbidades. Considerou-se como “resposta” a redução no mínimo de 35% nos escores da Y-BOCS e uma pontuação na CGI “normal” ou “limítrofe para doença” do pós para o pré-tratamento. O estudo pretende verificar se as seguintes variáveis: sexo, idade do paciente no início do tratamento, tempo de duração da doença, idade de início da doença, situação conjugal, nível de instrução, situação ocupacional, tipo de início da doença, curso, intensidade dos sintomas do TOC no início do tratamento, juízo crítico, história familiar, tipos de sintomas, uso de medicação específica para o TOC concomitante à TCCG estão associadas ou não com a resposta ao tratamento. Para avaliar a associação entre as variáveis categóricas à resposta ao tratamento, foi utilizado o teste qui-quadrado de Pearson. Nas variáveis dicotômicas foi aplicada a correção de Yates. Para avaliar as variáveis quantitativas em relação às categorias de resposta ao tratamento, foi utilizado o teste t de Student para amostras independentes. As variáveis que obtiveram um nível descritivo amostral (valor p) menor do que 0,25 foram inseridas no modelo de regressão logística múltipla.Fatores associados com uma melhor resposta à TCCG: sexo feminino (p=0,074); melhor juízo crítico acerca dos sintomas da doença (p=0,017); melhor qualidade de vida antes do início do tratamento: domínio físico (p=0,039), domínio psicológico (p<0,001), domínio ambiental (p=0,038), domínio social (p=0,053). Fatores associados com piores resultados: maior gravidade global da doença no início do tratamento, avaliada pela CGI (p=0,007); maior número de comorbidades associadas ao TOC (p=0,063); presença de fobia social (p=0,044) e distimia (p=0,072); presença de compulsão de repetição (p=0,104).Numa segunda etapa da análise estatística, incluiu-se no modelo todas as variáveis que na primeira fase haviam apresentado associação com os resultados. As variáveis que na análise de regressão logística múltipla permaneceram associadas significativamente foram: sexo feminino (ORAjustado=2,58; p=0,021); domínio psicológico da WHOQOLBREF (ORAjustado=1,05; p=0,011); juízo crítico (ORAjustado=2,67; p=0,042) e CGI-gravidade antes do inicio da terapia (ORAjustado=0,62; p=0,045). Embora alguns fatores relacionados com a resposta ao tratamento tenham sido identificados, poder prever quais os pacientes irão aproveitar a terapia e quais não irão se beneficiar é uma questão em aberto e está longe de ser esclarecida. As razões para essas dificuldades podem estar relacionadas à heterogeneidade do TOC e das amostras utilizadas nos diferentes estudos, além da falta de padronização das técnicas psicoterápicas utilizadas. Por fim, é possível que fatores não-específicos relacionados com a pessoa do terapeuta, com a qualidade da relação terapêutica, além da motivação e capacidade de tolerar frustração por parte do paciente possam exercer um papel importante que não tem sido avaliado pelas pesquisas.
