Latent Change Score Analyses: Phase III Data from the OCDI
Creators: name: Snorrason, Ivar
name: Conway, Christopher
name: Falkenstein, Martha
name: Kelley, Kara
Publisher: name: Open Science Framework
Year: 2022
Subjects: subject: Social and Behavioral Sciences
subject: body dysmorphic
subject: hair pulling
subject: HiTOP
subject: hoarding
subject: Latent change score
subject: obsessive compulsive
subject: skin picking
subject: trichotillomania

description: PREREGISTRATION Title Higher-Order Compulsivity versus Grooming Dimensions as Treatment Targets for the DSM-5 Obsessive-Compulsive and Related Disorders Authors Ivar Snorrason, Christopher C. Conway, Martha J. Falkenstein, Kara N. Kelley &amp; Jennie Kuckertz Overview The study sample (see details below) is comprised of adult patients who received intensive/residential treatment for obsessive-compulsive and related disorders (OCRDs). The table shows the constructs and measures used in the study. Patients completed the measures before and after treatment. Constructs and Measures in the Study (see “Measured variables” section below) Obsessive-compulsive disorder (OCD) = Yale-Brown Obsessive-Compulsive Scale Body dysmorphic disorder (BDD)= Yale-Brown Obsessive-Compulsive Scale modified for BDD Hoarding disorder (HD) = Hoarding Rating Scale Hair pulling disorder (HPD) = Massachusetts General Hospital Hair Pulling Scale Skin picking disorder (SPD) = Skin Picking Scale-Revised Generalized anxiety disorder (GAD) = Penn State Worry Questionnaire Major depressive disorder (MDD)=Hamilton Rating Scale for Depression &amp; Quick Inventory for Depressive Symptoms Research Question#1 What is the optimal way to model the higher-order comorbidity structure at pretreatment? Statistical Approach: Five confirmatory factor analysis (CFA) models will be compared. The rationale for the five model is discussed in Snorrason et al. (2020). 1. Model#1: 1-factor model indicated by symptoms of all the disorders (OCD, BDD, HD, HPD, SPD, MDD, GAD). 2. Model#2: A correlated 2-factor model comprised of compulsivity/distress factor (OCD, BDD, HD, MDD, GAD) and grooming factor (HPD, SPD). 3. Model#3: A correlated 3-factor model comprised of compulsivity (OCD, BDD, HD), distress (MDD, GAD) and grooming (HPD, SPD) factors. 4. Model#4: A version of the 2-factor model, in which BDD is allowed to cross-load on both factors. 5. Model#5: A version of the 3-factor model, in which BDD is allowed to cross-load on compulsivity and grooming. We expect that the study variables will have non-normal distribution (based on data from previous cohort in the population). We will therefore use maximum likelihood estimator with robust standard errors (i.e., “MLR” in lavaan). Model fit will be considered adequate if the root mean square of approximation and the standardized root mean square residual is 0.08 or lower and comparative fit index and Tucker–Lewis index are 0.90 or higher. We also will attend to interpretability of parameter estimates when judging model fit. To compare models, we will use the sample-size adjusted Bayesian information criterion (a decrease of 10 or more indicates better fitting model). Hypotheses: We expect that the 1-factor model (model 1) will fit the data poorly. We predict that all the 2 or 3 factor models (i.e., models 2-5) will have adequate fit, and superior fit than model#1. We predict that 3-factor models (i.e., models 3 and 5) will have better fit than 2-factor models (i.e., models 2 and 4). We also expect that model 3 will be superior to model 5. Research Question#2 Is the pre-to-post treatment change in the latent grooming factor correlated with the pre-to-post treatment change in other latent factors? (This question only makes sense if any of the models 2-5 fit adequately and better than model 1). Statistical approach: We will first create a latent change score factor (Kievit et al., 2018) based on the best-fitting model from research question#1, then examine the correlations between the latent change score factors. We intend to examine the size of the correlations between the latent factors as well as corresponding p-values (see the “Inference criteria” section below). Hypotheses: • If either model 2 or 4 fit