The Yale and Brown Obsessive Compulsive Scale as a Measure of OCD - Essay Example

? The Yale–Brown Obsessive Compulsive Scale as a measure of OCD Obsessive – compulsive disorder (OCD) is a condition characterized by a variety of symptoms that prompt the individual to indulge in repetitive actions as a means to reduce anxiety. It has been categorized as an anxiety related problem; and patients report intrusive thoughts that give rise to anxiety unless they exhibit the said repetitive behaviors. The symptoms of OCD occur across a wide spectrum, ranging from cleaning and checking behaviors to hoarding and preoccupations. Patients suffering from OCD tend to be ritualistic about actions; though sometimes, the anxiety manifests itself in aversions instead of excesses. Individuals coping with OCD can become aloof or preoccupied with their actions to the extent of alienating others and causing themselves and others significant distress. Often, they are aware of the irrationality of their actions; but may be unable to change them due to the overwhelming anxiety that they experience in the absence of these behaviors. In an attempt to identify individuals who require treatment for OCD and to verify the severity of the person’s symptoms; Dr Goodman and his colleagues (Goodman, Price & Rasmussen; 1989) designed a scale that could be used to screen individuals with OCD as well as to be used to gauge progress of the individual across different points in therapy. This scale – the Yale–Brown Obsessive Compulsive Scale (Y-BOCS) attempts to test the severity of OCD symptoms and has provided valuable results in both practice and research. The test is unbiased towards the type of obsessive thoughts and / or compulsive behaviors exhibited by the individual; and measures the two separately. The Y-BOCS was initially designed to be used as an interview tool by the clinician; and consisted of two parts that were administered via an interview between a clinician and a client. In the first part, the clinician helps a client select categories of thought and behavior that the client experiences obsessions and compulsions with. The client is presented with a list of categories, and encouraged to pick out three categories each for obsessive thought and for compulsive actions. The categories for obsessive thought include obsessions that may be classified as aggressive, pertaining to contamination, religion or sex, obsessions about hoarding and /or saving; the need for symmetry or Exactness; Somatic Obsessions and miscellaneous obsessions. The categories for compulsive behaviors include cleaning or checking behaviors, repetitive Rituals or counting, Ordering or Arranging, hoarding objects, other Mental Rituals and miscellaneous behaviors. Once the symptoms that cause the most distress are selected; the scale is administered. This scale consists of ten items that can be rated from 0 to 4 each. For each item, a 0 score means that the symptom is not observed; and 4 means that the symptom is manifested to an extreme. The first five items correspond to obsessive thoughts while the latter five items check for severity of compulsive behaviors. The elements tested for obsessive thoughts include the Time Occupied by them, the Interference and distress caused by these thoughts, the resistance experienced and the control over the obsessive thoughts. Items associated with compulsive behaviors gauge the severity of Time Spent in performing these behaviors, the Interference and Distress they cause in daily functioning, the Resistance Against and Degree of Control Over the said Compulsive Behaviors. A total score for obsessions and compulsions each is tallied; and interpretation for clinical use is made on the basis of this score. A score of 7 or below implies the lack of clinical symptoms; and one between 8 and 15 implies mild symptoms; which the clinician may evaluate as not needing treatment outside counseling. Scores of 16 and above are recommended for further exploration and treatment; with 16 – 23 being considered moderate, 24 -31 being considered severs and scores above 32 being considered very extreme. A two part study was conducted by the authors to examine the psychometric properties of the scale. The first, (Goodman, Price, Rasmussen, Mazure, Fleischmann, Hill, Heninger, & Charney; 1989) reported high inter-rater and internal consistency measures of reliability; and also reported the ability to estimate a wide range of scores, and distinguish between participants’ symptom severities. The second study (Goodman, Price, Rasmussen, Mazure, Delgado, Heninger, & Charney; 1989) reported the validity estimates for the Y-BOCS. The study found that the Y-BOCS has adequate to strong construct and discriminant validity. They also found that the scale was sensitive to changes that were induced by medication; and would be able to show similar sensitivity to changes associated with different forms of therapy. This makes the instrument valuable not only for identifying patients in need of treatment; but also for identifying the changes that are proof of progress. The development of the Yale–Brown Obsessive Compulsive Scale (Y-BOCS) may be tied to the behaviorist theories of personality. This line of thought that was initially propounded by B. F. Skinner. The scale emphasizes on the prevalence and severity of existing symptoms that are consciously experienced by the individual. The scale does not explore the underlying causes, and focuses attention on the visible issues faced by the individual that affect his / her life. This emphasis on the issues is seen in the fact that all items are associated with the prevalence of and the severity of the said symptoms. The scale is based on the premise that the behavior exhibited and the thoughts associated with a particular experience lead to reduced anxiety. This reduction in anxiety acts as a reinforcer for the thoughts and behaviors that over time become stronger and take up a more significant amount of time and effort. As time passes; the behavior and thoughts get stronger as the association between performing them and reduction in anxiety becomes stronger. The Y-BOCS focuses on the presence and intensity of the symptoms presented; and does not consider the background to the said obsessive thought and compulsive behaviors. It also does not attempt to identify the reasons why they cause distress to the person; but it does attempt to measure the extent to which the person has control over these thoughts and behaviors. Given this understanding; the Y-BOCS does have roots in the