Anxiety Disorders: Shafran R

Shafran R, Rachman S. · Department of Psychiatry, Oxford University, Warneford Hospital, Oxford, OX3 7JX, UK. · J Behav Ther Exp Psychiatry. · Pubmed #15210372 No free full text.

Abstract: The cognitive bias of "Thought Action Fusion" (TAF) has received significant research attention in the past decade. The review addresses the assessment of TAF, its place in cognitive theories of obsessional difficulties, and the evidence demonstrating that TAF is relevant to disorders beyond Obsessive Compulsive Disorder (OCD). Data on the components of TAF, its extension to positive outcomes and its role in the aetiology, maintenance and treatment of OCD are reviewed. It is concluded that the moral form of TAF is less robust than the likelihood form and that scales may be best used as a starting point in identifying beliefs and conducting experimental investigations. It is also suggested that the scales be amended to include harm avoidance, which would also increase their clinical utility.

Lee M, Shafran R. · Department of Psychiatry, Warneford Hospital, Oxford University, Oxford, OX3 7JX, UK. · Clin Psychol Rev. · Pubmed #15081517 No free full text.

Abstract: Research has supported a link between emotional disorders (such as depression and anxiety) and information processing biases of attention and memory. This article reviews the extension of this approach to such biases in eating disorders. Two paradigms are considered in detail: the modified Stroop task and the dot probe task. In addition, the relative merits and problems associated with both approaches are considered. The limitations of the current research for clinical practice are discussed and suggestions are made for ways in which the research may be made more ecologically valid.

Shafran R, Mansell W. · Department of Psychiatry, Warneford Hospital, University of Oxford, UK. · Clin Psychol Rev. · Pubmed #11497211 No free full text.

Abstract: Clinical experience suggests that perfectionism can impede the successful treatment of psychological disorders. This review examines the concept of perfectionism, critically evaluates its assessment, reviews the association between existing measures of perfectionism and psychopathology, and considers the impact of perfectionism on treatment. It is concluded that existing measures do not reflect the original construct of perfectionism and that, consequently, new measures are needed. The evidence reviewed indicates that high personal standards are specifically elevated in patients with eating disorders and beliefs about others' high standards for the self are associated with a broad range of psychopathology. The importance of examining mean scares across studies (as well as associations between variables within studies) is emphasized. There has been no systematic evaluation of the treatment of perfectionism despite existing cognitive-behavioral treatment protocols.

Salkovskis P, Shafran R, Rachman S, Freeston MH. · University of Oxford Department of Psychiatry, Warneford Hospital, UK. · Behav Res Ther. · Pubmed #10500320 No free full text.

Abstract: The purpose of this paper is to consider the possible origins of an inflated sense of responsibility which occupies an important place in the cognitive theory of obsessive compulsive disorder (Rachman, S. (1993). Obsessions, responsibility, and guilt. Behaviour Research and Therapy, 31, 149-154. Salkovskis, P. M. (1985). Obsessional-compulsive Problems: A cognitive-behavioural analysis. Behaviour Research and Therapy, 23 (5), 571-583). Clinical experience and consideration of current cognitive conceptualisations of obsessions and obsessive compulsive disorder suggest a number of possibilities, each of which is described after a brief introduction to the concept itself. While there are reasons to believe that some general patterns can be identified, the origins of obsessional problems are best understood in terms of complex interactions specific to each individual.

de Silva P, Menzies RG, Shafran R. · Department of Psychology, Institute of Psychiatry, King's College London, De Crespigny Park, SE5 8AF, London, UK. · Behav Res Ther. · Pubmed #12547375 No free full text.

Abstract: It is well established that many patients with obsessive-compulsive disorder have covert, or internal, compulsions. Empirical studies of this phenomenon, however, are limited. The present study followed the paradigm developed by Rachman and his colleagues for the study of overt compulsions. Patients with urges to carry out covert compulsions underwent an experimental procedure in which their compulsive urges were provoked, followed by a period of response prevention. The strength of the compulsive urges and associated discomfort were monitored. There was marked, and relatively rapid, spontaneous decay of both the compulsive urges and the discomfort. Implications of these results are discussed.

Lee M, Shafran R. · Department of Psychiatry, University of Oxford, Oxford, United Kingdom. · Int J Eat Disord. · Pubmed #18213690 No free full text.

