Jonathan Abramowitz

University of North Carolina at Chapel Hill | UNC · Department of Psychology

Purpose Obsessive-compulsive disorder (OCD) has an elevated prevalence among pregnant and postpartum women, with negative impacts on both mother and child. There is a need for brief, efficient screening tools for OCD in perinatal care because OCD is underrecognized. We evaluated the psychometric properties of the 4-item Obsessive Compulsive Invento...

Obsessive-compulsive disorder (OCD) and posttraumatic stress disorder (PTSD) share overlapping features for which similar cognitive behavioral treatment (CBT) strategies can be employed. However, the comorbid presence of these conditions poses unique clinical considerations, and a nuanced approach to assessment, conceptualization, and treatment is...

Childhood maltreatment (CM) is associated with elevated depression and anxiety in young adulthood; however, there is a dearth of research identifying the intermediary pathways that link CM to these phenomena. The present study investigated two psychological factors— contrast avoidance , sensitivity to and avoidance of sudden negative emotional shif...

Prevalence of obsessive-compulsive disorder (OCD) appears to be higher in sexual and gender minority (SGM) individuals compared to cisgender, heterosexual individuals. Although existing self-report measures for OCD (i.e., Yale Brown Obsessive Compulsive Scale Self-Report-II-Self Report [Y-BOCS-II-SR], Dimensional Obsessive Compulsive Scale [DOCS],...

Obsessive-compulsive disorder (OCD) and posttraumatic stress disorder (PTSD) frequently co-occur, and phenotypic and functional similarities between the disorders necessitate assessment and treatment considerations by providers. To date, no research has reported on mental health treatment providers’ approach to, and barriers associated with, assess...

Current psychological models of obsessive-compulsive disorder account for a surprisingly small degree of variability in obsessive-compulsive (OC) symptoms in statistical models. The current study examined whether constructs from the inference-based approach to OCD (i.e., inferential confusion and fear of self) explain OC symptom dimensions above an...

Background. Obsessive-compulsive disorder (OCD) and co-occurring posttraumatic stress disorder (PTSD) is associated with more severe and chronic OCD. However, findings regarding treatment effectiveness of cognitive behavioral treatment (CBT) with exposure and response prevention (ERP) with this comorbidity are mixed. Research aimed at understanding...

The Exposure Therapy Consortium (ETC) was established to advance the science and practice of exposure therapy. To encourage participation from researchers and clinicians, we describe the organizational structure and activities of the ETC. Initial research working group experiences and a proof-of-principle study underscore the potential of team scie...

Mental contamination (MC), an internal feeling of dirtiness that is typically experienced in the absence of contact with a physical contaminant, is increasingly recognized as a sequela of trauma. This scoping review identified 19 studies on MC among trauma survivors and aimed to (a) summarize qualitative research on the phenomenology of MC among tr...

Obsessive‐compulsive disorder (OCD) is a debilitating psychiatric disorder. Worldwide, its prevalence is ~2% and its etiology is mostly unknown. Identifying biological factors contributing to OCD will elucidate underlying mechanisms and might contribute to improved treatment outcomes. Genomic studies of OCD are beginning to reveal long‐sought risk...

Obsessive-compulsive and related disorders include obsessive-compulsive disorder, hoarding disorder, body dysmorphic disorder, trichotillomania (hair-pulling disorder), and excoriation (skin-picking) disorder. This volume reviews the phenomenology and epidemiology of each of the disorders. Next, it reviews how the disorders are maintained, from bio...

Obsessive-compulsive and related disorders include obsessive-compulsive disorder, hoarding disorder, body dysmorphic disorder, trichotillomania (hair-pulling disorder), and excoriation (skin-picking) disorder. This volume reviews the phenomenology and epidemiology of each of the disorders. Next, it reviews how the disorders are maintained, from bio...

