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Examining depression symptoms within OCD: the role of experiential avoidance

Published online by Cambridge University Press:  20 December 2021

Morgan E. Browning
Affiliation:
Department of Psychology, University of Massachusetts Dartmouth, 285 Old Westport Road, North Dartmouth, MA 02747, USA
Nathaniel P. Van Kirk*
Affiliation:
McLean Hospital OCD Institute, 115 Mill Street, Mail Stop #207, Belmont, MA 02478, USA Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, USA
Jason W. Krompinger
Affiliation:
McLean Hospital OCD Institute, 115 Mill Street, Mail Stop #207, Belmont, MA 02478, USA Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, USA
*
*Corresponding author. Email: [email protected]

Abstract

Background:

Obsessive compulsive disorder (OCD) and depression commonly co-occur. Past research has evaluated underlying mechanisms of depression in the context of other diagnoses, but few to no studies have done this within OCD.

Aims:

This study examines the relationships between distress tolerance (DT), experiential avoidance (EA), depression, and OCD symptom severity across intensive/residential treatment (IRT) for OCD. It was hypothesized that all variables would be significantly moderately related and EA would emerge as a potential contributing factor to change in depression and OCD symptoms across IRT for OCD.

Method:

The sample included 311 participants with a primary diagnosis of OCD seeking IRT. Correlations were performed between all variables at both admission and discharge. A two-step hierarchical regression with change in OCD symptoms and change in DT in the first block and change in EA in the second block examined if change in EA explained change in depression above and beyond change in OCD and DT ability.

Results:

At both admission and discharge, higher EA, lower DT, and higher OCD symptom severity were significantly associated with more depressive symptoms. Change in EA explained a significant amount of variance in change in depression above and beyond change in OCD symptom severity and change in DT.

Conclusions:

This study expands past results within an OCD sample, emphasizing EA as an important treatment target in OCD. Future studies could utilize samples from other treatment contexts, use a measure of EA specific to OCD, and utilize a longitudinal model that takes temporal precedence into account.

Type
Main
Copyright
© The Author(s), 2021. Published by Cambridge University Press on behalf of the British Association for Behavioural and Cognitive Psychotherapies

