How willing are you? Willingness as a predictor of change during treatment of adults with obsessive–compulsive disorder

Classified as probably not a substantial claim.

Following through with assigned exposures (treatment adherence) is associated with improved outcomes.

“Research has shown that following through with assigned exposures (i.e., treatment adherence) is associated with improved outcomes (Wheaton et al., 2016), but this fails to capture the internal stance of the patient.”

• cites Wheaton et al., 2016 sourceSupported

May combine two claims.

These novel clinical findings align with recent literature suggesting that ACT is an effective treatment for OCD and point to willingness to experience obsessions and anxiety as a potential mechanism of change during exposure therapy.

“These novel clinical findings align with recent literature suggesting that ACT is an effective treatment for OCD (Twohig et al., 2010) and point to willingness to experience obsessions and anxiety as a potential mechanism of change during exposure therapy.”

• cites Twohig et al., 2010 sourceSupported

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

The NetSCID is a validated, web-based version of the SCID-IV and was used in this study.

“The NetSCID(Brodey et al., 2016) is a validated, web-based version of the SCID-IV and was used in this study.”

• cites Brodey et al., 2016 sourceSupported

May combine two claims.

Willingness may be associated with mindfulness and improved attentional capacities.

“There is evidence that willingness may be associated with mindfulness and improved attentional capacities (Arch & Craske, 2010;Baer, Smith, Hopkins, Krietemeyer, & Toney, 2006;Bullis, Bøe, Asnaani, & Hofmann, 2014;Treanor, 2011).”

• cites Arch & Craske, 2010 sourceNot checked — no full text of the source
• cites Baer, Smith, Hopkins, Krietemeyer, & Toney, 2006 sourcePartly supported

  In Part 2 (p. 6), experiential avoidance—a measure involving unwillingness to experience internal events—is negatively correlated with mindfulness scores, while absent-mindedness is also negatively correlated with them. This supports associations with mindfulness and attention-related behavior, but the paper does not show that willingness is directly associated with improved attentional capacities. (LLM, conf=0.84)

  Experimental — accuracy not yet measured
• cites Bullis, Bøe, Asnaani, & Hofmann, 2014 sourceNot checked — no full text of the source

Probably not a substantial claim: may not pass S3 (load-bearing).

Willingness may be increased by putting challenges in the context of one's personal values.

“Willingness may be increased by putting challenges in the context of one's personal values (Branstetter-Rost, Cushing, & Douleh, 2009;Luciano et al., 2010), and this aligns with our clinical experience.”

• cites Branstetter-Rost, Cushing, & Douleh, 2009 sourceNot checked — no full text of the source
• cites Luciano et al., 2010 sourceSupported

Probably not a substantial claim: may not pass S3 (load-bearing).

Average Y-BOCS scores at baseline were 25.42 (SD = 5.98), indicating clinically severe obsessive-compulsive symptoms at admission.

“Average Y-BOCS scores at baseline were 25.42 (SD = 5.98), indicating that the average patient had clinically severe obsessive-compulsive symptoms at admission.”

May combine two claims.

During 6 weeks of IRT, obsessive-compulsive symptoms reduced an average of 8.16 (SD = 6.88) points on the Y-BOCS, an average reduction of 31% (SD = 27%).

“During 6 weeks of IRT, obsessive-compulsive symptoms reduced an average of 8.16 (SD = 6.88) points on the Y-BOCS, resulting in an average reduction of 31% in symptoms (SD = 27%).”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Higher number of SSRIs/SNRIs and number of rituals during exposure trials were very weakly associated with higher average obsessive-compulsive symptoms across treatment.

“Higher number of SSRIs/SNRIs (b = 0.80, t = 1.73, p = .08)and number of rituals during exposure trials (b = 0.58, t = 1.65, p = .10)were very weakly associated with higher average obsessive-compulsive symptoms across treatment.”

• AssumptionRests on an assumption: Coaches' ratings of rituals and adherence validly measure those constructs.

May combine two claims.

Higher willingness was significantly associated with more adherence, less ritualizing, and more habituation during ERP.

“More so, higher willingness was significantly associated with more adherence, less ritualizing, and more habituation during ERP.”

• Also stated in: § 4 DISCUSSION · plain

  “In this study, higher willingness was significantly associated with improved adherence and less ritualization during exposures.”

• Also stated in: § 4 DISCUSSION · plain

  “In our study, those who were more willing experienced more withinsession habituation.”

