Behavioral Treatment of Feelings of Incompleteness: A Randomized Controlled Trial

• Other Authors: Fitch, Kristin E. (Kristin Evelyn) (authoraut)
• Format: Others
• Language: English; English
• Published: Florida State University
• Subjects: Clinical psychology
• Online Access: http://purl.flvc.org/fsu/fd/FSU_migr_etd-9597

Two core dimensions of obsessive-compulsive disorder (OCD), harm avoidance and incompleteness, have been proposed to underlie overt symptom subtypes (Summerfeldt, 2004). Foa, Abramowitz, Franklin and Kozak (1999) have found that patients with OCD who could not articulate fears of a specific consequence (i.e. harm) of not completing rituals displayed less improvement from cognitive behavioral therapy using exposure and response prevention (ERP) than patients who could articulate feared consequences (i.e., were motivated by harm avoidance). Summerfeldt (2008) argued that current treatments may not be as effective for patients with feelings of incompleteness as they do not report obsessional fears that can be disconfirmed in treatment and has suggested that exposure treatment with a focus on purposefully leaving stimuli incomplete would be effective for such individuals. The aims of the current study were to: (1) evaluate the effectiveness of a purely exposure-based treatment (ERP) for feelings of incompleteness in comparison to progressive muscle relaxation (PMR) among individuals with elevated levels of dispositional incompleteness; and (2) determine if reductions in feelings of incompleteness were associated with reductions in multiple OC symptom dimensions and perfectionism. Undergraduate students with elevated feelings of incompleteness completed self-report questionnaires and behavioral assessments of incompleteness (visual and tactile), ordering and arranging, washing, and contamination approach during a pretreatment evaluation. Forty-eight participants were randomly assigned to complete three sessions of either ERP or PMR. Following these sessions, participants completed a post-treatment evaluation including the questionnaires and behavioral assessments administered at pretreatment, and a behavioral assessment of checking. Participants completed questionnaires one month following the post-treatment assessment. Results suggest that ERP, in comparison to PMR, was effective in reducing visual and tactile incompleteness on behavioral tasks; however, there were no differences between groups on other behavioral measures of OC symptoms or task-related perfectionism. No group differences were found on self-report measures of dispositional incompleteness, OCD symptoms, or perfectionism at post-treatment or follow up. ERP did result in greater reductions in harm avoidance at post-treatment compared to PMR. Exploratory moderation analyses revealed that among individuals low in pretreatment OCD severity, ERP was associated with greater reductions in incompleteness, ordering symptoms, and trait anxiety than PMR; no effects of condition were found among those high in pre-treatment OCD symptoms. These findings suggest a higher dose of ERP may be necessary to reduce incompleteness among individuals with elevated OCD symptoms. Further clinical implications are discussed. === A Dissertation submitted to the Department of Psychology in partial fulfillment of the requirements for the degree of Doctor of Philosophy. === Summer Semester, 2015. === July 17, 2014. === exposure, incompleteness, NJREs, obsessive-compulsive disorder, perfectionism === Includes bibliographical references. === Jesse R. Cougle, Professor Directing Dissertation; Frank D. Fincham, University Representative; Thomas E. Joiner, Committee Member; E. Ashby Plant, Committee Member; Norman B. Schmidt, Committee Member.