@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{belleville_efficacy_2023,

title = {Efficacy of a Therapist-Assisted Self-Help Internet-Based Intervention Targeting PTSD, Depression, and Insomnia Symptoms After a Disaster: A Randomized Controlled Trial},

author = {G. Belleville and M. -C. Ouellet and V. Békés and J. Lebel and C. M. Morin and S. Bouchard and S. Guay and N. Bergeron and S. Ghosh and T. Campbell and F. P. Macmaster},

url = {https://www.scopus.com/inward/record.uri?eid=2-s2.0-85140981202&doi=10.1016%2fj.beth.2022.08.004&partnerID=40&md5=261383919bbdaa149ac0eeb6d3317fc0},

doi = {10.1016/j.beth.2022.08.004},

issn = {00057894 (ISSN)},

year  = {2023},

date = {2023-01-01},

journal = {Behavior Therapy},

volume = {54},

number = {2},

pages = {230–246},

publisher = {Elsevier Inc.},

abstract = {This study aimed at evaluating the efficacy of an online CBT intervention with limited therapist contact targeting a range of posttraumatic symptoms among evacuees from the 2016 Fort McMurray wildfires. One hundred and thirty-six residents of Fort McMurray who reported either moderate PTSD symptoms (PCL-5 ≥ 23) or mild PTSD symptoms (PCL-5 ≥ 10) with moderate depression (PHQ-9 ≥ 10) or subthreshold insomnia symptoms (ISI ≥ 8) were randomized either to a treatment (n = 69) or a waitlist condition (n = 67). Participants were on average 45 years old, and mostly identified as White (82%) and as women (76%). Primary outcomes were PTSD, depression, and insomnia symptoms. Secondary outcomes were anxiety symptoms and disability. Significant Assessment Time × Treatment Condition interactions were observed on all outcomes, indicating that access to the treatment led to a decrease in posttraumatic stress (F[1,117.04] = 12.128},

note = {Publisher: Elsevier Inc.},

keywords = {adult, Anxiety, article, clinical effectiveness, clinical feature, cognitive behavioral therapy, controlled study, Depression, disaster, Disasters, disease severity, e-mental health, female, human, Humans, insomnia, Internet-Based Intervention, major clinical study, male, Middle Aged, natural disaster, physical disability, Post-Traumatic, posttraumatic stress disorder, psychotherapist, PTSD, randomized controlled trial, risk factor, Sleep Initiation and Maintenance Disorders, Stress Disorders, telepsychotherapy, treatment outcome, wildfire},

pubstate = {published},

tppubtype = {article}

}

@article{bellevilleEfficacyTherapistAssistedSelfHelp2023,

title = {Efficacy of a Therapist-Assisted Self-Help Internet-Based Intervention Targeting PTSD, Depression, and Insomnia Symptoms After a Disaster: A Randomized Controlled Trial},

author = {G. Belleville and M. -C. Ouellet and V. Békés and J. Lebel and C. M. Morin and S. Bouchard and S. Guay and N. Bergeron and S. Ghosh and T. Campbell and F. P. Macmaster},

url = {https://www.scopus.com/inward/record.uri?eid=2-s2.0-85140981202&doi=10.1016%2fj.beth.2022.08.004&partnerID=40&md5=261383919bbdaa149ac0eeb6d3317fc0},

doi = {10.1016/j.beth.2022.08.004},

issn = {00057894 (ISSN)},

year  = {2023},

date = {2023-01-01},

journal = {Behavior Therapy},

volume = {54},

number = {2},

pages = {230–246},

publisher = {Elsevier Inc.},

abstract = {This study aimed at evaluating the efficacy of an online CBT intervention with limited therapist contact targeting a range of posttraumatic symptoms among evacuees from the 2016 Fort McMurray wildfires. One hundred and thirty-six residents of Fort McMurray who reported either moderate PTSD symptoms (PCL-5 ≥ 23) or mild PTSD symptoms (PCL-5 ≥ 10) with moderate depression (PHQ-9 ≥ 10) or subthreshold insomnia symptoms (ISI ≥ 8) were randomized either to a treatment (n = 69) or a waitlist condition (n = 67). Participants were on average 45 years old, and mostly identified as White (82%) and as women (76%). Primary outcomes were PTSD, depression, and insomnia symptoms. Secondary outcomes were anxiety symptoms and disability. Significant Assessment Time × Treatment Condition interactions were observed on all outcomes, indicating that access to the treatment led to a decrease in posttraumatic stress (F[1,117.04] = 12.128},