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References

Anholt, G. E., Aderka, I. M., Balkom, A. J. V., Smit, J. H., Hermesh, H., Haan, E. D., & Oppen, P. V. (2011). The impact of depression on the treatment of obsessive–compulsive disorder: results from a 5-year follow-up. Journal of Affective Disorders, 135, 201207. https://doi.org/10.1016/j.jad.2011.07.018 CrossRefGoogle ScholarPubMed
Arch, J. J., Eifert, G. H., Davies, C., Vilardaga, J. C. P., Rose, R. D., & Craske, M. G. (2012). Randomized clinical trial of cognitive behavioral therapy (CBT) versus acceptance and commitment therapy (ACT) for mixed anxiety disorders. Journal of Consulting and Clinical Psychology, 80, 750765. https://doi.org/10.1037/a0028310 CrossRefGoogle ScholarPubMed
Bech, P., Allerup, P., Gram, L. F., Reisby, N., Rosenberg, R., Jacobsen, O., & Nagy, A. (1981). The Hamilton Depression Scale. Acta Psychiatrica Scandinavica, 63, 290299. https://doi.org/10.1111/j.1600-0447.1981.tb00676.x CrossRefGoogle ScholarPubMed
Berking, M., Neacsiu, A., Comtois, K. A., & Linehan, M. M. (2009). The impact of experiential avoidance on the reduction of depression in treatment for borderline personality disorder. Behaviour Research and Therapy, 47, 663670. https://doi.org/10.1016/j.brat.2009.04.011 CrossRefGoogle ScholarPubMed
Blakey, S. M., Jacoby, R. J., Reuman, L., & Abramowitz, J. S. (2015). The relative contributions of experiential avoidance and distress tolerance to OC symptoms. Behavioural and Cognitive Psychotherapy, 44, 460471. https://doi.org/10.1017/s1352465815000703 CrossRefGoogle ScholarPubMed
Bluett, E. J., Homan, K. J., Morrison, K. L., Levin, M. E., & Twohig, M. P. (2014). Acceptance and commitment therapy for anxiety and OCD spectrum disorders: an empirical review. Journal of Anxiety Disorders, 28, 612624. https://doi.org/10.1016/j.janxdis.2014.06.008 CrossRefGoogle ScholarPubMed
Bond, F. W., Hayes, S. C., Baer, R. A., Carpenter, K. M., Guenole, N., Orcutt, H. K., Waltz, T., & Zettle, R. D. (2011). Preliminary psychometric properties of the Acceptance and Action Questionnaire-II: a revised measure of psychological flexibility and experiential avoidance. Behavior Therapy, 42, 676688.10.1016/j.beth.2011.03.007CrossRefGoogle Scholar
Brodey, B. B., First, M., Linthicum, J., Haman, K., Sasiela, J. W., & Ayer, D. (2016). Validation of the NetSCID: an automated web-based adaptive version of the SCID. Comprehensive Psychiatry, 66, 6770. https://doi.org/10.1016/j.comppsych.2015.10.005 CrossRefGoogle ScholarPubMed
Cohen, J. (1988). Statistical Power Analysis for the Behavioral Sciences (2nd edn). Lawrence Erlbaum Associates.Google Scholar
Cribb, G., Moulds, M., & Carter, S. (2006). Rumination and experiential avoidance in depression. Behaviour Change, 23, 165176. https://doi.org/10.1375/bech.23.3.165 CrossRefGoogle Scholar
Dalrymple, K. L., & Herbert, J. D. (2007). Acceptance and commitment therapy for generalized social anxiety disorder: a pilot study. Behavior Modification, 31, 543568. https://doi.org/10.1177/0145445507302037 CrossRefGoogle ScholarPubMed
Dormann, C. F., Elith, J., Bacher, S., Buchmann, C., Carl, G., Carré, G., Marquéz, J. R. G., Gruber, B., Lafourcade, B., Leitão, P. J., Münkemüller, T., McClean, C., Osborne, P. E., Reineking, B., Schröder, B., Skidmore, A. K., Zurell, D., & Lautenbach, S. (2013). Collinearity: a review of methods to deal with it and a simulation study evaluating their performance. Ecography (Copenhagen), 36(1), 2746. https://doi.org/10.1111/j.1600-0587.2012.07348 CrossRefGoogle Scholar
Eisen, J. L., Mancebo, M. A., Pinto, A., Coles, M. E., Pagano, M. E., Stouf, R., & Rasmussen, S. A. (2006). Impact of obsessive-compulsive disorder on quality of life. Comprehensive Psychiatry, 47, 270275. http://doi.org/10.1016/j.comppsych.2005.11.006 CrossRefGoogle ScholarPubMed
First, M. B., Spitzer, R. L., Gibbon, M., & Williams, J. B. W. (2007). Structured Clinical Interview for DSM-IV-TR Axis I Disorders - Patient Edition (with psychotic screen). New York, USA: Biometrics Research Department.Google Scholar
