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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.

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Nonsuicidal self-injury (NSSI) is conceptualized as an emotion-avoidant behavior similar to other co-occurring maladaptive behaviors such as substance abuse, disordered eating, and obsessive-compulsive behaviors. Although all these behaviors are motivated by emotion avoidance resulting in short-term benefits, a variety of cognitive processes are vital to understanding the onset and maintenance of these behaviors. This chapter overviews current research on the cognitive processes and related neurobiological features believed to increase vulnerability to NSSI. The chapter provides an integrative summary proposing that NSSI originates from a cognitive control dysfunction, rumination, and attentional biases toward negative emotions that result in the use of NSSI or other maladaptive regulation strategies. Continued use of the behavior leads to a cyclical pattern of reward that increases positive expectancies, attentional biases, development of rule-governed behavior, and cognitive inflexibility, and reliance on NSSI for coping is exacerbated. The integrated cycle of cognitive processes discussed in this chapter complements recent transdiagnostic models of emotion-avoidant disorders and helps to expand current emotion-focused theoretical understandings of NSSI.