Chad Wetterneck

Compass Health Center

Posttraumatic stress disorder (PTSD) is associated with functional impairment and poor quality of life (QoL) across multiple domains, such as social functioning, occupational and educational attainment, physical health, and overall life satisfaction and wellbeing. Yet, there is limited evidence for which PTSD symptom clusters may be more strongly a...

There is a growing body of literature demonstrating that experiences of oppression (e.g., racism, sexism, heterosexism, poverty) are associated with posttraumatic stress disorder symptoms. Traditional trauma assessments do not assess experiences of oppression and it is therefore imperative to develop instruments that do. To assess oppression-based...

The Dimensional Obsessive-Compulsive Scale (DOCS) is widely used to measure obsessive-compulsive disorder (OCD) severity across four broad symptom dimensions (i.e., contamination, responsibility for harm, unacceptable thoughts, symmetry). Despite its proven utility, there is reason to suspect that the unacceptable thoughts subscale conflates differ...

Objective: Trauma-related shame (TR-shame) is associated with Posttraumatic Stress Disorder (PTSD) symptoms. However, research findings are inconsistent regarding the role of TR-shame in PTSD treatment. The purpose of this study was to examine if change in TR-shame predicted change in PTSD symptoms in treatment. Method: A sample of 462 adults who r...

PTSD symptoms and psychological inflexibility have been linked to a lack of self-compassion and poor psychological health. Prior work has explored these relationships in a trauma-exposed undergraduate population and found that, while self-compassion was correlated with PTSD symptom severity at the bivariate level, this relationship was no longer si...

Several case studies describe utilizing combined approaches to treating individuals with co-occurring obsessive-compulsive disorder (OCD) and posttraumatic stress disorder (PTSD), yet empirical support for concurrent approaches is lacking. Further, no study has described a combined exposure and response prevention (ERP) and prolonged exposure (PE)...

OCD and PTSD share many commonalities, including phenotypic and functional overlap in symptoms. Specifically, both disorders are characterized by unwanted, intrusive, anxiety/distress-eliciting intrusive thoughts and evoking behaviors intended to control, neutralize, suppress, or outright avoid intrusive thoughts and associated anxiety/distress. Ex...

Objectives Despite numerous advances in the understanding of the development and maintenance of posttraumatic stress disorder (PTSD), current research is often narrowly focused on symptom reduction. Despite this, the impact of PTSD also extends into areas such as interpersonal relationships, pursuit of valued activities, and self-acceptance. These...

Gender and sexual minorities are subjected to minority stress in the form of discrimination and violence that leads to vigilance, identity concealment and discomfort, and internalized homophobia, biphobia, and transphobia. These experiences are related to increased susceptibility to mental health concerns in this population. Historically, the behav...

Maladaptive schemas have been linked with increased posttraumatic stress disorder (PTSD) symptoms. Posttraumatic negative self-appraisals (i.e., posttraumatic shame and self-blame) have also been empirically supported as contributors to PTSD symptom severity following traumatic events. These associations are well known; however, the pathways betwee...

Individuals with comorbid obsessive-compulsive disorder (OCD) and posttraumatic stress disorder (PTSD) experience more severe OCD symptoms and poorer treatment response. Despite some evidence linking OCD symptom domains to trauma, only one study to date has examined typical OCD and PTSD presentations in individuals with OCD+PTSD, and findings were...

Objective: Empirically supported treatments (ESTs) have been criticized for lack of ethnoracial representation, which may limit the generalizability of findings for non-White patients. This study assessed ethnoracial representation in United States-based randomized controlled trials (RCTs) for three evidence-based treatments for posttraumatic stre...

Researchers (Van Minnen et al., 2015) have examined the relationship between posttraumatic stress disorder (PTSD) and substance use. Yet, this scholarship is often focused on explicit use and does not account for underlying personality variables that might impact the bidirectional relationship between PTSD and substance use (McCauley et al., 2012)....

The Trauma-Related Shame Inventory (TRSI) was initially developed to explore the construct of trauma-related shame. The purpose of this study was to develop a standard, shortened version of the TRSI to address issues regarding clinical utility, participant fatigue, and the use of unstandardized shortened versions of the TRSI in the current literatu...

Scrupulous obsessions are a prominent presentation of obsessive-compulsive disorder (OCD). Previous conceptualizations of scrupulosity have indicated that it belongs to the unacceptable thoughts dimension, which pertains to sexual, violent, and religious obsessive themes. However, research suggests that scrupulous symptoms may differ from other una...