Fontenelle, I. S., Fontenelle, L. F., Borges, M. C., Prazeres, A. M., Range, B. P., Mendlowicz, M. V., & Versiani, M. (2010). Quality of life and symptom dimensions of patients with obsessive-compulsive disorder. Psychiatry Research, 179, 198203. https://doi.org/10.1016/j.psychres.2009.04.00 CrossRefGoogle ScholarPubMed
Giorgio, J., Sanflippo, J., Kleiman, E., Reilly, D., Bender, R., Wagner, C., Liu, R., & Alloy, L. (2010). An experiential avoidance conceptualization of depressive rumination: three tests of the model. Behaviour Research and Therapy, 48, 10211031. https://doi.org/10.1016/j.brat.2010.07.004 CrossRefGoogle ScholarPubMed
Goodman, W. K., Price, L. H., & Rasmussen, S. A. (1989). The Yale-Brown Obsessive Compulsive Scale. I. Development, use, and reliability. Archives of General Psychiatry, 466, 10061011. https://doi.org/10.1001/archpsyc.1989.01810110048007 CrossRefGoogle Scholar
Hayes, S. C., Strosahl, K. D., Wilson, K. G., Bissett, R. T., Pistorello, J., Toarmino, D., Polusny, M., A., Dykstra, T. A., Batten, S. V., Bergan, J., Stewart, S. H., Zvolensky, M. J., Eifert, G. H., Bond, F. W., Forsyth, J. P., Karekla, M., & McCurry, S. M. (2004). Measuring experiential avoidance: a preliminary test of a working model. The Psychological Record, 54, 553578. https://doi.org/10.1007/bf03395492 CrossRefGoogle Scholar
IBM Corporation (2020). IBM SPSS Statistics for Windows, version 27.0. Armonk, NY, USA: IBM.Google Scholar
Jacoby, R. J., Leonard, R. C., Riemann, B. C., & Abramowitz, J. S. (2014). Predictors of quality of life and functional impairment in obsessive-compulsive disorder. Comprehensive Psychiatry, 55, 11951202. https://doi.org/10.1016/j.comppsych.2014.03.011 CrossRefGoogle ScholarPubMed
Leyro, T. M., Zvolensky, M. J., & Bernstein, A. (2010). Distress tolerance and psychopathological symptoms and disorders: a review of the empirical literature among adults. Psychological Bulletin, 136, 576600. https://doi.org/10.1037/a0019712 CrossRefGoogle ScholarPubMed
McKay, D., & Andover, M. (2012). Should nonsuicidal self-injury be a putative obsessive-compulsive-related condition? A critical appraisal. Behavior Modification, 36, 317. https://doi.org/10.1177/0145445511417707 CrossRefGoogle ScholarPubMed
Meyer, J. M., McNamara, J. P. H., Reid, A. M., Storch, E. A., Geffken, G. R., Mason, D. M., Murphy, T.K., Bussing, R. (2013). Prospective relationship between obsessive-compulsive and depressive symptoms during multimodal treatment in pediatric obsessive-compulsive disorder. Child Psychiatry & Human Development, 45, 163172. https://doi.org/10.1007/s10578-013-0388-4 CrossRefGoogle Scholar
Miguel, E. C., Ferrão, Y. A., Rosário, M. C., Mathis, M. A., Torres, A. R., Fontenelle, L. F., Hounie, A. G., Shavitt, R.G., Cordioli, A.V., Gonzalez, C.H., Petribú, K., Diniz, J. B., Malavazzi, D. M., Torresan, R. C., Raffin, A. L., Meyer, E., Braga, D. T., Borcato, S., Valério, C., …& Silva, E. D. (2008). The Brazilian Research Consortium on Obsessive-Compulsive Spectrum Disorders: recruitment, assessment instruments, methods for the development of multicenter collaborative studies and preliminary results. Brazilian Journal of Psychiatry, 30, 185196. https://doi.org/10.1590/S1516-44462008000300003 CrossRefGoogle Scholar
Motivala, S. J., Arellano, M., Greco, R. L., Aitken, D., Hutcheson, N., Tadayonnejad, R., O’Neill, J., & Feusner, J. D. (2018). Relationships between obsessive-compulsive disorder, depression and functioning before and after exposure and response prevention therapy. International Journal of Psychiatry in Clinical Practice, 22, 4046. https://doi.org/10.1080/13651501.2017.1351991 CrossRefGoogle ScholarPubMed
O’Sullivan, R. L., Fava, M., Augustin, C., Baer, L., & Rosenbaum, J. F. (1997). Sensitivity of the six-item Hamilton Depression Rating Scale. Acta Psychiatrica Scandinavica, 95, 379384. https://doi.org/10.1111/j.1600-0447.1997.tb09649.x CrossRefGoogle ScholarPubMed