the data best, we predict that the latent change score of the grooming factor will not be correlated with the latent change score of the distress/compulsivity factor. • If either model 3 or 5 fit the data best, we predict that the latent change score of the compulsivity factor will be correlated with the latent change score of the distress factor. However, the latent change score of the grooming factor will not be correlated with the latent change scores of the latent distress or compulsivity factors. Other Questions • Do differences in pretreatment grooming affect the degree of change in compulsivity or distress? • Do differences in pretreatment distress affect the degree of change in compulsivity or grooming? • Do differences in pretreatment compulsivity affect the degree of change in distress or grooming? Research question#3 (exploratory analyses): Is the pre-to-post treatment change in symptom of all the disorders intercorrelated? Statistical approach: We will create a univariate latent change score for each disorder and examine the correlation between them (see the “Inference criteria” section below). Hypotheses: 1. Change in HPD will correlate with change in SPD but not GAD, MDD, OCD, BDD or HD 2. Change in SPD will correlate with change in HPD but not GAD, MDD, OCD, BDD, or HD 3. Change in OCD will correlate with change in GAD, MDD, BDD, and HD but not HPD or SPD 4. Change in BDD will correlate with change in GAD, MDD, OCD, and HD but not HPD or SPD 5. Change in HD will correlate with change in GAD, MDD, OCD, and BDD, but not HPD or SPD 6. Change in GAD will correlate with change in MDD, OCD, BDD, and HD but not HPD or SPD 7. Change in MDD will correlate with change in GAD, OCD, BDD, and HD but not HPD or SPD Name or brief description of data set Phase III data from the OCD Institute at McLean Hospital Is this data open or publicly available? Yes, see https://osf.io/8kwb4/ How can the data be accessed? Provide link if available online. https://osf.io/8kwb4/ Date of download or access N/A Data source The OCD Institute at McLean Hospital Codebook We will post a codebook at https://osf.io/8kwb4/ Sampling and data collection procedures Patients completed self-report questionnaires as part of routine clinical care. Prior work based on the dataset The authors who conceived of the study and conducted the analyses (Ivar Snorrason and Chris Conway) have never before worked with this dataset. The remaining authors have worked with the data in other capacities (e.g., see list of publications at the end of the document). Prior Knowledge current dataset The authors who conceived of the study and conducted the analyses (Ivar Snorrason and Chris Conway) had no prior knowledge of the nature of the dataset. They only had information about what instruments were administered and the nature of the population (i.e., patient with severe OCRDs). Moment of preregistration We are registering after data cleaning, but before any inferential statistics were computed. Manipulated variables Not applicable. This is an observational study. Measured variables The following self-report scales were administered before and after treatment. 1. Yale-Brown Obsessive-Compulsive Scale (YBOCS-OCD; Federici et al., 2010). The YBOCS-OCD provides measure of OCD symptom severity independent of symptom content. The severity scale refers to symptoms in the past week and consists of 10 items rated on a 5-point scale ranging from none (0) to extreme (4). 2. Yale-Brown Obsessive-Compulsive Scale Modified for Body Dysmorphic Disorder (YBOCS-BDD; Phillips et al., 2014). The YBOCS-BDD consists of 12 items that measure severity and frequency of BDD symptoms over the past week. 3. Hoarding Rating Scale (HRS; Tolin et al., 2010). The HRS consists of 5-items that assess severity of hoarding disorder (clutter, difficulty discarding, acquisition, distress, and impairment). Each item is rated on a 9-point scale from 0 (none) to 8 (extreme). 4. Massachusetts General Hospital Hair Pulling Scale (MGH-HPS; Keuthen et al., 2007). The MGH-HPS was designed to measure severity of trichotillomania (hair-pulling disorder) over the past week. The questionnaire was modeled after YBOCS-OCD and includes 7 items rated on 0-4 scale. 