The goal of the present study is twofold. The first one is to develop a Recogntion Task for adolescents with OCD analogue to the Recognition Task for adults. This Revised Recognition Task can afterwards be used for measurement of the effectiveness…
Source
Brief title
Condition
- Anxiety disorders and symptoms
Synonym
Research involving
Sponsors and support
Intervention
No registrations found.
Outcome measures
Primary outcome
OBQ-CV: The Obsessive Belief Questionnaire-Child Version (OBQ-CV) is a 44-item
youth version of the widely used adult OBQ-44.[24] The adult OBQ-44 was
designed to comprehensively assess OCD-related beliefs.[25,26] Refinement of
the measure has produced a 44-item scale assessing OCD-related beliefs across
three domains: responsibility/threat, perfectionism/certainty, and importance/
control of thoughts.[24] The scales of the adult OBQ-44 have been found to have
strong internal consistency in clinical samples (full scale a 5.95, subscales
range from .89 to .95), as well as strong convergent validity with measures of
obsessive-compulsive symptoms (Coles, Wolters, Sochting, De Haan, Pietrefesa &
Whiteside, (ingediend voor publicatie).OBQ-CV: The Obsessive Belief
Questionnaire-Child Version (OBQ-CV) is a 44-item youth version of the widely
used adult OBQ-44.[24] The adult OBQ-44 was designed to comprehensively assess
OCD-related beliefs.[25,26] Refinement of the measure has produced a 44-item
scale assessing OCD-related beliefs across three domains:
responsibility/threat, perfectionism/certainty, and importance/ control of
thoughts.[24] The scales of the adult OBQ-44 have been found to have strong
internal consistency in clinical samples (full scale a 5.95, subscales range
from .89 to .95), as well as strong convergent validity with measures of
obsessive-compulsive symptoms (Coles, Wolters, Sochting, De Haan, Pietrefesa &
Whiteside, 2011).
LOI-CV: Leyton Obsessional Invertory - Child Version: The LOI-CV is a 20-item
self-report measure of current obsessive compulsive symptoms present over the
past 2 weeks. It has high internal reliability (α = .81), specificity (77%-
84%), and sensitivity (75%-88%) (Berg et al., 1988; Flament et al., 1988). The
original scoring method requires yes/no answers plus a rating of the degree of
interference for each positively scored item. For this study, scoring used was
a 4-point measure of symptom frequency (always = 3, mostly = 2, sometimes = 1,
and never = 0). (Bamber, Tamplin et. al, 2002).
CY-BOCS: Children*s Yale-Brown 0bsessive Compulsive Scale: The CY-BOCS is a
modified version of the Y-BOCS, which was developed by Goodman and colleagues
for adults with OCD (Goodman et al., 1989a,b). Like the adult version, the
CY-BOCS is a 10-item, clinicianrated, semistructured instrument designed to
assess the symptom severity of OCD over the previous week. The overall
structure, the anchor points, and scoring of the original instrument were
retained in the CYBOCS,
but the wording of the probe questions was modified to make them more
developmentally appropriate for children and adolescents. For example, the
suggested probe for interference in the Obsession subscale is *How much do
these thoughts get in the way of school work or doing things with friends?* For
the distress item, the suggested probe is *How much do
the thoughts bother you?* (A copy of the complete instrument is available on
request from Dr. Goodman.) The CY-BOCS has five primary sections: (1)
Instructions, (2) Obsessions Checklist, (3) Severity Items for Obsessions, (4)
Compulsions Checklist, and (5) Severity Items for Compulsions. The CY-BOCS also
includes a set of investigational items concerning insight, avoidance,
indecisiveness, pathological doubting, obsessive slowness, and overvalued
ideation, which may be associated with OCD. The reliability and validity of
these items have not been evaluated in adult samples and will not be included
in this report. The Instructions describe the administration and scoring of the
CY-BOCS for the clinician using the scale. Unlike the adult instrument, the
CY-BOCS often involves two informants: the child and a parent. Depending on age
and level of anxiety, the interview may be conducted jointly with the parent
and child or sequentially. The clinician conducting the interview is called on
to integrate data from all informants into the rating of each item (Scahill
e.a., 1997).
