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Tjelle K, Opstad HB, Solem S, Kvale G, Wheaton MG, Björgvinsson T, Hansen B, Hagen K. Patient adherence as a predictor of acute and long-term outcomes in concentrated exposure treatment for difficult-to-treat obsessive-compulsive disorder. BMC Psychiatry 2024; 24:327. [PMID: 38689256 PMCID: PMC11059693 DOI: 10.1186/s12888-024-05780-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 04/19/2024] [Indexed: 05/02/2024] Open
Abstract
BACKGROUND Exposure and response prevention (ERP) is considered the first-line psychotherapy for obsessive-compulsive disorder (OCD). Substantial research supports the effectiveness of ERP, yet a notable portion of patients do not fully respond while others experience relapse. Understanding poor outcomes such as these necessitates further research. This study investigated the role of patient adherence to ERP tasks in concentrated exposure treatment (cET) in a sample who had previously not responded to treatment or relapsed. METHOD The present study included 163 adults with difficult-to-treat OCD. All patients received cET delivered during four consecutive days. Patients' treatment adherence was assessed using the Patient EX/RP Adherence Scale (PEAS-P) after the second and third day of treatment. OCD severity was evaluated at post-treatment, 3-month follow-up, and 1-year follow-up by independent evaluators. RESULTS PEAS-P scores during concentrated treatment were associated with OCD-severity at post-treatment, 3-month follow-up, and 1-year follow-up. Moreover, PEAS-P scores predicted 12-month OCD severity adjusting for relevant covariates. Adherence also predicted work- and social functioning at 1-year follow-up. CONCLUSIONS These results indicate that ERP adherence during the brief period of cET robustly relates to improvement in OCD symptoms and functioning in both the short and long term. Assessing adherence might identify patients at risk of poor outcomes, while improving adherence may enhance ERP for treatment resistant patients. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT02656342.
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Affiliation(s)
- Kristian Tjelle
- Department of Psychiatry, Møre og Romsdal Hospital Trust, Molde Hospital, Molde, 6412, Norway
- Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway
| | - Håvard Berg Opstad
- Department of Psychiatry, Møre og Romsdal Hospital Trust, Molde Hospital, Molde, 6412, Norway
- Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway
| | - Stian Solem
- Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway
- Bergen Center for Brain Plasticity, Haukeland University Hospital, Bergen, Norway
| | - Gerd Kvale
- Bergen Center for Brain Plasticity, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Psychology, University of Bergen, Bergen, Norway
| | | | - Thröstur Björgvinsson
- Behavioral Health Partial Hospital Program, McLean Hospital, Harvard Medical School, Belmont, MA, USA
| | - Bjarne Hansen
- Bergen Center for Brain Plasticity, Haukeland University Hospital, Bergen, Norway
- Department of Psychosocial Sciences, University of Bergen, Bergen, Norway
| | - Kristen Hagen
- Department of Psychiatry, Møre og Romsdal Hospital Trust, Molde Hospital, Molde, 6412, Norway.
- Bergen Center for Brain Plasticity, Haukeland University Hospital, Bergen, Norway.
- Department of Mental Health, Norwegian University of Science and Technology, Trondheim, Norway.
