The Institute of Living

Hartford, CT, United States

The Institute of Living

Hartford, CT, United States

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PubMed | University of Tennessee at Knoxville, University of Texas Health Science Center at Houston, The Institute of Living and Baylor College of Medicine
Type: Journal Article | Journal: Translational behavioral medicine | Year: 2015

The Institute of Medicine advocates the examination of innovative models of care to expand mental health services available for older adults. This article describes training and supervision procedures in a recent clinical trial of cognitive behavioral therapy (CBT) for older adults with generalized anxiety disorder (GAD) delivered by bachelor-level lay providers (BLPs) and to Ph.D.-level expert providers (PLPs). Supervision and training differences, ratings by treatment integrity raters (TIRs), treatment characteristics, and patient perceptions between BLPs and PLPs are examined. The training and supervision procedures for BLPs led to comparable integrity ratings, patient perceptions, and treatment characteristics compared with PLPs. These results support this training protocol as a model for future implementation and effectiveness trials of CBT for late-life GAD, with treatment delivered by lay providers supervised by a licensed provider in other practice settings.

News Article | November 30, 2015

A man who takes thousands of digital pictures weekly and spends hours every day organizing the photos on his computer could have a condition that, until now, has never been described in medical literature. The patient might have "digital hoarding disorder," according to the authors of a recent report on the man's case. The 47-year-old man lives in the Netherlands, and doesn't only collect digital photos; he collects physical objects, too. He has been diagnosed with tactile hoarding disorder, which means he holds onto objects ranging from old bicycle parts to scraps of useless paper. The clutter fills his Amsterdam apartment and prevents him from inviting anyone over to visit, according to the report, which was published Oct. 8 in the journal BMJ Case Reports. But much of the man's hoarding occurs in the digital realm — he stores tens of thousands of photographs on his computer, and the four hard drives he has purchased. His doctors think his tendency to hold onto so many digital files is a problem, according to the report. Dealing with all of these electronic files keeps the man from doing other things, like cleaning his home, going outside or sleeping, they wrote. [Hypersex to Hoarding: 7 New Psychological Disorders] "He enjoyed taking the photos. However, the processing and saving of the digital pictures caused suffering and distress," Dr. Martine van Bennekom, a psychiatry resident at the Academic Medical Center in the Netherlands who treated the man and is the lead author of the report, told Live Science. The man's inability to let go of digital things — and the fact that this inability affected his life in a negative way — led van Bennekom and her co-authors to suggest that digital hoarding shouldbe "classified as a subtype of hoarding disorder," which would make it possible for doctors to diagnose and treat digital hoarding as a mental health condition. Right now, digital hoarding isn't an established condition like hoarding disorder, which is included in the the DSM-5, the reference manual that doctors use to diagnose mental disorders. But this distinctly modern kind of hoarding is something that a lot of people are talking about. The pseudo condition even has its own Wikipedia page. In the case report, van Bennekom and her colleagues suggest making digital hoarding an official disorder. They say this would make the disorder easier to detect. Yet, not all mental health experts agree. Making digital hoarding a disorder would be "premature," said David Tolin, a clinical psychologist and director of the anxiety disorders center at the Connecticut mental health center, The Institute of Living. The new case report is based on the experiences of just one person — a person who has tactile hoarding disorder. It isn't yet clear whether there are many people who hoard only digital files, Tolin said. And since there isn't a newspaper-hoarding disorder for people who collect only newspapers, or a clothes-hoarding disorder for people who collect only clothes, it isn't clear why digital hoarding deserves a special categorization, he added. And there's another problem with labeling the hoarding of digital stuff as a mental disorder, Tolin noted. Patients who hoard physical objects, like photographs, are sometimes encouraged by their doctors to go digital. Converting photographs into files gives patients more living space in their cluttered homes, he said. If digital hoarding became an official disorder, it's unclear whether doctors would still want to recommend such measures to patients. This question and many others should be answered before digital hoarding makes its way into the diagnostic guidebooks, Tolin said. [5 Controversial Mental Health Treatments] Tolin said he agrees with van Bennekom that people who feel distressed by their abundance of digital possessions are, in fact, hoarders. Feeling distressed or being impaired by too much stuff is what makes hoarding hoarding. "Lots of people have quirky behaviors, but we don't go around calling those disorders," Tolin said. "If somebody was just hoarding digital objects, but their house was relatively clean," then they may be impaired by their behavior, but they may also just have a quirk about saving digital stuff, he said. The patient in the case report was truly impaired by his digital hoarding, but other people might not be impaired by similar behaviors, said Larry Rosen, a psychology professor at California State University, Dominguez Hills. For example, if you have 7,000 unread emails in your inbox, but you don't give a hoot, then you're not a hoarder, said Rosen, whose research focuses on the relationship between mental health and technology. People who are concerned they may have a problem should ask themselves whether all their virtual stuff is causing them anxiety, he said. Those who have anxiety might find it helpful to make a plan to deal with their digital clutter, or find someone who can help, he said. But if you're just a little overwhelmed by the 7,000 unread emails in your inbox, and are concerned about that the time it would take to sort through them all, then Rosen recommends an easy way to reduce that anxiety-inducing number.  "Go on and trick your email system into calling them all 'read.' And then it'll say zero. There goes the stimulus that creates the anxiety," he said. Psychiatry's New Guide: 6 Things You Should Know Copyright 2015 LiveScience, a Purch company. All rights reserved. This material may not be published, broadcast, rewritten or redistributed.

