The presence of overvalued ideation (OVI) in patients with obsessive-compulsive disorder (OCD) ha... more The presence of overvalued ideation (OVI) in patients with obsessive-compulsive disorder (OCD) has been theoretically linked to poorer treatment outcome. OVI has recently been shown to predict treatment outcome in OCD. The purpose of the present study is to determine whether OVI predicts medication treatment response, controlling for initial symptom severity and measurement error. The sample consisted of 34 outpatients diagnosed with OCD who completed an open-label clinical trial of fluvoxamine of 10 weeks' duration. Clinicians administered the Overvalued Ideas Scale (OVIS) at baseline. Symptom severity was rated at baseline and at the end of week 10 using the Yale-Brown Obsessive-Compulsive Scale. Of those who completed the trial, 68% showed a reliable change in obsessions and 62% showed a reliable change in compulsions. Analysis of variance showed that baseline OVIS predicted outcome for obsessions, but not compulsions. A key limitation was the relatively low number of individuals in the upper quartile on the OVIS, thus reducing the predictive power of the measure in relation to treatment outcome. Future research should examine medication treatment outcome with higher scoring patients. ᮊ
Research has suggested that obsessive-compulsive (OC) beliefs are differentially predictive of OC... more Research has suggested that obsessive-compulsive (OC) beliefs are differentially predictive of OC symptom dimensions. One additional way in which beliefs and symptoms may be related is by severity; that is, the role of beliefs may vary as a function of symptom severity. In order to evaluate this possibility, correspondence analysis with biplot was applied to evaluate the association between OC beliefs and OC symptom severity across three subsamples, individuals with obsessive-compulsive disorder (OCD; N=398), individuals with anxiety disorders (N=104), and undergraduate students (N=285). To do so, we generated five row categories of symptom severity and six columns based on the Obsessive Compulsive Beliefs Questionnaire (OBQ) for three subsamples. Unlike factor analyses of inter-variable correlations (or covariances), the CA-biplot paradigm calibrates simultaneously row and column information and estimates dimensional coordinates (analogous to factor loadings) separately for rows and columns. We used the first two dimensions from each subsample because they accounted for most variance (on average 89%) so as to construct a hypothetical plane with them. Then, we visually inspected associations among five severity categories (rows) and six OBQ subscales (columns) in the plane and also calculated their correlations. The visual configurations and numerical correlations were consistent across three subsamples, indicating that inflated responsibility was significantly associated with OC symptoms, but only for those with the least severe symptoms. Importance and control of thoughts were associated with OC symptoms across all levels of symptom severity. The implications of these findings for the cognitive model of OCD are considered.
The obsessive-compulsive spectrum is a heterogeneous class of conditions. Recently, expert consen... more The obsessive-compulsive spectrum is a heterogeneous class of conditions. Recently, expert consensus has emerged regarding possible candidate disorders [Mataix-Cols, D., Petrusa, A., Leckman, J.F., 2007. Issues for DSM-V: How should obsessive-compulsive and related disorders should be classified. American Journal of Psychiatry, 164, 1313-1314]. Further, expert survey data suggest that obsessive-compulsive disorder is composed of overlapping subtypes. However, methodological approaches for testing whether candidate disorders properly belong in the spectrum have varied widely, and do not necessarily differentiate conditions from subtypes. We describe preliminary methodological and statistical recommendations for a systematic approach to determining what constitutes a subtype, how to determine inclusion in the spectrum, and means for ruling out candidate disorders.
Cognitive-behavioral therapy for refractory cases: Turning failure into success., 2010
Monosymptomatic hypochondriasis (MSH) is frequently referred to as a delusional variant of hypoch... more Monosymptomatic hypochondriasis (MSH) is frequently referred to as a delusional variant of hypochondriasis. Treatment is typically difficult to initiate and complete for this condition. This article describes three uncontrolled cases of MSH where cognitive-behavioral therapy was administered following an initial phase of motivational interviewing. Cognitivebehavioral therapy consisted of combinations of exposure and cognitive therapy. At treatment termination and 6-month follow-up, all three clients showed improvement on measures of depression, anxiety, and belief conviction of the presence of illness. Implications for treatment and future research on MSH are discussed.