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Himle JA, Grogan-Kaylor A, Hiller MA, Mannella KA, Norman LJ, Abelson JL, Prout A, Shunnarah AA, Becker HC, Russman Block SR, Taylor SF, Fitzgerald KD. Exposure and response prevention versus stress management training for adults and adolescents with obsessive compulsive disorder: A randomized clinical trial. Behav Res Ther 2024; 172:104458. [PMID: 38103359 DOI: 10.1016/j.brat.2023.104458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 11/24/2023] [Accepted: 12/06/2023] [Indexed: 12/19/2023]
Abstract
OBJECTIVE Though exposure and response prevention (ERP) is a well-proven treatment for OCD across the lifespan, prior RCTs have not studied adolescent and adult patients with the same ERP protocol relative to an active comparator that controls for non-specific effects of treatment. This approach assesses differences in the effect of OCD-specific exposures in affected adolescents and adults and in response to ERP compared to a stress-management control therapy (SMT). METHODS This assessor-blinded, parallel, 2-arm, randomized, ambulatory clinical superiority trial randomized adolescents (aged 12-18) and adults (24-46) with OCD (N = 126) to 12 weekly sessions of ERP or SMT. OCD severity was measured before, during and after treatment using the child or adult version of the Yale-Brown Obsessive Compulsive Scale (C/Y-BOCS), depending on participant age. We predicted that ERP would produce greater improvement in OCD symptoms than SMT and that there would be no significant post-treatment differences across age groups. RESULTS ERP (n = 63) produced significantly greater improvements on C/Y-BOCS scores at post-treatment than SMT (n = 63) (Effect size = -0.72, CI = -0.52 to -0.91, p < .001). ERP also produced more treatment responders (ERP = 86%, SMT = 32%; χ2 = 46.37, p < .001) and remitters than SMT (ERP = 39%, SMT = 7%; χ2 = 16.14, p < .001). Finally, there were no statistically significant post-treatment differences in C/Y-BOCS scores between adolescents and adults assigned to ERP. CONCLUSION A single ERP protocol is superior to SMT in treating both adolescents and adults with OCD. OCD-specific therapy is necessary across the lifespan for optimal outcomes in this highly disabling disorder, though non-specific treatments like SMT are still all-too-commonly provided.
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Affiliation(s)
- Joseph A Himle
- School of Social Work, University of Michigan, 1080 South University Ave, Ann Arbor, MI, 48109, USA; Department of Psychiatry, Medical School, University of Michigan, 1500 East Medical Center Dr., Ann Arbor, MI, 48109, USA.
| | - Andrew Grogan-Kaylor
- School of Social Work, University of Michigan, 1080 South University Ave, Ann Arbor, MI, 48109, USA
| | - Matthew A Hiller
- School of Social Work, University of Michigan, 1080 South University Ave, Ann Arbor, MI, 48109, USA
| | - Kristin A Mannella
- Department of Psychiatry, Medical School, University of Michigan, 1500 East Medical Center Dr., Ann Arbor, MI, 48109, USA
| | - Luke J Norman
- Department of Psychiatry, Medical School, University of Michigan, 1500 East Medical Center Dr., Ann Arbor, MI, 48109, USA
| | - James L Abelson
- Department of Psychiatry, Medical School, University of Michigan, 1500 East Medical Center Dr., Ann Arbor, MI, 48109, USA
| | - Aileen Prout
- Department of Psychiatry, Medical School, University of Michigan, 1500 East Medical Center Dr., Ann Arbor, MI, 48109, USA
| | - Angela A Shunnarah
- Department of Psychiatry, Medical School, University of Michigan, 1500 East Medical Center Dr., Ann Arbor, MI, 48109, USA
| | - Hannah C Becker
- Department of Psychiatry, Medical School, University of Michigan, 1500 East Medical Center Dr., Ann Arbor, MI, 48109, USA
| | - Stefanie R Russman Block
- Department of Psychiatry, Medical School, University of Michigan, 1500 East Medical Center Dr., Ann Arbor, MI, 48109, USA
| | - Stephan F Taylor
- Department of Psychiatry, Medical School, University of Michigan, 1500 East Medical Center Dr., Ann Arbor, MI, 48109, USA
| | - Kate D Fitzgerald
- Department of Psychiatry, College of Physicians and Surgeons, Columbia University, 630 W 168th St, New York, NY, 10032, USA
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Radomsky AS, Alcolado GM, Dugas MJ, Lavoie SL. Responsibility, probability, and severity of harm: An experimental investigation of cognitive factors associated with checking-related OCD. Behav Res Ther 2022; 150:104034. [DOI: 10.1016/j.brat.2022.104034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 11/12/2021] [Accepted: 01/05/2022] [Indexed: 11/02/2022]
