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Vaccaro LD, Jones MK, Menzies RG, Wootton BM. The treatment of obsessive‐compulsive checking: A randomised trial comparing danger ideation reduction therapy with exposure and response prevention. CLIN PSYCHOL-UK 2020. [DOI: 10.1111/cp.12019] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- Lisa D. Vaccaro
- Discipline of Behavioural and Social Sciences in Health, The University of Sydney, Sydney, New South Wales, Australia,
| | - Mairwen K. Jones
- Discipline of Behavioural and Social Sciences in Health, The University of Sydney, Sydney, New South Wales, Australia,
| | - Ross G. Menzies
- Discipline of Behavioural and Social Sciences in Health, The University of Sydney, Sydney, New South Wales, Australia,
| | - Bethany M. Wootton
- Department of Psychology, Centre for Emotional Health, Macquarie University, North Ryde, New South Wales, Australia,
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2
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Wolters LH, Prins PJM, Garst GJA, Hogendoorn SM, Boer F, Vervoort L, de Haan E. Mediating Mechanisms in Cognitive Behavioral Therapy for Childhood OCD: The Role of Dysfunctional Beliefs. Child Psychiatry Hum Dev 2019; 50:173-185. [PMID: 30032391 PMCID: PMC6428795 DOI: 10.1007/s10578-018-0830-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Reframing cognitions is assumed to play an important role in treatment for obsessive-compulsive disorder (OCD). However, there hardly is any empirical support for this assumption, especially for children. The aim of this study was to examine if changing dysfunctional beliefs is a mediating mechanism of cognitive behavioral therapy (CBT) for childhood OCD. Fifty-eight children (8-18 years) with OCD received CBT. Dysfunctional beliefs (OBQ-CV) and OCD severity (CY-BOCS) were measured pre-treatment, mid-treatment, post-treatment, and at 16-week follow-up. Results showed that OCD severity and dysfunctional beliefs decreased during CBT. Changes in severity predicted changes in beliefs within the same time interval. Our results did not support the hypothesis that changing dysfunctional beliefs mediates treatment effect. Future studies are needed to replicate these findings and shed more light on the role of explicit and implicit cognitions in treatment for childhood OCD.
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Affiliation(s)
- L H Wolters
- Department of Child and Adolescent Psychiatry, Academic Medical Center, Meibergdreef 5, 1105 AZ, Amsterdam, The Netherlands.
- Academic Center for Child and Adolescent Psychiatry, De Bascule, Meibergdreef 5, 1105 AZ, Amsterdam, The Netherlands.
| | - P J M Prins
- Faculty of Social and Behavioural Sciences, University of Amsterdam, Nieuwe Achtergracht 127, 1018 WS, Amsterdam, The Netherlands
| | - G J A Garst
- Faculty of Social and Behavioural Sciences, University of Amsterdam, Nieuwe Achtergracht 127, 1018 WS, Amsterdam, The Netherlands
| | - S M Hogendoorn
- Academic Center for Child and Adolescent Psychiatry, De Bascule, Meibergdreef 5, 1105 AZ, Amsterdam, The Netherlands
| | - F Boer
- Department of Child and Adolescent Psychiatry, Academic Medical Center, Meibergdreef 5, 1105 AZ, Amsterdam, The Netherlands
| | - L Vervoort
- Department of developmental, personality and social psychology, Ghent University, Henri Dunantlaan 2, 9000, Ghent, Belgium
| | - E de Haan
- Academic Center for Child and Adolescent Psychiatry, De Bascule, Meibergdreef 5, 1105 AZ, Amsterdam, The Netherlands
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3
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Laposa JM, Hawley LL, Grimm KJ, Katz DE, Rector NA. What Drives OCD Symptom Change During CBT Treatment? Temporal Relationships Among Obsessions and Compulsions. Behav Ther 2019; 50:87-100. [PMID: 30661569 DOI: 10.1016/j.beth.2018.03.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2017] [Revised: 03/16/2018] [Accepted: 03/22/2018] [Indexed: 01/04/2023]
Abstract
Cognitive behavior therapy (CBT) is an effective treatment for obsessive-compulsive disorder (OCD). However, less is known about how obsessions and compulsions change during treatment, either in tandem, sequentially, or independently. The current study used latent difference score analysis to show path-analytic dynamic modeling of OCD symptom change during CBT. Four competing models of the temporal relationship between obsessions and compulsions were examined: no coupling (obsessions and compulsions are not dynamically related), goal directed (obsessions lead to subsequent changes in compulsions), habit driven (compulsions lead to subsequent changes in obsessions), and reciprocal. Treatment seeking participants (N = 84) with a principal diagnosis of OCD completed 12 weeks of CBT group therapy and completed measures assessing obsession and compulsion severity at pretreatment, Sessions 4 and 8, and end of treatment. Bivariate results supported the goal directed traditional CBT model, where obsession scores are temporally associated with subsequent changes in compulsion scores. These results have implications for theoretical and treatment modelling of obsessions and compulsions in OCD treatment.
