@article{ouellet-courtoisCognitiveMechanismsChange2026,

title = {Cognitive mechanisms of change in OCD: Inferential confusion, obsessive beliefs, and mindfulness across three randomized treatments},

author = {C. Ouellet-Courtois and S. Bouchard and C. -E. Giguère and D. Koszycki and M. E. Lavoie and F. Aardema},

url = {https://www.scopus.com/pages/publications/105034701697?origin=resultslist},

doi = {10.1016/j.brat.2026.105022},

issn = {00057967 (ISSN)},

year  = {2026},

date = {2026-01-01},

journal = {Behaviour Research and Therapy},

volume = {201},

publisher = {Elsevier Ltd},

abstract = {Cognitive-behavioral therapy (CBT) with exposure and response prevention (ERP) is widely regarded as the gold-standard psychological treatment for obsessive–compulsive disorder (OCD). Inference-based cognitive behavioral therapy (I-CBT) represents a distinct cognitive approach that targets inferential confusion, defined as a reasoning process whereby imagined possibilities are treated as reflecting reality, without relying on deliberate exposure. The present study reports further mechanism-focused analyses from a previously published multicenter randomized controlled trial (Aardema et al., 2022; ClinicalTrials.gov Identifier: NCT01794156) comparing CBT with ERP, I-CBT, and mindfulness-based stress reduction (MBSR) for OCD. A total of 111 participants with a primary diagnosis of OCD were randomized to one of three treatment conditions. Across treatments, therapy was associated with significant reductions in inferential confusion and obsessive belief domains, whereas dispositional mindfulness did not show significant change. At the bivariate level, residualized changes in inferential confusion, obsessive belief domains, and mindfulness were associated with reductions in OCD symptoms. However, when examined concurrently using mixed-effects models, only reductions in inferential confusion accounted for unique symptom improvement over time. This association was consistent across modalities and remained robust after controlling for concurrent anxiety and depression. Sensitivity analyses indicated that psychotropic medication use did not account for this association; controlling for medication strengthened the independent contribution of inferential confusion (partial η2 ≈ .29). These findings indicate that inferential confusion was independently associated with symptom improvement in OCD across therapeutic approaches. © 2026 Elsevier Ltd},

keywords = {adult, antidepressant agent, Anxiety disorder, article, behavior therapy, benzodiazepine, clinical outcome, clinical trial, cognition, cognitive behavioral therapy, Cognitive mechanisms of change, confusion, confusion (uncertainty), controlled study, Depression, exposure and response prevention, female, human, Humans, Implosive Therapy, inference based cognitive behavioral therapy, Inferential confusion, major clinical study, male, Middle Aged, mindfulness, mindfulness-based stress reduction, multicenter study, obsession, obsessive compulsive disorder, Obsessive-Compulsive Disorder, procedures, psychology, randomized controlled trial, risk factor, Sensitivity analysis, Therapy, treatment outcome, Young Adult},

pubstate = {published},

tppubtype = {article}

}

@article{scholten_baseline_2023,

title = {Baseline Severity as a Moderator of the Waiting List-Controlled Association of Cognitive Behavioral Therapy with Symptom Change in Social Anxiety Disorder: A Systematic Review and Individual Patient Data Meta-analysis},

author = {W. Scholten and A. Seldenrijk and A. Hoogendoorn and R. Bosman and A. Muntingh and E. Karyotaki and G. Andersson and T. Berger and P. Carlbring and T. Furmark and S. Bouchard and P. Goldin and I. Kampmann and N. Morina and N. Kocovski and E. Leibing and F. Leichsenring and T. Stolz and A. Van Balkom and N. Batelaan},

url = {https://www.scopus.com/inward/record.uri?eid=2-s2.0-85166386036&doi=10.1001%2fjamapsychiatry.2023.1291&partnerID=40&md5=c279c8b0ff2d3b4558c6f8803cdda0af},

