Caitlin M. Pinciotti , Gabriella T. Ponzini , Natalie E. Hundt , Terri L. Fletcher , Stephanie Y. Wells , Lauren P. Wadsworth , Nathaniel Van Kirk , Jonathan S. Abramowitz , Kimberley Quinlan , Wayne K. Goodman , Eric A. Storch
{"title":"Approach and barriers to the assessment and treatment of individuals with co-occurring OCD and PTSD: Treatment providers’ perspectives","authors":"Caitlin M. Pinciotti , Gabriella T. Ponzini , Natalie E. Hundt , Terri L. Fletcher , Stephanie Y. Wells , Lauren P. Wadsworth , Nathaniel Van Kirk , Jonathan S. Abramowitz , Kimberley Quinlan , Wayne K. Goodman , Eric A. Storch","doi":"10.1016/j.jocrd.2024.100877","DOIUrl":"https://doi.org/10.1016/j.jocrd.2024.100877","url":null,"abstract":"<div><p>Obsessive-compulsive disorder (OCD) and posttraumatic stress disorder (PTSD) frequently co-occur, and phenotypic and functional similarities between the disorders necessitate assessment and treatment considerations by providers. To date, no research has reported on mental health treatment providers’ approach to, and barriers associated with, assessing and treating patients with this complex comorbidity. The present study included 169 mental health providers, the majority of whom were cognitive behaviorally-oriented specialists who had recently treated co-occurring OCD and PTSD. Having a doctorate degree and overall years of experience predicted greater perceived competence to assess and conceptualize co-occurring OCD and PTSD. Recent clinical experience with co-occurring OCD and PTSD predicted perceived competence to conceptualize and treat individuals with both disorders. PTSD specialists perceived themselves as more competent to treat co-occurring OCD and PTSD than non-PTSD specialists. Most providers indicated some barriers to adequate assessment and treatment of individuals with co-occurring OCD and PTSD, including competing priorities and lack of time. Implications of findings are discussed within the context of future training targets to equip providers with the tools needed to conduct comprehensive and accurate diagnostic and functional assessment, as well as provide evidence-based treatment tailored to the unique needs of individuals with co-occurring OCD and PTSD.</p></div>","PeriodicalId":48902,"journal":{"name":"Journal of Obsessive-Compulsive and Related Disorders","volume":"41 ","pages":"Article 100877"},"PeriodicalIF":1.8,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140618798","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Marianna Graziosi , Julia S. Rohde , Praachi Tiwari , Jedidiah Siev , David B. Yaden
{"title":"Psychedelics, OCD and related disorders: A systematic review","authors":"Marianna Graziosi , Julia S. Rohde , Praachi Tiwari , Jedidiah Siev , David B. Yaden","doi":"10.1016/j.jocrd.2024.100873","DOIUrl":"https://doi.org/10.1016/j.jocrd.2024.100873","url":null,"abstract":"<div><p>This systematic review analyzes the current literature on the potential therapeutic use of classic psychedelics (i.e., psilocybin, lysergic acid diethylamide [LSD], N,N-dimethyltryptamine [DMT], 5-methoxy-N,N-dimethyltryptamine [5-MeO-DMT], mescaline, and other classic psychedelic analogs utilized in preclinical models) in obsessive-compulsive disorder (OCD) and related disorders. Our search identified 23 articles meeting our predetermined eligibility criteria, comprising 2 non-systematic reviews, 11 preclinical studies investigating the use of classic psychedelics or analogs in preclinical models of OCD, 8 case studies or case reports, and 2 clinical trials. This review provides an up-to-date synthesis of psychedelic OCD research, bridging preclinical findings, historical case reports, and initial clinical trial outcomes. Psilocybin appears to be the most widely used classic psychedelic and is well-tolerated in both OCD and body dysmorphic disorder (BDD) populations, with some participants experiencing significant symptom reduction. This review contributes to our understanding of the potential of classic psychedelics (in particular LSD and psilocybin) as novel therapeutic interventions for OCD and related disorders, offering insights into future research directions and clinical applications in this emerging field.