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Affiliation(s)
- Judith M Laposa
- Centre for Addiction and Mental Health, Toronto; University of Toronto.
| | - Lance L Hawley
- Frederick W. Thompson Anxiety Disorders Centre, Sunnybrook Health Sciences Centre, Toronto; University of Toronto
| | | | - Danielle E Katz
- Frederick W. Thompson Anxiety Disorders Centre, Sunnybrook Health Sciences Centre, Toronto
| | - Neil A Rector
- Frederick W. Thompson Anxiety Disorders Centre, Sunnybrook Health Sciences Centre, Toronto; University of Toronto
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4
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Mumma GH, Marshall AJ, Mauer C. Person-specific validation and testing of functional relations in cognitive-behavioural case formulation: Guidelines and options. Clin Psychol Psychother 2018; 25:672-691. [DOI: 10.1002/cpp.2298] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2016] [Revised: 03/29/2018] [Accepted: 04/04/2018] [Indexed: 11/07/2022]
Affiliation(s)
- Gregory H. Mumma
- Psychological Sciences; Texas Tech University; Lubbock Texas USA
| | - Andrew J. Marshall
- Psychological Sciences; Texas Tech University; Lubbock Texas USA
- Texas Department of Family and Protective Services; Austin Texas USA
| | - Cortney Mauer
- VA San Diego Healthcare System; San Diego California USA
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5
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Schwartz C, Hilbert S, Schubert C, Schlegl S, Freyer T, Löwe B, Osen B, Voderholzer U. Change Factors in the Process of Cognitive-Behavioural Therapy for Obsessive-Compulsive Disorder. Clin Psychol Psychother 2016; 24:785-792. [DOI: 10.1002/cpp.2045] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Revised: 09/12/2016] [Accepted: 09/12/2016] [Indexed: 11/08/2022]
Affiliation(s)
- C. Schwartz
- Department of Psychiatry and Psychotherapy; University Hospital of Munich (LMU); Munich Germany
| | - S. Hilbert
- Department of Methodology and Diagnostics; University of Munich (LMU); Munich Germany
| | | | - S. Schlegl
- Department of Psychiatry and Psychotherapy; University Hospital of Munich (LMU); Munich Germany
| | - T. Freyer
- Department of Psychiatry and Psychotherapy; University of Freiburg; Freiburg Germany
| | - B. Löwe
- Department of Psychosomatic Medicine and Psychotherapy; University of Hamburg; Hamburg Germany
- Schön Clinic Hamburg Eilbek; Hamburg Germany
| | - B. Osen
- Schön Clinic Bad Bramstedt; Bad Bramstedt Germany
| | - U. Voderholzer
- Schoen Clinic Roseneck; Prien Germany
- Department of Psychiatry and Psychotherapy; University of Freiburg; Freiburg Germany
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6
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Andersson E, Ljótsson B, Hedman E, Hesser H, Enander J, Kaldo V, Andersson G, Lindefors N, Rück C. Testing the Mediating Effects of Obsessive Beliefs in Internet-Based Cognitive Behaviour Therapy for Obsessive-Compulsive Disorder: Results from a Randomized Controlled Trial. Clin Psychol Psychother 2014; 22:722-32. [PMID: 25418575 DOI: 10.1002/cpp.1931] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2014] [Revised: 10/21/2014] [Accepted: 10/22/2014] [Indexed: 11/05/2022]
Abstract
UNLABELLED Although cognitive interventions for obsessive-compulsive disorder (OCD) have been tested in randomized trials, there are few trials that have tested the specific mechanisms of cognitive interventions, i.e. how they achieve their effects. In this study, we aimed to investigate the mediating effects of a short cognitive intervention in the treatment of OCD and used data from a recently conducted randomized controlled trial where 101 participants were allocated to either Internet-based CBT (ICBT) or to a control condition. Obsessive beliefs were measured at pre-treatment, at the time they had received the cognitive intervention, and also at post-treatment. Weekly OCD symptoms were measured throughout the 10 weeks of treatment. We hypothesized that (1) the ICBT group would have greater reductions in obsessive beliefs (controlling for change in OCD symptoms) after completing the cognitive intervention, and that (2) this reduction would, in turn, predict greater OCD symptom reduction throughout the rest of the treatment period. Contrary to our