Obsessive-compulsive and related disorders include obsessive-compulsive disorder, hoarding disorder, body dysmorphic disorder, trichotillomania (hair-pulling disorder), and excoriation (skin-picking) disorder. This volume reviews the phenomenology and epidemiology of each of the disorders. Next, it reviews how the disorders are maintained, from bio...

Obsessive-compulsive disorder (OCD) is characterized by engagement in rituals that serve to obtain certainty and prevent feared outcomes. Exposure and response prevention is most effective when rituals are resisted, yet existing self-report measures of OCD limit identification of the full range of possible rituals, and little is known about how rit...

Background: Acceptance and commitment therapy (ACT) has been shown to promote willingness to experience intrusive thoughts among individuals with obsessive-compulsive disorder (OCD). Exposure with response prevention (ERP) delivered from an ACT framework (i.e., ACT+ERP) may facilitate changes in how patients relate to their unwanted internal experi...

Background: Obsessive-compulsive disorder (OCD) is associated with particular cognitive processes, such as beliefs about the importance of intrusive thoughts. The present study examined the explanatory power of guilt sensitivity to OCD symptom dimensions after controlling for well-established cognitive predictors. Methods: 164 patients with OCD...

Now in its fourth edition, the acclaimed Oxford Textbook of Psychopathology aims for both depth and breadth, with a focus on adult disorders and special attention given to personality disorders. It provides an unparalleled guide for professionals and students alike. Esteemed editors Robert F. Krueger and Paul H. Blaney selected the most eminent res...

Obsessive-compulsive disorder (OCD) is a debilitating psychiatric disorder. Worldwide, its prevalence is ~2% and its etiology is mostly unknown. Identifying biological factors contributing to OCD will elucidate underlying mechanisms and might contribute to improved treatment outcomes. Genomic studies of OCD are beginning to reveal long-sought risk...

Background: The perinatal period is a unique context during which biopsychosocial factors rapidly change to influence health outcomes for individuals and families. The COVID-19 pandemic has resulted in a widespread crisis for perinatal mental health (PMH), compounding issues of access in clinical practice and research. Ambulatory assessment (AA) an...

Ecological momentary assessment (EMA) permits the real-time measurement of psychological phenomena as they occur in real-world settings, and thus, has the potential to critically enhance our understanding of clinical phenomena. Yet, EMA-based measures are rarely subjected to psychometric evaluation prior to their use in substantiative research, lim...

Background Depressive and obsessive-compulsive (OCD) symptoms often co-occur and a number of possible explanations for this co-occurrence have been explored, including shared biological and psychosocial risk factors. Network approaches have offered a novel hypothesis for the link between depressive and OCD: functional inter-relationships across the...

Many individuals with obsessive-compulsive disorder (OCD) also meet criteria for additional diagnoses. Among the most common co-occurring diagnoses are mood disorders-especially depression. This article focuses on the comorbidity between OCD and major depression. After discussing nature of OCD and depression, the rates and clinical impact of depres...

Background: Obsessive-compulsive disorder (OCD) is an often disabling and chronic condition that is normally assessed using diagnostic interviews or lengthy self-report questionnaires. This makes routine screening in general health settings impractical, and as a result OCD is often under-(or mis-)recognized. The present study reports on the develo...

Many individuals with obsessive-compulsive disorder (OCD) also meet criteria for additional diagnoses. Among the most common co-occurring diagnoses are mood disorders—especially depression. This article focuses on the comorbidity between OCD and major depression. After discussing nature of OCD and depression, the rates and clinical impact of depres...

Interpersonal emotion dynamics in couples have implications for the interpersonal maintenance of psychopathology. That is, how individuals regulate their own emotions and respond to their partners’ emotions is part of the interpersonal context of psychopathology and could influence treatment. The present study explored associations of (a) intrapers...

Exposure and response prevention (ERP) is the most empirically supported treatment for obsessive-compulsive disorder (OCD). However, details on how to effectively conduct ERP are lacking. The current study aimed to identify exposure parameters associated with better subsequent outcomes in ERP for OCD. We analyzed data from 271 therapy sessions acro...

