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We aim to develop fMRI neurofeedback as a treatment for obsessive compulsive disorder (OCD). In prior work, we found that providing neurofeedback of activity in the anterior prefrontal cortex (aPFC) improved control over contamination anxiety in a subclinical population. Here, we present the results of a randomized, double-blind clinical trial (NCT02206945) testing this intervention in patients with OCD. We recruited patients with primary symptoms in the fear-of-harm/checking or contamination/washing domains. During neurofeedback, they viewed symptom provocative images and attempted to up- and down-regulate the aPFC during different blocks of time. The active group received two sessions of neurofeedback and the control group received yoked sham feedback. The primary outcome measure was the Yale-Brown Obsessive-Compulsive Symptom scale. The secondary outcome was control over aPFC. Thirty-six participants completed feedback training (18 active, 18 control). The active group had a slightly but significantly greater reduction of obsessive-compulsive symptoms after neurofeedback compared to the control group (p<.05) but no significant differences in control over the aPFC. These data demonstrate that neurofeedback targeting the aPFC can reduce symptoms in OCD. Future investigations should seek to optimize the training protocol to yield larger effects and to clarify the mechanism of action.

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Electroencephalography (EEG) measures the brain's electrical activity with high temporal resolution. In comparison to neuroimaging modalities such as MRI or PET, EEG is relatively cheap, non-invasive, portable, and simple to administer, making it an attractive tool for clinical deployment. Despite this, studies utilizing EEG to investigate obsessive-compulsive disorder (OCD) are relatively sparse. This contrasts with a robust literature using other brain imaging methodologies. The present review examines studies that have used EEG to examine predictors and correlates of response in OCD and draws tentative conclusions that may guide much needed future work. Key findings include a limited literature base; few studies have attempted to predict clinical change from EEG signals, and they are confounded by the effects of both pharmacotherapy and psychotherapy. The most robust literature, consisting of several studies, has examined event-related potentials, including the P300, which several studies have reported to be abnormal at baseline in OCD and to normalize with treatment; but even here the literature is quite heterogeneous, and more work is needed. With more robust research, we suggest that the relatively low cost and convenience of EEG, especially in comparison to fMRI and PET, make it well-suited to the development of feasible personalized treatment algorithms.

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Few studies have investigated the relationship between comorbid depression and anxiety and cognitive and academic functioning. To understand this relationship, this study used a retrospective chart review from an inpatient facility for 42 adolescents diagnosed with a comorbid anxiety and depressive disorder. Multiple regression was used to determine whether anxiety and depression predicted academic achievement, as well as whether intelligence predicted current levels of anxiety and depression. Results indicated that higher severity of depression was associated with lower reading (ß = -0.39) and writing (ß = -0.40) achievement, while higher severity of anxiety was associated with higher scores on reading (ß = 0.41) and writing (ß = 0.36). Full-scale IQ was not significantly predictive of anxiety severity (ß = 0.08) or depression severity (ß = -0.24). Results are discussed in terms of identifying risk factors and improving outcomes for adolescents with severe comorbid anxiety and depression psychopathology.

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The current study examined quality of life (QOL) and its clinical correlates among 225 intensive treatment-seeking children and adolescents with obsessive-compulsive disorder (OCD) using the Pediatric Quality of Life Enjoyment and Satisfaction Questionnaire (PQ-LES-Q). Youth completed the PQ-LES-Q along with self-report measures assessing functional impairment, anxiety sensitivity, OCD symptoms, nonspecific anxiety, depression, and social anxiety. Parents completed measures on their child's anxiety, the presence of inattention/hyperactivity, depression, functional impairment, and frequency of family accommodation of symptoms. Contrary to expectation, child-reported OCD symptoms did not significantly predict QOL; however, lower overall QOL was strongly associated with the presence of comorbid major depressive disorder (g=3D -0.76) and slightly related to comorbid social phobia (g=3D -0.36). These results suggest that assessing and addressing comorbid conditions in the treatment of youth with OCD is an important component of intensive treatment.