Obsessive-compulsive disorder (OCD) frequently is a chronic disorder that incapacitates about 10% of patients. Symptoms severety affect the life of patients, change their routines and cause misunderstandings with family and all those that have contact with the patient. Group cognitive-behavioral therapy (GCBT) in 12 two-hour weekly sessions is an efficient treatment that reduces OCD symptoms in over 70% of the patients and results in complete remission of symptoms in 27%. However, about 30% of the patients do not show any improvement. The knowledge of reasons why these patients do not improve and the identification of factors associated with these different therapy outcomes may help to understand OCD better, and may inform treatment indications and the development of strategies to increase its efficacy. This study included 181 patients with OCD treated with 12 session of GCBT from October 1991 to December 2006 at the Anxiety Disorders Program (Programa dos Transtornos de Ansiedade – PROTAN) of Hospital de Clínicas de Porto Alegre (HCPA), Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil. The purpose of this study was to investigate predictors of response to GCBT.The following instruments were used to evaluate patients before and at the end of the treatment: Y-BOCS, Y-BOCS checklist, CGI, WHOQOL-BREF. Evaluation was conducted by means of a structured clinical interview to collect data about the patient’s symptoms, disease history, previous treatments, and OCD diagnosis according to DSM-IVTR (APA, 2002). Demographic and socioeconomic data, occupational status, use of medication and criteria for inclusion in the study were also recorded. The interview wascomplemented with the MINI (International Neuropsychiatric Interview) to investigate comorbidities. Response criteria were: >35% reduction in Y-BOCS scores and normal or borderline CGI scores at post-treatment evaluation. The study investigated the possible association of the following variables with response to treatment: sex, age at beginning of treatment, disease duration, age at onset, marital status, education, occupation, type of disease onset, disease course, intensity of OCD symptoms at beginning of treatment, insight, family history, types of symptoms, and use of antiobsessional medications during GCBT. The Pearson chi-square test was used to evaluate the association between categorical variables and response to treatment. Yates correction was performed for dichotomous variables. The Student t test for independent samples was used to evaluate quantitative variables in relation to categories of response to treatment. Variables that achieved a p value lower than 0.25 were included in the initial logistic regression model, which evaluated the predictors of response to treatment and also controlled for possible confounding variables. The following factors showed associations with response to GCBT: women had greater odds of responding to treatment (p=0.074); better insight into disease symptoms was associated with better results (p=0.017); better quality of life before the beginning of treatment was also associated with better results (physical domain: p=0.039; psychological domain: p<0.001; environmental domain: p=0.038; social domain: p=0.053); patients with greater global severity of disease according to CGI had worse results (p=0.007); a greater number of associated comorbidities (p=0.063), social phobia (p=0.044) and dysthymia (p=0.072) were associated with poorer results; repeating compulsion was also associated with lower odds of responding to treatment (p=0.104).In the second stage of statistical analysis, all variables associated with results in the first analysis were included in the multivariate model, and the variables that retained significance were: female sex (ORAdjusted=2.58; p=0.021); WHOQOL-BREF psychological domain (ORAdjusted=1.05; p=0.011); insight (ORAdjusted=2.67; p=0.042) and CGI-severity before GCBT (ORAdjusted=0.62; p=0.045). Although we identified some factors associated with response to treatment, predicting which patients will benefit from therapy and which will not is still an open question. The reasons for such different outcomes may be associated with the heterogeneity of OCD and of the samples used in different studies, as well as with the lack of standardization of the psychotherapeutic techniques used. Finally, unspecific factors not associated with the person of the therapist, the quality of the therapeutic relationship, and the patient’s motivation and tolerance to frustration may play an important role that remains to be evaluated.

D-cycloserine (DCS), a partial agonist that acts on the N-methyl-D-aspartate (NMDA) receptor of the glutamatergic receptor complex, may enhance fear extinction learning during exposure-based therapy. Clinical studies in adults with obsessive-compulsive disorder (OCD) and non-OCD anxiety disorders - and a recent trial in pediatric OCD - have shown that DCS can improve treatment response to exposure therapy relative to placebo and exposure therapy. Some have hypothesized that improved treatment response is a function of increased compliance and engagement in therapeutic homework tasks, a core component of behavioral treatment. The present study examined the relationship between DCS and homework compliance in a 10-week, double-blind, placebo controlled DCS+CBT treatment trial with 30 children and adolescents with a primary diagnosis of OCD. D-cycloserine was dosed 25 or 50mg (depending on weight) one hour before therapy sessions 4-10. Group status (DCS or placebo) did not predict improved homework compliance over the course of treatment. However, significant group differences in homework compliance were found at the first exposure session. Additionally, homework compliance mediated the relationship between DCS and treatment outcome. When groups were collapsed, homework compliance was directly associated with treatment outcome. These findings suggest that outside the context of DCS, homework compliance is an integral part of OCD treatment.