keywords = {adult, Anxiety, article, clinical effectiveness, clinical feature, cognitive behavioral therapy, controlled study, Depression, disaster, Disasters, disease severity, e-mental health, female, human, Humans, insomnia, Internet-Based Intervention, major clinical study, male, Middle Aged, natural disaster, physical disability, Post-Traumatic, posttraumatic stress disorder, psychotherapist, PTSD, randomized controlled trial, risk factor, Sleep Initiation and Maintenance Disorders, Stress Disorders, telepsychotherapy, treatment outcome, wildfire},

pubstate = {published},

tppubtype = {article}

}

@article{couture_consequences_2020,

title = {Consequences associated with the use of psychoactive substances among female adolescents placed in residential care: the role of sexual exploitation},

author = {S. Couture and N. Lanctôt and G. Parent and S. Lemieux and A. Lemieux},

url = {https://www.scopus.com/inward/record.uri?eid=2-s2.0-85087764280&doi=10.1080%2f03630242.2020.1789262&partnerID=40&md5=4340b68f807cf337f0a1abb617ed1df5},

doi = {10.1080/03630242.2020.1789262},

issn = {03630242 (ISSN)},

year  = {2020},

date = {2020-01-01},

journal = {Women and Health},

pages = {1052–1062},

publisher = {Routledge},

abstract = {Sexual exploitation is a major burden among female adolescents placed in residential care centers. Moreover, problematic psychoactive substance use is a concern because of its prevalence and various associated consequences. However, little is known about the consequences resulting specifically from the use of psychoactive substances among sexually exploited female adolescents. This study explored the association between sexual exploitation and the various consequences associated with substance use among adolescent female (15.3–17.1 years old) living in Quebec’s residential care centers during 2008–2009. To better understand this association, 83 sexually exploited female adolescents and 66 non-sexually exploited female adolescents responded to self-reported questionnaires. As expected, even controlling for age of onset and frequency of substance use, an ANCOVA showed that sexually exploited female adolescents experience more consequences associated with their use of psychoactive substances (F (4, 148) = 24.79, p <.001},

note = {Publisher: Routledge},

keywords = {Adolescent, Adolescent Behavior, analysis of covariance, article, Child, controlled study, delinquency, dissociation, drug dependence, drug effect, female, high risk behavior, human, human experiment, Humans, major clinical study, male, onset age, Prevalence, prostitution, Psychoactive substance use, psychology, psychotropic agent, Psychotropic Drugs, Quebec, questionnaire, rehabilitation center, residential care, Residential Facilities, residential home, risk factor, Risk Factors, Risk-Taking, Sex Work, Sexual Behavior, sexual exploitation, substance use, Substance-Related Disorders},

pubstate = {published},

tppubtype = {article}

}

@article{coutureConsequencesAssociatedUse2020,

title = {Consequences associated with the use of psychoactive substances among female adolescents placed in residential care: the role of sexual exploitation},

author = {S. Couture and N. Lanctôt and G. Parent and S. Lemieux and A. Lemieux},

url = {https://www.scopus.com/inward/record.uri?eid=2-s2.0-85087764280&doi=10.1080%2f03630242.2020.1789262&partnerID=40&md5=4340b68f807cf337f0a1abb617ed1df5},

doi = {10.1080/03630242.2020.1789262},

issn = {03630242 (ISSN)},

year  = {2020},

date = {2020-01-01},

journal = {Women and Health},

pages = {1052–1062},

publisher = {Routledge},

abstract = {Sexual exploitation is a major burden among female adolescents placed in residential care centers. Moreover, problematic psychoactive substance use is a concern because of its prevalence and various associated consequences. However, little is known about the consequences resulting specifically from the use of psychoactive substances among sexually exploited female adolescents. This study explored the association between sexual exploitation and the various consequences associated with substance use among adolescent female (15.3–17.1 years old) living in Quebec’s residential care centers during 2008–2009. To better understand this association, 83 sexually exploited female adolescents and 66 non-sexually exploited female adolescents responded to self-reported questionnaires. As expected, even controlling for age of onset and frequency of substance use, an ANCOVA showed that sexually exploited female adolescents experience more consequences associated with their use of psychoactive substances (F (4, 148) = 24.79, p <.001},

keywords = {Adolescent, Adolescent Behavior, analysis of covariance, article, Child, controlled study, delinquency, dissociation, drug dependence, drug effect, female, high risk behavior, human, human experiment, Humans, major clinical study, male, onset age, Prevalence, prostitution, Psychoactive substance use, psychology, psychotropic agent, Psychotropic Drugs, Quebec, questionnaire, rehabilitation center, residential care, Residential Facilities, residential home, risk factor, Risk Factors, Risk-Taking, Sex Work, Sexual Behavior, sexual exploitation, substance use, Substance-Related Disorders},

pubstate = {published},

tppubtype = {article}

}