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OBJECTIVE: Social anxiety increases college student drop-out risk and stifles employment opportunities. Group cognitive-behavioral therapy with exposure (CBT ERP) has the potential to alleviate campus resource strain but remains under-researched with college students. The present study investigated the efficacy of group CBT ERP in a randomized clinical trial on a college campus. METHOD: Thirty-one postsecondary students were randomly assigned to an exposure-only group or an active control. RESULTS: Linear mixed-effects models indicated significant Group × Time interactions for general social anxiety (t = -2.02, g = 0.62) and depression (t = -2.77, g = 0.55); nonsignificant main effects were found for group and time variables. On a measure of fear of negative evaluation, only the main effect of time was significant (t = 2.15, p = 0.032). CONCLUSIONS: When compared to an active control group, CBT ERP is an efficacious and time-effective treatment for college students experiencing social anxiety.

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Hoarding disorder is present in 2-6% of the population and can have an immense impact on the lives of patients and their families. Before its inclusion the Diagnostic and Statistical Manual of Mental Disorders, 5th edition, pathological hoarding was often characterized as a symptom of obsessive-compulsive disorder, and several different diagnostic assessment methods were used to identify and characterize it. Although the age of onset of pathological hoarding is an important epidemiological measure, as clarifying the age of onset of hoarding symptoms may allow for early identification and implementation of evidence-based treatments before symptoms become clinically significant, the typical age of onset of hoarding is still uncertain. To that end, this study is a systematic review and meta-analysis of research published in English between the years 1900 and 2016 containing information on age of onset of hoarding symptoms. Twenty-five studies met inclusion criteria. The mean age of onset of hoarding symptoms across studies was 16.7 years old, with evidence of a bimodal distribution of onset. The authors conclude by discussing practice implications for early identification and treatment.

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Interpretation of intelligence tests has changed over time, from a focus on the elevation of general ability in the early 1900s, to the shape and/or scatter of subtest and index scores in the mid-1900s to the early 2000s, and back to elevation today. The primary emphasis of interpretation now, however, is widely recommended to be on normative strengths and weaknesses of scores reflecting broad and narrow abilities in the Cattell-Horn-Carroll (CHC) theory (Schneider & McGrew, 2012). Decisions about which abilities are important to assess for the diagnosis of learning difficulties are based largely on literature reviews by Flanagan, Ortiz, Alfonso, and Mascolo (2006) and McGrew and Wendling (2010). These were narrative research syntheses, however, and did not attempt to estimate the magnitude of the relations between CHC abilities and academic achievement. The purpose of this study, therefore, was to conduct a meta-analysis to determine the effect size for these relations across age groups. Results of our analyses found that psychometric g and one or more broad cognitive abilities are substantially related to each area of academic achievement. Across all achievement domains and ages, g had by far the largest effect, with a mean effect size of r2 = 0.540. In fact, psychometric g explained more variance in academic outcomes than all broad abilities combined. Most broad abilities explained less than 10% of the variance in achievement and none explained more than 20%. Some age-related changes in cognitive ability-achievement relations were also observed. In sum, results of our meta-analysis support the interpretation of the overall score on intelligence tests as a measure of psychometric g for diagnosing difficulties in reading and mathematics, but only the interpretation of index scores measuring Comprehension-Knowledge (Gc) when diagnosing difficulties in reading. Implications of these results for research and practice are discussed.

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Appearing in 40% of the cases of autism spectrum disorder (ASD), comorbid anxiety presents unique challenges for practitioners by amplifying problem behaviors such as social skills deficits, resistance to change and repetitive behaviors. Furthermore, comorbid ASD/anxiety strains familial relationships and increases parental stress. Research indicates that the neurobiological interactions between anxiety and ASD require comprehensive assessment approaches, modified cognitive behavioral therapy and carefully managed pharmacological interventions. Meta-analyses indicate that cognitive behavioral therapy with exposure is an effective treatment option when adequately accounting for social, familial and cognitive variables. The purpose of this focused review is to update readers on the latest research advances in comorbid ASD and anxiety, including prevalence, assessment, psychosocial and pharmacological treatment.