PubMed | Yale University, University of Hartford, The Institute of Living, Binghamton University State University of New York and University of Tasmania
Type: | Journal: Assessment | Year: 2016

Three hundred sixty-two adult patients were administered the Diagnostic Interview for Anxiety, Mood, and OCD and Related Neuropsychiatric Disorders (DIAMOND). Of these, 121 provided interrater reliability data, and 115 provided test-retest reliability data. Participants also completed a battery of self-report measures that assess symptoms of anxiety, mood, and obsessive-compulsive and related disorders. Interrater reliability of DIAMOND anxiety, mood, and obsessive-compulsive and related diagnoses ranged from very good to excellent. Test-retest reliability of DIAMOND diagnoses ranged from good to excellent. Convergent validity was established by significant between-group comparisons on applicable self-report measures for nearly all diagnoses. The results of the present study indicate that the DIAMOND is a promising semistructured diagnostic interview for DSM-5 disorders.

Tolin D.F.,The Institute of Living | Tolin D.F.,Yale University | Villavicencio A.,The Institute of Living | Umbach A.,The Institute of Living | Kurtz M.M.,Wesleyan University
Psychiatry Research | Year: 2011

Hoarding disorder (HD) is increasingly viewed as distinct from obsessive-compulsive disorder (OCD). In particular, some researchers have suggested that HD is characterized by substantial problems of neurocognitive function; however, HD patients have not yet been compared to OCD patients in this respect. The aim of the present study was to compare neuropsychological test performance in HD patients (n= 27), OCD patients (n= 12), and healthy controls (n= 26). Consistent with previous research, HD patients showed an attenuated ability to sustain attention and poorer employment of adaptive memory strategies compared to healthy controls. HD and OCD patients did not differ significantly on these measures, although moderate effect sizes suggested that hoarders showed somewhat greater attenuation of attentional capacity. Rates of true impairment on any particular neuropsychological test were fairly low across all three groups, although 67% of HD patients (compared to 58% of OCD patients and 42% of healthy controls) scored in the impaired range on at least one measure (odds ratio = 2.22). Results are discussed in terms of emerging conceptualizations of HD as a distinct illness. © 2011 Elsevier Ireland Ltd.

