Obsessive-compulsive disorder (OCD) is an anxiety disturbance in which distress and impairment extend beyond the patient to their immediate family members. Many family members become involved in their loved one's compulsions by engaging in accommodation behaviors, which ultimately make it easier to perform compulsions or avoid obsession-invoking triggers, frequently exacerbating the severity of the OCD symptoms and decreasing motivation for treatment. Also, accommodation behaviors can indirectly result in negative consequences for the family member engaging in them and for other non-OCD members of the family, reducing their quality-of-life. The current case study documents and discusses a 3-month, 10-session, cognitive-behavioral treatment designed to help "Brianne," a married Caucasian mother of two in her 40s, reduce her accommodation behaviors with her 19-year-old son, "Charlie," who was unmotivated to accept treatment for his diagnosed OCD and who was living at home. In line with the above, the treatment was premised on the hypothesis that reducing Brianne's accommodation behaviors would have a positive impact not only on Charlie and Brianne, but also on the other two members of Brianne's nuclear family: her husband "Jack," and her older son "Shane." The therapy focused on (a) providing Brianne with psychoeducation regarding the nature of OCD and the negative impact of accommodation behaviors, (b) developing Brianne's alternative coping behaviors in response to Charlie's rituals, (c) offering Brianne communication training, and (d) promoting Brianne's self-care behaviors. Results indicate that the treatment was effective in reducing Brianne's accommodation and improving her quality of life as well as her husband's and other son's within the household, but that more treatment was likely necessary in order to consolidate therapeutic gains. The treatment did not appear to impact Charlie's OCD treatmentseeking motivation nor his levels of anxiety or aggressive outbursts by the end of therapy. Factors contributing to the results of the treatment are discussed. Overall, the case results suggest that family members living with OCD-diagnosed adults not currently seeking treatment can derive benefit from a brief intervention designed to reduce accommodation behaviors, improve family communication, and promote self-care.

Sudden gains (SGs) are defined as abrupt and significant improvements in mental health symptoms that occur between two psychotherapy sessions. Preliminary evidence suggests that SGs may be an important pattern of symptom reduction in the treatment of alcohol use disorder (AUD) (i.e., a steep between-session reduction in drinking or alcohol craving frequency or intensity) (Drapkin et al., 2015). The current study examined SGs within two randomized clinical trials (RCTs) testing female-specific cognitive behavior therapy (CBT) protocol for AUD (n = 146). We tested a priori hypotheses about whether women’s baseline depression, anxiety, and confidence to be abstinent while in a negative emotional state would predict attainment of SGs after attending sessions that addressed depression, anxiety, and emotion regulation (i.e., sessions five and six of the 12-session protocol). Data were collected at baseline, within treatment, and 15 months after baseline. Results showed that women with high levels of depression and/or anxiety and low confidence to be abstinent in a negative emotional state at baseline were more likely to experience a SG (steep decrease in drinking) after sessions five and six (p=.02). Further, among women with high levels of depression and/or anxiety at baseline, those who experienced both a SG in drinking after session five/six and had higher confidence to remain abstinent in a negative emotional state at the end of treatment reported lower drinking frequency at 9- but not 15-month follow-up [95% CI = (−2.65, −0.86)]. Findings support the value of providing interventions targeting mood and emotion regulation in AUD treatment for women.

Exposure and response prevention (ERP) is considered the gold standard treatment for obsessivecompulsive disorder (OCD). However, when comorbidity or other clinically relevant issues arise, the standard ERP protocol may require modification. Golden and Holaway's (2013) case of "Mr. H" and Pontes and Pereira's (2013) case of "Angela" offer excellent examples of clients presenting with these clinical challenges. Our commentary addresses some of the concerns raised by these authors by bringing in the emerging field of Distress Tolerance (DT) research. Using examples from the authors' cases, along with relevant research, we suggest that clinicians who wish to modify ERP consider the proposed alterations carefully by simultaneously thinking more broadly and more specifically about the psychopathology present. In addition, we stress the necessity of various forms of continual outcome monitoring.

No abstract