Cognitive-behavioral therapy for refractory cases: Turning failure into success., 2010
... Cognitive-behavioral therapy for refractory cases: Turning failure into success. McKay, Dean;... more ... Cognitive-behavioral therapy for refractory cases: Turning failure into success. McKay, Dean; Taylor, Steven; Abramowitz, Jonathan S. McKay, Dean (Ed); Abramowitz, Jonathan S. (Ed); Taylor, Steven (Ed), (2010). ... Garb & Boyle, 2003; Garske & Anderson, 2003). ...
Handbook of Child and Adolescent Anxiety Disorders, 2011
Coined the “omnivore’s dilemma” (Rozin & Fallon, 1987... more Coined the “omnivore’s dilemma” (Rozin & Fallon, 1987), this evolutionarily-based mechanism, which is characterized by seemingly conflicting inclinations to ingest and avoid unfamiliar foods, is thought to influence the food preferences and consumption of humans and other omnivorous species (Addessi, Galloway, Visalberghi, & Birch, 2005; Birch, Gunder, Grimm-Thomas, & Laing, 1998; Dovey, Staples, Gibson, & Halford, 2008; Martins & Pliner,
This article is a commentary on "Psychotherapy Outcome Research: Issues ... more This article is a commentary on "Psychotherapy Outcome Research: Issues and Questions" by Glenn Shean (this issue). While we agree with a couple of Shean's points, such as over-reliance on diagnoses and lack of attention to global measures of quality of life and functioning, there are several very substantive points of disagreement. We argue that evidence-based therapies and evidence-based practice occupy a central role in developing effective and non-harmful therapies. Shean conflates evidence-based therapies and evidence-based practice in a way that is not representative of how science is intended to advance everyday treatment delivery. We further contest Shean's notion that reliance on empirically based research is limiting to clinicians and instead argue that it offers a helpful and pragmatic starting point for clinical decision making with each unique patient. Further, evidence-based practice, in contrast to evidence-based therapies, represents the model ideal for service delivery, rather than a slavish adherence to protocols employed in randomized clinical trials. Finally, we argue that both nomothetic and idiographic approaches are valid and important in the ongoing advancement of modern psychotherapy, a position wholly consistent with the evidence-based practice movement.
Confidence that randomized controlled trial (RCT) results accurately reflect intervention effecti... more Confidence that randomized controlled trial (RCT) results accurately reflect intervention effectiveness depends on proper trial conduct and the accuracy and completeness of published trial reports. The Journal of Consulting and Clinical Psychology (JCCP) is the primary trials journal amongst American Psychological Association (APA) journals. The objectives of this study were to review RCTs recently published in JCCP to evaluate (1) adequacy of primary outcome analysis definitions; (2) registration status; and, (3) among registered trials, adequacy of outcome registrations. Additionally, we compared results from JCCP to findings from a recent study of top psychosomatic and behavioral medicine journals. Eligible RCTs were published in JCCP in 2013-2014. For each RCT, two investigators independently extracted data on (1) adequacy of outcome analysis definitions in the published report, (2) whether the RCT was registered prior to enrolling patients, and (3) adequacy of outcome registration. Of 70 RCTs reviewed, 12 (17.1%) adequately defined primary or secondary outcome analyses, whereas 58 (82.3%) had multiple primary outcome analyses without statistical adjustment or undefined outcome analyses. There were 39 (55.7%) registered trials. Only two trials registered prior to patient enrollment with a single primary outcome variable and time point of assessment. However, in one of the two trials, registered and published outcomes were discrepant. No studies were adequately registered as per Standard Protocol Items: Recommendation for Interventional Trials guidelines. Compared to psychosomatic and behavioral medicine journals, the proportion of published trials with adequate outcome analysis declarations was significantly lower in JCCP (17.1% versus 32.9%; p = 0.029). The proportion of registered trials in JCCP (55.7%) was comparable to behavioral medicine journals (52.6%; p = 0.709). The quality of published outcome analysis definitions and trial registrations in JCCP is suboptimal. Greater attention to proper trial registration and outcome analysis definition in published reports is needed.