Secondary outcome
RCADS: Revised Child Anxiety and Depression Scales. The initial version of the
RCADS began with a 56-item adaptation of the Spence Children's Anxiety Scale
(SCAS; Spence, 1997, 1998). In addition to the 38 SCAS anxiety items, seven new
items re¯ecting
excessive worry were added to the RCADS item pool to provide an improved test
of the structural validity of the GA scale. These items were generated from
existing questionnaires related to GAD criteria and pathological worry in
children (Chorpita, Tracey, Brown, Collica & Barlow, 1997; Reynolds & Richmond,
1978). Further, new items were added to assess depression, generated from
evaluation of the DSM-IV criteria for Major Depressive Disorder (MDD) as well
as existing measures of childhood depression (e.g. Kovacs, 1980/1981). The
initial depression item pool was 25 items, corresponding to the nine symptoms
of Criterion A for DSM- IV Major Depressive Episode (these also subsumed the
six symptoms of Criterion B for DSM- IV Dysthymic Disorder). This pool was
evaluated by a panel of seven experts in the area of childhood anxiety and mood
disorders, and was then narrowed to 11 items that were felt best to sample the
content domain for the purposes of empirical investigation. Children rate how
often each item applies to them. Items are scored 0 to 3 corresponding to
``never'', ``sometimes'', ``often'' and ``always''. (Chorpita, Yim, Mo, Umemoto
& Francis, 1999).
CDI: Children Depression Inventory. The Children*s Depression Inventory (CDI)
is a widely used, 27-item self-report of depressive symptoms for children and
adolescents (Kovacs, 1985). Raw scores range from 0 to 54; a score of 16 is
often cited as the threshold for depression (Smucker et al., 1986). However,
the specificity of the CDI for the diagnosis of depression has been questioned,
and some investigators have suggested that it measures emotional distress more
generally (Costello and Angold, 1988). (Scahill e.a., 1997).
Background summary
Evidence has accumulated that anxiety is associated with a negative
interpretive bias. That is, highly anxious individuals have
the tendency to interpret ambiguous information in a more threatening manner
than low anxious individuals (Mathews &
MacLeod, 2005). Cognitive theories argue that this biased information
processing is not an incidental epiphenomenon of anxiety,
but that it plays a critical role in the aetiology and maintenance of
pathological anxiety (Beck et al., 1985; Muris & Field, 2008; Matthews &
Mackintosh, 2000). It has been proved that this negative interpretation bias
(and associated feelings of anxiety) can be manupulated in a positive direction
in anxious adults by Cognitive Bias Modification procedures (CBM-I, Matthews &
Mackintosh, 2000). In this procedure participants will read a short socially
ambigueous story and then are required to generate an emotionally positive
outcome. Results
showed that the modification of interpretive bias resulted in a concomitant
change in anxiety. To test whether to test whether
the interpretive bias modification procedure does indeed affect the
interpretation of ambiguous events, the so called *Recognition Task* (based on
the Recognition Task of Eysenk et al. 1991). was used. Participants read
another set of social stories that remained ambiguous in terms of positive or
negative outcome. Afterwards, four interpretations of each story were presented
and participants were asked to indicate the level of similarity between the
provided interpretations and the original ambiguous story.