</p></div>","PeriodicalId":48902,"journal":{"name":"Journal of Obsessive-Compulsive and Related Disorders","volume":"41 ","pages":"Article 100873"},"PeriodicalIF":1.8,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140547109","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"“Should I keep washing my groceries?“: Predictors of differential patterns of contamination-related obsessive-compulsive symptoms since the onset of COVID-19 pandemic","authors":"Sara Wilkerson, Dean McKay","doi":"10.1016/j.jocrd.2024.100878","DOIUrl":"10.1016/j.jocrd.2024.100878","url":null,"abstract":"<div><h3>Introduction</h3><p>Contamination fears and associated washing behaviors are common in obsessive-compulsive symptoms (<em>c</em>-OCS). These fears and behaviors are often motivated by disease avoidance. The COVID-19 pandemic provided a unique opportunity to better understand <em>c</em>-OCS given that public health recommendations centered on behaviors common to <em>c</em>-OCS in non-pandemic times. This review systematically examined the nature of <em>c</em>-OCS associated with the COVID-19 pandemic.</p></div><div><h3>Method</h3><p>PubMed and PsycINFO databases were searched. A total of sixteen studies were retained (n = 16) using PRISMA guidelines.</p></div><div><h3>Results</h3><p>the present findings point to the relative infrequency of net-new <em>c</em>-OCS and the importance of elevated <em>c</em>-OCS prior to the pandemic in predicting worsening <em>c</em>-OCS during the pandemic.</p></div><div><h3>Implications</h3><p>Clinical implications in future pandemics as well as suggestions for future research are discussed.</p></div>","PeriodicalId":48902,"journal":{"name":"Journal of Obsessive-Compulsive and Related Disorders","volume":"41 ","pages":"Article 100878"},"PeriodicalIF":1.8,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140795746","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Michael G. Wheaton , Kristen Hagen , Thröstur Björgvinsson , Gerd Kvale , Bjarne Hansen
{"title":"Behavioral avoidance as a factor in concentrated exposure and response prevention for obsessive-compulsive disorder","authors":"Michael G. Wheaton , Kristen Hagen , Thröstur Björgvinsson , Gerd Kvale , Bjarne Hansen","doi":"10.1016/j.jocrd.2024.100871","DOIUrl":"https://doi.org/10.1016/j.jocrd.2024.100871","url":null,"abstract":"<div><p>Although exposure and response prevention (ERP) is recommended for adults with obsessive-compulsive disorder (OCD), some recipients do not fully respond while others improve and subsequently relapse. Identifying factors associated with poor outcomes is therefore highly important. We investigated behavioral avoidance as one potential factor. Data came from a large randomized controlled trial that delivered a concentrated ERP protocol over the course of four consecutive days in accord with the Bergen 4-Day Treatment (B4DT). Avoidance was assessed with the auxiliary item from the Yale-Brown Obsessive-Compulsive Scale (YBOCS). Although behavioral avoidance did not predict acute outcome at immediate post-treatment, patients with substantial avoidance behaviors prior to treatment had worse long term (12-month) outcomes (increased OCD severity and greater functional impairment), after controlling for OCD severity at baseline. Avoidance significantly decreased from pre-to post-treatment but increased from post-treatment to 3-month and 12-month follow-up. Change in avoidance from post-treatment to 3-month follow-up predicted subsequent OCD worsening at 12-months, after controlling for change in global OCD severity. Results suggest that avoidant patients can benefit from concentrated ERP but may be at increased risk of poorer long-term outcomes. Future work should investigate strategies to identify and ameliorate worsening avoidance to reduce relapse.</p></div>","PeriodicalId":48902,"journal":{"name":"Journal of Obsessive-Compulsive and Related Disorders","volume":"41 ","pages":"Article 100871"},"PeriodicalIF":1.8,"publicationDate":"2024-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140209515","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Sensory processing in skin picking disorder","authors":"Madison Collins, Jon E. Grant","doi":"10.1016/j.jocrd.2024.100870","DOIUrl":"10.1016/j.jocrd.2024.100870","url":null,"abstract":"<div><h3>Background</h3><p>Skin Picking Disorder (SPD) is an oftentimes disabling disorder wherein people compulsively pick their skin. While sensory processing abnormalities have been examined in body-focused repetitive behaviors more broadly, relatively little attention has been played to the role of sensory processing in SPD specifically.