5. Skin Picking Scale-Revised (SPS-R; Snorrason et al., 2012). This is an 8-item questionnaire that was modeled after YBOCS-OCD and designed to assess severity of excoriation (skin-picking) disorder in the past week. 6. 16-item Quick Inventory for Depressive Symptoms (QIDS16; Rush et al., 2006). The QIDS16 was designed to measure overall severity of major depressive disorder by assessing each of the nine DSM symptom domains that define major depressive episode. 7. 6-item Hamilton Rating Scale for Depression (HRSD6; Carrozzino et al., 2020). The HRSD6 is a shortened version of a widely used measure of severity of depression. Items are rated on 0-4 scale and refer to past 3 days. 8. 8-item Penn State Worry Questionnaire (PSWQ8; Hopko et al., 2003). This is a self-report questionnaire designed to assess tendency to worry (e.g., “I know I should not worry about things, but I just cannot help it.”). Items are rated on a 5-point scale ranging from 1 (“not at all typical of me”) to 5 (“very typical of me”). Transformations None planned. Data Inclusion/exclusion We intend to include data from patients admitted to the program from 05/2014 to 11/2016. This time frame corresponds to a period were all the study measures were included in the admission/discharge assessment battery. We intend to include all patients admitted during this period as long as they had available data for either pre or post treatment. For patients who admitted more than once during the period, only data from the first admission will be included. Outliers We do not plan to remove any cases due to outlier status. The sample includes individual with severe psychopathology and valid extreme score on the questionnaires are possible. Weights Not applicable. Sample size The study dataset includes 407 patients (admitted 05/2014-11/2016). We performed power simulations in an independent cohort from the same clinic (N=427, admitted 05/2011-01/2014). See code and data here: https://osf.io/8kwb4/. The results showed that a sample size as small as 300 will be large enough to detect pre-to-post treatment change in OCD, HD, and MDD as well as correlation between univariate change scores (power=1 in all cases). No data were available for SPD and HPD. However, given that HD tends to response less to treatment than other OCRDs (Tolin et al., 2015), we assumed we had enough power to detect changes in SPD and HPD as well. Missing data Occasionally a patient may have failed to complete an item or instruments. Additionally, some cases are missing questionnaire data at treatment discharge. This occurred mostly because of because of administrative constraints. We will handle missing data via full information maximum likelihood (FIML) estimation, as implemented in lavaan. Statistical models See “Research Question” section. Follow-up analyses None planned. Inference criteria p&lt; .05 = “statistically significant”, although we will emphasize effect size when interpreting the results. Sensitivity Analyses None planned. Statistical Analysis Backup Plan If none of the multivariate models (research question#1) are viable, we will focus on the univariate change scores (research question#2) Exploratory analysis Non planned. References Carrozzino, D., Patierno, C., Fava, G. A., &amp; Guidi, J. (2020). The Hamilton Rating Scales for Depression: A critical review of clinimetric properties of different versions. Psychotherapy and Psychosomatics, 89(3), 133-150. doi: 10.1159/000506879 Federici, A., Summerfeldt, L. J., Harrington, J. L., McCabe, R. E., Purdon, C. L., Rowa, K., &amp; Antony, M. M. (2010). Consistency between self-report and clinician-administered versions of the Yale-Brown Obsessive–Compulsive Scale. Journal of Anxiety Disorders, 24(7), 729-733. Hopko, D. R., Reas, D. L., Beck, J. G., Stanley, M. A., Wetherell, J. L., Novy, D. M., et al. (2003). Assessing worry in older adults: confirmatory factor analysis of the Penn State worry questionnaire and psychometric properties of an abbreviated model. Psychological Assessment, 15, 173–183. Kievit, R. A., Brandmaier, A. M., Ziegler, G., Van Harmelen, A. L., de Mooij, S. M., Moutoussis, M., ... &amp; Lindenberger, U. (2018). Developmental cognitive neuroscience