Our lab has recently been awarded two research grants from the Obsessive Compulsive Foundation (OCF). The grants are funding studies to (a) develop and test a couples-based OCD treatment program, and (b) develop and test a prevention program for postpartum OCD symptoms.
Couples-based treatment for OCD. We know that intimate relationships can have a significant impact on OCD symptoms. Some partners accommodate their loved ones with OCD by participating in rituals or assisting with avoidance strategies. In other cases, relationship stress (that might develop from the presence of OCD in the first place) increases the sufferer's OCD symptoms. For example, if there is hostility or personal criticism directed at the person with OCD by his or her partner, this can paradoxically increase OCD symptoms. Our study is in collaboration with Donald Baucom, PhD and the UNC Couples Lab. We are designing and testing a cognitive-behavioral therapy program that addresses OCD and includes the sufferer's partner as a coach. In addition to exposure and response prevention treatment, the couple (both partners attend all 12 treatment sessions) work on developing their relationship in ways that help the OCD sufferer to reduce his or her symptoms.
Prevention of Postpartum OCD Symptoms. This study represents a collaboration with Florida State University researchers Kiara Cromer, MA, and N. Brad Schmidt, PhD. Given Dr. Abramowitz's previous research suggesting that certain psychological variables predict the severity of postpartum OC symptoms, we are developing a program to be implemented within routine prenatal education (birthing classes). The program contains educational modules about OCD symptoms, the normalcy of intrusive unwanted thoughts in the postpartum, and the tendency to misinterpret the significance of these senseless thoughts. Participants wil also learn cognitive therapy and exposure strategies. This program will be compared with a control group.
Prepulse Inhibition, Startle Response, and OCD. The neuropsychiatric literature has documented impaired cognitive processing in patients with OCD, but as of yet no investigation has been made of the physiological functioning associated with obsessive beliefs--cognitive biases thought to lead to the misinterpretation of otherwise benign intrusive negative thoughts and thereby the development of obsessions. Thus, in this study, we are examining the cognitive processing in individuals high in obsessive beliefs using an efficient and non-invasive measure of physiology--the startle response.
Our lab also conducts research focusing on the areas mentioned further below.
Dr. Abramowitz's research focuses on the nature and treatment of obsessive-compulsive disorder (OCD) and other anxiety disorders, and is conducted within the UNC Anxiety and Stress Disorders Clinic (ASDC). The ASDC is a clinical research laboratory in which studies are conducted to better understand the nature of, and improve the treatment of, anxiety problems. Our research is also concerned with finding out what makes a person vulnerable to developing an anxiety disorder, and what can be done to prevent the development of such problems.
Our lab's research maintains a "translational" framework, based on the assumption that basic research on psychological processes will directly inform answers to important clinical questions. The Anxiety Disorders Program is committed to training advanced undergraduate and graduate students in the development of scientific values and skills. This approach is based on the assumption that critical thinking and empirical (scientific) methods provide the most accurate answers to questions about psychological functioning and psychological treatment.
Scientific inquiry is highly creative, allowing for individuals to “push” the limits of their own curiosity. Accordingly, students who work in the UNC Anxiety Disorders Program operate as “junior colleagues” as we hope to instill skills in critical thinking and research development, allowing for the production and training of caring and effective clinical psychologists. There is also ample opportunity (and it is strongly encouraged) for students to apply for funding to support their research, to earn authorship on publications (journal articles and book chapters), and to present research papers and posters at professional conferences.
Clinical research within the ASDC
takes place within two state-of-the-art facilities. One of these, the Davie Hall Clinic, operates within the Department of Psychology on the UNC campus. The other facility, which opened in July 2006, is our Clinical Research Center and Clinic (CRCC). The CRCC is located off campus at Finley Golf Course Road and serves the local community of Chapel Hill as well as the surrounding region which includes the cities of Durham and Raleigh, NC. Both of these clinics are designed for collecting clinical research data and contain audio/video equipment (including cameras for recording sessions), networked computers, rooms for individual and group assessment and therapy, as well as ample office workspace and conference/meeting space. The Anxiety Disorders Program has office space at each location for the purposes of clinical and research activities.