Trauma exposure may complicate the treatment of individuals with obsessive-compulsive disorder (OCD). Existing research examining the relationship between exposure to traumatic events and obsessive-compulsive (OC) symptoms is incomplete in its examination of trauma as a binary construct (exposed versus not exposed) impacting OC symptom dimensions o...

The relationships between sexual trauma, cognitive appraisals, and subtypes of sexual intrusive thoughts have not been adequately examined in the context of obsessive-compulsive concerns. We employed variations of a moderated mediation model to test these relationships, situating sexual trauma as the predictor, sexual intrusive thoughts as the outc...

Most individuals with OCD report experiencing impairment in functioning, which may limit individuals’ engagement in valued behaviors, leading to worsened life satisfaction and sustained impairment in avoided domains of functioning. OCD-related impairment in intimacy, specifically, has been understudied despite evidence suggesting long-lasting impai...

Studies investigating the impact of depressive symptoms on obsessive-compulsive disorder (OCD) treatment have yielded mixed findings. The purpose of the study is to extend previous research, which primarily used outpatient samples, to determine whether depression affects OCD treatment outcome among patients receiving intensive residential treatment...

Event centrality, defined as the extent to which a traumatic event becomes a core component of a person's identity (Berntsen & Rubin, 2006), is both a correlate and predictor of posttraumatic stress disorder (PTSD) symptoms, over and above event severity. These findings suggest that decreasing the perceived centrality of a traumatic event to one's...

Acceptance and Commitment Therapy (ACT) targets six core processes of change including acceptance/experiential avoidance/, mindfulness/lack of contact with the present moment, committed action/inaction, cognitive defusion/fusion, self-as-context/self-as-content, and values clarification/values problems (Hayes, Strosahl, & Wilson, 1999). Previous re...

Functional Analytic Psychotherapy (FAP) is a contextual behavioral therapy that targets specific ideographic behaviors related to interpersonal functioning and intimacy. There is a scarcity of measures specifically focused on behavioral measurement of intimacy as well as limited studies that examine intimacy in obsessive-compulsive and related diso...

Extant research has found that patients with OCD+PTSD experience significantly worse symptoms, have higher treatment dropout rates, and are less responsive to treatment. While both disorders are characterized by intolerance of uncertainty (IU), it has been suggested that IU presents differently in OCD and PTSD. Specifically, individuals with OCD re...

In this study, 285 adults who met criteria for trichotillomania (TTM) via self-report completed an online, cross-sectional survey examining antecedent phenomenological experiences pertaining to hair pulling along with measures of TTM severity and experiential avoidance (i.e., avoidance of or escape from unwanted thoughts or feelings). Results showe...

Although there have been several manuals written about how to treat obsessive-compulsive disorder (OCD) using cognitive-behavioral therapy (CBT), there has been little focus on application of CBT principles to those suffering from sexual obsessions. Treating sexual obsessions in OCD differs from the treatment of other forms of OCD due to heightened...

The embarrassing nature of unwanted sexual thoughts in individuals with obsessive-compulsive disorder (OCD) increases shame and generates feelings of disgust. This requires a specialized approach by clinicians to address the challenges associated with the sexual subtype of OCD (S-OCD). This chapter first addresses psychoeducation as it relates to u...

This chapter contains a case study of the treatment of pedophilic obsessions in OCD (also called P-OCD). The case study includes the background and case conceptualization of an adult client who was effectively treated using exposure and response prevention with values-based exposures using acceptance and commitment therapy. Examples of values-based...

Obsessive-compulsive disorder (OCD) has a heterogeneous presentation, and many of those afflicted experience symptoms that include sexual content. Sexual obsessions occur across ethnicity, race, and culture, although they may present as culturally bound syndromes. Common types of sexual obsessions include pedophile obsessions, sexual orientation ob...

This chapter reviews the most important considerations when assessing a client with sexual obsessions within OCD (S-OCD). Clients typically experience increased shame surrounding symptoms and obsess about the cause and meaning of obsessions, and this chapter provides guidance for therapists during the initial consultation. Also reviewed are recomme...

This chapter discusses the impact of sexually themed obsessive-compulsive disorder (OCD) on relationships, with a focus on intimate partners. Discussed is the role of family accommodations on relationships and how OCD can interfere with relationship and marital satisfaction. Included are strategies for therapists surrounding family counseling and i...

Practitioners working with OCD sufferers are sometimes presented with complicated issues that make it difficult to see significant progress within a client’s treatment. Being skilled at recognizing when treatment is at a standstill is important in and of itself. It is impossible to predict all of the problems that can arise, but being mindful of co...