using latent change score models: A tutorial and applications. Developmental Cognitive Neuroscience, 33, 99-117. Keuthen, N. J., Flessner, C. A., Woods, D. W., Franklin, M. E., Stein, D. J., &amp; Cashin, S. E. (2007). Factor analysis of the Massachusetts general hospital hairpulling scale. Journal of Psychosomatic Research, 62(6), 707-709. Phillips, K. A., Hart, A. S., &amp; Menard, W. (2014). Psychometric evaluation of the yale–brown obsessive-compulsive scale modified for body dysmorphic disorder (BDD-YBOCS). Journal of Obsessive-Compulsive and Related Disorders, 3(3), 205-208. Rush, A. J., Bernstein, I. H., Trivedi, M. H., Carmody, T. J., Wisniewski, S., Mundt, J. C., ... &amp; Fava, M. (2006). An evaluation of the quick inventory of depressive symptomatology and the hamilton rating scale for depression: a sequenced treatment alternatives to relieve depression trial report. Biological Psychiatry, 59(6), 493-501. Snorrason, I., Beard, C., Peckham A.D., &amp; Björgvinsson, T. (2020). Transdiagnostic dimensions in obsessive-compulsive and related disorders: Associations with internalizing and externalizing symptoms. Psychological Medicine. doi: 10.1017/S0033291720000380 Snorrason, I., Olafsson, R. P., Flessner, C. A., Keuthen, N. J., Franklin, M. E., &amp; Woods, D. W. (2012). The skin picking scale-revised: factor structure and psychometric properties. Journal of Obsessive-Compulsive and Related Disorders, 1(2), 133-137. Tolin, D.F., Frost, R.O., &amp; Steketee, G. (2010). A brief interview for assessing compulsive hoarding: The Hoarding Rating Scale-Interview. Psychiatry Research, 178, 147-152. Tolin, D. F., Frost, R. O., Steketee, G., &amp; Muroff, J. (2015). Cognitive behavioral therapy for hoarding disorder: A meta‐analysis. Depression and Anxiety, 32(3), 158-166. List of peer-reviewed publications using data from the OCDI population 1. Nota, J. A., Potluri, S., Kelley, K. N., Elias, J. .A, Krompinger, J. W. Delayed bedtimes are associated with more obsessive-compulsive symptoms in intensive residential treatment. Behavior Therapy. 2. Falkenstein, M. J., Schreck. M., Potluri, S., Nota, J. A., Kelley, K. N., Beard, C., &amp; Elias, J. A. (2020). Longitudinal relations of obsessive beliefs, obsessions, and compulsions during treatment for obsessive compulsive disorder. Cognitive Therapy and Research. 3. Wadsworth, L., Potluri, S., Schreck, M., &amp; Hernandez-Vallant, A. (2020). Measurement and Impacts of Intersectionality on OCD Symptoms Across Intensive Treatment. American Journal of Orthopsychiatry. 4. Brakoulias V, Starcevic V, Albert U, Arumugham SS, Bailey BE, Belloch A… Elias J. A., Falkenstein M. J. , Potluri S.… Fineberg NA. (2020). The rates of co-occurring behavioural addictions in treatment-seeking individuals with obsessive-compulsive disorder: a preliminary report. International Journal of Psychiatry in Clinical Practice, 1-3. 5. Wei, M.A., Van Kirk, N., Reid, A.M., Garner, L.E., Krompinger, J.W., Crosby, J.M., Elias, J.A., &amp; Weisz, J.R. (2020). Emotion regulation strategy use and symptom change during intensive treatment of transitional age patients with obsessive compulsive disorder. Journal of Behavioral and Cognitive Therapy. 6. Wheaton, M. G., Pinto, A. M., Cervoni, C., Crosby, J. M., Tifft, E. D., Mathes, B. M., Garner, L. E., Van Kirk, N., Elias, J. A. &amp; Pinto, A. (2019). Perfectionism in Intensive Residential Treatment of Obsessive–Compulsive Disorder. Cognitive Therapy and Research, 1-9. 7. Jalal, B., McNally, R. J., Elias, J. A., Potluri, S., &amp; Ramachandran, V. S. (2019). “Fake it till You Make it”! Contaminating Rubber Hands to Treat Obsessive-Compulsive Disorder. Frontiers in Human Neuroscience, 13, 414. 8. Falkenstein, M. J., Nota, J. A., Krompinger, J. W., Schreck, M., Garner, L. E., Potluri, S., ... &amp; Mathes, B. (2019). Empirically-derived response trajectories of intensive residential treatment in obsessive-compulsive disorder: A growth mixture modeling approach. Journal of Affective Disorders, 245, 827-833. 9. Brennan, B. P., Wang, D., Li, M., Perriello, C., Ren, J., Elias, J. A., ... &amp; Rauch, S. L. (2019). Use of an individual-level approach to identify cortical connectivity biomarkers in obsessive-compulsive disorder. Biological Psychiatry: Cognitive Neuroscience and Neuroimaging, 4(1), 27-38. 