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Comprehensive Cortical Structural Features Predict the Efficacy of Cognitive Behavioral Therapy in Obsessive-Compulsive Disorder. Brain Sci 2022; 12:brainsci12070921. [PMID: 35884728 PMCID: PMC9322050 DOI: 10.3390/brainsci12070921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 06/30/2022] [Accepted: 07/09/2022] [Indexed: 12/10/2022] Open
Abstract
Although cognitive behavioral therapy (CBT) is effective for patients with obsessive-compulsive disorder (OCD), 40% of OCD patients show a poor response to CBT. This study aimed to identify the cortical structural factors that predict CBT outcomes in OCD patients. A total of 56 patients with OCD received baseline structural MRI (sMRI) scanning and 14 individual CBT sessions. The linear support vector regression (SVR) models were used to identify the predictive performance of sMRI indices, including gray matter volume, cortical thickness, sulcal depth, and gyrification value. The patients’ OC symptoms decreased significantly after CBT intervention (p < 0.001). We found the model with the comprehensive variables exhibited better performance than the models with single structural indices (MAE = 0.14, MSE = 0.03, R2 = 0.36), showing a significant correlation between the true value and the predicted value (r = 0.63, p < 0.001). The results indicated that a model integrating four cortical structural features can accurately predict the effectiveness of CBT for OCD. Future models incorporating other brain indicators, including brain functional indicators, EEG indicators, neurotransmitters, etc., which might be more accurate for predicting the effectiveness of CBT for OCD, are needed.
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Provider perceptions of telehealth and in-person exposure and response prevention for obsessive-compulsive disorder. Psychiatry Res 2022; 313:114610. [PMID: 35567851 PMCID: PMC9910090 DOI: 10.1016/j.psychres.2022.114610] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 05/04/2022] [Accepted: 05/06/2022] [Indexed: 01/27/2023]
Abstract
Until recently, psychotherapies, including exposure and response prevention (ERP) for obsessive-compulsive disorder (OCD), have primarily been delivered in-person. The COVID-19 pandemic required OCD providers delivering ERP to quickly transition to telehealth services. While evidence supports telehealth ERP delivery, limited research has examined OCD provider perceptions about patient characteristics that are most appropriate for this modality, as well as provider abilities to identify and address factors interfering with effective telehealth ERP. In the present study, OCD therapists (N = 113) rated the feasibility of delivering telehealth ERP relative to in-person for different (1) patient age-groups, (2) levels of OCD severity, and (3) provider ability to identify and address factors interfering with ERP during in-person and telehealth ERP (e.g., cognitive avoidance, reassurance seeking, etc.). Providers reported significantly greater feasibility of delivering telehealth ERP to individuals ages 13-to-65-years relative to other age groups assessed. Greater perceived feasibility for telehealth relative to in-person ERP was reported for lower versus higher symptom severity levels. Lastly, providers felt better able to identify and address problematic factors in-person. These findings suggest that providers should practice appropriate caution when offering telehealth ERP for certain patients with OCD. Future research may examine how to address these potential limitations of telehealth ERP delivery.
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Anti-Disgust Cognitive Behavioral Therapy for Contamination-Based Obsessive Compulsive Disorder: A Randomized Controlled Clinical Trial. J Clin Med 2022; 11:jcm11102875. [PMID: 35629000 PMCID: PMC9145879 DOI: 10.3390/jcm11102875] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2022] [Revised: 05/15/2022] [Accepted: 05/18/2022] [Indexed: 02/01/2023] Open
Abstract
Background: Disgust is a strong and persistent emotion that frequently occurs during exposure-based treatments for contamination-based obsessive compulsive disorder (C-OCD). This study aimed to examine the efficacy of augmenting cognitive behavioral therapy (CBT) with a novel type of anti-disgust cognitive intervention in reducing the severity of OCD, disgust propensity/sensitivity, and refusal rate of exposure and response prevention, while simultaneously increasing acceptance of disgust. Materials and Methods: Fifty-five individuals with C-OCD (mean age 28.1 years, SD = 3.52; 77% female) were randomly assigned to 15 weekly sessions of anti-disgust plus CBT (AD-CBT) or CBT alone. They were evaluated for outcomes four times (pretreatment, prior to exposure and response prevention (ERP) sessions, posttreatment, and three-month follow-up), and mixed-design ANOVAs were used to analyze the data. Results: The findings indicated that when compared to CBT alone, AD-CBT significantly reduced OCD severity, disgust propensity/sensitivity, and concurrently increased disgust acceptance (p < 0.001). Additionally, engaging in an anti-disgust cognitive intervention was associated with lower ERP refusal rate (4% vs. 16%). The superiority of AD-CBT over CBT persisted through the three-month follow-up period. Conclusions: The current study suggests that supplementing CBT for C-OCD with an anti-disgust cognitive intervention significantly increased acceptance of disgust and decreased the refusal rate of ERP, OCD severity, and disgust-related factors.