The presence of overvalued ideation (OVI) in patients with obsessive-compulsive disorder (OCD) ha... more The presence of overvalued ideation (OVI) in patients with obsessive-compulsive disorder (OCD) has been theoretically linked to poorer treatment outcome. OVI has recently been shown to predict treatment outcome in OCD. The purpose of the present study is to determine whether OVI predicts medication treatment response, controlling for initial symptom severity and measurement error. The sample consisted of 34 outpatients diagnosed with OCD who completed an open-label clinical trial of fluvoxamine of 10 weeks' duration. Clinicians administered the Overvalued Ideas Scale (OVIS) at baseline. Symptom severity was rated at baseline and at the end of week 10 using the Yale-Brown Obsessive-Compulsive Scale. Of those who completed the trial, 68% showed a reliable change in obsessions and 62% showed a reliable change in compulsions. Analysis of variance showed that baseline OVIS predicted outcome for obsessions, but not compulsions. A key limitation was the relatively low number of individuals in the upper quartile on the OVIS, thus reducing the predictive power of the measure in relation to treatment outcome. Future research should examine medication treatment outcome with higher scoring patients. ᮊ
Research has suggested that obsessive-compulsive (OC) beliefs are differentially predictive of OC... more Research has suggested that obsessive-compulsive (OC) beliefs are differentially predictive of OC symptom dimensions. One additional way in which beliefs and symptoms may be related is by severity; that is, the role of beliefs may vary as a function of symptom severity. In order to evaluate this possibility, correspondence analysis with biplot was applied to evaluate the association between OC beliefs and OC symptom severity across three subsamples, individuals with obsessive-compulsive disorder (OCD; N=398), individuals with anxiety disorders (N=104), and undergraduate students (N=285). To do so, we generated five row categories of symptom severity and six columns based on the Obsessive Compulsive Beliefs Questionnaire (OBQ) for three subsamples. Unlike factor analyses of inter-variable correlations (or covariances), the CA-biplot paradigm calibrates simultaneously row and column information and estimates dimensional coordinates (analogous to factor loadings) separately for rows and columns. We used the first two dimensions from each subsample because they accounted for most variance (on average 89%) so as to construct a hypothetical plane with them. Then, we visually inspected associations among five severity categories (rows) and six OBQ subscales (columns) in the plane and also calculated their correlations. The visual configurations and numerical correlations were consistent across three subsamples, indicating that inflated responsibility was significantly associated with OC symptoms, but only for those with the least severe symptoms. Importance and control of thoughts were associated with OC symptoms across all levels of symptom severity. The implications of these findings for the cognitive model of OCD are considered.
The obsessive-compulsive spectrum is a heterogeneous class of conditions. Recently, expert consen... more The obsessive-compulsive spectrum is a heterogeneous class of conditions. Recently, expert consensus has emerged regarding possible candidate disorders [Mataix-Cols, D., Petrusa, A., Leckman, J.F., 2007. Issues for DSM-V: How should obsessive-compulsive and related disorders should be classified. American Journal of Psychiatry, 164, 1313-1314]. Further, expert survey data suggest that obsessive-compulsive disorder is composed of overlapping subtypes. However, methodological approaches for testing whether candidate disorders properly belong in the spectrum have varied widely, and do not necessarily differentiate conditions from subtypes. We describe preliminary methodological and statistical recommendations for a systematic approach to determining what constitutes a subtype, how to determine inclusion in the spectrum, and means for ruling out candidate disorders.
Cognitive-behavioral therapy for refractory cases: Turning failure into success., 2010
Monosymptomatic hypochondriasis (MSH) is frequently referred to as a delusional variant of hypoch... more Monosymptomatic hypochondriasis (MSH) is frequently referred to as a delusional variant of hypochondriasis. Treatment is typically difficult to initiate and complete for this condition. This article describes three uncontrolled cases of MSH where cognitive-behavioral therapy was administered following an initial phase of motivational interviewing. Cognitivebehavioral therapy consisted of combinations of exposure and cognitive therapy. At treatment termination and 6-month follow-up, all three clients showed improvement on measures of depression, anxiety, and belief conviction of the presence of illness. Implications for treatment and future research on MSH are discussed.