expectations, the longitudinal mediation analysis indicated that (1) being randomized to ICBT actually increased the degree of obsessive beliefs after receiving the cognitive intervention at weeks 1-3, and (2) increase in obsessive beliefs predicted better outcome later in treatment. However, when repeating the analysis using cross-sectional data at post-treatment, the results were in line with the initial hypotheses. Results were replicated when the control condition received ICBT. We conclude that, although obsessive beliefs were significantly reduced at post-treatment for the ICBT group, early increase rather than decrease in obsessive beliefs predicted favourable outcome. KEY PRACTITIONER MESSAGE This study investigated the impact of cognitive interventions on obsessive beliefs for patients with obsessive-compulsive disorder. Results showed that a sudden increase in obsessive beliefs is not an indicator of worse treatment response. On the contrary, it is more likely that the patient is better off when having this sudden increase. Clinicians should not be alarmed if the patient has a sudden increase in obsessive beliefs, but we do recommend the clinician to investigate the reasons for this further.
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Affiliation(s)
- Erik Andersson
- Department of Clinical Neuroscience, Division of Psychiatry, Karolinska Institutet, Stockholm, Sweden.,Department of Clinical Neuroscience, Division of Psychology, Karolinska Institutet, Stockholm, Sweden
| | - Brjánn Ljótsson
- Department of Clinical Neuroscience, Division of Psychology, Karolinska Institutet, Stockholm, Sweden
| | - Erik Hedman
- Department of Clinical Neuroscience, Division of Psychology, Karolinska Institutet, Stockholm, Sweden.,Osher Center for Integrative Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Hugo Hesser
- Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden
| | - Jesper Enander
- Department of Clinical Neuroscience, Division of Psychiatry, Karolinska Institutet, Stockholm, Sweden
| | - Viktor Kaldo
- Department of Clinical Neuroscience, Division of Psychiatry, Karolinska Institutet, Stockholm, Sweden
| | - Gerhard Andersson
- Department of Clinical Neuroscience, Division of Psychiatry, Karolinska Institutet, Stockholm, Sweden.,Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden
| | - Nils Lindefors
- Department of Clinical Neuroscience, Division of Psychiatry, Karolinska Institutet, Stockholm, Sweden
| | - Christian Rück
- Department of Clinical Neuroscience, Division of Psychiatry, Karolinska Institutet, Stockholm, Sweden
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7
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Perreault V, O'Connor K. Inference-Based Therapy: Processes of Change in Compulsions and Obsessional Beliefs. Int J Cogn Ther 2014. [DOI: 10.1521/ijct.2014.7.1.6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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8
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Acceptance and Commitment Therapy and Habit Reversal Training for the Treatment of Trichotillomania. COGNITIVE AND BEHAVIORAL PRACTICE 2012. [DOI: 10.1016/j.cbpra.2012.02.002] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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9
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Acceptance and commitment therapy as a treatment for problematic internet pornography viewing. Behav Ther 2010; 41:285-95. [PMID: 20569778 DOI: 10.1016/j.beth.2009.06.002] [Citation(s) in RCA: 111] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2008] [Revised: 06/19/2009] [Accepted: 06/22/2009] [Indexed: 11/18/2022]
Abstract