• AssumptionRests on an assumption: The ERP Feedback Form validly measures willingness.
• AssumptionRests on an assumption: Coaches' ratings of rituals and adherence validly measure those constructs.

The quote only partly states this claim.

Higher average willingness (before-exposure, during-exposure, and future-exposure) was significantly associated with faster symptom reduction during 6 weeks of residential ERP, even when controlling for length of stay, psychopharmacological intervention, depression, adherence, and rituals during ERP.

“Data indicated that individuals with higher willingness during ERP reported faster symptom reduction during residential treatment, even when controlling for length of stay, psychopharmacological intervention, depression, adherence, and rituals performed during ERP.”

• Also stated in: § 3.3 Willingness and treatment response · plain

  “In general, higher average before-exposure willingness, during-exposure willingness, and future-exposure willingness were all significantly associated with faster symptom reduction during treatment.”

• Also stated in: § 4 DISCUSSION · plain

  “Data showed that higher willingness immediately before beginning an exposure, willingness during an exposure, and willingness to engage in a future exposure were each associated with faster symptom reduction during 6 weeks of residential-level exposure therapy for adults with severe OCD.”

• AssumptionRests on an assumption: The ERP Feedback Form validly measures willingness.

May combine two claims.

Longer length of treatment and increased depressive symptoms were associated with higher average obsessive-compulsive symptoms across treatment.

“Results indicated that longer length of treatment (b = 0.64, t = 3.15, p < .01)and increased depressive symptoms (b = 2.61, t = 9.84, p < .001)were associated with higher average obsessive-compulsive symptoms across treatment.”

May combine two claims.

Before-exposure willingness and during-exposure willingness had a significant positive linear trajectory, but the increases were very modest.

“Before-exposure willingness (b = 0.38, t = 2.05, p < .05)and duringexposure willingness (b = 1.17, t = 4.27, p < .001)had a significant positive linear trajectory.However, the sizes of these increases were very modest (e.g., just over one point in average during-exposure willingness per week).”

• AssumptionRests on an assumption: The ERP Feedback Form validly measures willingness.

May combine two claims.

Compared to the null model, the two covariate models that estimated linear and quadratic time resulted in a significant -2LL reduction (χ2(2, N = 286) = 613.63, p < .001) and explained 42% of the between-subject variance and 0% of the within-subject variance in obsessive-compulsive severity.

“Compared to the null model, the two covariate models that estimated linear and quadratic time resulted in a significant -2LL reduction (𝜒 2 (2, N = 286) = 613.63,p < .001)and explained 42% of the between-subject variance and 0% of the withinsubject variance in obsessive-compulsive severity.”

May combine two claims.

Paradoxically, strategies intended to reduce distress prolong emotional distress, whereas acceptance strategies may reduce suffering.

“Paradoxically, these strategies, which are intended to reduce distress, prolong emotional distress, whereas acceptance strategies may reduce suffering (see Ruiz, 2010 for a review).”

• cites Ruiz, 2010Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

Classified as probably not a substantial claim.

Cultivating willingness encourages the individual to embrace unwanted obsessions or anxiety during an exposure without trying to inhibit or change these inner experiences.

“In contrast, cultivating willingness encourages the individual to embrace unwanted obsessions or anxiety during an exposure without trying to inhibit or change these inner experiences (Twohig et al., 2015).”

• cites Twohig et al., 2015 sourceNot checked — no full text of the source

May combine two claims.

In pain task studies, participants in the acceptance condition tolerated pain for longer periods and reported greater willingness to experience pain than controls.

“These participants tolerated pain for longer periods and reported a greater willingness to experience pain than those in the control condition (Gutiérrez, Luciano, Rodríguez, & Fink, 2004;Hayes, Bissett, Korn, & Zettle, 1999).”

• cites Gutiérrez et al., 2004 sourceNot checked — no full text of the source
• cites Hayes et al., 1999 sourceNot checked — no full text of the source

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Participants who consented averaged 4 years younger than those who did not consent; no other significant differences between these groups were observed, including obsessive-compulsive severity at admission.

“Analyses indicated that those who consented averaged 4 years younger than those who did not consent, F(2, 462) = 5.54, p < .01.No other significant differences between these groups were observed, including obsessive-compulsive severity at admission.”

May combine two claims.

Willingness may provide a clinical marker of exposure response that can be feasibly captured by clinicians in a naturalistic clinical setting.