Chepenik L.G.,Yale University | Chepenik L.G.,Depression Center | Raffo M.,Yale University | Hampson M.,Yale University | And 9 more authors.
Psychiatry Research - Neuroimaging | Year: 2010

Trait abnormalities in bipolar disorder (BD) within the ventral prefrontal cortex (vPFC) and the amygdala suggest dysfunction in their connectivity. This study employed low frequency resting state functional magnetic resonance imaging (LFRS-fMRI) to analyze functional connectivity between the vPFC and the amygdala in BD. LFRS-fMRI identified a negative correlation in vPFC-amygdala activity, and the magnitude of this correlation was greater in healthy participants than in subjects with BD. Additionally, whole-brain analysis revealed higher correlations between left and right vPFC in BD, as well as with ventral striatum. © 2010.

Tolin D.F.,The Institute of Living | Tolin D.F.,Yale University | Villavicencio A.,The Institute of Living
Behaviour Research and Therapy | Year: 2011

Current models of hoarding disorder (HD) emphasize problems of decision-making. Evidence for neuropsychological impairment in HD, however, has been mixed. The present study examined whether HD patients show problems of economic reasoning that could be associated with decision-making problems. Forty-two HD patients, 29 obsessive-compulsive disorder (OCD) patients, and 36 healthy control participants completed the Iowa gambling task (IGT), a computerized card playing game that assesses participants' ability to learn and utilize a rule of sacrificing short-term gain for long-term gain, and a cognitive dissonance reduction task that measured changes in preference for items (art prints) after selecting or rejecting them. Results showed no deficits on the IGT for HD participants, and no difference in dissonance reduction results after selecting or rejecting items on the dissonance reduction task. Furthermore, performance on these two tasks was unrelated to hoarding symptom severity or self-reported indecisiveness. It is suggested that the problems of cognitive processing in HD patients may be largely related to as-yet understudied processes, including idiosyncratic categorization problems for personally-owned items as well as other aspects of economic reasoning. © 2011 Elsevier Ltd.

Tolin D.F.,The Institute of Living | Steenkamp M.M.,Yale University | Marx B.P.,Boston University | Litz B.T.,Boston University
Psychological Assessment | Year: 2010

Although validity scales of the Minnesota Multiphasic Personality Inventory-2 (MMPI-2; J. N. Butcher, W. G. Dahlstrom, J. R. Graham, A. Tellegen, & B. Kaemmer, 1989) have proven useful in the detection of symptom exaggeration in criterion-group validation (CGV) studies, usually comparing instructed feigners with known patient groups, the application of these scales has been problematic when assessing combat veterans undergoing posttraumatic stress disorder (PTSD) examinations. Mixed group validation (MGV) was employed to determine the efficacy of MMPI-2 exaggeration scales in compensation-seeking (CS) and noncompensation-seeking (NCS) veterans. Unlike CGV, MGV allows for a mix of exaggerating and nonexaggerating individuals in each group, does not require that the exaggeration versus nonexaggerating status of any individual be known, and can be adjusted for different base-rate estimates. MMPI-2 responses of 377 male veterans were examined according to CS versus NCS status. MGV was calculated using 4 sets of base-rate estimates drawn from the literature. The validity scales generally performed well (adequate sensitivity, specificity, and efficiency) under most base-rate estimations, and most produced cutoff scores that showed adequate detection of symptom exaggeration, regardless of base-rate assumptions. These results support the use of MMPI-2 validity scales for PTSD evaluations in veteran populations, even under varying base rates of symptom exaggeration. © 2010 American Psycholgical Association.

Tolin D.F.,The Institute of Living | Tolin D.F.,Yale University
Clinical Psychology Review | Year: 2010