Recently he CBM-I has also been used in patients with an Obsessive Compulsive
Disorder(OCD). OCD has been classified in DSM-IV (American Psychiatric
Association, 2000) as an anxiety disorder and is characterized by obsessions
and compulsions. Negative interpretations have also been proved to play an
important role in OCD: intrusions of 'normal' people can be interpreted
negatively and become obsessions(Frost & Steketee, 2002). Compulsions serve to
neutralize the anxiety caused by obsessions.dienen Clerkin en Teachman (2010)
demonstrated that negative interpretations of intrusive thoughts could be
modified in more healthy interpretations. in this study the Recognitions Task
was used to measure the effectiveness. in this Recognition Task the welknown
domains of obsessions are used: Tolerance for Uncertainty (e.g.,difficulty
tolerating ambiguity); Threat Estimation (e.g., overestimationof the likelihood
of negative outcomes); Control ofThoughts (e.g., notion that thoughts must be
actively controlled); Importance of Thoughts (e.g., belief that intrusive
thoughts are
meaningful and indicative of one*s character); Responsibility (e.g.,idea that
one must be vigilant about preventing harm at all times);
and Perfectionism (e.g., belief that one must be *perfect*). ( OCCWG, 2003;
2005).
From research in children and adolescents we now know that there is a relation
between anxiety and negative interpretation bias (Bögels & Zigterman, 2000)
and that this interpretationbias can be manipulated in a postive direction in
adolescents with a social anxiety disorder using CBM-I (Salemink & Wiers,
2010).
It can be expetected tthat the negative interpretations of children and
adolescents with an OCD also can be manipulated with this training. This,
however, has never been investigated.
Study objective
The goal of the present study is twofold. The first one is to develop a
Recogntion Task for adolescents with OCD analogue to the Recognition Task for
adults. This Revised Recognition Task can afterwards be used for measurement of
the effectiveness of the intervention (second goal of the study).
The second goal is to evaluate the Cognitive Bias Modification Training
(CBM-I) in a group of 20 adolescents diagnosed with OCD, and in outpatient or
clinical treatment.
It is hypothesized that after eight days of daily training during 30 minutes
patients would give less negative interpretations on the Recognition Task and
their scores on the OBQ would decrease.
Study design
20 OCD patients in outpatient of clinical treatment are involved in the study.
After informed consent of both the patient and the parents assessment takes
place (questionnaires for cognitions (OBQ) and for measuring the OCD (CY-BOCS).
The same questionnaires will be used in the a group of 20 normal adolescents
From this group a matched controlgroup, with low scores for OCD will be put
together. In both groups the Revised Recognition Task will be administered.
the scores of the two groups will be compared.
Next the intervention study will start in the same patients. 16 patients with
the highest scores on the CY-BOCS will be randomised in a positive trainings
condition (the experimental group) (8 patients) and a neutral trainings
condition (the placebogroup). The patients will be trained every day, eight
days long, during 30 miniutes. To evaluate the effect of the training a pre
and a post measurement will be administered. (OBQ and Recognition Task)
Intervention
The Cognitive Bias Modification procedure (CBM-I, Matthews & Mackintosh, 2000)
will be used. the training consists of 50 short stories (scenarios). For the
patients in the positive training condition these scenarios are based on the
five domains of OCD. Each scenario consists of three lines that are ambiguous
in terms of valence. The last word in each scenario is a word fragment that
resolvs the ambiguity of the scenario. Patients are asked to fill in the
wordfragment. This is only possible in a manner that contradict the negative
OC-relevant interpretation. Patients in the neutral conitions will read short
stories that have nothing to do with obsessions.
Study burden and risks
The burden for participants of the study consists of filling-in inventories,
which takes circa two times 45 minutes.
Meibergdreef 5
1105 AZ Amsterdam
NL
Meibergdreef 5
1105 AZ Amsterdam
NL
Listed location countries
Age
Inclusion criteria
diagnosis obsessive compulsieve disorder,
obsessions
age between 12 and 18 years
informed consent
Exclusion criteria
psychosis
serious depression
Design
Recruitment
Followed up by the following (possibly more current) registration
No registrations found.
Other (possibly less up-to-date) registrations in this register
No registrations found.
In other registers
Register | ID |
---|---|
CCMO | NL35351.018.11 |