“Considering the recent movement away from traditional markers of the exposure process (e.g., initial fear activation, within-session habituation; Craske et al., 2008), willingness may provide a clinical marker of exposure response that can be feasibly captured by clinicians in a naturalistic clinical setting.”

• cites Craske et al., 2008 sourceNot checked — no full text of the source

• AssumptionRests on an assumption: The ERP Feedback Form validly measures willingness.

Classified as probably not a substantial claim.

Research suggests that willingness is associated with increased engagement in unpleasant tasks.

“Research suggests that this willingness is associated with increased engagement in unpleasant tasks.”

Probably not a substantial claim: may not pass S3 (load-bearing).

Longitudinal analyses controlled for discharge date.

“Additionally, longitudinal analyses described below controlled for discharge date.”

Probably not a substantial claim: may not pass S3 (load-bearing).

Similar results were found in two additional studies using carbon dioxide exposure.

“Similar results were found in two additional studies in which participants were exposed to carbon dioxide, which can be used to induce symptoms of anxiety (Eifert & Heffner, 2003;Levitt, Brown, Orsillo, & Barlow, 2004).”

• cites Eifert & Heffner, 2003 sourceNot checked — no full text of the source
• cites Levitt et al., 2004 sourceNot checked — no full text of the source

Probably not a substantial claim: may not pass S3 (load-bearing).

Advanced statistical modeling such as MLM is suggested to have more power to capture effects than traditional analyses of repeated measures.

“Advanced statistical modeling such as MLM is suggested to have more power to capture effects than traditional analyses of repeated measures (Kahn & Schneider, 2013;Snijders & Bosker, 1999).”

• cites Kahn & Schneider, 2013 sourceNot checked — no full text of the source
• cites Snijders & Bosker, 1999Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

Classified as probably not a substantial claim.

Multilevel modeling was conducted after controlling for length of treatment, number of SSRIs/SNRIs, depressive symptoms, number of rituals during treatment, and adherence to the exposure plan.

“Multilevel modeling (MLM; see Singer & Willett, 2003) was then conducted to assess how willingness enhances or reduces the rate of change in obsessive-compulsive symptoms during residential exposure therapy, after controlling for length of treatment, number of selective serotonin reuptake inhibitors (SSRIs) or serotonin norepinephrine reuptake inhibitors (SNRIs), depressive symptoms, number of rit”

Probably not a substantial claim: may not pass S3 (load-bearing).

The Hamilton Depression Scale has demonstrated acceptable psychometric properties.

“This scale has demonstrated acceptable psychometric properties (Bech, 2008).”

• cites Bech, 2008Not checked — no full text of the source

Classified as probably not a substantial claim. May combine two claims.

The IRT setting was ideal for the study aim because of ability to recruit a large sample, high symptom severity, frequency of coached exposure sessions, and controlled environment.

“This IRT setting was ideal for the study aim considering our ability to recruit a large sample, the high symptom severity typically observed, and the frequency of coached exposure sessions that occur in a controlled environment (e.g., family factors are minimized).”

May combine two claims.

More than 50% of the sample had left residential care by week 7 (42% by week 6).

“Six weeks was selected as a cut-off because more than 50% of the sample had left residential care by week 7 (42% of the sample left residential care by week 6).”

Classified as probably not a substantial claim.

There is some evidence that increases in willingness are associated with reduced distress and improved functioning in individuals with chronic pain and occupation strain.

“Further, there is some evidence that willingness may be a factor associated with positive ACT outcomes, such that increases in willingness were associated with reduced distress and improved functioning in individuals with chronic pain and occupation strain (Bond & Bunce, 2000;McCracken, Vowles, & Eccleston, 2005).”

• cites Bond & Bunce, 2000 sourceNot checked — no full text of the source
• cites McCracken et al., 2005 sourceNot checked — no full text of the source

May combine two claims.

These results appear to have both statistical and clinical significance.

“These results appear to have both statistical and clinical significance.”

• AssumptionRests on an assumption: The ERP Feedback Form validly measures willingness.

May combine two claims.

As ACT shows promise as a viable treatment for reducing OCD symptoms, willingness may be a core factor associated with symptom change in ERP for OCD.

“As ACT shows promise as a viable treatment for reducing OCD symptoms (see Twohig, Morrison, & Bluet, 2014 for review), willingness may be a core factor associated with symptom change in ERP for OCD.”

• cites Twohig, Morrison, & Bluet, 2014 sourceNot checked — no full text of the source

Probably not a substantial claim: may not pass S3 (load-bearing).

