@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{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}

}