A seven-factor model of the Posttraumatic Stress Disorder (PTSD) Checklist for Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (PCL-5) has been shown to be the best fitting model in community, military, and undergraduate samples. This study replicates and adds to these findings by comparing four-, six-, seven-, and higher order...

Self-compassion involves extending kindness and understanding to one's self. Research has demonstrated inverse relationships between self-compassion and maladaptive constructs associated with obsessive–compulsive disorder (OCD), including emotion regulation (ER) difficulties. The current study sought to explore associations between self-compassion,...

High quality relationships are essential to psychological health and well-being, and relational intimacy is a core feature of these relationships. Decades of research in relationship science have converged on a central model of intimacy wherein individuals develop close, trusting relationships with one another. Functional Analytic Psychotherapy (FA...

Published in: Directions in Psychiatry, 38, 179-196. LEARNING OBJECTIVES: On completing this lesson, the clinician will be able to (1) recognize various factors that contribute to an increased risk for posttraumatic stress disorder (PTSD) in people of color; (2) identify under-recognized race-based traumatic experiences; and (3) indicate appropriat...

Objective Evidence suggests that eating disorders (EDs) may be under‐detected in males. Commonly used measures of EDs such as the Eating Disorder Examination‐Questionnaire (EDE‐Q) were initially developed within female samples, raising concern regarding the extent to which these instruments may be appropriate for detecting EDs in males. The current...

Background Network analysis is an emerging approach in the study of psychopathology, yet few applications have been seen in eating disorders (EDs). Furthermore, little research exists regarding changes in network strength after interventions. Therefore the present study examined the network structures of ED and co-occurring depression and anxiety s...

The proposed mechanism of action in Functional Analytic Psychotherapy (FAP) is therapist-contingent responses to client in-session behavior that parallels out-of-session problematic behavior. In theory, these responses shape adaptive behaviors that generalize into the client’s daily life (Tsai et al., 2009). Therefore, the therapist’s response repe...

Despite evidence documenting relationships between eating disorder (ED) psychopathology, depression, and anxiety, little is known regarding how social anxiety is related to ED symptoms in treatment. Therefore this study examined associations between depression, general anxiety, social anxiety, and ED psychopathology at the beginning and end of trea...

Obsessive-compulsive disorder (OCD) includes many symptom presentations, which creates unique diagnostic challenges. Fears surrounding one’s sexual orientation are common within OCD (also called SO-OCD), but SO-OCD is consistently misdiagnosed by physicians and psychologists. To address this issue, we describe the development of a self-report measu...

The aim of this study was to investigate a new measure, the Wetterneck-Hart OCD Screener (WHOS), as a self-report screening tool for obsessive-compulsive disorder (OCD). The authors examined relationships between the WHOS and severity scores of OCD measures taken via three methods of data collection: online, at OCD consumer conferences, and from an...

Given limited knowledge about how psychosocial factors interact to modulate posttraumatic stress symptoms, this study evaluated an integrative model proposing that experiencing more interpersonal trauma types (e.g., abuse, assault, rape, etc.) leads to greater avoidant attachment and lower self-compassion, which limits the development and use of ef...

Prior research has found that a strong positive ethnic identity is a protective factor against anxiety and depression in African Americans. In this study, ethnic identity is examined in a geographically representative sample of African American young adults (n = 242), using the Multigroup Ethnic Identity Measure (MEIM) (Phinney in J Adolescent Res...

Objective: Evidence indicates that males account for a significant minority of patients with eating disorders (EDs). However, prior research has been limited by inclusion of small and predominantly non-clinical samples of males. This study aimed to (1) provide male clinical norms for widely used ED measures (Eating Disorder Examination Questionnai...

Individuals who suffer from obsessive-compulsive disorder have persistent intrusive thoughts that cause severe distress that impairs daily functioning. These individuals often conceal their intrusive thoughts and delay help-seeking for fear of being stigmatized. Stigma can be problematic when it is present among mental health professionals because...

Background and aims Pornography use has become increasingly common. Studies have shown that individuals who use sexually explicit materials (SEMs) report negative effects (Schneider, 2000b). However, Bridges (2008b) found that couples who use SEM together have higher relationship satisfaction than those who use SEM independently. A further investig...

Treatment effectiveness of exposure and response prevention for obsessive-compulsive disorder (OCD) might be attenuated in part because of the complex, heterogeneous nature of OCD. Previous studies have indicated relationships between thought control strategies and OCD severity. This study replicates and extends these findings by using a dimensiona...

This study addressed how sex addiction and problematic IP use present to mental health professionals (MHPs), and how MHPs conceptualize and treat these issues. MHPs (N = 183) reported on beliefs about, experiences with, and treatment of problematic sexual behaviors (PBS). Most MHPs saw clients with PBS, but most do not feel competent to treat PBS....

