This narrative review examines neuromodulation as a potential augmentation strategy for cognitive-behaviour therapy (CBT) with exposure and response prevention (ERP) in obsessive-compulsive disorder (OCD). By synthesising behavioural, neurobiological, and clinical literature, we evaluate how circuit-based interventions can enhance extinction learning (EL), the core mechanism of ERP, and improve outcomes. ERP is the gold-standard treatment for OCD, yet a substantial proportion of patients do not respond adequately or drop out. EL, driven by habituation, inhibitory memory formation, and expectancy violation underpins ERP. EL is often impaired in OCD, linked to cortico-limbic dysfunction. Of note, ventromedial prefrontal cortex (vmPFC) plays a central role in extinction memory formation as well as retrieval, and hence, can be considered as the central “extinction locus”. Non-invasive neuromodulation techniques have shown preliminary efficacy in modulating these circuits. Preclinical studies show that stimulation of vmPFC before or during exposure may enhance EL. However, conventional methods may not be adequate to stimulate deeper structures such as the vmPFC. Novel focal and noninvasive neuromodulatory techniques, such as transcranial focused ultrasound or temporal interference stimulation, have to be evaluated. Cognitive domains beyond extinction, including working memory, error monitoring, and distress tolerance, also represent promising neuromodulatory targets. Neuromodulation offers a promising, circuit-based approach to augment ERP in OCD by strengthening EL and related processes. Future progress requires focal, personalised, and mechanistically guided protocols.

Background:Common mental disorders (CMDs) in older adults contribute to considerable disease burden and are associated with significant multimorbidity. With the increase in population ageing, the concerns related to multimorbidity are likely to increase. Cognitive-behavioural therapy (CBT) is an evidence-based approach for CMDs. More recently, transdiagnostic approaches to address shared mechanisms across disorders have been studied. Novelty: Despite a considerable body of literature on psychological interventions in higher-income countries, there is a notable lack of empirical studies examining the efficacy of transdiagnostic CBT (tCBT) in CMDs and older adults in India. In this study, we propose to test the effectiveness of a tCBT adapted for older adults, involving stakeholders. Objectives:To examine the efficacy of a tCBT for older adults with CMDs. Methods:A two-group parallel-arm randomised controlled design will be adopted to examine the efficacy of tCBT in older adults with CMDs. A total of 120 older adults (N = 60; intervention and control arm, respectively), meeting criteria for CMDs and scoring above the cut-off on Patient Health Questionnaire-9 and/or GAD-7, consenting for participation, will be randomised to receive either tCBT or treatment as usual plus psychoeducation (TAU + psychoeducation). The primary outcome (mood) will be measured using HAM-A and HAM-D. Secondary outcomes include sleep disturbances, repetitive negative thinking (RNT), metabolic effects, and quality of life. Participants will be assessed at baseline, post-intervention, and 3-month follow-up. The intervention will be adapted to older adults in India, based on a needs analysis with stakeholders (patients, caregivers, and experts). Expected Outcomes:There is a dearth of systematic studies in India on psychotherapy in older adults, particularly those that target multimorbidity and transdiagnostic processes such as sleep and RNT. This psychotherapy trial will provide important empirical data on the efficacy of evidence-based tCBT in older adults with CMDs.

Background:Experiential avoidance (EA) and mindfulness are the two important transdiagnostic process and outcome variables in psychological formulation and treatment. While smartphones have a large utility value, they also have the potential for adverse impacts on functioning. Studies have separately shown associations among EA, dispositional mindfulness (DM), and problematic smartphone use (PSU). However, there is a lack of study exploring the associations and mediation relationship among these variables together in an Indian context. The current study aims to explore the associations of PSU, DM, EA, and sociodemographic factors; including the mediating effect of EA between DM and PSU in the Indian adult context. Methods:Four hundred and thirty-four participants (M age = 25.4, standard deviation = 2.6, 58.8% females) were recruited for an online survey using a cross-sectional design. Data were collected using sociodemographic questionnaire, Smartphone Addiction Scale-Short Version, brief EA scale, and Mindfulness Attention Awareness Scale. Statistical analyses comprised multiple regression, mediation analysis, and significance in sociodemographic variables. Results:Both EA and DM significantly predicted PSU with a 37% variance; however, DM had an inverse relationship. EA as a mediator could account for a quarter of the effect, PM = 24.4%, ab = -0.14, 95% CIcs (-0.19, -0.09). Conclusion:The current study implicates the monitoring and treatment planning for PSU from a transdiagnostic perspective in the Indian context.