doi = {10.1001/jamapsychiatry.2023.1291},

issn = {2168622X (ISSN)},

year  = {2023},

date = {2023-01-01},

journal = {JAMA Psychiatry},

volume = {80},

number = {8},

pages = {822–831},

publisher = {American Medical Association},

abstract = {Importance: Social anxiety disorder (SAD) can be adequately treated with cognitive behavioral therapy (CBT). However, there is a large gap in knowledge on factors associated with prognosis, and it is unclear whether symptom severity predicts response to CBT for SAD. Objective: To examine baseline SAD symptom severity as a moderator of the association between CBT and symptom change in patients with SAD. Data Sources: For this systematic review and individual patient data meta-analysis (IPDMA), PubMed, PsycInfo, Embase, and the Cochrane Library were searched from January 1, 1990, to January 13, 2023. Primary search topics were social anxiety disorder, cognitive behavior therapy, and randomized controlled trial. Study Selection: Inclusion criteria were randomized clinical trials comparing CBT with being on a waiting list and using the Liebowitz Social Anxiety Scale (LSAS) in adults with a primary clinical diagnosis of SAD. Data Extraction and Synthesis: Authors of included studies were approached to provide individual-level data. Data were extracted by pairs of authors following the Preferred Reporting Items for Systematic Reviews and Meta-analyses reporting guideline, and risk of bias was assessed using the Cochrane tool. An IPDMA was conducted using a 2-stage approach for the association of CBT with change in LSAS scores from baseline to posttreatment and for the interaction effect of baseline LSAS score by condition using random-effects models. Main Outcomes and Measures: The main outcome was the baseline to posttreatment change in symptom severity measured by the LSAS. Results: A total of 12 studies including 1246 patients with SAD (mean [SD] age, 35.3 [10.9] years; 738 [59.2%] female) were included in the meta-analysis. A waiting list-controlled association between CBT and pretreatment to posttreatment LSAS change was found (b = -20.3; 95% CI, -24.9 to -15.6; P <.001; Cohen d = -0.95; 95% CI, -1.16 to -0.73). Baseline LSAS scores moderated the differences between CBT and waiting list with respect to pretreatment to posttreatment symptom reductions (b = -0.22; 95% CI, -0.39 to -0.06; P =.009), indicating that individuals with severe symptoms had larger waiting list-controlled symptom reductions after CBT (Cohen d = -1.13 [95% CI, -1.39 to -0.88] for patients with very severe SAD; Cohen d = -0.54 [95% CI, -0.80 to -0.29] for patients with mild SAD). Conclusions and Relevance: In this systematic review and IPDMA, higher baseline SAD symptom severity was associated with greater (absolute but not relative) symptom reductions after CBT in patients with SAD. The findings contribute to personalized care by suggesting that clinicians can confidently offer CBT to individuals with severe SAD symptoms.. © 2023 American Medical Association. All rights reserved.},

note = {Publisher: American Medical Association},

keywords = {adult, antidepressant agent, Anxiety disorder, article, avoidant personality disorder, clinical outcome, cognitive behavioral therapy, comorbidity, cycloserine, Depression, disease severity, female, hospital admission, human, Humans, Liebowitz Social Anxiety Scale, male, meta analysis, paroxetine, phobia, Preferred Reporting Items for Systematic Reviews and Meta-Analyses, procedures, psychotropic agent, randomized controlled trial (topic), Randomized Controlled Trials as Topic, semi structured interview, Social, social anxiety, social phobia, Structured Clinical Interview for DSM Disorders, symptom, systematic review, treatment response, Waiting Lists},

pubstate = {published},

tppubtype = {article}

}

@article{scholtenBaselineSeverityModerator2023,

title = {Baseline Severity as a Moderator of the Waiting List-Controlled Association of Cognitive Behavioral Therapy with Symptom Change in Social Anxiety Disorder: A Systematic Review and Individual Patient Data Meta-analysis},