Aaron T. Beck, M.D., is among the most impactful figures in the entire history of mental health treatment and his ideas have made important contributions to the understanding and treatment of OCD. I am honored to have the opportunity to write this essay in his memory. His legacy of alleviating suffering and improving the lives of people with emotio...

Background A growing body of evidence suggest individuals with obsessive-compulsive disorder (OCD) are at an increased risk for suicidal thoughts and behaviors (SITB). However, the literature on suicidality in OCD remains limited. Thus, the present study examined the prevalence and predictors of suicidality in a sample of adults seeking treatment f...

Despite empirical support for the efficacy of exposure-based therapy for anxiety-related disorders, many individuals do not respond to this intervention or else experience a return of fear after treatment. Inhibitory learning theory has informed novel approaches to exposure therapy delivery that aim to improve both short- and long-term outcomes. On...

Background The Obsessive-Compulsive Inventory-Children’s Version (OCI-CV) was developed to assess obsessive-compulsive symptoms in youth. Recent changes in the Diagnostic and Statistical Manual (DSM-5) exclude hoarding from inclusion in the diagnosis of obsessive-compulsive disorder (OCD). Accordingly, the present study examined the reliability, va...

Written by internationally recognized experts, this comprehensive CBT clinician's manual provides disorder-specific chapters and accessible pedagogical features. The cutting-edge research, advanced theory, and attention to special adaptations make this an appropriate reference text for qualified CBT practitioners, students in post-graduate CBT cour...

Up to 30% of individuals with psychosis also experience significant obsessive-compulsive symptoms (OCS). This common, yet understudied, co-occurrence is associated with a more severe clinical presentation and course than psychosis alone, making identifying effective treatments for this comorbidity profile critical. This systematic review synthesize...

The novel coronavirus disease (COVID-19), first detected in December of 2019 and declared a global pandemic in March of 2020, continues to pose a serious threat to public health and safety worldwide. Many individuals report anxiety in response to this threat, and at high levels, such anxiety can result in adverse mental health outcomes and maladapt...

Obsessive-compulsive disorder (OCD) was once considered a rare and untreatable condition. Over the past half-century, however, a dramatic surge in research has led not only to a clearer understanding of this problem but also to the realization that it is fairly common and impairing, afflicting up to about 3% of the population. When the prevalence a...

For a number of reasons, it may be critical to involve a romantic partner or spouse in exposure and response prevention (ERP) for obsessive-compulsive disorder (OCD). Indeed, relationship stress focal to OCD is associated with greater symptom severity, a more severe course, and poor global functioning. Research also indicates that involving partner...

Exposure and response prevention (ERP) is the most effective treatment for obsessive-compulsive disorder (OCD), with robust symptom gains consistently observed. Yet, both research and clinical practice indicate ERP is not equally efficacious for all individuals with OCD, and a considerable portion fail to achieve full symptom remission or experienc...

Intolerance of uncertainty (IU), which can include prospective (i.e., desire for predictability) and inhibitory (i.e., uncertainty paralysis) IU, is widely understood to be a central underlying component of obsessive-compulsive disorder (OCD). IU has several treatment implications, yet research on the differences in IU underlying OCD dimensions is...

It is well established that the transition to new parenthood is associated with the onset or worsening of obsessive-compulsive symptoms (OCS); however, less is known regarding specific risk factors associated with the development of postpartum OCS. The present prospective study examined experiential avoidance and interpretations of intrusive though...

The 18-item Obsessive-Compulsive Inventory-Revised (OCI-R) is a widely used self-report measure of Obsessive-Compulsive Disorder (OCD) symptoms, yet its factor structure does not converge with contemporary dimensional models of OCD symptoms. In addition to assessing the four core OCD dimensions, the OCI-R includes hoarding and neutralizing factors....

Fear-based disorders (FBDs) occur in an interpersonal context as relatives (e.g., partners, parents) often accommodate symptoms. Symptom accommodation, which is ubiquitous and reinforces FBD behavior, is associated with increased FBD symptom severity and interferes with treatment. Accordingly, reducing accommodation represents a crucial aim for int...