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Cognitive-Behavioral Treatment of Obsessive-Compulsive Disorder: The Results of a Naturalistic Outcomes Study. J Clin Med 2022; 11:jcm11102762. [PMID: 35628888 PMCID: PMC9145175 DOI: 10.3390/jcm11102762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 05/10/2022] [Accepted: 05/12/2022] [Indexed: 12/10/2022] Open
Abstract
Cognitive−behavioral therapy is a well-established treatment for obsessive−compulsive disorder (OCD). There are a variety of cognitive and behavioral strategies, and it is necessary to analyze the outcomes of the treatments. The aim of the present study is to verify the effectiveness of a treatment that combines evidence-based procedures and specific cognitive interventions highlighting the issue of acceptance. Forty patients with OCD were recruited and underwent a specific treatment procedure. All patients had a psychodiagnostic assessment for OCD using the Y−BOCS (Yale−Brown obsessive−compulsive scale) performed twice: before treatment (t0) and after nine months (t1). Data analysis showed a decrease in the scores between t0 and t1 according to the Y−BOCS in terms of the interference, severity, and impairment of obsessive−compulsive symptoms. A repeated-measures ANOVA showed a significant reduction in symptoms after treatment, with values of F (1, 39) = 137.56, p < 0.001, and η2 = 0.78. The ANOVA results were corroborated by a Wilcoxon signed-rank test. A reliable change index analysis indicated that 33 participants reported improvements in symptoms, of which 23 were clinically significant. The results showed clinical relevance for OCD treatment and highlighted how this cognitive procedure favored positive outcomes.
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55
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Nezgovorova V, Reid J, Fineberg NA, Hollander E. Optimizing first line treatments for adults with OCD. Compr Psychiatry 2022; 115:152305. [PMID: 35325671 DOI: 10.1016/j.comppsych.2022.152305] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 02/16/2022] [Accepted: 02/28/2022] [Indexed: 11/03/2022] Open
Abstract
OCD is characterized by obsessions (recurrent, intrusive, unwanted thoughts, images or impulses and compulsions (repetitive behaviors or mental acts that the individual feels compelled to perform), which can manifest together or separately (Fineberg et al., 2020). NICE guidelines suggest that low intensity psychological treatments (including ERP) is the first line treatment for OCD, and that a "stepped care" treatment approach for OCD reserves combination treatment for adults with OCD with severe functional impairment, and for adults without an adequate response to: 1) treatment with an SSRI alone (12 weeks duration) or 2) CBT (including ERP) alone (NICE, 2005). Existing US treatment guidelines (APA guidelines) suggest that there are three first-line treatments for OCD (SSRI, CBT, SSRI+CBT) and recommends combined treatment for patients with an unsatisfactory response to monotherapy or for patients with severe OCD. Although, systematic review and meta-analysis of studies published in 1993-2014 suggest that combination treatment was not significantly better than CBT plus placebo (Ost et al., 2015), based on data from a recent systematic and meta-analysis which searched the two controlled trials registers maintained by the Cochrane Collaboration Common Mental Disorders group, the combination treatment approach is likely to be more effective than psychotherapeutic interventions alone, at least in severe obsessive-compulsive disorder (Skapinakis et al., 2016a). Based on data from Optimal treatment for OCD study conducted by Fineberg et al., (2018) combined treatment appeared to be the most effective especially when compared to CBT monotherapy, but SSRI monotherapy was found as the most cost effective. In this review we summarize available treatment recommendations.
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Affiliation(s)
- V Nezgovorova
- Autism and Obsessive-Compulsive Spectrum Disorders Program, Psychiatric Research Institute of Montefiore-Einstein, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY, United States
| | - J Reid
- Center for Clinical & Health Research Services, School of Life and Medical Sciences, University of Hertfordshire, Hatfield, UK; Hertfordshire Partnership University NHS Foundation Trust, Rosanne House, Welwyn Garden City, Hertfordshire, UK
| | - N A Fineberg
- Center for Clinical & Health Research Services, School of Life and Medical Sciences, University of Hertfordshire, Hatfield, UK; Hertfordshire Partnership University NHS Foundation Trust, Rosanne House, Welwyn Garden City, Hertfordshire, UK; University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - E Hollander
- Autism and Obsessive-Compulsive Spectrum Disorders Program, Psychiatric Research Institute of Montefiore-Einstein, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY, United States.