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Metacognitions and Obsessive Beliefs in Obsessive–Compulsive Disorder: A Study of Within- and Between-Person Effects on Long-Term Outcome. COGNITIVE THERAPY AND RESEARCH 2021. [DOI: 10.1007/s10608-021-10210-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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5
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Launes G, Hagen K, Sunde T, Öst LG, Klovning I, Laukvik IL, Himle JA, Solem S, Hystad SW, Hansen B, Kvale G. A Randomized Controlled Trial of Concentrated ERP, Self-Help and Waiting List for Obsessive- Compulsive Disorder: The Bergen 4-Day Treatment. Front Psychol 2019; 10:2500. [PMID: 31803089 PMCID: PMC6873786 DOI: 10.3389/fpsyg.2019.02500] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Accepted: 10/22/2019] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND The Bergen 4-day treatment (B4DT) is a concentrated exposure-based treatment for patients with Obsessive-Compulsive Disorder (OCD) delivered during four consecutive days. The B4DT has in a number of effectiveness studies demonstrated promising results as approximately 90% of patients gain reliable clinical change post-treatment and nearly 70% are recovered on a long-term basis. METHODS The current study is the first randomized controlled trial evaluating the effects of the B4DT. Forty-eight patients diagnosed with OCD were randomized to B4DT, self-help (SH), or waiting list (WL) with 16 patients in each condition. All participants randomized to the B4DT underwent the treatment without any attrition. RESULTS The B4DT yielded significantly better effects than control conditions on measures of OCD, depression, and generalized anxiety. The response rate (≥35% reduction of the individual patient's pre-treatment Y-BOCS score) was 93.8% in B4DT, 12.5% in SH and 0% in WL, while remission rate (response criterion is fulfilled and the post-treatment Y-BOCS score is ≤12 points) was 62.5%, 6.3%, and 0%, respectively. Furthermore, patients who had received the B4DT, showed improved work- and social functioning. None of the patients treated with B4DT showed signs of deterioration. In comparison, one patient in the SH condition was in remission, and one showed significant clinical improvement, whereas the remaining showed no change. CONCLUSION The results indicate that the B4DT is an effective treatment for patients suffering from OCD. CLINICAL TRIAL REGISTRATION www.ClinicalTrials.gov, identifier NCT02886780.
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Affiliation(s)
- Gunvor Launes
- Sørlandet Sykehus, Kristiansand, Norway
- Department of Clinical Psychology, University of Bergen, Bergen, Norway
| | - Kristen Hagen
- Department of Psychiatry, Molde Hospital, Molde, Norway
- Bergen Center for Brain Plasticity, Haukeland University Hospital, Bergen, Norway
| | - Tor Sunde
- Sørlandet Sykehus, Kristiansand, Norway
| | - Lars-Göran Öst
- Bergen Center for Brain Plasticity, Haukeland University Hospital, Bergen, Norway
- Department of Psychology, Stockholm University, Stockholm, Sweden
| | | | - Inger-Lill Laukvik
- Sørlandet Sykehus, Kristiansand, Norway
- Bergen Center for Brain Plasticity, Haukeland University Hospital, Bergen, Norway
| | - Joseph A. Himle
- Department of Psychiatry, University of Michigan, Ann Arbor, MI, United States
| | - Stian Solem
- Bergen Center for Brain Plasticity, Haukeland University Hospital, Bergen, Norway
- Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway
| | - Sigurd W. Hystad
- Department of Psychosocial Science, University of Bergen, Bergen, Norway
| | - Bjarne Hansen
- Department of Clinical Psychology, University of Bergen, Bergen, Norway
- Bergen Center for Brain Plasticity, Haukeland University Hospital, Bergen, Norway
| | - Gerd Kvale
- Department of Clinical Psychology, University of Bergen, Bergen, Norway
- Bergen Center for Brain Plasticity, Haukeland University Hospital, Bergen, Norway