The section below describes the types of research projects carried out in the Anxiety Disorders Program. A list of Dr. Abramowitz's publications can be found here. OCD is an anxiety disorder that is chronic if left untreated. It is also characterized by heterogeneity- meaning that affected individuals might present with any number of diverse and individualized obsessive-compulsive symptoms. For example:
• Obsessional thoughts of catching AIDS from public bathrooms
• Unwanted obsessional ideas of harming one’s own child or an elderly relative
• Obsessive doubts whether one turned off the oven before leaving home
• Compulsive urges to wash one’s hands according to self-prescribed “rules”
• Ritualistically repeating prayers until they are said “just right”
• "Cancelling out" upsetting thoughts and images with other “safe” thoughts
• Re-checking locks and switches 12 or 14 (but not 13) times before leaving the house
Our research examines the following aspects of OCD:
- Similarities and differences between the various forms of OCD symptoms.
- The nature of mental rituals- compulsive behaviors carried out in one's mind
- Scrupulosity- obsessions and compulsions about religion and morality
- The relationship between religion and OCD
- The assessment of OCD symptoms
- The development and evaluation of new instruments to assess OCD symptoms
- Whether different types of OCD symptoms respond differently to treatment
Research from around the world suggests that cognitive-behavior therapy (CBT) using the techniques of exposure and response prevention (ERP) is the most effective short- and long-term treatment for OCD. Dr. Abramowitz has conducted treatment outcome studies of CBT as well as quantitative reviews (meta-analyses) of the treatment literature. He has also written manuals for clinicians to follow when working with individuals with OCD. Current and recently completed studies in this area include the following topics:
-Factors that predict either a good or poor response to treatment for OCD and anxiety disorders
-Development of a CBT program for depressed OCD patients
-Developing intensive programs for people without access to local CBT therapists
-Evaluation of a 2-day intensive CBT program for people with panic disorder and agoraphobia
-Evaluation of a self help (with minimal therapist contact)
program for social anxiety
-Cognitive-behavioral treatment of hypochondriasis (health anxiety)
-Treatment preferences between medication and cognitive-behavioral therapy
Research indicates that certain problematic styles of thinking play an important role in the development and persistence of anxiety disorders. Examples of such "dysfunctional thinking" include overestimating the probability or dangerousness of a feared situation. A person with social phobia, for example, might believe that being embarrassed or teased is very likely, and that this would be intolerable (e.g., "I will definitely embarrass myself and it will be absolutely awful"). As a result, he or she fears social situations and avoids them.
Research also shows that certain behavioral (conditioning) processes serve to maintain anxiety disorders. If the person with social phobia, for example, always avoids social situations, he or she will never learn that embarrassment is not imminent and not as awful as he thinks. So, he never gets to disprove his fear and the fear remains in place. Other types of behavioral responses that contribute to anxiety disorders include compulsive rituals, reassurance-seeking, and so-called "safety-seeking" behaviors (e.g., rehearsing what to say before ordering food in a restaurant).
Research in the Anxiety Disorders Program studies how people with anxiety disorders think and behave in ways that are self-defeating. Examining these phenomena helps clinicians (including ourselves) understand and better treat people who suffer from severe anxiety problems. Some of our studies have examined:
-The tendency to pay close attention to internal body sensations
-The tendency to misinterpret normal (but uncomfortable) bodily sensations
-The tendency to misinterpret the importance of unwanted thoughts
-The role of ritualistic safety-seeking behavior
in severe health anxiety (hypochondriasis)
These two research areas are grouped together because by studying OCD symptoms during pregnancy and the postpartum, we have developed a method for examining what makes a person vulnerable to developing OCD symptoms. Expecting parents present an excellent opportunity to prospectively study this question since there is an increased risk of OCD development during the postpartum period. Most new parents normally experience unwanted intrusive thoughts regarding their newborn that are similar in content to obsessions as observed in OCD (e.g., intrusive thoughts about the child dying of SIDS). Yet, only a relatively small proportion of new parents actually develop clinically severe obsessional problems. Because childbirth is relatively predictable, the presence of cognitive biases can be ascertained in expecting parents well before delivery. We can then follow the study participants into the postpartum to determine whether the presence of pre-existing cognitive biases predicts the severity of postpartum obsessions and compulsions (e.g., excessive checking on the baby). Our research in this area has led to a greater understanding of postpartum OCD. It has also helped us to understand some of the factors that contribute to the development of OCD.
We are currently planning additional studies on these topics, including a study to examine the prevalence and incidence of postpartum anxiety disorders, and the developmentof prevention programs for postpartum OCD and anxiety.
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