Introduction Obsessive-compulsive disorders (OCD) are common mental disorders, which – especially without treatment – may take a chronic course. Although they often remain undetected, there is a lack of short and valid screening instruments. With the Dimensional Obsessive-Compulsive Scale - Short Form (DOCS-SF) a screening instrument is available i...

Obsessive-compulsive disorder (OCD) is a prevalent and burdensome condition that is typically assessed using in-depth interviews or lengthy self-report measures. Accordingly, routine screening in busy non-mental health settings is impractical, and OCD is often under- (or mis-) recognized. We evaluated an ultra-brief version of a widely used self-re...

OCD is characterized by (a) intrusive unwanted thoughts that the person misappraizes as threatening, and (b) attempts to reduce the chances of danger, or control the thought itself, with tactics such as compulsive rituals, avoidance, or other neutralizing strategies. This chapter explains the symptoms and features of OCD before turning to empirical...

Earworms refer to catchy tunes that run repeatedly through a person's mind. Empirical literature regarding earworms is scant; however, some researchers have conceptualized the phenomenon as an unwanted intrusion in the context of obsessive-compulsive disorder. The current study expands upon past research by characterizing the experience of earworms...

Despite cross-cultural differences in obsessive-compulsive disorder (OCD) symptomology, little work has been extended in those in Mexico. To bridge this gap, the current study administered standardised and culturally-validated measures of OCD and a critical cultural construct – spirituality – to young adults in Mexico (n = 430) and the USA (n = 194...

Importance Evidence is lacking for viable treatment options for patients with difficult-to-treat obsessive-compulsive disorder (OCD). It has been suggested that D-cycloserine (DCS) could potentiate the effect of exposure and response prevention (ERP) treatment, but the hypothesis has not been tested among patients with difficult-to-treat OCD. Obje...

COVID-19 presents significant social, economic, and medical challenges. Because COVID-19 has already begun to precipitate huge increases in mental health problems, clinical psychological science must assert a leadership role in guiding a national response to this secondary crisis. In this article, COVID-19 is conceptualized as a unique, compounding...

Anxiety and related disorders (ARDs) occur in an interpersonal context. Individuals with ARDs respond well to individual cognitive behavioral therapy (CBT); however, there is room for improvement. As such, family members may be included to “enhance” treatment outcomes, yet findings from studies examining family involvement in CBT for ARDs are equiv...

The Dimensional Obsessive-Compulsive Scale (DOCS) is a self-report questionnaire aimed to measure the severity of obsessive-compulsive symptoms on four thematically different symptom dimensions (contamination, responsibility for harm, unacceptable thoughts, and symmetry and completeness). The DOCS was developed in the US in response to the insuffic...

We write with great concern in response to the recent systematic review and meta-analysis of cognitive-behavioral therapy (CBT) in pediatric obsessive-compulsive disorder (OCD) by Uhre et al.¹ Although the authors’ results consistently support the clinical efficacy of CBT for pediatric OCD, we expect that, much like ourselves, readers will be confu...

Introduction The obsessive-compulsive inventory revised (OCI-R) is commonly used for the assessment of obsessive-compulsive symptom-severity, yet no severity benchmarks have been developed, limiting utilization in clinical practice, clinical research, and analogue studies. Additionally, since its development, no large normative work has been publis...

Anxiety sensitivity (AS), the fear of anxiety-related physiological sensations, is a predictor of posttraumatic stress symptoms (PTSS) following a traumatic event, yet there is limited research on the relationship between AS and PTSS among sexual assault survivors. The present study was designed to test the hypothesis that AS would emerge as a stat...

COVID-19 presents humanity with one of the greatest health and economic crises of the 21st Century. Because COVID-19 has already begun to precipitate a huge increase in mental health problems, we believe that clinical science must also play a leadership role in guiding a national response to this secondary crisis. In this article, we explain why CO...