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Sunde T, Hummelen B, Himle JA, Walseth LT, Vogel PA, Launes G, Haaland VØ, Haaland ÅT. Early maladaptive schemas impact on long-term outcome in patients treated with group behavioral therapy for obsessive-compulsive disorder. BMC Psychiatry 2019; 19:318. [PMID: 31655556 PMCID: PMC6815412 DOI: 10.1186/s12888-019-2285-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Accepted: 09/11/2019] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Some studies have previously found that certain elevated early maladaptive schemas (EMSs) are negative predictors for outcome for patients with obsessive-compulsive disorder (OCD) treated with Cognitive-Behavioral Therapy (CBT) or Exposure and Response Prevention (ERP). The current study explores whether EMS were related to reductions in OCD symptom severity at long-term follow-up (Mean = 8 years) after group ERP for patients with OCD. The central hypothesis was that patients with no response to treatment or patients who relapsed during the follow-up period were more likely to have elevated pre-treatment EMSs compared to those who responded to initial treatment and maintained gains over time. We also investigated whether there were any differences in change over time of overall EMS between patients who were recovered versus patients who were not recovered at extended follow-up. METHODS Young Schema Questionnaire -Short Form (YSQ-SF), Yale-Brown Obsessive-Compulsive Scale (Y-BOCS), Beck Depression Inventory (BDI) were measured in 40 OCD patients in a general outpatient clinic before and after group ERP, after 12-months and at extended follow-up. To analyze the predictors, a multiple regression analyses was conducted. Changes in overall EMS was analyzed by mixed models procedures. RESULTS The major finding is that patients with high pre-treatment YSQ-SF total scores were less likely to respond to initial treatment or were more likely to relapse between post-treatment and the extended follow-up. The YSQ-SF total score at pre-treatment explained 10.5% of the variance of extended long-term follow-up outcome. The entire sample experienced a significant reduction in overall EMS over time with largest reduction from pre- to post-test. There were no statistically significant differences in total EMS change trajectories between the patients who were recovered at the extended follow-up compared to those who were not. CONCLUSION The results from the present study suggest that patients with higher pre-treatment EMSs score are less likely to recover in the long-term after receiving group ERP for OCD. A combined treatment that also targets early maladaptive schemas may be a more effective approach for OCD patients with elevated EMS who don't respond to standard ERP.
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Affiliation(s)
- Tor Sunde
- DPS Solvang, Sørlandet Hospital, SSHF, Seviceboks 416, 4604 Kristiansand, Norway
| | - Benjamin Hummelen
- Clinic of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Joseph A. Himle
- School of Social Work and School of Medicine-Psychiatry, University of Michigan, Ann Arbor, USA
| | - Liv Tveit Walseth
- DPS Solvang, Sørlandet Hospital, SSHF, Seviceboks 416, 4604 Kristiansand, Norway
| | - Patrick A. Vogel
- Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway
| | - Gunvor Launes
- DPS Solvang, Sørlandet Hospital, SSHF, Seviceboks 416, 4604 Kristiansand, Norway
| | - Vegard Øksendal Haaland
- DPS Solvang, Sørlandet Hospital, SSHF, Seviceboks 416, 4604 Kristiansand, Norway
- Clinical Neuroscience Research Group, Department of Psychology, University of Oslo, Oslo, Norway
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7
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Launes G, Laukvik IL, Sunde T, Klovning I, Hagen K, Solem S, Öst LG, Hansen B, Kvale G. The Bergen 4-Day Treatment for Obsessive-Compulsive Disorder: Does It Work in a New Clinical Setting? Front Psychol 2019; 10:1069. [PMID: 31164848 PMCID: PMC6534081 DOI: 10.3389/fpsyg.2019.01069] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2018] [Accepted: 04/24/2019] [Indexed: 01/17/2023] Open
Abstract
Sørlandet Hospital in Norway has a history of offering patients with obsessive-compulsive disorder (OCD) cognitive behavior group therapy using 12 weekly sessions of 2.5 h each. A previous evaluation of this treatment has shown that 51.9% did not respond at post-treatment. Recently, a highly concentrated group-treatment format, the Bergen 4-day treatment (B4DT), has been shown to help more than 90% of patients with OCD post-treatment. Based on these positive results, it was decided to explore whether the B4DT could be a feasible format for delivering ERP at another clinic. Thirty-five consecutively recruited patients were included in the current pilot study, and assessed at pre-treatment, post-treatment, and 3-month follow-up. Treatment response rate (35% reduction in OCD-symptom score) was 94% at post-treatment, and 80% at follow-up. Seventy-four percent were in remission at post-treatment and 68% at follow-up. Only one patient dropped out of treatment. The patients were highly satisfied with the treatment content and format. The results indicate that the 4-day treatment could successfully be implemented at a new clinic.