</p></div><div><h3>Methods</h3><p>A total of 183 adults, 118 with SPD and 65 healthy controls, completed the Adolescent Adult Sensory Profile (AASP) to assess sensory processing patterns. Those with SPD also completed measures to assess skin picking severity, quality of life, and functional impairment. We examined whether scores on the four AASP subscales differ between individuals with SPD and healthy controls, and whether sensory processing among those with SPD affects disorder severity, quality of life, or functional impairment.</p></div><div><h3>Results</h3><p>Participants with SPD scored significantly higher on the AASP subscales of low registration, sensory sensitivity, and sensation avoiding than healthy controls (all <em>p</em>'s < 0.01). There were no differences in sensation seeking between the two groups. Among those with SPD, those scoring “high” on the low registration subscale reported significantly greater skin picking severity and reduced quality of life as compared to those scoring lower on this subscale (<em>p</em>'s < 0.001) Additionally, those scoring “high” on sensory sensitivity reported greater functional impairment than those scoring lower on this subscale (<em>p</em> < 0.01).</p></div><div><h3>Conclusions</h3><p>These data suggest that individuals with SPD display abnormalities in sensory processing relative to unaffected individuals. Future research should examine whether targeting sensory abnormalities among a subset of individuals with SPD may reduce the severity and associated burden caused by the disorder.</p></div>","PeriodicalId":48902,"journal":{"name":"Journal of Obsessive-Compulsive and Related Disorders","volume":"41 ","pages":"Article 100870"},"PeriodicalIF":1.8,"publicationDate":"2024-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140150150","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Hoarding disorder – Investigating the relationship between reported prior deprivation and current beliefs about fear of material deprivation.","authors":"Fahreen Walji , Paul Salkovskis","doi":"10.1016/j.jocrd.2024.100861","DOIUrl":"10.1016/j.jocrd.2024.100861","url":null,"abstract":"<div><h3>Background and aims</h3><p>It has been suggested that there are multiple pathways leading to the development of Hoarding Disorder (HD). One suggested pathway is that early material deprivation can lead to hoarding primarily driven by a fear of further material deprivation: the present study examines the link between the recall of prior experience of deprivation and current beliefs about possessions including fear of future deprivation.</p></div><div><h3>Method</h3><p>A cross-sectional design dividing participants into three groups was used: individuals with hoarding with early material deprivation experience (HWD); individuals with hoarding without early material deprivation experience (HND); and community controls (CC). All groups completed measures assessing demographics, psychopathology, and three hoarding-related beliefs (fear of material deprivation, harm avoidance, attachment disturbance). The final sample size used for analysis was 74.</p></div><div><h3>Results</h3><p>There was no evidence of a difference between the HWD and HND groups in terms of fear of material deprivation or the other two hoarding-related beliefs. All three beliefs were raised in the HND and HWD groups relative to the CC group.</p></div><div><h3>Discussion</h3><p>Fear of material deprivation beliefs may motivate hoarding irrespective of any perceived experience of early material deprivation.</p></div>","PeriodicalId":48902,"journal":{"name":"Journal of Obsessive-Compulsive and Related Disorders","volume":"40 ","pages":"Article 100861"},"PeriodicalIF":1.8,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2211364924000058/pdfft?md5=ed16c60bb2d95d4c55c1d1be68c63861&pid=1-s2.0-S2211364924000058-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139688480","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Danielle L. Cooke , Ryan J. McCarty , Sierra Budd , Ashley Ordway , Dikea Roussos-Ross , Carol A. Mathews , Joseph P.H. McNamara , Andrea D. Guastello