Cognitive-behavioral therapy for refractory cases: Turning failure into success., 2010
... Cognitive-behavioral therapy for refractory cases: Turning failure into success. McKay, Dean;... more ... Cognitive-behavioral therapy for refractory cases: Turning failure into success. McKay, Dean; Taylor, Steven; Abramowitz, Jonathan S. McKay, Dean (Ed); Abramowitz, Jonathan S. (Ed); Taylor, Steven (Ed), (2010). ... Garb & Boyle, 2003; Garske & Anderson, 2003). ...
Handbook of Child and Adolescent Anxiety Disorders, 2011
Coined the “omnivore’s dilemma” (Rozin & Fallon, 1987... more Coined the “omnivore’s dilemma” (Rozin & Fallon, 1987), this evolutionarily-based mechanism, which is characterized by seemingly conflicting inclinations to ingest and avoid unfamiliar foods, is thought to influence the food preferences and consumption of humans and other omnivorous species (Addessi, Galloway, Visalberghi, & Birch, 2005; Birch, Gunder, Grimm-Thomas, & Laing, 1998; Dovey, Staples, Gibson, & Halford, 2008; Martins & Pliner,
This article is a commentary on "Psychotherapy Outcome Research: Issues ... more This article is a commentary on "Psychotherapy Outcome Research: Issues and Questions" by Glenn Shean (this issue). While we agree with a couple of Shean's points, such as over-reliance on diagnoses and lack of attention to global measures of quality of life and functioning, there are several very substantive points of disagreement. We argue that evidence-based therapies and evidence-based practice occupy a central role in developing effective and non-harmful therapies. Shean conflates evidence-based therapies and evidence-based practice in a way that is not representative of how science is intended to advance everyday treatment delivery. We further contest Shean's notion that reliance on empirically based research is limiting to clinicians and instead argue that it offers a helpful and pragmatic starting point for clinical decision making with each unique patient. Further, evidence-based practice, in contrast to evidence-based therapies, represents the model ideal for service delivery, rather than a slavish adherence to protocols employed in randomized clinical trials. Finally, we argue that both nomothetic and idiographic approaches are valid and important in the ongoing advancement of modern psychotherapy, a position wholly consistent with the evidence-based practice movement.
Confidence that randomized controlled trial (RCT) results accurately reflect intervention effecti... more Confidence that randomized controlled trial (RCT) results accurately reflect intervention effectiveness depends on proper trial conduct and the accuracy and completeness of published trial reports. The Journal of Consulting and Clinical Psychology (JCCP) is the primary trials journal amongst American Psychological Association (APA) journals. The objectives of this study were to review RCTs recently published in JCCP to evaluate (1) adequacy of primary outcome analysis definitions; (2) registration status; and, (3) among registered trials, adequacy of outcome registrations. Additionally, we compared results from JCCP to findings from a recent study of top psychosomatic and behavioral medicine journals. Eligible RCTs were published in JCCP in 2013-2014. For each RCT, two investigators independently extracted data on (1) adequacy of outcome analysis definitions in the published report, (2) whether the RCT was registered prior to enrolling patients, and (3) adequacy of outcome registration. Of 70 RCTs reviewed, 12 (17.1%) adequately defined primary or secondary outcome analyses, whereas 58 (82.3%) had multiple primary outcome analyses without statistical adjustment or undefined outcome analyses. There were 39 (55.7%) registered trials. Only two trials registered prior to patient enrollment with a single primary outcome variable and time point of assessment. However, in one of the two trials, registered and published outcomes were discrepant. No studies were adequately registered as per Standard Protocol Items: Recommendation for Interventional Trials guidelines. Compared to psychosomatic and behavioral medicine journals, the proportion of published trials with adequate outcome analysis declarations was significantly lower in JCCP (17.1% versus 32.9%; p = 0.029). The proportion of registered trials in JCCP (55.7%) was comparable to behavioral medicine journals (52.6%; p = 0.709). The quality of published outcome analysis definitions and trial registrations in JCCP is suboptimal. Greater attention to proper trial registration and outcome analysis definition in published reports is needed.
Uploads
Papers by Dean McKay