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Tao Y, Li H, Li L, Zhang H, Xu H, Zhang H, Zou S, Deng F, Huang L, Wang Y, Wang X, Tang X, Fu X, Yin L. Comparing the efficacy of pharmacological and psychological treatment, alone and in combination, in children and adolescents with obsessive-compulsive disorder: A network meta-analysis. J Psychiatr Res 2022; 148:95-102. [PMID: 35121274 DOI: 10.1016/j.jpsychires.2022.01.057] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2021] [Revised: 12/24/2021] [Accepted: 01/26/2022] [Indexed: 10/19/2022]
Abstract
BACKGROUND Studies have shown that pharmacological and psychological treatments are effective for children and adolescents with obsessive-compulsive disorder (OCD). However, few network meta-analyses have examined whether pharmacological or psychological treatments on their own, or combined, are most effective. METHODS We conducted a database search and selected randomized controlled trials of pharmacological or psychological treatments, alone or in combination, for children and adolescents with OCD. The primary outcome was change in symptom severity as a result of treatment, as assessed using the Yale-Brown Obsessive Compulsive Scale (YBOCS) or Children's Yale-Brown Obsessive Compulsive Scale (CY-BOCS). RESULTS We included 18 studies with 1353 participants and 12 kinds of treatments. In terms of efficacy, all pharmacological and psychotherapy treatments were more effective than placebo. Among the 12 treatments, the efficacy of pharmacological treatment combined with cognitive behavioral therapy (CBT) was more effective than pharmacological treatment alone. When pharmacological treatment was used alone, escitalopram was significantly more effective than clomipramine (CY-BOCS average change 3.42; 95% CI 2.11, 4.65), fluvoxamine (CY-BOCS average change 3.59; 95% CI 1.09, 6.20), paroxetine (CY-BOCS average change 2.80; 95% CI 0.01, 5.64) and sertraline (CY-BOCS average change 3.49; 95% CI 1.53, 5.64). CONCLUSIONS The available evidence suggests that the combination of pharmacological and psychological treatment is likely to be most effective for children and adolescents with OCD.
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Affiliation(s)
- Yuanmei Tao
- Department of Psychiatry, West China Hospital of Sichuan University, No. 28 Dianxin South Street, Chengdu, Sichuan, 610041, China
| | - Hancong Li
- West China School of Medicine, Chengdu, Sichuan, 610041, China
| | - Lu Li
- West China School of Public Health, Sichuan University, Chengdu, Sichuan, 610041, China
| | - Hang Zhang
- Department of Psychiatry, West China Hospital of Sichuan University, No. 28 Dianxin South Street, Chengdu, Sichuan, 610041, China
| | - Hanmei Xu
- Department of Psychiatry, West China Hospital of Sichuan University, No. 28 Dianxin South Street, Chengdu, Sichuan, 610041, China
| | - Hong Zhang
- Department of Psychiatry, West China Hospital of Sichuan University, No. 28 Dianxin South Street, Chengdu, Sichuan, 610041, China
| | - Shoukang Zou
- Department of Psychiatry, West China Hospital of Sichuan University, No. 28 Dianxin South Street, Chengdu, Sichuan, 610041, China
| | - Fang Deng
- Department of Psychiatry, West China Hospital of Sichuan University, No. 28 Dianxin South Street, Chengdu, Sichuan, 610041, China
| | - Lijuan Huang
- Department of Psychiatry, West China Hospital of Sichuan University, No. 28 Dianxin South Street, Chengdu, Sichuan, 610041, China
| | - Yanping Wang
- Department of Psychiatry, West China Hospital of Sichuan University, No. 28 Dianxin South Street, Chengdu, Sichuan, 610041, China
| | - Xiaolan Wang
- Department of Psychiatry, West China Hospital of Sichuan University, No. 28 Dianxin South Street, Chengdu, Sichuan, 610041, China
| | - Xiaowei Tang
- Department of Psychiatry, West China Hospital of Sichuan University, No. 28 Dianxin South Street, Chengdu, Sichuan, 610041, China
| | - Xia Fu
- Department of Psychiatry, West China Hospital of Sichuan University, No. 28 Dianxin South Street, Chengdu, Sichuan, 610041, China
| | - Li Yin
- Department of Psychiatry, West China Hospital of Sichuan University, No. 28 Dianxin South Street, Chengdu, Sichuan, 610041, China; Institute for System Genetics, Frontiers Science Center for Disease-related Molecular Networks, Chengdu, Sichuan, 610041, China; Sichuan Clinical Medical Research Center for Mental Disorders, Chengdu, Sichuan, 610041, China.