behaviorist thoughts on personality. McKay, Danyko, Neziroglu, and Yaryura-Tobias (1995) have confirmed the distinctions between the obsessive and compulsive symptoms examined by the Y-BOCS. They found that the first 5 items loaded on the factor for obsessive thoughts; while the last 5 items loaded heavily on the factor for compulsive behaviors. These two factors were significantly different; underlining the validity of examining the scores for the two differently. The authors of this study have thus suggested that the Y-BOCS could be divided into two subscales without losing information. The study also found that both the factor for obsessions and the one for compulsions was correlated with depression as measured using Beck’s inventory; but only obsessions were correlated with trait anxiety as measured using the Speilberger (1989) State-Trait anxiety scale. Another study that verified the reliability and validity for the Y-BCOS was conducted by Kim, Dysken, and Kuskowski (1990). The study found that the Y-BOCS had a sound reliability and validity; and that it was a better and more sensitive measure of OCD symptoms as compared to the Leyton Obsessional Inventory (LOI). These findings validate the use of the Y-BOCS over other instruments. Similar value of the Y-BOCS was ascertained by Woody, Steketee, & Chambless (1995). They found that the scale had adequate internal and inter-rater consistency. They also found that test – retest reliability when tested about 48 days apart was low; likely as a result of the test being sensitive to changes due to treatment. They also established adequate validity, especially convergent validity. The biggest concern they found was that the divergent validity from depression measures was poor. The study also found that deleting the items related to resistance and adding an item relating to avoidance did improve the psychometric properties of the scale. A number of other studies have also examined the validity and the reliability of the Y-BOCS in different conditions. Steketee, Frost & Bogart, (1996) found that the self report version of the Y-BOCS showed as high internal and test re-rest reliability as the clinician administered version. There was a high correlation between the scores of clinical and non – clinical samples across the methods of administration. The study also showed evidence of both convergent validity with the clinician administered versions, and discriminant validity in terms of identifying clinical and non clinical populations. They observed that the clinical sample actually selected more symptoms when using the self report form – possibly as they were uninhibited by the presence of the clinician. There were no order effects to report for the clinical population; making the self report version of the scale as valuable as the clinician administered one. Another study by Rosenfeld, Dar, Anderson, Kobak, Greist (1992) verified the psychometric properties of the computer administered interactive version of the scale. This study found a strong correlation between the two versions of the scale – the clinician administered version and the computer administered interactive version. They also found reason to believe that this version of the scale has adequate internal reliability. The computer administered interactive version was also able to distinguish between clinical OCD and other clinical populations; as well as clinical OCD and non clinical populations. Further investigation showed that the participants did find the computer administered version of the Y-BOCS simple to use and easy to understand. They did not show any preference for one version over the other; an important result, especially for the clinical sample. Given this information, it would be possible to accept the Y-BOCS as an adequate measure of identifying the presence and intensity of symptoms of OCD. The scale is specific to the measurement of symptoms of OCD; and has been proven to be a sensitive and useful tool to screen individuals with OCD. It has also been found useful in the regular testing during treatment as it is sensitive enough to establish if the goals of treatment are working. Since it is not affected by the category of symptoms; it can also be used with patients exhibiting a variety of symptoms at the same time; and thus has value in research in treatment and incidence. The Y-BOCS although short; has been verified to have adequate to strong psychometric properties and so can be used with clinical populations without hesitation. The one concern that may be mentioned about the Y-BOCS is that the scale cannot be used in lieu of regular tools of assessment; but only in conjunction with them. Thus, the use of the self – report and the computerized measures - although established as being valid and reliable; should not be used indiscriminately by untrained individuals, as the analysis based solely on this scale without proper assessment may be counter-productive in ensuring the health of an individual. References Bradberry, T. (2007). The Personality Code. New York: Putnam. Engler, Barbara (2006). Personality Theories. Houghton Mifflin. Goodman, W.K., Price, L.H., Rasmussen, S.A., Mazure, C., Fleischmann, R.L., Hill, C.L., Heninger, G.R., Charney, D.S. (1989). The Yale-Brown Obsessive Compulsive Scale: I. Development, Use, and Reliability. Archives of General Psychiatry. Vol.46(11). Pp. 1006-1011 Goodman, W.K., Price, L.H., Rasmussen, S.A., Mazure, C., Delgado, P., Heninger, G.R., Charney, D.S. (1989). The Yale-Brown Obsessive Compulsive Scale: II. Validity. Archives of General Psychiatry. Vol. 46(11). Pp. 1012-1016. Kim, S.W., Dysken, M.W., Kuskowski, M. (1990). The Yale-Brown obsessive-compulsive scale: A reliability and validity study, Psychiatry Research, Vol. 34, (1), Pp 99-106. McKay, D., Danyko, S., Neziroglu, F., Yaryura-Tobias, J.A. (1995). Factor structure of the Yale-Brown Obsessive-Compulsive scale: A two dimensional measure, Behaviour Research and Therapy, Vol. 33( 7), Pp. 865-869. Rosenfeld, R., Dar, R., Anderson, D., Kobak, K.A., Greist, J.H. (1992). A computer-administered version of the Yale-Brown Obsessive-Compulsive Scale. Psychological Assessment, Vol 4(3), pp. 329-332. Steketee, G., Frost, R., Bogart, K.(1996). The Yale-Brown Obsessive Compulsive Scale: Interview versus self-report. Behaviour Research and Therapy, Vol. 34, (8) pp. 675-684. Woody, S.R., Steketee, G., Chambless, D.L. (1995). Reliability and validity of the Yale-Brown Obsessive-Compulsive Scale, Behaviour Research and Therapy, Vol. 33( 5), pp. 597-605. Read More