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Affiliation(s)
- Gunvor Launes
- Sørlandet Sykehus, Kristiansand, Norway.,Department of Clinical Psychology, University of Bergen, Bergen, Norway
| | - Inger Lill Laukvik
- Sørlandet Sykehus, Kristiansand, Norway.,OCD-Team, Haukeland University Hospital, Bergen, Norway
| | - Tor Sunde
- Sørlandet Sykehus, Kristiansand, Norway
| | | | - Kristen Hagen
- OCD-Team, Haukeland University Hospital, Bergen, Norway.,Department of Psychiatry, Molde Hospital, Molde, Norway
| | - Stian Solem
- OCD-Team, Haukeland University Hospital, Bergen, Norway.,Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway
| | - Lars-Göran Öst
- OCD-Team, Haukeland University Hospital, Bergen, Norway.,Department of Psychology, Stockholm University, Stockholm, Sweden
| | - Bjarne Hansen
- Department of Clinical Psychology, University of Bergen, Bergen, Norway.,OCD-Team, Haukeland University Hospital, Bergen, Norway
| | - Gerd Kvale
- Department of Clinical Psychology, University of Bergen, Bergen, Norway.,OCD-Team, Haukeland University Hospital, Bergen, Norway
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8
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Kvale G, Hansen B, Björgvinsson T, Børtveit T, Hagen K, Haseth S, Kristensen UB, Launes G, Ressler KJ, Solem S, Strand A, van den Heuvel OA, Öst LG. Successfully treating 90 patients with obsessive compulsive disorder in eight days: the Bergen 4-day treatment. BMC Psychiatry 2018; 18:323. [PMID: 30286745 PMCID: PMC6172736 DOI: 10.1186/s12888-018-1887-4] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Accepted: 09/17/2018] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND Oslo University Hospital, Norway, had by autumn 2016, accumulated a waiting list of 101 patients with obsessive-compulsive disorder (OCD) who had a legal right to receive treatment by a specialized OCD team. In this challenging situation, the Bergen OCD-team suggested to solve the problem by offering all patients an option for the rapid Bergen 4-day treatment (B4DT). The B4DT is an individual treatment delivered during four consecutive days in a group of six patients with the same number of therapists. The approach has previously shown a post-treatment response rate of 90% and a 3-month remission rate of 70%. METHODS Ninety-seven of the wait-list patients were available for the scheduled time slots, and 90 received the 4-day format during 8 days (45 patients each week). The therapists were recruited from 22 different specialized OCD-teams from all over Norway, and 44 (68%) had not previously delivered the 4-day format. RESULTS Post-treatment; 91.1% of the patients were classified as responders, and 72.2% were in remission. At 3-month follow-up; 84.4 were classified as responders and the remission rate was 67.7%. Oslo University Hospital now offers the 4-day treatment as standard treatment for OCD. CONCLUSIONS We conclude that the B4DT is an acceptable and potentially effective OCD-treatment.
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Affiliation(s)
- Gerd Kvale
- Haukeland University Hospital, OCD-team, 5021 Bergen, Norway
- Department of Clinical Psychology, University of Bergen, Bergen, Norway
| | - Bjarne Hansen
- Haukeland University Hospital, OCD-team, 5021 Bergen, Norway
- Department of Clinical Psychology, University of Bergen, Bergen, Norway
| | | | - Tore Børtveit
- Haukeland University Hospital, OCD-team, 5021 Bergen, Norway
| | - Kristen Hagen
- Haukeland University Hospital, OCD-team, 5021 Bergen, Norway
- Molde Hospital, Molde, Norway
| | - Svein Haseth
- Nidaros DPS, Division of Psychiatry, St. Olav University Hospital, Trondheim, Norway
| | | | | | - Kerry J. Ressler
- McLean Hospital, Belmont, MA USA
- Harvard Medical School, Boston, MA USA
| | - Stian Solem
- Haukeland University Hospital, OCD-team, 5021 Bergen, Norway
- Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway
| | - Arne Strand
- Norwegian OCD-foundation, Ananke, Oslo, Norway
| | - Odile A. van den Heuvel
- Haukeland University Hospital, OCD-team, 5021 Bergen, Norway
- Department of Psychiatry and Department of Anatomy & Neurosciences, VU university medical center (VUmc), Amsterdam, The Netherlands
| | - Lars-Göran Öst
- Haukeland University Hospital, OCD-team, 5021 Bergen, Norway
- Department of Psychology, Stockholm University, Stockholm, Sweden
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Abstract
AbstractAccording to interpersonal theory of personality, interpersonal behaviours can be causal and maintaining factors in emotional disorders. However, interpersonal styles have not yet been investigated in the treatment of obsessive compulsive disorder (OCD). The aim of the study was to investigate interpersonal style in OCD. The Inventory of Interpersonal Problems – Circumplex was used to assess the interpersonal styles of 101 outpatients with OCD treated with cognitive behavioural therapy (CBT). Patients with OCD had more interpersonal problems than the healthy control group. However, the OCD group presented with slightly fewer interpersonal problems than a further comparison group of psychiatric outpatients. Interpersonal style did not predict improvement in OCD symptoms. Following CBT for OCD, there were small to moderate improvements in interpersonal problems. These changes remained stable at 12-month follow-up. Although the OCD group reported reduced interpersonal problems post-treatment, the group still experienced more submissiveness compared to healthy controls. Interpersonal problems in OCD appeared to be more attributable to comorbid conditions than to OCD-specific symptoms. Although patients with OCD were found to have interpersonal styles that might cause some problems, these were minimal at baseline and did not significantly affect OCD treatment outcomes. Interpersonal problems in this population might be more strongly related to depressive symptoms than to OCD-specific symptoms. CBT was associated with slight improvements in interpersonal problems.