Background: Non-suicidal self-injury (NSSI) is an emerging issue among adolescents with a growing prevalence in clinical settings. It is a multi-faceted condition in terms of psychiatric comorbidities, variation in the form and method of self-harm, body area, the pattern of the wound and the function served, and therefore, understanding and managing it adequately in routine clinical practice is a challenge. There is a need for research to focus on in-depth understanding of the effectiveness of and process issues for existing interventions for NSSI in adolescents. Aim: The present research is a case series aimed at examining the effectiveness of the cutting-down programme (CDP), a manualized cognitive behaviour therapy programme, in reducing the frequency and intensity of NSSI acts and urges in two adolescents. The objectives of the study were to examine the effect of the CDP on depressive symptoms, dysfunctional attitudes, emotion regulation, experiential avoidance and global functioning in adolescents with NSSI, and to explore the association of patient motivation and patient perception of therapy with therapy outcome in adolescents with NSSI. Method: For the study, two adolescents with NSSI who presented to the Department of Child and Adolescent Psychiatry, NIMHANS, Bangalore, were recruited using purposive sampling. They were assessed using the MINI-International Neuropsychiatric Interview for Children and Adolescents (MINI Kid Screen 7.0.2). In addition, standardized were used to assess the severity and functions of NSSI, borderline personality disorder, depression, emotion regulation skills, dysfunctional attitudes, psychological flexibility and global functioning. The participants were also assessed on a semi-structured interview to assess NSSI every week during the intervention. Baseline measures were repeated when the CDP was completed. Further, the non-specific factors such as patient’s perceptions of therapy and patient motivation were assessed using the standardized scales. Results: The CDP was found to be effective in reducing the NSSI among the two adolescents. It also improved their depressive symptoms, dysfunctional attitudes, emotion regulation, experiential avoidance and global functioning. The therapy outcome was related to the participants’ motivations and perceptions of therapy. Conclusion: The CDP is an effective intervention for reducing NSSI acts. However, client characteristics such as perception and motivation for therapy will play a role in therapy outcome.

Background: The emotion of disgust has been linked with the underlying nature of the contamination subtype of obsessive-compulsive disorder (C-OCD). Prior studies show that disgust contributes to the development of C-OCD by reinforcing avoidance strategies. Therefore, experiential avoidance (EA) may influence the effect between disgust sensitivity (DS) and C-OCD symptom severity. This study aimed to investigate the mediational role of EA between DS and C-OCD severity. Methods: A cross-sectional design was adopted with 45 patients of OCD and 45 healthy controls. Both the groups were assessed on the Obsessive-Compulsive Inventory, the Disgust Scale (Revised), and Acceptance and Action Questionnaire–II. Yale-Brown Obsessive Compulsive Scale (Y-BOCS) checklist and symptom severity scale were additionally administered to the patients with OCD. Independent t-tests, Pearson’s product–moment correlation, regression analysis, and mediation analysis were used. Results: DS and EA were positively associated with contamination-washing symptoms and symptom severity. Regression analysis indicated that DS and EA were highly associated with contamination/washing severity scores among both the patients with C-OCD and the healthy controls. Conclusion: The study implicates that disgust is a central emotion underlying the presentation of obsessions and compulsions, which are of contamination concerns. Further, EA has a role in the maintenance of OCD through avoidance learning; however, it may not be interacting with DS to cause OCD.

We explored perceived barriers to homework adherence in clients receiving individual psychotherapy. Ninety-four adults with at least four individual psychotherapy sessions were recruited from outpatient services of a tertiary hospital in India and assessed on the Barriers to CBT Homework Completion Scale, Homework Compliance Scale, and Clinical Global Impressions scale. More than one-fourth completed some portion of the homework. Participants reported a high level of overall perceived barriers to homework, with more task-and-patient related factors. Higher perceived barriers were associated with lower adherence. Findings highlight the importance of understanding perceived barriers to homework adherence and addressing them systematically.

Objective: A substantial proportion of severely ill patients with obsessive-compulsive disorder (OCD) do not respond to serotonin reuptake inhibitors (SRIs) and are unable to practice cognitive behavioral therapy (CBT) on an out-patient basis. We report the short-term (at discharge) and long-term (up to 2 years) outcome of a multimodal inpatient treatment program that included therapist-assisted intensive CBT with adjunctive pharmacotherapy for severely ill OCD patients who are often resistant to SRIs and are either unresponsive or unable to practice outpatient CBT. Methods: A total of 420 patients, admitted between January 2012 and December 2017 were eligible for the analysis. They were evaluated using the Mini International Neuropsychiatric Interview, the Yale-Brown Obsessive Compulsive Scale (YBOCS), and the Clinical Global Impression (CGI) scale. All patients received 4 to 5 therapist-assisted CBT sessions per week along with standard pharmacotherapy. Naturalistic follow-up information at 3, 6, 12, and 24 months were recorded. Results: At baseline, patients were mostly severely ill (YBOCS = 29.9 +/- 4.5) and nonresponsive to >= 2 SRIs (83%). Mean duration of inpatient stay was 42.7 +/- 25.3 days. At discharge, there was a significant decline in the mean YBOCS score (29.9 +/- 4.5 vs. 18.1 +/- 7.7, P < .001, Cohen's d = 1.64); 211/420 (50%) were responders (>= 35% YBOCS reduction and CGI-I <= 2) and an additional 86/420 (21%) were partial responders (25% to 35% YBOCS reduction and CGI-I <= 3). Using latent class growth modeling of the follow-up data, 4 distinct classes were identified, which include "remitters" (14.5%), "responders" (36.5%), "minimal responders" (34.7%), and "nonresponders" (14.6%). Shorter duration of illness, better insight, and lesser contamination/washing symptoms predicted better response in both short- and long-term follow-up. Conclusion: Intensive, inpatient-based care for OCD may be an effective option for patients with severe OCD and should be considered routinely in those who do not respond with outpatient treatment.