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57
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Feusner JD, Farrell NR, Kreyling J, McGrath PB, Rhode A, Faneuff T, Lonsway S, Mohideen R, Jurich JE, Trusky L, Smith SM. Online Video Teletherapy Treatment of Obsessive-Compulsive Disorder Using Exposure and Response Prevention: Clinical Outcomes from a Retrospective Longitudinal Observational Study (Preprint). J Med Internet Res 2022; 24:e36431. [PMID: 35587365 PMCID: PMC9164091 DOI: 10.2196/36431] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 03/07/2022] [Accepted: 04/25/2022] [Indexed: 12/22/2022] Open
Abstract
Background Exposure and response prevention, a type of cognitive-behavioral therapy, is an effective first-line treatment for obsessive-compulsive disorder (OCD). Despite extensive evidence of the efficacy of exposure and response prevention (ERP) from clinical studies and in real-world samples, it is still underused as a treatment. This is likely due to the limits to access to care that include the availability of adequately trained therapists, as well as geographical location, time, and cost barriers. To address these, NOCD created a digital behavioral health treatment for OCD using ERP delivered via video teletherapy and with technology-assisted elements including app-based therapy tools and between-session therapist messaging. Objective We examined treatment outcomes in a large naturalistic sample of 3552 adults with a primary OCD diagnosis who received NOCD treatment. Methods The treatment model consisted of twice-weekly, live, face-to-face video teletherapy ERP for 3 weeks, followed by 6 weeks of once-weekly brief video teletherapy check-ins for 30 minutes. Assessments were conducted at baseline, at midpoint after completion of 3 weeks of twice-weekly sessions, and at the end of 6 weeks of brief check-ins (endpoint). Longitudinal assessments were also obtained at 3, 6, 9, and 12 months after endpoint. Results Treatment resulted in clinically and statistically significant improvements, with a 43.4% mean reduction in obsessive-compulsive symptoms (g=1.0; 95% CI 0.93 to 1.03) and a 62.9% response rate. Treatment also resulted in a 44.2% mean reduction in depression, a 47.8% mean reduction in anxiety, and a 37.3% mean reduction in stress symptoms. Quality of life improved by a mean of 22.7%. Reduction in OCD symptoms and response rates were similar for those with mild, moderate, or severe symptoms. The mean duration of treatment was 11.5 (SD 4.0) weeks, and the mean total therapist time was 10.6 (SD 1.1) hours. Improvements were maintained at 3, 6, 9, and 12 months. Conclusions In this sample, representing the largest reported treated cohort of patients with OCD to date, video teletherapy treatment demonstrated effectiveness in reducing obsessive-compulsive and comorbid symptoms and improved quality of life. Further, it achieved meaningful results in less than half the total therapist time compared with standard once-weekly outpatient treatment, an efficiency that represents substantial monetary and time savings. The effect size was large and similar to studies of in-person ERP. This technology-assisted remote treatment is readily accessible for patients, offering an advancement in the field in the dissemination of effective evidence-based care for OCD.
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Affiliation(s)
- Jamie D Feusner
- NOCD Inc, Chicago, IL, United States
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
- General Adult Psychiatry & Health Systems Division, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
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Ralph S, Cooper M. Brief humanistic counselling with an adolescent client experiencing obsessive‐compulsive difficulties: A theory‐building case study. COUNSELLING & PSYCHOTHERAPY RESEARCH 2022. [DOI: 10.1002/capr.12499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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59
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Laws KR, Pellegrini L, Reid JE, Drummond LM, Fineberg NA. The Inflating Impact of Waiting-List Controls on Effect Size Estimates. Front Psychiatry 2022; 13:877089. [PMID: 35815038 PMCID: PMC9257237 DOI: 10.3389/fpsyt.2022.877089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 05/25/2022] [Indexed: 11/13/2022] Open
Affiliation(s)
- Keith R Laws
- School of Life and Medical Sciences, University of Hertfordshire, Hatfield, United Kingdom
| | - Luca Pellegrini
- School of Life and Medical Sciences, University of Hertfordshire, Hatfield, United Kingdom.,Hertfordshire Partnership University NHS Foundation Trust, Welwyn Garden City, United Kingdom.,Centre for Psychedelic Research, Imperial College London, London, United Kingdom
| | - Jemma E Reid
- School of Life and Medical Sciences, University of Hertfordshire, Hatfield, United Kingdom
| | - Lynne M Drummond
- School of Life and Medical Sciences, University of Hertfordshire, Hatfield, United Kingdom.,South West London and St George's NHS Trust, London, United Kingdom
| | - Naomi A Fineberg
- School of Life and Medical Sciences, University of Hertfordshire, Hatfield, United Kingdom.,South West London and St George's NHS Trust, London, United Kingdom.,Hertfordshire Partnership University NHS Foundation Trust, Hatfield, United Kingdom.,University of Cambridge School of Clinical Medicine, Cambridge, United Kingdom
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60
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Grant JE, Drummond L, Nicholson TR, Fagan H, Baldwin DS, Fineberg NA, Chamberlain SR. Obsessive-compulsive symptoms and the Covid-19 pandemic: A rapid scoping review. Neurosci Biobehav Rev 2022; 132:1086-1098. [PMID: 34740755 PMCID: PMC8570941 DOI: 10.1016/j.neubiorev.2021.10.039] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2021] [Revised: 10/27/2021] [Accepted: 10/29/2021] [Indexed: 12/14/2022]
Abstract
BACKGROUND There has been much speculation about untoward effects of the Covid-19 pandemic on psychological symptoms. OCD may be expected to be especially impacted. Our aim was to distil the current evidence base on relationships between the pandemic and obsessive-compulsive symptoms, in patients, and general population samples. METHODS We conducted a rapid scoping review, in the form of a systematic literature search, coupled with narrative review. 32 relevant papers were identified. RESULTS AND INTERPRETATION (1) A sizable proportion of people with OCD (but not all) experienced/reported symptom worsening during the pandemic, especially during initial restrictions (approximately 20-65 % of cases in longitudinal studies); (2) contamination/washing symptoms appeared particularly susceptible; and (3) OCD symptoms in general population samples were associated with trait compulsivity and pandemic-related-stress. The literature was heterogeneous with various methodological issues being commonplace. FUTURE DIRECTIONS The review identified important unaddressed issues: how should exposure based therapy be adapted during pandemics? How can we minimise harm from exacerbation of OCD in vulnerable individuals arising from public health messaging? Why do some but not all OCD patients experience worsening? And does Covid-19 infection affect (or lead to) OCD symptoms?