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Loerinc AG, Meuret AE, Twohig MP, Rosenfield D, Bluett EJ, Craske MG. Response rates for CBT for anxiety disorders: Need for standardized criteria. Clin Psychol Rev 2015; 42:72-82. [DOI: 10.1016/j.cpr.2015.08.004] [Citation(s) in RCA: 290] [Impact Index Per Article: 32.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2015] [Revised: 07/17/2015] [Accepted: 08/12/2015] [Indexed: 11/26/2022]
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Abstract
This paper gives an overview of group psychotherapy in Norway: the history, approaches in use, programs for systematic training, how group services are financed, and finally how practice and research are integrated in the public mental health system.
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Affiliation(s)
- Steinar Lorentzen
- Professor emeritus and a psychiatrist at the Institute of Clinical Medicine, University of Oslo
| | - Theresa Wilberg
- Senior researcher at the Department of Research and Development, Clinic for Mental Health and Addiction, at Oslo University Hospital
| | - Egil W Martinsen
- Head of the Department of Research and Development, Clinic for Mental Health and Addiction, at Oslo University Hospital and professor at the Institute of Clinical Medicine, University of Oslo
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12
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Solem S, Hagen K, Wenaas C, Håland ÅT, Launes G, Vogel PA, Hansen B, Himle JA. Psychotic and schizotypal symptoms in non-psychotic patients with obsessive-compulsive disorder. BMC Psychiatry 2015; 15:121. [PMID: 26017268 PMCID: PMC4446858 DOI: 10.1186/s12888-015-0502-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2015] [Accepted: 05/18/2015] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Research is scarce with regard to the role of psychotic and schizotypal symptoms in treatment of obsessive-compulsive disorder (OCD). The aim of the current study was to investigate the occurrence and specificity of psychotic and schizotypal symptoms among non-psychotic OCD patients, and to examine whether such symptoms was associated with response to exposure and response prevention (ERP), and whether ERP for OCD had an impact on psychotic and schizotypal symptoms. METHODS Non-psychotic OCD patients (n = 133) and a general non-psychotic psychiatric outpatient sample (n = 110) were assessed using self-report inventories before and after psychological treatment. RESULTS Non-psychotic OCD patients did not report greater degree of psychotic or schizotypal symptoms than the control group. Psychotic and schizotypal symptoms were not associated with OCD symptoms before or after ERP. Psychotic and schizotypal symptom were significantly reduced following ERP. CONCLUSIONS Psychotic and schizotypal symptoms seem to be equally prevalent among non-psychotic OCD patients and non-psychotic psychiatric controls. These symptoms were more linked to depressive symptoms than OCD symptoms. In non-psychotic OCD patients, ERP seems sufficient in reducing OCD symptoms despite the presence of psychotic- and schizotypal symptoms, and reductions in psychotic- and schizotypal symptoms were observed following ERP.