author = {W. Scholten and A. Seldenrijk and A. Hoogendoorn and R. Bosman and A. Muntingh and E. Karyotaki and G. Andersson and T. Berger and P. Carlbring and T. Furmark and S. Bouchard and P. Goldin and I. Kampmann and N. Morina and N. Kocovski and E. Leibing and F. Leichsenring and T. Stolz and A. Van Balkom and N. Batelaan},

url = {https://www.scopus.com/inward/record.uri?eid=2-s2.0-85166386036&doi=10.1001%2fjamapsychiatry.2023.1291&partnerID=40&md5=c279c8b0ff2d3b4558c6f8803cdda0af},

doi = {10.1001/jamapsychiatry.2023.1291},

issn = {2168622X (ISSN)},

year  = {2023},

date = {2023-01-01},

journal = {JAMA Psychiatry},

volume = {80},

number = {8},

pages = {822–831},

publisher = {American Medical Association},

abstract = {Importance: Social anxiety disorder (SAD) can be adequately treated with cognitive behavioral therapy (CBT). However, there is a large gap in knowledge on factors associated with prognosis, and it is unclear whether symptom severity predicts response to CBT for SAD. Objective: To examine baseline SAD symptom severity as a moderator of the association between CBT and symptom change in patients with SAD. Data Sources: For this systematic review and individual patient data meta-analysis (IPDMA), PubMed, PsycInfo, Embase, and the Cochrane Library were searched from January 1, 1990, to January 13, 2023. Primary search topics were social anxiety disorder, cognitive behavior therapy, and randomized controlled trial. Study Selection: Inclusion criteria were randomized clinical trials comparing CBT with being on a waiting list and using the Liebowitz Social Anxiety Scale (LSAS) in adults with a primary clinical diagnosis of SAD. Data Extraction and Synthesis: Authors of included studies were approached to provide individual-level data. Data were extracted by pairs of authors following the Preferred Reporting Items for Systematic Reviews and Meta-analyses reporting guideline, and risk of bias was assessed using the Cochrane tool. An IPDMA was conducted using a 2-stage approach for the association of CBT with change in LSAS scores from baseline to posttreatment and for the interaction effect of baseline LSAS score by condition using random-effects models. Main Outcomes and Measures: The main outcome was the baseline to posttreatment change in symptom severity measured by the LSAS. Results: A total of 12 studies including 1246 patients with SAD (mean [SD] age, 35.3 [10.9] years; 738 [59.2%] female) were included in the meta-analysis. A waiting list-controlled association between CBT and pretreatment to posttreatment LSAS change was found (b = -20.3; 95% CI, -24.9 to -15.6; P <.001; Cohen d = -0.95; 95% CI, -1.16 to -0.73). Baseline LSAS scores moderated the differences between CBT and waiting list with respect to pretreatment to posttreatment symptom reductions (b = -0.22; 95% CI, -0.39 to -0.06; P =.009), indicating that individuals with severe symptoms had larger waiting list-controlled symptom reductions after CBT (Cohen d = -1.13 [95% CI, -1.39 to -0.88] for patients with very severe SAD; Cohen d = -0.54 [95% CI, -0.80 to -0.29] for patients with mild SAD). Conclusions and Relevance: In this systematic review and IPDMA, higher baseline SAD symptom severity was associated with greater (absolute but not relative) symptom reductions after CBT in patients with SAD. The findings contribute to personalized care by suggesting that clinicians can confidently offer CBT to individuals with severe SAD symptoms.. © 2023 American Medical Association. All rights reserved.},

keywords = {adult, antidepressant agent, Anxiety disorder, article, avoidant personality disorder, clinical outcome, cognitive behavioral therapy, comorbidity, cycloserine, Depression, disease severity, female, hospital admission, human, Humans, Liebowitz Social Anxiety Scale, male, meta analysis, paroxetine, phobia, Preferred Reporting Items for Systematic Reviews and Meta-Analyses, procedures, psychotropic agent, randomized controlled trial (topic), Randomized Controlled Trials as Topic, semi structured interview, Social, social anxiety, social phobia, Structured Clinical Interview for DSM Disorders, symptom, systematic review, treatment response, Waiting Lists},