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Affiliation(s)
- Jon E. Grant
- Department of Psychiatry, University of Chicago, Chicago, USA
| | - Lynne Drummond
- South West London and St George’s NHS Trust and University of Hertfordshire, UK
| | - Timothy R. Nicholson
- Institute of Psychiatry Psychology and Neuroscience, King’s College London, London, UK
| | - Harry Fagan
- Clinical and Experimental Sciences (CNS and Psychiatry), Faculty of Medicine, University of Southampton, UK,Southern Health NHS Foundation Trust, Southampton, UK
| | - David S. Baldwin
- Clinical and Experimental Sciences (CNS and Psychiatry), Faculty of Medicine, University of Southampton, UK,Southern Health NHS Foundation Trust, Southampton, UK
| | - Naomi A. Fineberg
- National Treatment Service for OCD (England and Wales), Hertfordshire, UK
| | - Samuel R. Chamberlain
- Clinical and Experimental Sciences (CNS and Psychiatry), Faculty of Medicine, University of Southampton, UK,Southern Health NHS Foundation Trust, Southampton, UK,Corresponding author at: Clinical and Experimental Sciences (CNS and Psychiatry), Faculty of Medicine, University of Southampton, UK
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61
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Mao L, Hu M, Luo L, Wu Y, Lu Z, Zou J. The effectiveness of exposure and response prevention combined with pharmacotherapy for obsessive-compulsive disorder: A systematic review and meta-analysis. Front Psychiatry 2022; 13:973838. [PMID: 36186855 PMCID: PMC9520065 DOI: 10.3389/fpsyt.2022.973838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 08/22/2022] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE To systematically evaluate the effectiveness of exposure and response prevention (ERP) combined with medication on obsessive-compulsive disorder (OCD). METHODS PubMed, Web of Science, EBSCO, Cochrane, Embase, and Science Direct databases were searched to include randomized controlled trials of ERP combined with medication for OCD that met the criteria. The Yale Brown Obsessive Compulsive Scale was used as the primary outcome indicator, and Depression scales were used as secondary outcome indicators. An evaluation of bias risk was conducted to identify possible sources of bias based on methodological and clinical factors. Review Manager 5.3 and Stata 16.0 software was used to perform meta-analysis of the extracted data. RESULTS A total of 21 studies with 1113 patients were included. Meta-analysis showed that ERP combined with medication therapy was significantly better than medication therapy alone including selective serotonin reuptake inhibitors, clomipramine and risperidone (MD = -6.60, 95% CI: -8.35 to -4.84, P < 0.00001), but D-cycloserine (DCS) drugs do not enhance the effect of ERP intervention in patients with OCD (MD = 0.15, 95% CI: -0.87 to 1.17, P = 0.77). There is more significant maintenance by combined treatment method of medication plus ERP than medication treatment alone during the follow-up period (MD = -7.14, 95% CI: -9.17 to -5.10, P < 0.00001). DCS drugs did not enhance the effect of ERP intervention on depression in patients with OCD (SMD = -0.08, 95% CI: -0.31 to 0.15, P = 0.50). ERP combined with drug improved patients' depression levels significantly better than providing drug alone (SMD = -0.40, 95% CI: -0.68 to -0.11, P = 0.006). CONCLUSION Patients with OCD have significant improvement in symptoms of obsessive-compulsive disorder and depression when ERP is combined with medication, however, not enough to prove that DCS can enhance ERP effectiveness.