{"title":"Public stigma and recognition of perinatal obsessive-compulsive disorder","authors":"Danielle L. Cooke , Ryan J. McCarty , Sierra Budd , Ashley Ordway , Dikea Roussos-Ross , Carol A. Mathews , Joseph P.H. McNamara , Andrea D. Guastello","doi":"10.1016/j.jocrd.2024.100858","DOIUrl":"10.1016/j.jocrd.2024.100858","url":null,"abstract":"<div><p>Stigma is a barrier to disclosure of psychiatric symptoms and treatment seeking among perinatal patients, including those with perinatal obsessive-compulsive disorder (POCD), perinatal depression (PPD), and postpartum psychosis (PPP). This study examines the relationship between stigma, illness recognition, and familiarity with illness in six distinct postpartum experiences. In a cross-sectional online survey, participants (N = 572) were randomized to one of six postpartum vignettes: subclinical, depression, psychosis, and three subtypes of obsessive-compulsive disorder: contamination, responsibility for harm, and sexual content. Participants were asked to provide a diagnostic label of the condition and rate different aspects of stigma. Sexual content POCD, responsibility for harm content POCD, and the subclinical vignettes were less likely to be accurately recognized than PPD, contamination POCD, and PPP. A multivariate analysis of variance revealed the sexual POCD and PPP vignettes were met with the highest level of stigma, while the subclinical condition, PPD, and contamination POCD were met with the lowest levels of stigma. Significant interactions were present between accurate recognition of the condition and type of vignette on stigma variables, with recognition generally being associated with lower stigma for POCD and PPD. This demonstrates the need for comprehensive educational efforts on perinatal mental health.</p></div>","PeriodicalId":48902,"journal":{"name":"Journal of Obsessive-Compulsive and Related Disorders","volume":"40 ","pages":"Article 100858"},"PeriodicalIF":1.8,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139515704","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Lena Jelinek , Alicia Balzar , Steffen Moritz , Sarah Liebherz , Amir H. Yassari
{"title":"Exposure therapy in patients with harm-related obsessive-compulsive disorder: The theory-practice gap and its relation to experiential avoidance and negative beliefs about exposure","authors":"Lena Jelinek , Alicia Balzar , Steffen Moritz , Sarah Liebherz , Amir H. Yassari","doi":"10.1016/j.jocrd.2024.100860","DOIUrl":"10.1016/j.jocrd.2024.100860","url":null,"abstract":"<div><p>Despite its efficacy and effectiveness, exposure with response prevention (ERP) is underused in patients with obsessive-compulsive disorder (OCD). As this underuse of ERP may apply particularly to harm-related OCD, we investigated the theory-practice gap as well as negative beliefs and experiential avoidance as potential reasons for the underutilization of ERP with this group in a sample of trainee and qualified therapists.</p><p>We assessed 339 therapists’ general knowledge about ERP using a harm-related OCD case example and their utilization of ERP in clinical practice for harm-related OCD. Of the total sample, 74% of the therapists (<em>n</em> = 251) were CBT-oriented and 61% (<em>n</em> = 209) were in training. We assessed negative beliefs and experiential avoidance using the Therapist Beliefs about Exposure Scale (TBES) and the Acceptance and Action Questionnaire-II (AAQ-II).</p><p>While 74% of the therapist recommended ERP for the case example, only 43% admitted to using ERP for harm-related OCD in their clinical practice. ERP affinity of therapists in theory and practice was related to fewer negative beliefs about ERP, with large effect size (η<sub>p</sub><sup>2</sup> = 0.367 [CI<sub>95%</sub> 0.285 − 0.433]) and lower experiential avoidance with small effect size (η<sub>p</sub><sup>2</sup> = 0.024 [CI<sub>95%</sub> 0.001 − 0.059]) in the total sample.</p><p>We found evidence of a theory-practice gap in the treatment of harm-related OCD in a sample of trainee and qualified therapists. To ensure that patients with harm-related OCD content receive the evidence-based treatment they need, negative beliefs about ERP may represent a potential target.</p></div>","PeriodicalId":48902,"journal":{"name":"Journal of Obsessive-Compulsive and Related Disorders","volume":"40 ","pages":"Article 100860"},"PeriodicalIF":1.8,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139892378","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Mauro Giacomantonio , Valeria De Cristofaro , Francesco Mancini