pubstate = {published},

tppubtype = {article}

}

@article{dugas_behavioral_2022,

title = {Behavioral Experiments for Intolerance of Uncertainty: A Randomized Clinical Trial for Adults With Generalized Anxiety Disorder},

author = {M. J. Dugas and K. A. Sexton and E. A. Hebert and S. Bouchard and J. -P. Gouin and R. Shafran},

url = {https://www.scopus.com/inward/record.uri?eid=2-s2.0-85133178888&doi=10.1016%2fj.beth.2022.05.003&partnerID=40&md5=4dd15547cbef29c5f1adc84169176c53},

doi = {10.1016/j.beth.2022.05.003},

issn = {00057894 (ISSN)},

year  = {2022},

date = {2022-01-01},

journal = {Behavior Therapy},

volume = {53},

number = {6},

pages = {1147–1160},

publisher = {Elsevier Inc.},

abstract = {Sophisticated multicomponent treatments for adults with generalized anxiety disorder (GAD) have been developed over the past three decades. Although these comprehensive treatments have produced encouraging results, they appear to be less efficacious than treatments for other anxiety disorders. The goal of this randomized controlled trial is to test a newly developed, highly focused treatment for adults with GAD: Behavioral Experiments for Intolerance of Uncertainty. Sixty (60) participants (51 women, 9 men), with a mean age of 34.60 years (range: 19 to 67 years), were randomized to either treatment (n = 30) or wait-list control (n = 30). Treatment consisted of 12 weekly 1-hour sessions in which participants learned to use behavioral experiments to test their catastrophic beliefs about uncertainty. Assessments were conducted at pre-, mid- and postcondition, and at 6- and 12-month follow-up. The primary outcome was the severity of GAD, and secondary outcomes were worry, depression, somatic anxiety, and intolerance of uncertainty. Using growth curve modeling, we found that (1) the treatment group was superior to the wait-list group in terms of change from pre- to posttest on all outcomes; (2) the combined sample (once wait-listed participants received treatment) evidenced large and significant decreases on all outcomes; and (3) treatment gains were either maintained or increased over the 12-month follow-up period of the study. The new treatment is a promising treatment option for adults with GAD considering that it may be as efficacious as more comprehensive evidence-based psychological treatments for GAD. © 2022},

note = {Publisher: Elsevier Inc.},

keywords = {adult, aged, antidepressant agent, Anxiety, Anxiety disorder, Anxiety Disorders, anxiolytic agent, article, behavior assessment, behavioral experiments, benzodiazepine, cognitive behavioral therapy, cognitive vulnerability, Cognitive-behavioral treatment, confusion (uncertainty), controlled study, dependent variable, Depression, disease severity, female, follow up, generalized anxiety disorder, growth curve, human, Humans, intolerance of uncertainty, major clinical study, male, mental disease, outcome assessment, patient worry, procedures, psychology, randomized controlled trial, uncertainty},

pubstate = {published},

tppubtype = {article}

}

@article{dugasBehavioralExperimentsIntolerance2022,

title = {Behavioral Experiments for Intolerance of Uncertainty: A Randomized Clinical Trial for Adults With Generalized Anxiety Disorder},

author = {M. J. Dugas and K. A. Sexton and E. A. Hebert and S. Bouchard and J. -P. Gouin and R. Shafran},

url = {https://www.scopus.com/inward/record.uri?eid=2-s2.0-85133178888&doi=10.1016%2fj.beth.2022.05.003&partnerID=40&md5=4dd15547cbef29c5f1adc84169176c53},