Mind-body therapies hold several advantages from the viewpoint of security, fulfilment, implementation and possible ancillary social and psychological health benefits. Side effects and risks of mind-body practice are generally nominal, implementation costs are little and most mind-body therapies can be performed by a broad range of populations, including overweight and sedentary menopausal women. The use of mind-body therapies for the alleviation of a menopausal symptoms is becoming increasingly common because of the perceived therapeutic benefits. The practice of mindfulness allows the participants to be aware of the present moment without concern for past or future consequences. Several researchers have discovered that being mindful may be helpful for menopausal women struggling with irritability, anxiety and depression. The purpose of this article aimed at reviewing the literature which studies the impact of the mindfulness-based training on menopausal symptoms among women during their climacteric period. Many midlife women try out practices like relaxation techniques, breathing exercises and yoga to help them get through these difficult times during their transitional period of life. Although these daily practices probably do not relieve symptoms such as hot flashes, they might improve overall wellbeing and help them sleep better. The literature was searched using databases such as CINAHL, Pub Med, Pro-Quest and Google scholar. The search terms used were: menopause, menopausal symptoms, mindfulness, quality of life and midlife transition. In India, the practice of mindfulness is not very well known among the menopausal women, so the aim of this review was to show a pathway to the primary health care workers like physicians, counsellors and the nurses, who can guide them about the practice of mindfulness thereby improving the quality of life.

The Preschool version of the Dimensions of Mastery Questionnaire (DMQ-18) is a popular instrument to assess children's ability to master the environment through action or activity to explore, influence, or control the physical atmosphere. Although this instrument was originally developed in English, it has now been translated and validated in five other languages: Hungarian, Turkish, Chinese, Spanish, and Persian. As we notice a growing interest in research on the mastery motivation among Bangladeshi preschoolers, we have taken this effort to translate and validate the DMQ-18 and explore the factor structure of the Bangla version of this questionnaire.After translating all 39 items of the questionnaire into Bangla, it was administered on 206 children, aged 3 to 6 years, recruited randomly from ten preschools in Dhaka. The schools were selected randomly from the official list of preschools prepared by the Dhaka City Corporation. Class teachers of the respective children completed the questionnaire with the assistant of research assistants.The Bangla version of the questionnaire retained all 39 items, with seven factors as they were in the English version. The Bangla version shows sufficient reliability (Cronbach's alpha = 0.87; test-retest reliability = 0.89 for whole questionnaire and .79–.89 for sub-scales; inter-rater reliability = 0.88 for whole questionnaire and .79–.88 for sub-scales), and validity (correlated positively with the English version; r = 0.85).Due to its robust psychometric properties, the Bangla DMQ-18 is suggested to be used for Bangladeshi preschool children to assess their mastery motivation.

The purpose of this study was to compare the Sports Competition Anxiety of successful female sports and un-successful sports female at college level. The present study was conducted on the 60 successful female sports and 60 un-successful sports female of college level of Punjab. Their age was ranged 18 to 25 year. The collection of data to measure e Sports Competition Anxiety Marten’s (1977) Inventory was used. For the analysis of data, collected by administering the questionnaire to all the subject’s ttest was employed at p<.001 level of significant. The result of the study concluded that there was statistically significant difference in successful female and unsuccessful sports female. It is clear that the mean successful female between of unsuccessful sports female is significantly higher than the mean Sports Competition Anxiety of the unsuccessful sports female.