Despite the prevalence of problematic Internet pornography viewing and the breadth of intervention approaches to potentially address it, no studies to address this problem have been reported to date. An emerging treatment approach, Acceptance and Commitment Therapy (ACT), holds promise as a treatment for Internet pornography viewing because of its focus on processes hypothesized to underlie this maladaptive behavior. In the first experiment on the treatment of problematic Internet pornography viewing, 6 adult males who reported that their Internet pornography viewing was affecting their quality of life were treated in eight 1.5-hour sessions of ACT for problematic pornography viewing. The effects of the intervention were assessed in a multiple-baseline-across-participants design with time viewing pornography as the dependent variable. Treatment resulted in an 85% reduction in viewing at posttreatment with results being maintained at 3-month follow-up (83% reduction). Increases were seen on measures of quality of life, and reductions were seen on measures of OCD and scrupulosity. Weekly measures of ACT-consistent processes showed reductions that corresponded with reductions in viewing. Large reductions were seen on a measure of psychological flexibility, and minor reductions were seen on measures of thought-action fusion and thought control. Overall, results suggest the promise of ACT as a treatment for problematic Internet pornography viewing and the value of future randomized trials of this approach.
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Polman A, Bouman TK, van Geert PLC, de Jong PJ, den Boer JA. Dysfunctional beliefs in the process of change of cognitive treatment in obsessive compulsive checkers. Clin Psychol Psychother 2010; 18:256-73. [PMID: 21584908 DOI: 10.1002/cpp.707] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Cognitive behaviour therapy (CBT) is considered to be effective in the reduction of obsessive compulsive symptoms. However, questions remain as to how CBT works. Cognitive-behavioural models postulate that negative appraisals of intrusive thoughts and dysfunctional beliefs that give rise to them underlie the development and maintenance of obsessive-compulsive disorder (OCD). The current study aimed to study this hypothesis by investigating the processes of change over the course of cognitive treatment for OCD. Furthermore, a new theoretical approach and method for studying processes of change was presented. The participants were seven patients suffering from OCD with predominantly checking symptoms. Process variables (beliefs, anxiety and compulsions) were measured using idiosyncratic diaries and were analysed on an intra- and inter-individual level using dynamic systems methods. Results showed significant decreases in credibility of dysfunctional beliefs in six out of the seven participants, which is in line with the cognitive-behavioural model. Associations between process variables were in general medium to high. However, the actual patterns of change showed important intra- and interpersonal differences. Results indicated that different paths can lead to clinical recovery, and it was concluded that process studies that focus on individual trajectories of change can contribute to our understanding of OCD and its treatment. Furthermore, dynamic systems methods provide insight into intra-individual processes and shed a new light on variability.
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Affiliation(s)
- Annemiek Polman
- Department of Psychiatry, University Medical Centre Groningen, University of Groningen, the Netherlands.
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11
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Polman A, Bouman TK, van Hout WJPJ, de Jong PJ, den Boer JA. Processes of change in cognitive-behavioural treatment of obsessive-compulsive disorder: Current status and some future directions. Clin Psychol Psychother 2010; 17:1-12. [PMID: 19658125 DOI: 10.1002/cpp.638] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The present paper discusses theoretical and methodological issues involved in the processes of change in cognitive-behavioural treatment (CBT) of obsessive-compulsive disorder (OCD). Treatment outcome studies showed that CBT is effective in reducing obsessive-compulsive symptoms. However, why and how CBT works cannot be corroborated by comparing pre- and post-assessment. Recently, there has been a resurgence of interest in theory driven process studies. By showing patterns of change over time, process studies can contribute to our insight into the actual mechanisms of change during treatment. We review process research in the field of OCD and discuss methodological issues involved in process studies for this particular disorder. It is concluded that studying the processes of change harbours promising possibilities for bridging the gap between theory and clinical practice.