Although suicidal thoughts are often associated with depression, individuals may experience suicidal obsessions, a type of suicidal thought, within obsessive compulsive disorder (OCD). We present the case of “Paul” (pseudonym), a Cuban-American high school teacher in his mid-40s, who struggled with treatment-resistant OCD. Paul sought treatment due...

Obsessive-compulsive disorder (OCD) is a highly distressing disorder and one of the leading causes of disability worldwide. Research has shown that several self-report measures of OCD are not valid for use with ethnoracially diverse populations, therefore it is important that all OCD measures be validated cross-culturally. There has been particular...

As the diversity of clients seeking mental health care services across the United States continues to grow, the need for culturally sensitive interventions is increasingly urgent. Discrimination associated with stigmatized minority status is associated with negative mental health outcomes and thus may require clinical attention. Unfortunately, many...

We examined outcomes from a residential treatment program emphasizing exposure and response prevention (ERP) to determine if the typically robust response to this treatment in outpatient settings extends to patients treated in this unique context. One hundred and seventy-two adolescents with primary Obsessive-compulsive disorder (OCD) completed mea...

Sexual obsessions are a common symptom of obsessive-compulsive disorder (OCD), often classified in a broader symptom dimension that includes aggressive and religious obsessions, as well. Indeed, the Dimensional Obsessive-Compulsive Scale (DOCS) Unacceptable Thoughts Scale includes obsessional content relating to sexual, violent, and religious theme...

Functional Analytic Psychotherapy (FAP) proposes that the therapeutic relationship is a social microcosm for both the client and therapist's lives. The present study addresses this proposition in regards to therapist relationships by examining intimacy and self-disclosure within personal and therapeutic contexts. Eighty therapists from various trai...

Although sexual obsessions in obsessive-compulsive disorder (OCD) are not uncommon, obsessions about sexual orientation have not been well studied. These obsessions focus on issues such as the fear of being or becoming gay, fear of being perceived by others as gay, and unwanted mental images involving homosexual acts. Sexual orientation obsessions...

Despite the heterogeneous nature of obsessive-compulsive disorder (OCD), many self-report assessments do not adequately capture the clinical picture presenting within each symptom dimension, particularly unacceptable thoughts (UTs). In addition, obsessions and ordering/arranging compulsions are often underrepresented in samples of treatment outcome...

Objective: To examine the factor structure of the Inventory of Parent Accommodations of Children’s Symptoms (IPACS) among a community sample of healthy children. Method: An online survey was completed by 220 parents ages 18-65 (M = 34.49; 96% female) for a study examining the effects of parent behaviors on frequency of general sickness and pain com...

Limited research has examined barriers to treatment for obsessive-compulsive disorder (OCD), and no known studies have addressed barriers to treatment for trichotillomania (TTM) or skin picking disorder (SPD). Additionally, existing literature does not examine differences in barriers to treatment based on the content and severity of OCD obsessions....

Obsessive-compulsive disorder (OCD) is a debilitating condition that does not always respond well to treatment. People with OCD often require a great deal of assistance from caregivers or family members, which is referred to as family accommodations. Caregivers may experience a great deal of stress, depression, and other problems as a result of car...

Experiential avoidance (EA) involves an unwillingness to remain in contact or experience unpleasant private events through attempts to avoid or escape from these experiences. EA is hypothesized to play a role in obsessive-compulsive disorder (OCD); however, previous studies have not found a significant relationship between EA and OCD severity. The...

Background: Functional analytic psychotherapy (FAP) is a contextual behavior therapy that targets idiographic behaviors relevant to interpersonal functioning. FAP often targets issues with intimacy, defined as behavior exchanges that are vulnerable to interpersonal punishment. While existing measures examine similar constructs to FAP’s conceptualiz...

Research examining the impact of therapist experience on client outcomes has yielded mixed findings. The current study aimed to improve upon previous research by examining the impact of global trainee therapists' experience, as well as treatment protocol-specific experience, on client outcomes. Data were obtained based on 319 clients being treated...

The correlation between obsessive-compulsive disorder (OCD) and perfectionism is well documented, yet it remains unclear if dimensions of perfectionism vary as a function of OCD symptom dimensions. To this end, the present study investigated the unique associations between dimensions of perfectionism (i.e., concern over mistakes, doubts about actio...

Although one study has noted that shame may play a significant role in anxiety disorders (Fergus, Valentiner, McGratch, & Jencius, 2010), the literature does not address the appearance of shame within specific dimensions of obsessive-compulsive disorder (OCD). In this study, shame is assessed within four common symptom dimensions of OCD: contaminat...