Abstract: OBJECTIVE: Previous research has indicated that temporal factors [specifically, the duration of interstimulus intervals (ISI) during a threat processing task] may influence the nature of processing biases exhibited in nonclinical populations with some degree of eating disorder psychopathology (Meyer et al., Int J Eat Disord, 27, 405-410, 2000). The current study aimed to test this hypothesis by investigating attentional biases for eating-disorder-relevant images and irrelevant visual images (animals) in patients with eating disorders (n = 23) and psychiatric (n = 19) and nonpsychiatric (n = 65) controls. METHOD: A dot probe task was modified from previous research (Shafran et al., Int J Eat Disord, 40, 369-380, 2007), whereby an original ISI of 500 ms was increased to 2,000 ms. RESULTS: Patients with an eating disorder continued to display a bias in the processing of weight stimuli. However, biases noted in previous research for shape and weight stimuli disappeared when the ISI duration was increased in this way. CONCLUSION: These findings highlight the importance of temporal factors in whether processing biases are displayed and may point to ways in which biases actually work in this population. However, further research is warranted.

Shafran R, Lee M, Cooper Z, Palmer RL, Fairburn CG. · Department of Psychiatry, Oxford University, Oxford, United Kingdom. · Int J Eat Disord. · Pubmed #18213684 No free full text.

Abstract: OBJECTIVE: The aims of these studies were (a) to investigate the relationship between attentional bias and eating disorders and (b) examine the impact of psychological treatment on attentional bias. METHOD: The first study compared performance on a pictorial dot probe of 82 female patients with clinical eating disorders and 44 healthy female controls. The second study compared the performance of 31 patients with eating disorder on the same task before and after receiving 20 weeks of standardized cognitive behavior therapy. Twenty-four patients with eating disorder served as wait-list controls RESULTS: With the exception of neutral shape stimuli, attentional biases for eating, shape, and weight stimuli were greater in the patient sample than the healthy controls. The second study found that attentional biases significantly reduced after active treatment only. CONCLUSION: Attentional biases may be an expression of the eating disorder. The question of whether such biases warrant specific intervention requires further investigation.

Rachman S, Radomsky AS, Shafran R. · Department of Psychology, University of British Columbia, 2136 West Mall, Vancouver, BC, V6T 1Z4, Canada. · Behav Res Ther. · Pubmed #18199423 No free full text.

Abstract: There is ample evidence that the use of safety behaviour can interfere with the progress of therapy, particularly if exposure is involved. As a result, it is widely asserted that safety behaviour is anti-therapeutic. However, an unqualified rejection of safety behaviour should be reconsidered because we now have theoretical justification, experimental evidence and clinical observations showing that the judicious use of safety behaviour, especially in the early stages of treatment, can be facilitative. Experiments in which escape behaviour facilitated fear reduction, and others in which the use of safety gear facilitated fear reduction, are reviewed. It also appears that safety behaviour does not necessarily prevent disconfirmatory experiences. We propose that additional investigations of the judicious use of safety behaviour will help to elucidate therapeutic uses of safety behaviour in the treatment of anxious and related types of psychopathology.

Uher R, Heyman I, Turner CM, Shafran R. · King's College London, Institute of Psychiatry, London, UK. · J Anxiety Disord. · Pubmed #18023139 No free full text.

Abstract: Self-report measures of obsessive-compulsive disorder (OCD) in children and adolescents are needed for practical evaluation of severity and treatment response. We compared the self- and parent-report Obsessional Compulsive Inventory Revised (CHOCI-R) to the interview-based Child Yale-Brown Obsessive-Compulsive Scale (CY-BOCS) in a clinical sample of 285 children and adolescents with OCD. Classical test theory and item-response theory were applied to compare the instruments. The self- and parent-report CHOCI-R had good internal consistency and were strongly related to each other. The self- and parent-report CHOCI-R severity scores correlated with the CY-BOCS (Pearson's r 0.55 and 0.45 respectively). The CY-BOCS discriminated better at the severe end of the spectrum. The CHOCI-R provided better discrimination in the mild to moderate range. The time-efficient self- and parent-report alternatives will enable routine measurement of OCD severity in clinical practice. Estimates of equivalent summed scores are provided to facilitate comparison.

Glover DS, Brown GP, Fairburn CG, Shafran R. · Royal Holloway University of London, UK. · Br J Clin Psychol. · Pubmed #17472203 No free full text.