Background The Research Domain Criteria seeks to bridge knowledge from neuroscience with clinical practice by promoting research into valid neurocognitive phenotypes and dimensions, irrespective of symptoms and diagnoses as currently conceptualized. While the Research Domain Criteria offers a vision of future research and practice, its 39 functiona...

Obsessive–compulsive disorder (OCD) is a serious psychiatric disorder that is associated with significant functional impairment. While efficacious psychological and pharmacological treatments exist, many individuals do not receive these interventions but rather are treated with inappropriate therapies. Indeed, there are ways that nonevidence‐based...

The therapeutic alliance has been the subject of a great deal of psychotherapy research, and evidence from numerous empirical studies suggests that a strong patient-therapist relationship predicts favorable treatment outcomes. Despite the consistency of the alliance outcome relationship across treatment modalities and diagnoses, little attention ha...

Exposure and response prevention (ERP) is an effective treatment for obsessive compulsive disorder (OCD); yet, improvement rates vary and it is therefore important to examine potential predictors of outcome. The present study examined adherence with ERP homework as a predictor of (a) treatment response across OCD symptom dimensions and (b) reductio...

The Clinical Handbook of Fear and Anxiety is a comprehensive guide to the understanding and treatment of clinical anxiety and related disorders. As the editors demonstrate, the clear delineations implied by DSM and ICD diagnoses are illusory when it comes to real-life clinical anxiety. This is because symptoms are shared among different diagnoses,...

The present study evaluated moderators and processes of change in a randomized controlled trial comparing exposure and response prevention (ERP) delivered from a traditional framework versus ERP from an acceptance and commitment therapy framework (ACT + ERP) for obsessive-compulsive disorder (OCD). This paper presents baseline, weekly session, post...

Cognitive fusion (CF), involves the tendency to “buy in” to thoughts and feelings and consists of three empirically established domains: somatic concerns, emotion regulation, and negative evaluation. CF is hypothesized to play a role in obsessive‐compulsive disorder (OCD). The present study examined how well the CF domains, relative to traditional...

Background Research supports a relationship between insomnia and obsessive-compulsive symptoms (OCS). However, given gaps in the literature, there is a need to further examine this relationship. Specifically, the present study investigated whether there are unique associations between insomnia and specific OCS dimensions (e.g., contamination, symme...

Exposure and response prevention (ERP) for obsessive-compulsive disorder (OCD) is often highly effective, yet some patients experience relapses following a seemingly successful course of treatment. In this article we describe the conceptual basis of ERP, and then present a client who relapsed after seemingly achieving substantial improvement follow...

Symptom reduction over the course of cognitive-behavioral therapy is not always distributed evenly across sessions. Some individuals experience a sudden gain, defined as a large, rapid, and stable decrease in symptoms during treatment. Although research documents a link between sudden gains and treatment for depression and anxiety, findings in the...

Many patients with obsessive-compulsive disorder (OCD) exhibit concurrent depressive symptoms, which are associated with negative psychological outcomes. Yet little research has focused on identifying factors that predict depressive symptoms in OCD. The current study examined three transdiagnostic constructs—anxiety sensitivity (AS), intolerance of...

The inhibitory learning model of exposure therapy posits that clinical anxiety is most effectively treated when clinicians employ strategies that maximize the (a) violation of negative expectancies and (b) generalization of non-threat associations. Translation of basic learning research to exposure therapy via this explanatory model underscores two...

Background and objectives: Although research suggests that introducing varying levels of fear during exposure enhances outcomes for some anxiety-related problems, this has not been examined in the context of obsessions. The current preliminary study tested the hypothesis that introducing variability in exposure intensity would improve long-term out...

Background: Scrupulosity is a common yet understudied presentation of obsessive compulsive disorder (OCD) that is characterized by obsessions and compulsions focused on religion. Despite the clinical relevance of scrupulosity to some presentations of OCD, little is known about the association between scrupulosity and symptom severity across religi...