doi = {10.1016/j.beth.2022.05.003},

issn = {00057894 (ISSN)},

year  = {2022},

date = {2022-01-01},

journal = {Behavior Therapy},

volume = {53},

number = {6},

pages = {1147–1160},

publisher = {Elsevier Inc.},

abstract = {Sophisticated multicomponent treatments for adults with generalized anxiety disorder (GAD) have been developed over the past three decades. Although these comprehensive treatments have produced encouraging results, they appear to be less efficacious than treatments for other anxiety disorders. The goal of this randomized controlled trial is to test a newly developed, highly focused treatment for adults with GAD: Behavioral Experiments for Intolerance of Uncertainty. Sixty (60) participants (51 women, 9 men), with a mean age of 34.60 years (range: 19 to 67 years), were randomized to either treatment (n = 30) or wait-list control (n = 30). Treatment consisted of 12 weekly 1-hour sessions in which participants learned to use behavioral experiments to test their catastrophic beliefs about uncertainty. Assessments were conducted at pre-, mid- and postcondition, and at 6- and 12-month follow-up. The primary outcome was the severity of GAD, and secondary outcomes were worry, depression, somatic anxiety, and intolerance of uncertainty. Using growth curve modeling, we found that (1) the treatment group was superior to the wait-list group in terms of change from pre- to posttest on all outcomes; (2) the combined sample (once wait-listed participants received treatment) evidenced large and significant decreases on all outcomes; and (3) treatment gains were either maintained or increased over the 12-month follow-up period of the study. The new treatment is a promising treatment option for adults with GAD considering that it may be as efficacious as more comprehensive evidence-based psychological treatments for GAD. © 2022},

keywords = {adult, aged, antidepressant agent, Anxiety, Anxiety disorder, Anxiety Disorders, anxiolytic agent, article, behavior assessment, behavioral experiments, benzodiazepine, cognitive behavioral therapy, cognitive vulnerability, Cognitive-behavioral treatment, confusion (uncertainty), controlled study, dependent variable, Depression, disease severity, female, follow up, generalized anxiety disorder, growth curve, human, Humans, intolerance of uncertainty, major clinical study, male, mental disease, outcome assessment, patient worry, procedures, psychology, randomized controlled trial, uncertainty},

pubstate = {published},

tppubtype = {article}

}

@article{cousineau_insomnia_2016,

title = {Insomnia symptoms following treatment for comorbid panic disorder with agoraphobia and generalized anxiety disorder},

author = {H. Cousineau and A. Marchand and S. Bouchard and C. Bélanger and P. Gosselin and F. Langlois and J. Labrecque and M. J. Dugas and G. Belleville},

url = {https://www.scopus.com/inward/record.uri?eid=2-s2.0-84962128029&doi=10.1097%2fNMD.0000000000000466&partnerID=40&md5=2ca2dd82c29553bd7377ba64dd5522cc},

doi = {10.1097/NMD.0000000000000466},

issn = {00223018},

year  = {2016},

date = {2016-01-01},

journal = {Journal of Nervous and Mental Disease},

volume = {204},

number = {4},

pages = {267–273},

publisher = {Lippincott Williams and Wilkins},

abstract = {Patients with panic disorder with agoraphobia (PDA) or generalized anxiety disorder (GAD) frequently also suffer from insomnia. However, the impact of cognitive-behavioral therapy (CBT) for anxiety disorders on insomnia has been understudied. Furthermore, comorbidity between anxiety disorders is common. Our main objective was to assess the impact of CBT for PDA or GAD on insomnia. In a quasi-experimental design, 86 participants with PDA and GAD received conventional CBT for their primary disorder or combined CBT for both disorders. Overall, CBTs had a significant impact on reducing insomnia symptoms (η2 = 0.58). However, among people with insomnia at pretest (67%), 33% still had an insomnia diagnosis, and the majority (63%) had clinically significant residual insomnia following treatment. In conclusion, the CBTs had a positive effect on the reduction of insomnia, but a significant proportion of participants still had insomnia problems following treatment. Clinicians should address insomnia during CBT for PDA and GAD. Copyright © 2016 Wolters Kluwer Health, Inc. All rights reserved.},