Ong, C. W., Pierce, B. G., Petersen, J. M., Barney, J. L., Fruge, J. E., Levin, M. E., & Twohig, M. P. (2020). A psychometric comparison of psychological inflexibility measures: discriminant validity and item performance. Journal of Contextual Behavioral Science, 18, 3447. https://doi.org/10.1016/j.jcbs.2020.08.007 CrossRefGoogle Scholar
Robinson, L. J., & Freeston, M. H. (2014). Emotion and internal experience in obsessive compulsive disorder: reviewing the role of alexithymia, anxiety sensitivity and distress tolerance. Clinical Psychology Review, 34, 256271. https://doi.org/10.1016/j.cpr.2014.03.003 CrossRefGoogle ScholarPubMed
Rochefort, C., Baldwin, A. S., & Chmielewski, M. (2018). Experiential avoidance: an examination of the construct balidity of the AAQ-II and MEAQ. Behavior Therapy, 49, 435449. https://doi.org/10.1016/j.beth.2017.08.008 CrossRefGoogle ScholarPubMed
Rogge, R. D., & Daks, J. S. (2021). Embracing the intricacies of the path toward mindfulness: broadening our conceptualization of the process of cultivating mindfulness in day-to-day life by developing the Unified Flexibility and Mindfulness Model. Mindfulness, 12, 701721. https://doi.org/10.1007/s12671-020-01537-w CrossRefGoogle Scholar
Rolffs, J. L., Rogge, R. D., & Wilson, K. G. (2018). Disentangling components of flexibility via the Hexaflex Model: development and validation of the Multidimensional Psychological Flexibility Inventory (MPFI). Assessment, 25, 458482. https://doi.org/10.1177/1073191116645905 CrossRefGoogle Scholar
Rueda, B., & Valls, E. (2016). Relationships among stress, experiential avoidance and depression in psychiatric patients. The Spanish Journal of Psychology, 19. https://doi.org/10.1017/sjp.2016.32 CrossRefGoogle Scholar
Saito, S. (2020). When is it most appropriate to control for initial scores? A comparison of examination methods for two-wave panel survey data changes. Tutorials in Quantitative Methods for Psychology, 16, 457466. https://doi.org/10.20982/tqmp.16.5.p457 CrossRefGoogle Scholar
Simons, J. S., & Gaher, R. M. (2005). The Distress Tolerance Scale: development and validation of a self-report measure. Motivation and Emotion, 29, 83102. https://doi.org/10.1007/s11031-005-7955-3 CrossRefGoogle Scholar
Spinhoven, P., Drost, J., Rooij, M. D., Hemert, A. M. V., & Penninx, B. W. (2014). A longitudinal study of experiential avoidance in emotional disorders. Behavior Therapy, 45, 840850. https://doi.org/10.1016/j.beth.2014.07.001 CrossRefGoogle ScholarPubMed
Steketee, G., Frost, R., & Bogart, K. (1996). The Yale-Brown Obsessive Compulsive Scale: interview versus self-report. Behaviour Research and Therapy, 34, 675684. https://doi.org/10.1016/0005-7967(96)00036-8 CrossRefGoogle ScholarPubMed
Tibi, L., Oppen, P. V., Balkom, A. V., Eikelenboom, M., Rickelt, J., Schruers, K., & Anholt, G. (2017). The long-term association of OCD and depression and its moderators: a four-year follow up study in a large clinical sample. European Psychiatry, 44, 7682. https://doi.org/10.1016/j.eurpsy.2017.03.009 CrossRefGoogle Scholar
Toledano, S., Guzick, A. G., McCarty, R. J., Browning, M. E., Downing, S. T., Geffken, G. R., & McNamara, J. P. H. (2020). An investigation of self-esteem in the treatment of OCD. Journal of Obsessive-Compulsive and Related Disorders, 27, 100563. https://doi.org/10.1016/j.jocrd.2020.100563 CrossRefGoogle Scholar
Torres, A. R., Fontenelle, L. F., Shavitt, R. G., Ferrão, Y. A., Rosário, M. C., Storch, E. A., & Miguel, E. C. (2016). Comorbidity variation in patients with obsessive–compulsive disorder according to symptom dimensions: results from a large multicentre clinical sample. Journal of Affective Disorders, 190, 508516. https://doi.org/10.1016/j.jad.2015.10.051 CrossRefGoogle ScholarPubMed