BACKGROUND:Cognitive behavior therapy (CBT) involving exposure and response prevention is the gold standard psychotherapeutic intervention for obsessive-compulsive disorder (OCD). However, applying traditional CBT techniques to treat patients with predominant obsessions (POs) without covert compulsions is fraught with problems because of inaccessibility of mental compulsions. In this context, we examined the efficacy of mindfulness-integrated CBT (MICBT) in patients with POs without prominent overt compulsions. MATERIALS AND METHODS:Twenty-seven patients with Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition diagnosis of OCD were recruited from the specialty OCD clinic and the behavior therapy services of a tertiary care psychiatric hospital over 14 months. Patients had few or no overt compulsions and were free of medication or on a stable medication regimen for at least 2 months prior to baseline assessment. All patients received 12-16 sessions of MICBT on an outpatient basis. An independent rater (psychiatrist) administered the Yale-Brown Obsessive-Compulsive Scale (YBOCS) and the Clinical Global Impression Scale at baseline, mid- and post-treatment, and at 3-month follow-up. RESULTS:Of the 27 patients, 18 (67%) achieved remission (55% reduction in the YBOCS severity score) at 3-month follow-up. The average mean percentage reduction of obsessive severity at postintervention and 3-month follow-up was 56 (standard deviation [SD] = 23) and 63 (SD = 21), respectively. CONCLUSIONS:Our study demonstrates that MICBT is efficacious in treating patients with POs without prominent overt compulsions. The results of this open-label study are encouraging and suggest that a larger randomized controlled trial examining the effects of MICBT may now be warranted.

Disaster has a negative impact on health conditions, especially on those of temporary housing residents. Health status has a close relationship with physical activity and performance. However, few reports have assessed physical performance among residents living in temporary housing. In this study, we compared physical capabilities between the elderly who evacuated to temporary housing and those who stayed in their own homes after the Great East Japan Earthquake.Subjects were recruited from those over 65 years of age who participated in the medical check-ups for temporary housing residents (TH group) or check-ups for residents of downtown areas (control group) in Soma City, Fukushima, in 2012. The subjects underwent grip strength, one-leg standing (OLS), and timed up and go tests (TUG).In total, 1890 participants were recruited. The TH group showed significantly stronger grip strength than that of the control group. On the other hand, the TH group showed weaker standing stability, according to decreased OLS and increased TUG scores.We revealed that standing stability was impaired among elderly temporary housing residents 1.5 years after the disaster. Disaster responders should take into account the health risks associated with living in temporary housing.

In a cross sectional study, we examined the contribution of cognitive appraisals to the quality of life (QOL) in patients with obsessive compulsive disorder (OCD). Thirty one patients with the DSMIV diagnosis of OCD and 30 normal volunteers from community completed the Interpretation of Intrusions Inventory-31 (III-31), the World Health Organization Quality of Life-Brief (WHOQOL-BREF) and the Depression Anxiety and Stress Scale-21 (DASS-21). Patients scored higher than the normal controls on ‘inflated personal responsibility’, ‘thought control’, and ‘importance of thoughts’. Patients' QOL were poorer than that of normal controls. Cognitive appraisals of ‘thought control’ (r=−0.56, p<0.01), ‘importance of thoughts’ (r=−0.49, p<0.01), and ‘inflated responsibility’ (r=−0.62, p<0.01) correlated negatively with the psychological domain of QOL after controlling for the duration of illness and the severity of depressive, and obsessive-compulsive symptoms. Total QOL correlated negatively with ‘thought control’ and ‘inflated personal responsibility’. Our findings suggest that cognitive appraisals contribute significantly to the poor QOL in patients with OCD. Therefore, modification of beliefs and appraisals may be essential for better QOL in patients with OCD.

OBJECTIVE:Many psychiatric patients undergoing vocational training do not achieve successful transition to regular work. In this study, we evaluated the barriers for discharge from day care center to actual work place. MATERIALS AND METHODS:In a cross-sectional study at a government-run day-care center at National Institute of Mental Health and Neuro Sciences (NIMHANS), Bangalore, we studied 76 patients who were undergoing vocational training for more than 1 year. We did a semi-structured interview with patients, their family members, and instructors of various occupational sections. We used a questionnaire of 17 different barriers to assess the obstacles in their discharge from day-care center to actual work place. RESULTS:The majority of them had a diagnosis of mental retardation (n=47) followed by schizophrenia (n=29), and bipolar disorder (n=9). The mean (SD) age and duration of illness was 33.6 (9.7) years and 12.5 (9.3) years, respectively. Patients had more than one diagnosis. The median duration of stay in day-care center was 5.9 years. Doubts regarding performance at a new work place (n=60), fear of performance at new work place (n=65), and the fear of transition to regular work (n=64) were the most common barriers reported by patients, their family members and instructors of various occupational sections, respectively. DISCUSSION:Educating patients and their family members, gradual exposure to new working environment, and increased community level vocational opportunities may potentially overcome above barriers. Getting them to the actual job early in their course of treatment will improve their adjustment to a new work place and overall outcome.