10. Brakoulias, V., Starcevic, V., Albert, U., Arumugham, S.S., Bailey, B.E…, Elias, J.A., Falkenstein, M. J., … Potluri, S., … Fineberg, N.A. (under review). The rates of co-occurring behavioural addictions in obsessive-compulsive disorder: a preliminary report. 11. Krompinger, J. W., Van Kirk, N. P., Garner, L. E., Potluri, S. I., &amp; Elias, J. A. (2018). Hope for the Worst: Occasional Reinforced Extinction and Expectancy Violation in the Treatment of OCD. Cognitive and Behavioral Practice. 12. Falkenstein, M. J., Conelea, C. A., Garner, L. A., &amp; Haaga, D. A. F. (2018). Sensory over-responsivity in trichotillomania (hair-pulling disorder). Psychiatry Research, 260, 207-218. 13. Gagné, J., Van Kirk, N., Hernandez-Vallant, A., Potluri, S., Krompinger, J. W., Cattie, J., … Elias, J.A. (2018). Validating an abbreviated version of the Obsessive Beliefs Questionnaire. Journal of Clinical Psychology. 10.1002/jclp.22629. 14. Ponzini, G., Van Kirk, N., Schreck, M., Nota, J. A., Schofield, C. A., Gironda, C., &amp; Elias, J. (2018). Does Motivation Impact OCD Symptom Severity? An Exploration of Longitudinal Effects. Behavior Therapy. 15. Garner, L.E., Van Kirk, N., Tifft, E.D., Krompinger, J. W., Mathes, B. M., Fraire, M., Falkenstein, M.J., Brennan, M. P., Crosby, J. M., &amp; Elias, J. A. (2018). Validation of the Distress Tolerance Scale-Short Form in obsessive compulsive disorder. Journal of Clinical Psychology. 74(6), 916-925. DOI: 10.1002/jclp.22554 16. Krompinger, J.W., Gironda, C.M.,.... &amp; Elias, J.A. (2017). Early response is predictive of treatment outcome in residential treatment for OCD. Journal of Obsessive-Compulsive and Related Disorders. 17. Reid, A. M., Garner, L. E., Kirk, N., Gironda, C., Krompinger, J. W., Brennan, B. P., ... &amp; Cattie, J., Crosby, J. M., &amp; Elias, J. A. (2017). How willing are you? Willingness as a predictor of change during treatment of adults with obsessive–compulsive disorder. Depression and Anxiety. 18. Brennan, B.P., Jensen, J.E., Perriello, C., Pope, H.G. Jr., Jenike, M.A., Hudson, J.I., Rauch, S.L., Kaufman, M.J. (2015) Lower posterior cingulate cortex glutathione levels in obsessive-compulsive disorder. Biological Psychiatry: Cognitive Neuroscience and Neuroimaging. 19. Allen, K. J., Krompinger, J. W., Mathes, B. M., Crosby, J. M., &amp; Elias, J. A. (2015). Thought control strategies in patients with severe obsessive-compulsive disorder: Treatment effects and suicide risk. Journal of Obsessive-Compulsive and Related Disorders. 20. Brennan, B.P., Tkachenko, T., Schwab, Z.J., Juelich, R.J., Ryan, E.M., Athey, A.J., Pope, H.G., Jr., Jenike, M.A., Baker, J.T., Killgore, W.D.S., Hudson, J.I., Jensen, J.E., &amp; Rauch, S.L. (2015). An examination of rostral anterior cingulate cortex function and neurochemistry in obsessive–compulsive disorder. Neuropsychopharmacology. 21. Monaghan, S.C., Cattie, J.E., Mathes, B.M., Shorser-Gentile, L.I., Crosby, J.M., &amp; Elias, J.A. (2015). Stages of change and the treatment of OCD. Journal of Obsessive-Compulsive and Related Disorders, 5, 1-7. 22. Athey, A.J., Elias, J.A., Crosby, J.M., Jenike, M.A., Pope, H.G. Jr., Hudson, J.I., &amp; Brennan, B.P. (2015). Reduced disgust propensity is associated with improvement in contamination/washing symptoms in obsessive-compulsive disorder. Journal of Obsessive Compulsive and Related Disorders, 4, 20-24. 23. Brennan, B.P., Lee, C., Elias, J.A., Crosby, J.M., Mathes, B.M., Andre, M.C., Gironda, C.M., Pope, H.G., Jr., Jenike, M.A., Fitzmaurice, G.M., &amp; Hudson, J.I. (2014). Intensive residential treatment for severe obsessive-compulsive disorder: Characterizing treatment course and predictors of response. Journal of Psychiatric Research, 56, 98-105. 24. Shapiro, L.J., Krompinger, J.W., Gironda, C.M., &amp; Elias, J.A. (2013). Development of a scrupulosity severity scale using the Pennsylvania Inventory of Scrupulosity-Revised. Journal of Obsessive-Compulsive and Related Disorders, 2(4), 420-424. 25. Crosby, J.M., Dehlin, J.P., Mitchell, P.R., &amp; Twohig, M.P. (2012). 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