Tull, M., & Gratz, K. (2008). Further examination of the relationship between anxiety sensitivity and depression: the mediating role of experiential avoidance and difficulties engaging in goal-directed behavior when distressed. Journal of Anxiety Disorders, 22, 199210. https://doi.org/10.1016/j.janxdis.2007.03.005 CrossRefGoogle ScholarPubMed
Tull, M. T., Gratz, K. L., Salters, K., & Roemer, L. (2004). The role of experiential avoidance in posttraumatic stress symptoms and symptoms of depression, anxiety, and somatization. Journal of Nervous and Mental Disease, 192, 754761. https://doi.org/10.1097/01.nmd.0000144694.30121.89 CrossRefGoogle ScholarPubMed
Twohig, M. P. (2009). The application of acceptance and commitment therapy to obsessive-compulsive disorder. Cognitive and Behavioral Practice, 16, 1828. https://doi.org/10.1016/j.cbpra.2008.02.008 CrossRefGoogle Scholar
Twohig, M. P., Abramowitz, J. S., Bluett, E. J., Fabricant, L. E., Jacoby, R. J., Morrison, K. L., Reuman, L., Smith, B. M. (2015). Exposure therapy for OCD from an acceptance and commitment therapy (ACT) framework. Journal of Obsessive-Compulsive and Related Disorders, 6, 167173. https://doi.org/10.1016/j.jocrd.2014.12.007 CrossRefGoogle Scholar
Twohig, M. P., Abramowitz, J. S., Smith, B. M., Fabricant, L. E., Jacoby, R. J., Morrison, K. L., Bluett, E. J., Reuman, L., Blakey, S. M., & Ledermann, T. (2018). Adding acceptance and commitment therapy to exposure and response prevention for obsessive-compulsive disorder: a randomized controlled trial. Behaviour Research and Therapy, 108, 19. https://doi.org/10.1016/j.brat.2018.06.005 CrossRefGoogle ScholarPubMed
Velloso, P., Piccinato, C., Ferrão, Y., Perin, E. A., Cesar, R., Fontenelle, L. F., Hounie, A.G., Rosário, M. C. (2018). Clinical predictors of quality of life in a large sample of adult obsessive-compulsive disorder outpatients. Comprehensive Psychiatry, 86, 8290. https://doi.org/10.1016/j.comppsych.2018.07.007 CrossRefGoogle Scholar
Vorstenbosch, V., Hood, H. K., Rogojanski, J., Antony, M. M., Summerfeldt, L. J., & McCabe, R. E. (2012). Exploring the relationship between OCD symptom subtypes and domains of functional impairment. Journal of Obsessive-Compulsive and Related Disorders, 1, 3340.10.1016/j.jocrd.2011.10.002CrossRefGoogle Scholar
Wahl, K., Hout, M. V., & Lieb, R. (2019). Rumination on unwanted intrusive thoughts affects the urge to neutralize in nonclinical individuals. Journal of Obsessive-Compulsive and Related Disorders, 20, 412. https://doi.org/10.1016/j.jocrd.2018.02.002 CrossRefGoogle Scholar
Wenze, S. J., Kats, D. M., & Gaudiano, B. A. (2018). Experiential avoidance and mood state in bipolar disorder. Journal of Cognitive Psychotherapy, 32, 8896. https://doi.org/10.1891/0889-8391.32.2.88 CrossRefGoogle Scholar
Wenzlaff, R., & Eisenberg, A. (2001). Mental control after dysphoria: evidence of a suppressed, depressive bias. Behavior Therapy, 32, 2745. https://doi.org/10.1016/S0005-7894(01)80042-3 CrossRefGoogle Scholar
Wenzlaff, R., Wegner, D., & Roper, D. (1988). Depression and mental control: the resurgence of unwanted negative thoughts. Journal of Personality and Social Psychology, 55, 882892. https://doi.org/10.1037/0022-3514.55.6.882 CrossRefGoogle ScholarPubMed
Woody, S. R., Steketee, G., & Chambless, D. L. (1995). Reliability and validity of the Yale-Brown Obsessive-Compulsive Scale. Behaviour Research and Therapy, 33, 597605.10.1016/0005-7967(94)00076-VCrossRefGoogle ScholarPubMed
World Health Organization (2017). Depression and Other Common Mental Disorders: Global Health Estimates. Geneva, Switzerland: WHO Document Production Services. https://apps.who.int/iris/bitstream/handle/10665/254610/WHO-MSD-MER-2017.2-eng.pdf Google Scholar
Zandberg, L. J., Zang, Y., McLean, C. P., Yeh, R., Simpson, H. B., & Foa, E. B. (2015). Change in obsessive-compulsive symptoms mediates subsequent change in depressive symptoms during exposure and response prevention. Behaviour Research and Therapy, 68, 7681. https://doi.org/10.1016/j.brat.2015.03.005 CrossRefGoogle ScholarPubMed
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