Cognitive-behavioral therapy (CBT) is effective for a range of psychiatric disorders. However, it remains unclear whether CBT is superior to other forms of psychotherapy, and previous quantitative reviews on this topic are difficult to interpret. The aim of the present quantitative review was to determine whether CBT yields superior outcomes to alternative forms of psychotherapy, and to examine the relationship between differential outcome and study-specific variables. From a computerized literature search through September 2007 and references from previous reviews, English-language articles were selected that described randomized controlled trials of CBT vs. another form of psychotherapy. Of these, only those in which the CBT and alternative therapy condition were judged to be . bona fide treatments, rather than "intent-to-fail" conditions, were retained for analysis (28 articles representing 26 studies, . N=. 1981). Four raters identified post-treatment and follow-up effect size estimates, as well as study-specific variables including (but not limited to) type of CBT and other psychotherapy, sample diagnosis, type of outcome measure used, and age group. Studies were rated for methodological adequacy including (but not limited to) the use of reliable and valid measures and independent evaluators. Researcher allegiance was determined by contacting the principal investigators of the source articles. CBT was superior to psychodynamic therapy, although not interpersonal or supportive therapies, at post-treatment and at follow-up. Methodological strength of studies was not associated with larger or smaller differences between CBT and other therapies. Researchers' self-reported allegiance was positively correlated with the strength of CBT's superiority; however, when controlling for allegiance ratings, CBT was still associated with a significant advantage. The superiority of CBT over alternative therapies was evident only among patients with anxiety or depressive disorders. These results argue against previous claims of treatment equivalence and suggest that CBT should be considered a first-line psychosocial treatment of choice, at least for patients with anxiety and depressive disorders. © 2010 Elsevier Ltd.

Tolin D.F.,The Institute of Living | Villavicencio A.,The Institute of Living
Behaviour Research and Therapy | Year: 2011

Hoarding Disorder (HD), defined as the acquisition of and failure to discard large volumes of possessions, resulting in clutter that precludes normal use of living spaces, is a common and debilitating condition. Although hoarding has historically been conceptualized as a variant of obsessive-compulsive disorder (OCD), increasing evidence suggests that hoarding might be more closely associated with the symptoms of attention deficit-hyperactivity disorder (ADHD). The aim of the present study was to clarify the relationship between the core features of hoarding (clutter, difficulty discarding, acquiring), OCD symptoms, and ADHD symptoms. HD (N = 39), non-hoarding OCD (N = 26), and healthy control (N = 36) participants underwent careful diagnostic interviewing and completed standardized self-report measures of the core features of hoarding (clutter, difficulty discarding, acquiring), OCD symptoms, negative affect, and the inattentive and hyperactive/impulsive symptoms of ADHD. Multiple linear regressions demonstrated that after controlling for global negative affect, OCD symptoms did not significantly predict any of the core features of HD. Conversely, the inattentive (but not hyperactive/impulsive) symptoms of ADHD significantly predicted severity of clutter, difficulty discarding, and acquiring. These results challenge current conceptualizations of hoarding as a subtype of OCD, and suggest an association with neurocognitive impairment. © 2010 Elsevier Ltd.

PubMed | Yale University and The Institute of Living
Type: Journal Article | Journal: Behavior therapy | Year: 2015

Internet-guided self-help (iGSH) has amassed significant empirical support for a variety of psychiatric conditions; however, it is not known who responds best to these treatments. This open trial examined the clinical outcomes and predictors of a 17-week iGSH program for obsessive-compulsive disorder (OCD). Therapist support was provided either in person or by phone 9 times for an average of 13minutes per session. Twenty-four patients initiated treatment, and 17 of these (70.8%) completed. Results of the intent-to-treat sample indicated statistically significant improvements at posttreatment with large treatment effects for OCD symptoms as assessed by the Yale Brown Obsessive-Compulsive Scale (d=0.87), and small to moderate improvements in depression (d=0.19), functioning (d=0.53), and quality of life (d=-0.18). These outcomes were largely maintained over a 6-month follow-up. Readiness to reduce avoidance of OCD triggers and attendance to therapist sessions were moderately associated with posttreatment response, and correctly classified the responder status (defined as clinically significant change) of nearly 9 out of 10 patients at posttreatment. These same variables did not predict responder status at 6-month follow-up. These results lend further empirical support to iGSH as a treatment for OCD and provide direction on the development of predictor models to identify patients who are and are not likely to acutely respond to iGSH.

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