Internet pornography (IP) consumption has increased, resulting in functioning and psychological problems. Thus, understanding what variables affect IP uses is needed. One of the variables may be religion. College students (N = 223) completed questions on IP use and religion. About 64 % ever viewed IP and 26 % currently viewed IP, at a rate of 74 mi...

Current conceptualizations for anxiety disorders focus heavily on cognitive and behavioral aspects of anxiety and address other emotions to a far lesser extent. Studies have demonstrated that negative appraisals of anxiety and fear (e.g., anxiety sensitivity) are elevated in each of the anxiety disorders and depressive disorders. Much less is known...

Sexual orientation symptoms in OCD (SO-OCD) are common but under-recognized and frequently misdiagnosed. SO-OCD may include worries of experiencing an unwanted change in sexual orientation, fears that others may perceive one as a member of the lesbian/gay/ bisexual/transgendered (LGBT) community, or fear that one has hidden same-sex desires. In thi...

This study evaluated health related quality of life (HRQOL) in obese children using obesity-specific HRQOL measures and examined potential race and sex differences.

Obsessive–compulsive disorder (OCD) is often described as one of the most chronic and severe anxiety disorders (American Psychiatric Association, 2000). Those with OCD typically experience both obsessions and compulsions most often revolving around one of the several themes in content. The most commonly reported themes for obsessions include: conta...

New interventions such as Acceptance and Commitment Therapy (ACT) have shown early promise in the treatment of OCD, focusing on aspects of psychological flexibility including valued living, mindfulness, and committed action. However, research is needed to explore the relationship between the various components of ACT and OCD. The present study soug...

Cognitive-behavioral therapy (CBT) utilizing exposure and response prevention for obsessive- compulsive disorder (OCD) has typically been studied in the context of time-limited treatment conducted in outpatient settings. However, in practice, patients vary in their response to such treatment, and some require more prolonged participation to obtain...

Without adequate representation of minority populations in scientific studies, the mental health community cannot fully understand or treat mental disorders cross-culturally. Cultural, economic, and logistic barriers can deter minorities from participating in mental health research, and can also deter clinicians from including them. The National In...

Purpose: Eating disorders and obsessive-compulsive disorder (OCD) commonly co-occur, but there is little data for how to treat these complex cases. To address this gap, we examined the naturalistic outcome of 56 patients with both disorders, who received a multimodal treatment program designed to address both problems simultaneously. Methods: A...

Previous research has found that a significant proportion of individuals who use Internet pornography (IP) report that their use is problematic in some area of functioning. Problematic IP use has been conceptualized as an aspect of sexual addiction and as having components of impulsivity and compulsivity. Experiential avoidance also has been implic...

Previous research has documented that ethnic minorities, particularly Latinos, obtain fewer mental health services than Caucasians (Kearney, Draper, & Baron 2005; Sue, Fujino, Hu, Takeuchi, & Zane, 1991). Conceivably, this may be due to a wide array of cultural issues (e.g., negative stigma attached to mental health, and language, socio-economic, a...

Cognitive accounts of obsessive compulsive disorder (OCD) assert that core beliefs are crucial to the development, maintenance, and treatment of the disorder. There are a number of obsessive beliefs that are considered fundamental to OCD, including personal responsibility, threat estimation, perfectionism, need for certainty, importance of thoughts...

Problems with intimacy and interpersonal issues are exhibited across most psychiatric disorders. However, most of the targets in Cognitive Behavioral Therapy are primarily intrapersonal in nature, with few directly involved in interpersonal functioning and effective intimacy. Functional Analytic Psychotherapy (FAP) provides a behavioral basis for w...

Problems with intimacy and interpersonal issues are exhibited across most psychiatric disorders. However, most of the targets in Cognitive Behavioral Therapy are primarily intrapersonal in nature, with few directly involved in interpersonal functioning and effective intimacy. Functional Analytic Psychotherapy (FAP) provides a behavioral basis for w...

Internet pornography (IP) use has increased over the past 10 years. The effects of IP use are widespread and are both negative (e.g., relationship and interpersonal distress) and positive (e.g., increases in sexual knowledge and attitudes toward sex). Given the possible negative effects of IP use, understanding the definition of IP, the types of IP...

Sexually intrusive thoughts (SITs) are commonly experienced; yet, there is a paucity of research on distress related to them. Given that the content is similar for intrusive thoughts and obsessions, examining factors related to obsessions in obsessive-compulsive disorder (e.g., thought appraisal and relationships to emotions) may help explain distr...