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Affiliation(s)
- Annemiek Polman
- Department of Psychiatry, University Medical Center Groningen, University of Groningen, the Netherlands.
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12
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Grenier S, O'Connor K, Bélanger C. Obsessional beliefs, compulsive behaviours and symptom severity: their evolution and interrelation over stages of treatment. Clin Psychol Psychother 2008; 15:15-27. [DOI: 10.1002/cpp.560] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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13
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Storchheim LF, O'Mahony JF. Compulsive behaviours and levels of belief in obsessive–compulsive disorder: a case-series analysis of their interrelationships. Clin Psychol Psychother 2006. [DOI: 10.1002/cpp.475] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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14
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O'Connor KP, Aardema F, Bouthillier D, Fournier S, Guay S, Robillard S, Pélissier MC, Landry P, Todorov C, Tremblay M, Pitre D. Evaluation of an Inference‐Based Approach to Treating Obsessive‐Compulsive Disorder. Cogn Behav Ther 2005; 34:148-63. [PMID: 16195054 DOI: 10.1080/16506070510041211] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
This study evaluated an inference-based approach (IBA) to the treatment of obsessive-compulsive disorder (OCD) by comparing its efficacy with a treatment based on the cognitive appraisal model (CAM) and exposure and response prevention (ERP). IBA considers initial intrusions in OCD (e.g. "Maybe the door is open", "My hands could be dirty") as idiosyncratic inferences about possible states of affairs arrived at through inductive reasoning. In IBA such primary inferences represent the starting point of obsessional doubt, and the reasoning maintaining the doubt forms the focus for therapy. This is unlike CAM, which regards appraisals of intrusions as the maintaining factors in OCD. Fifty-four OCD participants, of whom 44 completed, were randomly allocated to CAM, ERP or IBA. After 20 weeks of treatment all groups showed a significant reduction in scores on the Yale-Brown Obsessive Compulsive Scale (Y-BOCS) and the Padua Inventory. Participants with high levels of obsessional conviction showed greater benefit from IBA than CAM. Appraisals of intrusions changed in all treatment conditions. Strength of primary inference was not correlated with symptom measures except in the case of strong obsessional conviction. Strength of primary inference correlated significantly with the Y-BOCS insight item. Treatment matching for high and low conviction levels to IBA and CAM, respectively, may optimize therapy outcome.
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Affiliation(s)
- K P O'Connor
- Centre de Recherche Fernand-Seguin, Montréal, Canada.
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Aardema F, Emmelkamp PMG, O'Connor KP. Inferential confusion, cognitive change and treatment outcome in Obsessive-Compulsive Disorder. Clin Psychol Psychother 2005. [DOI: 10.1002/cpp.464] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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16
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O'Connor K, Freeston MH, Gareau D, Careau Y, Dufour MJ, Aardema F, Todorov C. Group versus individual treatment in obsessions without compulsions. Clin Psychol Psychother 2005. [DOI: 10.1002/cpp.439] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Abstract
Meta-cognition refers to the notion of thoughts about one’s own thoughts and has been defined as knowledge and cognition about cognitive phenomena (Flavell, 1979). In recent years, meta-cognitive models have provided accounts of the maintenance of anxiety disorders (e.g., Wells, 2000). Meta-cognitive models would argue that the thoughts about the appearance and utility of otherwise normal thoughts generate anxiety. In this article we apply a meta-cognitive approach to understanding obsessions but, rather than thoughts about thoughts, we suggest that the ruminations in obsessive-compulsive disorder (OCD) without overt compulsions result largely from thoughts about thoughts that do not actually occur. Persons with obsessions thinks they might have or might have had the thoughts, and through a meta-cognitive process termed “inferential confusion,” confuse these imagined thoughts with actual thoughts. This account would explain the repetitive, compulsive yet ego-dystonic nature of obsessions. The justification, provided by patients with OCD, for treating imaginary thoughts as actual thoughts appears to be an imaginary narrative, which produces and maintains the obsessional preoccupation, and seems imposed on reality by a distorted inductive reasoning process.
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