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Affiliation(s)
- Lingyun Mao
- Key Laboratory of Psychology of TCM and Brain Science, Jiangxi Administration of Traditional Chinese Medicine, Jiangxi University of Traditional Chinese Medicine, Nanchang, China.,Department of Psychosomatic Medicine, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Maorong Hu
- Key Laboratory of Psychology of TCM and Brain Science, Jiangxi Administration of Traditional Chinese Medicine, Jiangxi University of Traditional Chinese Medicine, Nanchang, China.,Department of Psychosomatic Medicine, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Lan Luo
- Key Laboratory of Psychology of TCM and Brain Science, Jiangxi Administration of Traditional Chinese Medicine, Jiangxi University of Traditional Chinese Medicine, Nanchang, China
| | - Yunhong Wu
- Department of Psychosomatic Medicine, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Zihang Lu
- Department of Psychosomatic Medicine, The First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Jingzhi Zou
- Department of Psychosomatic Medicine, The First Affiliated Hospital of Nanchang University, Nanchang, China
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62
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Imai H, Tajika A, Narita H, Yoshinaga N, Kimura K, Nakamura H, Takeshima N, Hayasaka Y, Ogawa Y, Furukawa T. Unguided computer-assisted self-help interventions without human contact in patients with obsessive-compulsive disorder: a systematic review and meta-analysis (Preprint). J Med Internet Res 2021; 24:e35940. [PMID: 35451993 PMCID: PMC9073609 DOI: 10.2196/35940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 03/07/2022] [Accepted: 03/11/2022] [Indexed: 12/02/2022] Open
Abstract
Background Computer-assisted treatment may reduce therapist contact and costs and promote client participation. This meta-analysis examined the efficacy and acceptability of an unguided computer-assisted therapy in patients with obsessive-compulsive disorder (OCD) compared with a waiting list or attention placebo. Objective This study aimed to evaluate the effectiveness and adherence of computer-assisted self-help treatment without human contact in patients with OCD using a systematic review and meta-analysis approach. Methods Randomized controlled trials with participants primarily diagnosed with OCD by health professionals with clinically significant OCD symptoms as measured with validated scales were included. The interventions included self-help treatment through the internet, computers, and smartphones. We excluded interventions that used human contact. We conducted a search on PubMed, Cochrane Central Register of Controlled Trials, EMBASE, World Health Organization International Clinical Trials Registry Platform, and ClinicalTrials.gov, as well as the reference lists of the included studies. The risk of bias was evaluated using version 2 of the Cochrane risk-of-bias tool for randomized trials. We calculated the standardized mean differences for continuous outcomes and risk ratios for dichotomous outcomes. The primary outcomes were short-term improvement of OCD symptoms measured by validated scales and dropout for any reason. Results We included 11 randomized controlled trials with a total of 983 participants. The results indicated that unguided computer-assisted self-help therapy was significantly more effective than a waiting list or psychological placebo (standard mean difference −0.47, 95% CI −0.73 to −0.22). Unguided computer-assisted self-help therapy had more dropouts for any reason than waiting list or psychological placebo (risk ratio 1.98, 95% CI 1.21 to 3.23). However, the quality of evidence was very low because of the risk of bias and inconsistent results among the included studies. The subgroup analysis showed that exposure response and prevention and an intervention duration of more than 4 weeks strengthen the efficacy without worsening acceptability. Only a few studies have examined the interaction between participants and systems, and no study has used gamification. Most researchers only used text-based interventions, and no study has used a mobile device. The overall risk of bias of the included studies was high and the heterogeneity of results was moderate to considerable. Conclusions Unguided computer-assisted self-help therapy for OCD is effective compared with waiting lists or psychological placebo. An exposure response and prevention component and intervention duration of more than 4 weeks may strengthen the efficacy without worsening the acceptability of the therapy. Trial Registration PROSPERO (International Prospective Register of Systematic Reviews) CRD42021264644; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=264644
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Affiliation(s)
- Hissei Imai
- Department of Health Promotion and Human Behavior, Graduate School of Medicine, School of Public Health, Kyoto University, Kyoto, Japan
| | - Aran Tajika
- Department of Health Promotion and Human Behavior, Graduate School of Medicine, School of Public Health, Kyoto University, Kyoto, Japan
| | - Hisashi Narita
- Department of Psychiatry, Graduate School of Medicine, Hokkaido University, Sapporo, Japan
- Department of Neurology, Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Naoki Yoshinaga
- School of Nursing, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
| | - Kenichi Kimura
- Department of Psychiatry, Hakodate Watanabe Hospital, Hakodate, Japan
| | - Hideki Nakamura
- Department of Cognitive Behavioral Physiology, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Nozomi Takeshima
- Department of Health Promotion and Human Behavior, Graduate School of Medicine, School of Public Health, Kyoto University, Kyoto, Japan
| | - Yu Hayasaka
- Department of Health Promotion and Human Behavior, Graduate School of Medicine, School of Public Health, Kyoto University, Kyoto, Japan
| | - Yusuke Ogawa
- Department of Healthcare Epidemiology, Graduate School of Medicine, School of Public Health, Kyoto University, Kyoto, Japan
| | - Toshi Furukawa
- Department of Health Promotion and Human Behavior, Graduate School of Medicine, School of Public Health, Kyoto University, Kyoto, Japan
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Matsumoto K, Hamatani S, Shimizu E. Effectiveness of Videoconference-Delivered Cognitive Behavioral Therapy for Adults With Psychiatric Disorders: Systematic and Meta-Analytic Review. J Med Internet Res 2021; 23:e31293. [PMID: 34898445 PMCID: PMC8713091 DOI: 10.2196/31293] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 09/14/2021] [Accepted: 10/29/2021] [Indexed: 12/23/2022] Open