The self-report Y-BOCS has displayed good psychometric properties.

“The self-report version of the Y-BOCS was used in this study (Steketee, Frost, & Bogart, 1996) and has displayed good psychometric properties (Federici et al., 2010).”

• cites Federici et al., 2010 sourceNot checked — no full text of the source

Probably not a substantial claim: may not pass S3 (load-bearing).

This study was approved by the Institutional Review Board.

“This study was approved by the Institutional Review Board and all patients 18 years or older were invited to participate in the research.”

Classified as probably not a substantial claim.

Only data collected during the first 6 weeks of residential care were analyzed to avoid estimates skewed by significant dropout.

“To best test study hypotheses and not have estimates skewed by significant dropout, only data collected during the first 6 weeks of residential care were analyzed.”

Classified as probably not a substantial claim.

If extinction learning occurs with a highly aversive stimulus (C), then the new stimulus functions of C (i.e., 'safe') will transfer to less aversive stimuli (A and B) without direct exposure to those stimuli.

“In this scenario, if extinction learning occurs with stimulus C (i.e., changing the stimulus function of C from”

Probably not a substantial claim: may not pass S2 (checkable), S4 (based).

Willingness should play an important role in any setting implementing exposure techniques.

“we conceptualize willingness as an aspect of exposure process that should play an important role in any setting implementing exposure techniques.”

Classified as probably not a substantial claim. May combine two claims.

We modeled our willingness questions after those used in experimental research and ensured our willingness questions aligned with how willingness is described in ACT.

“To improve measurement accuracy, we modeled our willingness questions after those used in experimental research and ensured our willingness questions aligned with how willingness is described in ACT (see Ruiz, 2010 for a review).”

• cites Ruiz, 2010Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Our study used advanced statistical modeling in a large sample size to minimize type 1 error.

“However, our study used advanced statistical modeling in a large sample size to minimize type 1 error.”

Classified as probably not a substantial claim.

Exposures involving a higher number of novel stimuli and combinations of stimuli cause a deepened extinction learning that is more likely to be accessed during future situations.

“which posits that exposures involving a higher number of novel stimuli and combinations of stimuli cause a deepened extinction learning that is more likely to be accessed during future situations.”

• cites Craske et al., 2008 sourceNot checked — no full text of the source

Classified as probably not a substantial claim. May combine two claims.

Increased willingness may allow for enhanced extinction learning that is more resistant to spontaneous recovery and generalizes to a wider range of stimuli not directly involved in the exposures.

“Second, increased willingness may allow for enhanced extinction learning that is more resistant to spontaneous recovery and generalizes to a wider range of stimuli not directly involved in the exposures.”

Probably not a substantial claim: may not pass S3 (load-bearing).

Our willingness variable lacked psychometric testing.

“Third, our willingness variable lacked psychometric testing.”

Probably not a substantial claim: may not pass S3 (load-bearing).

The range of willingness scores could reflect the residential sample where highly willing residents agreed to admit to a level of care requiring several hours of exposure a day.

“Individual average willingness scores in our sample ranged from 84 to 93 during exposure, which could reflect the residential sample where highly willing residents agreed to admit to a level of care requiring several hours of exposure a day.”

Probably not a substantial claim: may not pass S2 (checkable).

Until further replication via experimental and naturalistic observational research with diverse clinical samples is conducted, definite conclusions about the clinical significance of willingness cannot be drawn.

“Until further replication via experimental and naturalistic observational research with diverse clinical samples is conducted, definite conclusions about the clinical significance of willingness cannot be drawn.”

Classified as probably not a substantial claim.

In order for effective extinction learning to occur, attention must focus both on the conditioned stimuli and the lack of occurrence of the aversive unconditioned stimuli.

“In order for effective extinction learning to occur, attention must focus both on the conditioned stimuli and the lack of occurrence of the aversive unconditioned stimuli (Craske et al., 2008).”

• cites Craske et al., 2008 sourceNot checked — no full text of the source

Probably not a substantial claim: may not pass S3 (load-bearing).

We used self-report measures to assess symptom severity and willingness, which may be more prone to respondent bias.

“Second, we used self-report measures to assess symptom severity and willingness, which may be more prone to respondent bias.”

Classified as probably not a substantial claim.

A patient with increased willingness may experience expedited outcomes due to incorporation of stimuli with higher transformation of adverse functions.

“In this manner, a patient with increased willingness may experience expedited outcomes due to incorporation of stimuli with higher transformation of adverse functions.”