{"title":"In/stability of moral sense of self and OCD","authors":"Mauro Giacomantonio , Valeria De Cristofaro , Francesco Mancini","doi":"10.1016/j.jocrd.2024.100857","DOIUrl":"10.1016/j.jocrd.2024.100857","url":null,"abstract":"<div><p>Why are people with obsessive-compulsive disorder (OCD) susceptible to deontological (vs. altruistic) guilt? The present research addresses this question by examining the association of OC tendencies with deontological rather than altruistic guilt. Specifically, we conducted two correlational studies in which we examined whether and how the perceived instability of the moral sense of self (i.e., instability of morality) is associated with OC tendencies and deontological (vs. altruistic) guilt. As predicted, the results of path analysis models showed that the susceptibility to deontological (vs. altruistic) guilt typical of individuals with OC traits is primarily associated with the perceived instability of morality relative to the perceived status of morality (Study 1) and instability of extraversion (Study 2). These results suggest that deontological guilt and its association with OC traits can be understood better when the instability of the moral sense of self and vulnerability to sudden changes in moral status are considered. We discuss how these results contribute to theory, research, and clinical practice on OCD, morality, and guilt.</p></div>","PeriodicalId":48902,"journal":{"name":"Journal of Obsessive-Compulsive and Related Disorders","volume":"40 ","pages":"Article 100857"},"PeriodicalIF":1.8,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2211364924000010/pdfft?md5=5b0dee669edbba337a3c565a4026a5fd&pid=1-s2.0-S2211364924000010-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139500696","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Facial symmetry perception and attractiveness ratings in body dysmorphic disorder","authors":"Rebecca Onken , Davide Capponi , Fanny Alexandra Dietel , Clea Kneipp , Laura Hoppen , Claudia Schulz , Dieter Dirksen , Ulrike Buhlmann","doi":"10.1016/j.jocrd.2024.100859","DOIUrl":"10.1016/j.jocrd.2024.100859","url":null,"abstract":"<div><p>Cognitive-behavioral models of body dysmorphic disorder (BDD) conceptualize biases in visual information processing as maintaining factors of the disorder. Empirical findings point to selective attentional mechanisms and a detail-oriented information processing style in facial perception, which are related to perceived facial aesthetics. However, so far, it remains unclear whether higher discrimination abilities of facial symmetry and related attractiveness ratings contribute to the mind as a filter in BDD. BDD (<em>n</em> = 25) and mentally healthy subjects (<em>n</em> = 25) rated symmetry and attractiveness of fifty animated, three-dimensional facial photographs characterized by diverging geometrical symmetry. Main findings emerging from mixed effects models indicated that perceived symmetry, but not objective symmetry, predicted perceived attractiveness. Group status did not predict symmetry or attractiveness ratings. Exploratory analyses indicated potentially clinically relevant mechanisms of symmetry ratings in BDD and revealed faster attractiveness ratings in unattractive vs. attractive faces across groups. Our findings refute the hypothesis of higher discrimination abilities of facial symmetry as a maintaining factor in BDD. Implications for attention and perception retraining in the context of cognitive-behavioral therapy for BDD are discussed.</p></div>","PeriodicalId":48902,"journal":{"name":"Journal of Obsessive-Compulsive and Related Disorders","volume":"40 ","pages":"Article 100859"},"PeriodicalIF":1.8,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2211364924000034/pdfft?md5=9208a456ba246b22f8ebd80ec4fa9215&pid=1-s2.0-S2211364924000034-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139500446","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}