Abstract: OBJECTIVE: The construct of 'clinical perfectionism' has been developed in response to criticisms that other approaches have failed to yield advances in the treatment of the type of self-oriented perfectionism that poses a clinical problem. The primary aim of this study was to conduct a preliminary investigation into the efficacy of a theory-driven, cognitive-behavioural intervention for 'clinical perfectionism'. DESIGN: A multiple baseline single case series design was used. METHOD: A specific, 10-session cognitive-behavioural intervention to address clinical perfectionism in eating disorders was adapted to allow its use in nine patients referred with a range of axis I disorders and clinical perfectionism. RESULTS: The intervention led to clinically significant improvements in self-referential perfectionism from pretreatment to follow-up for six of the nine participants on two perfectionism measures and for three of the nine participants on the measure of clinical perfectionism. Statistically significant improvements from pre- to post-intervention for the group as a whole were found on all three measures. The improvements were maintained at follow-up. CONCLUSIONS: The finding that clinical perfectionism is improved in the majority of participants is particularly encouraging given that perfectionism has traditionally been viewed as a personality characteristic resistant to change. These preliminary findings warrant replication in a larger study.

Shafran R, Lee M, Cooper Z, Palmer RL, Fairburn CG. · Department of Psychiatry, Oxford University, Oxford, England, UK. · Int J Eat Disord. · Pubmed #17330290 No free full text.

Abstract: OBJECTIVE: To examine the relationship between eating disorders and attentional biases. METHOD: The first study comprised 23 female patients with clinical eating disorders, women with high levels of anxiety (n = 19), and three female normal control groups comprising low (n = 31), moderate (n = 21), or high levels of shape concern (n = 23). The second study comprised 82 women with clinical eating disorders and 44 healthy controls. All participants completed measures of eating disorder psychopathology and completed a modified pictorial dot-probe task. RESULTS: In the first study, biases were found for negative eating and neutral weight pictures, and for positive eating pictures in women with eating disorders; these biases were greater than those found in anxious and normal controls. The second study replicated these findings and biases were also found for negative and neutral shape stimuli. CONCLUSION: It is concluded that future research should establish whether such biases warrant specific therapeutic interventions.

Thordarson DS, Radomsky AS, Rachman S, Shafran R, Sawchuk CN, Ralph Hakstian A. · Department of Psychology, University of British Columbia, 2136 West Mall, Vancouver, BC, V6T 1Z4, Canada. · Behav Res Ther. · Pubmed #15381439 No free full text.

Abstract: The original Maudsley Obsessional Compulsive Inventory (MOCI) has been widely used and is considered to be one of the best available self-report instruments for measuring observable obsessive-compulsive problems such as washing and checking. However, it has several limitations and requires updating. Our revision of the MOCI, the Vancouver Obsessional Compulsive Inventory (VOCI), was designed to provide assessment of a range of obsessions, compulsions, avoidance behaviour, and personality characteristics of known or theoretical importance in obsessive-compulsive disorder (OCD). The development of the VOCI is described, and we provide evidence of its reliability and validity. Our findings in samples of people with OCD, people with other anxiety disorders or depression, community adults, and undergraduate students suggest that the VOCI is a promising new measure. We anticipate that, like its predecessor, the VOCI will have widespread use in both research and clinical settings.

Shafran R, Frampton I, Heyman I, Reynolds M, Teachman B, Rachman S. · Oxford University Department of Pschiatry, Warnefond Hospital, Oxford OX3 7JX, UK. · J Adolesc. · Pubmed #12550826 No free full text.

Abstract: The aim of this study was to develop a reliable self-report instrument to assess obsessive-compulsive disorder (OCD) in young people. The children's Obsessional Compulsive Inventory (CHOCI) had good internal consistency, criterion validity and was significantly correlated with the Children's Yale-Brown Obsessive Compulsive Scale (CY-BOCS). This preliminary new measure could serve to provide a more efficient and accessible way of assessing OCD in young people.

Rachman S, Grüter-Andrew J, Shafran R. · Department of Psychology, University of British Columbia, Vancouver, Canada. · Behav Res Ther. · Pubmed #10846809 No free full text.

Abstract: A psychometric study was conducted in order to collect basic information about post-event processing in social anxiety. It was found that such processing occurs commonly after an anxiety-evoking or embarrassing social event and post-event processing scores were significantly correlated (r = 0.40) with social anxiety. The recollections of the social event tended to be recurrent and intrusive, interfering with concentration. Post-event processing was associated with the avoidance of similar social situations. The results are discussed in terms of the Clark and Wells model of social phobia.