note = {Publisher: Lippincott Williams and Wilkins},

keywords = {adult, agoraphobia, antidepressant agent, Anxiety Disorders, anxiolytic agent, article, clinical trial, cognitive therapy, cohort analysis, Cohort Studies, Combined Modality Therapy, comorbidity, comparative study, controlled study, Depression, disease severity, female, generalized anxiety disorder, human, Humans, hypnotic agent, insomnia, major clinical study, male, Middle Aged, multicenter study, multimodality cancer therapy, nocturnal panic attack, panic, Panic Disorder, panic disorder with agoraphobia, patient worry, procedures, psychoeducation, psychology, psychotropic agent, Psychotropic Drugs, quasi experimental study, Quebec, randomized controlled trial, Sleep Initiation and Maintenance Disorders, statistical significance, treatment outcome, wakefulness, Young Adult},

pubstate = {published},

tppubtype = {article}

}

@article{cousineauInsomniaSymptomsFollowing2016,

title = {Insomnia symptoms following treatment for comorbid panic disorder with agoraphobia and generalized anxiety disorder},

author = {H. Cousineau and A. Marchand and S. Bouchard and C. Bélanger and P. Gosselin and F. Langlois and J. Labrecque and M. J. Dugas and G. Belleville},

url = {https://www.scopus.com/inward/record.uri?eid=2-s2.0-84962128029&doi=10.1097%2fNMD.0000000000000466&partnerID=40&md5=2ca2dd82c29553bd7377ba64dd5522cc},

doi = {10.1097/NMD.0000000000000466},

issn = {00223018},

year  = {2016},

date = {2016-01-01},

journal = {Journal of Nervous and Mental Disease},

volume = {204},

number = {4},

pages = {267–273},

publisher = {Lippincott Williams and Wilkins},

abstract = {Patients with panic disorder with agoraphobia (PDA) or generalized anxiety disorder (GAD) frequently also suffer from insomnia. However, the impact of cognitive-behavioral therapy (CBT) for anxiety disorders on insomnia has been understudied. Furthermore, comorbidity between anxiety disorders is common. Our main objective was to assess the impact of CBT for PDA or GAD on insomnia. In a quasi-experimental design, 86 participants with PDA and GAD received conventional CBT for their primary disorder or combined CBT for both disorders. Overall, CBTs had a significant impact on reducing insomnia symptoms (η2 = 0.58). However, among people with insomnia at pretest (67%), 33% still had an insomnia diagnosis, and the majority (63%) had clinically significant residual insomnia following treatment. In conclusion, the CBTs had a positive effect on the reduction of insomnia, but a significant proportion of participants still had insomnia problems following treatment. Clinicians should address insomnia during CBT for PDA and GAD. Copyright © 2016 Wolters Kluwer Health, Inc. All rights reserved.},

keywords = {adult, agoraphobia, antidepressant agent, Anxiety Disorders, anxiolytic agent, article, clinical trial, cognitive therapy, cohort analysis, Cohort Studies, Combined Modality Therapy, comorbidity, comparative study, controlled study, Depression, disease severity, female, generalized anxiety disorder, human, Humans, hypnotic agent, insomnia, major clinical study, male, Middle Aged, multicenter study, multimodality cancer therapy, nocturnal panic attack, panic, Panic Disorder, panic disorder with agoraphobia, patient worry, procedures, psychoeducation, psychology, psychotropic agent, Psychotropic Drugs, quasi experimental study, Quebec, randomized controlled trial, Sleep Initiation and Maintenance Disorders, statistical significance, treatment outcome, wakefulness, Young Adult},

pubstate = {published},

tppubtype = {article}

}