Abstract
Background Cognitive behavioral therapy (CBT) is the gold standard of psychotherapy for psychiatric disorders. However, the format of delivering CBT in person limits access to the intervention. The advancements in information and communication technology, especially the internet, present an opportunity for cognitive behavioral therapists to service patients or clients in remote areas through videoconferencing. Although many randomized controlled trials of videoconference-delivered cognitive behavioral therapy (VCBT) have already been conducted, the overall estimated effect size of VCBT for psychiatric disorders has not been examined by systematic reviews and meta-analyses. Objective This study attempts to evaluate the effectiveness of VCBT for psychiatric disorders through a systematic and meta-analytic review. Methods A systematic review and meta-analysis of studies in which VCBT was directly compared to control groups (such as treatment as usual, attention control, wait-list control, and other minimal supports) was carried out. To identify previous studies that meet our study objective, 2 independent reviewers undertook a systematic search through seven databases: MEDLINE (via PubMed), Web of Science, Science Direct, PsycINFO, CINAHL, LILACS, and SciELO. Other databases (ClinicalTrials.gov and Cochrane Central Resister of Controlled Trials) were also checked. All studies included in the review were assessed using the quality criteria of the Cochrane Collaboration. Statistical analysis was performed by using Cochrane Review Manager (RevMan, version 5.4.0). Standardized mean difference was used in major meta-analyses where a P value of .05 or less was the threshold for statistical significance. A heterogeneity test and the chi-square test were performed to assess the presence and extent of statistical heterogeneity with significance set at P<.10. Funnel plots were visually inspected to assess the risk of bias. Subgroup analyses were conducted for each disorder to estimate intervention effects. Results The systematic search resulted in 16 studies (total N=1745) that met the criteria for this study and were included in the review. There were 10 studies on depressive symptoms, 3 on chronic pain, 1 on generalized anxiety disorder, 1 on obsessive-compulsive disorder, and 1 on hypochondriasis. The quality and risk of bias was also assessed. Results showed a pooled effect size (Hedge g) post treatment of −0.49 (95% CI –0.68 to –0.29), indicating that VCBT is effective for clients with psychiatric disorders. Study quality did not affect outcomes. Conclusions While the overall results indicate the effectiveness of VCBT, there are still only a limited number of studies on specific psychiatric and somatic conditions. Therefore, more randomized controlled trials are needed to establish the effectiveness of VCBT for different disorders. Trial Registration International Prospective Register of Systematic Reviews (PROSPERO) CRD42021224832; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=224832
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Affiliation(s)
- Kazuki Matsumoto
- Research Center for Child Mental Development, Chiba University, Chiba, Japan.,Laboratory of Neuropsychology, Institute of Liberal Arts and Science, Kanazawa University, Kanazawa, Japan
| | - Sayo Hamatani
- Research Center for Child Mental Development, Chiba University, Chiba, Japan.,Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden.,Research Center for Child Mental Development, University of Fukui, Fukui, Japan
| | - Eiji Shimizu
- Research Center for Child Mental Development, Chiba University, Chiba, Japan.,Department of Cognitive Behavioral Physiology, Graduate School of Medicine, Chiba University, Chiba, Japan.,Cognitive Behavioral Therapy Center, Chiba University Hospital, Chiba, Japan
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64
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Meehan S, O'Connor J, Keogh K. Beauty and the beast: A psychoanalytically oriented qualitative study detailing mothers' experience of perinatal obsessive‐compulsive disorder. INTERNATIONAL JOURNAL OF APPLIED PSYCHOANALYTIC STUDIES 2021. [DOI: 10.1002/aps.1732] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- Sofie Meehan
- School of Psychology Trinity College Dublin Dublin Ireland
| | - John O'Connor
- School of Psychology Trinity College Dublin Dublin Ireland
| | - Karen Keogh
- Adult Community Psychology, Health Service Executive Wicklow Ireland
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65
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Stein DJ, Craske MG, Rothbaum BO, Chamberlain SR, Fineberg NA, Choi KW, de Jonge P, Baldwin DS, Maj M. The clinical characterization of the adult patient with an anxiety or related disorder aimed at personalization of management. World Psychiatry 2021; 20:336-356. [PMID: 34505377 PMCID: PMC8429350 DOI: 10.1002/wps.20919] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
The clinical construct of "anxiety neurosis" was broad and poorly defined, so that the delineation of specific anxiety disorders in the DSM-III was an important advance. However, anxiety and related disorders are not only frequently comorbid, but each is also quite heterogeneous; thus diagnostic manuals provide only a first step towards formulating a management plan, and the development of additional decision support tools for the treatment of anxiety conditions is needed. This paper aims to describe systematically important domains that are relevant to the personalization of management of anxiety and related disorders in adults. For each domain, we summarize the available research evidence and review the relevant assessment instruments, paying special attention to their suitability for use in routine clinical practice. We emphasize areas where the available evidence allows the clinician to personalize the management of anxiety conditions, and we point out key unmet needs. Overall, the evidence suggests that we are becoming able to move from simply recommending that anxiety and related disorders be treated with selective serotonin reuptake inhibitors, cognitive-behavioral therapy, or their combination, to a more complex approach which emphasizes that the clinician has a broadening array of management modalities available, and that the treatment of anxiety and related disorders can already be personalized in a number of important respects.
