Category: Obsessive Compulsive and Related Disorders

Symposium

Not Just Right Experiences and Incompleteness

Sunday, November 19
10:15 AM - 11:45 AM
Location: Sapphire Ballroom C & D, Level 4, Sapphire Level

Keywords: OCD (Obsessive Compulsive Disorder) | Emotion Regulation | Exposure
Presentation Type: Symposium

Models for classifying psychopathology have garnered increased attention over the past several years due to the publication of the revised DSM (Diagnostic and Statistical manual of mental Disorders) and the NIMH R-DOC (Research Domain Criteria) initiatives. Creating meaningful groups can facilitate our understanding of these conditions and allow us to make more informed treatment recommendations. The most common framework for classifying symptoms of obsessive compulsive disorder (OCD) relies on overt symptom content (e.g., washing, checking, ordering). However, the utility of this model has been questioned. An alternative model is to consider the motivations underlying the symptoms. Symptoms of OCD driven by a desire to prevent bad things from happening have received the bulk of attention in understanding and treating OCD. However, there is increasing recognition that OCD symptoms can also be associated with feelings of things being incomplete or not just-right (not just right experiences, NJREs). A number of studies have shown support for this distinction in non-clinical samples (Pietrefesa & Coles, 2009; Rosario et al 2009) and there is a growing number of studies from clinical samples (Coles & Ravid, 2016; Ferrao, Shavitt, Prado et al 2012; Starcevic et al 2011).


Studies of these NJREs in clinical samples have largely focused on documenting their occurrence and separability from symptoms driven by harm avoidance. We build from the existing data in 2 primary ways: First, we broadly characterize the clinical picture of individuals presenting for OCD who report symptoms driven by not-just right experiences. Second, we characterize their responses to cognitive –behavioral therapy. Preliminary findings from a sample of 60 individuals with primary OCD shows that experiencing NJREs is associated with difficulties controlling emotions, a lack of clarity regarding emotions, and behavioral avoidance. In regards to treatment, higher severity of NJREs is associated with less optimistic predictions regarding the efficacy of therapy. This may be problematic as patients who doubt the efficacy of the intervention may be less likely to engage in therapy or to complete homework such as doing exposures between session, resulting in poorer outcomes. Data on these issues will be presented and the implications will be discussed. Developing a deeper understanding of NJREs in OCD may help us improve treatment for this disorder.

Meredith Coles

Binghamton University

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