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Affiliation(s)
- Dan J Stein
- South African Medical Research Council Unit on Risk & Resilience in Mental Disorders, Department of Psychiatry and Neuroscience Institute, University of Cape Town, Cape Town, South Africa
| | - Michelle G Craske
- Department of Psychology and Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, (UCLA), Los Angeles, CA, USA
| | | | - Samuel R Chamberlain
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, and Southern Health NHS Foundation Trust, Southampton, UK
| | - Naomi A Fineberg
- School of Life and Medical Sciences, University of Hertfordshire, and Hertfordshire Partnership University NHS Foundation Trust, Hatfield, UK
- University of Cambridge Clinical Medical School, Cambridge, UK
| | - Karmel W Choi
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Peter de Jonge
- Developmental Psychology, Department of Psychology, Rijksuniversiteit Groningen, Groningen, The Netherlands
| | - David S Baldwin
- Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, and Southern Health NHS Foundation Trust, Southampton, UK
| | - Mario Maj
- Department of Psychiatry, University of Campania "L. Vanvitelli", Naples, Italy
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Reddy YCJ, Arumugham SS, Balachander S. Cognitive-behavioral and related therapies for obsessive-compulsive and related disorders. Curr Opin Psychiatry 2021; 34:467-476. [PMID: 34292182 DOI: 10.1097/yco.0000000000000731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Cognitive behavioral therapy (CBT) with exposure and response prevention is the first-line treatment for obsessive-compulsive disorder (OCD) and related disorders such as body dysmorphic disorder (BDD). We review here recent developments in CBT and related therapies in treating OCD and related disorders. RECENT FINDINGS Superiority of CBT over medications in treating OCD is being questioned by some recent meta-analyses, nonetheless CBT continues to be the mainstay of treatment. Web-based therapies have been shown to be beneficial in treating at least mild-to-moderately ill patients. Mindfulness-based CBT, intensive residential treatment and Bergen 4-day concentrated exposure are also proving to be useful in treating OCD. Large well designed studies have demonstrated the efficacy CBT over supportive therapy in treating BDD. Research on the efficacy of CBT in treating hoarding disorder is accumulating. SUMMARY Efficacy of web-based CBT has a potential public health importance in that CBT may now become accessible to all and benefit at least mild-to-moderately ill patients who form most of the clinically ill sample. Similarly, efficacy of Bergen 4-day concentrated exposure will have a huge public health implication if the findings can be replicated in other centers across the world.
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Affiliation(s)
| | | | - Srinivas Balachander
- Obsessive-Compulsive Disorder (OCD) Clinic
- Accelerator Program for Discovery in Brain Disorders Using Stem Cells (ADBS)
- Department of Psychiatry, National Institute of Mental Health & Neurosciences (NIMHANS), Bangalore, India
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Nadeem NJ, Chan E, Drummond L. A Naturalistic Study of the Maintenance of Gains Made With Treatment of Patients With Profound Treatment-Refractory Obsessive-Compulsive Disorder. Front Psychiatry 2021; 12:673390. [PMID: 34354609 PMCID: PMC8329362 DOI: 10.3389/fpsyt.2021.673390] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Accepted: 06/24/2021] [Indexed: 11/13/2022] Open
Abstract
Obsessive-compulsive disorder (OCD) generally responds to first-line treatment but patients often relapse. The United Kingdom National OCD Inpatient Service treats patients who have failed to respond to at least two trials of SRI, augmented with a dopamine blocker and two trials of ERP. Despite this, they have profound treatment-refractory OCD and require 24-h nursing care due to severe OCD. We examined patients' Y-BOCS score on admission, discharge and at each follow-up from all patients discharged over 5 years (02/01/2014-31/12/18). Data were analysed using SPSS. Paired student t-tests were used to assess improvement from admission to discharge and each follow-up. Over 5 years, 130 adult patients were treated: 79 male and 51 female with an average age of 42.3 years (20-82; sd14.4). Their ethnic backgrounds were; 115 Caucasian, 11 South Asian, 1 Chinese, and 3 Unspecified. On admission, the average Y-BOCS total score was 36.9 (30-40; sd2.6). At discharge, patients had improved on average by 36% (Y-BOCS reduction to 23.4 = moderate OCD). Similar reduction in Y-BOCS continued throughout the year with an average Y-BOCS of 22.9 at 1 month (n = 69); 23 at 3 months (n = 70); 21.3 at 6 months (n = 78) and 21.9 at 1 year (n = 77). Twenty-seven patients did not attend any follow-up appointment whilst others attended at least one appointment with the majority attending more than 3. Using student t-test, improvements at discharge, 1, 3, 6, and 12 months post-treatment showed a highly significant improvement (p < 0.001). Gains made following inpatient treatment for treatment-refractory OCD were generally maintained until 1 year post-treatment.
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Affiliation(s)
- Nighat Jahan Nadeem
- South West London and St George's Mental Health NHS Trust, London, United Kingdom
| | - Emily Chan
- St George's University of London, London, United Kingdom
| | - Lynne Drummond
- South West London and St George's Mental Health NHS Trust, London, United Kingdom
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