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Affiliation(s)
- Stian Solem
- Department of Psychology, Norwegian University of Science and Technology, 7491, Trondheim, Norway.
| | - Kristen Hagen
- Divison of Psychiatry, St. Olavs University Hospital, Trondheim, Norway.
| | - Christoffer Wenaas
- Department of Psychology, Norwegian University of Science and Technology, 7491, Trondheim, Norway.
| | - Åshild T. Håland
- Clinic of Mental Health, Psychiatry and Addiction Treatment, Sørlandet Hospital HF, Kristiansand, Norway
| | - Gunvor Launes
- Clinic of Mental Health, Psychiatry and Addiction Treatment, Sørlandet Hospital HF, Kristiansand, Norway.
| | - Patrick A. Vogel
- Department of Psychology, Norwegian University of Science and Technology, 7491 Trondheim, Norway
| | - Bjarne Hansen
- Department of psychiatry, Haukeland University Hospital, Bergen, Norway.
| | - Joseph A. Himle
- Department of Psychiatry, University of Michigan, Ann Arbor, MI USA ,School of Social Work, University of Michigan, Ann Arbor, MI USA
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13
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Solem S, Hagen K, Hansen B, Håland ÅT, Launes G, Lewin AB, Storch EA, Vogel PA. Thought Content and Appraisals in Cognitive Behavioral Therapy for Obsessive-Compulsive Disorder. J Cogn Psychother 2015; 29:106-115. [PMID: 32759161 DOI: 10.1891/0889-8391.29.2.106] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
A premise for cognitive behavioral therapy (CBT) for obsessive-compulsive disorder (OCD) is that appraisal of obsessions maintains OCD symptoms whereas obsessive content is less important. The main aim of this study was therefore to explore this notion using the autogenous and reactive classification of obsessive content and by assessing changes in appraisals and symptoms following CBT for OCD. More specifically, the study investigates whether recovery from OCD is associated with changes in appraisal and explores how thought content relates to appraisal and symptoms both before and CBT. Data from 156 adults with OCD completing CBT for OCD were analyzed. Changes in appraisals were related to improvement in OCD symptoms. Slightly more participants reported reactive intrusions (47%) than autogenous (29%), but combinations of the two were common (24%). These classifications of thought content were not related to levels of appraisal or change in symptoms, with the exception of patients with autogenous thoughts who appraised their intrusions as more important than others. OCD is heterogeneous regarding thought content and strength of appraisals but can be quite homogeneous in terms of CBT treatment response. Also, and in line with cognitive theory, recovery from OCD is associated with changes in appraisals.
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Affiliation(s)
- Stian Solem
- Norwegian University of Science and Technology, Trondheim, Norway .,Division of Psychiatry, St. Olavs University Hospital, Trondheim, Norway
| | - Kristen Hagen
- Division of Psychiatry, St. Olavs University Hospital, Trondheim, Norway
| | - Bjarne Hansen
- Department of Psychiatry, Haukeland University Hospital, Bergen, Norway
| | - Åshild T Håland
- Norwegian University of Science and Technology, Trondheim, Norway.,Division of Psychiatry, St. Olavs University Hospital, Trondheim, Norway.,Division of Psychiatry, St. Olavs University Hospital, Trondheim, Norway.,Department of Psychiatry, Haukeland University Hospital, Bergen, Norway.,Clinic of Mental Health, Psychiatry and Addiction Treatment, Sørlandet Hospital HF, Kristiansand, Norway.,Department of Pediatrics, University of South Florida.,Norwegian University of Science and Technology, Trondheim, Norway
| | - Gunvor Launes
- Clinic of Mental Health, Psychiatry and Addiction Treatment, Sørlandet Hospital HF, Kristiansand, Norway
| | - Adam B Lewin
- Norwegian University of Science and Technology, Trondheim, Norway.,Division of Psychiatry, St. Olavs University Hospital, Trondheim, Norway.,Division of Psychiatry, St. Olavs University Hospital, Trondheim, Norway.,Department of Psychiatry, Haukeland University Hospital, Bergen, Norway.,Clinic of Mental Health, Psychiatry and Addiction Treatment, Sørlandet Hospital HF, Kristiansand, Norway.,Department of Pediatrics, University of South Florida.,Norwegian University of Science and Technology, Trondheim, Norway
| | - Eric A Storch
- Department of Pediatrics, University of South Florida
| | - Patrick A Vogel
- Norwegian University of Science and Technology, Trondheim, Norway
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14
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Doki S, Sasahara S, Matsuzaki I. Psychological approach of occupational health service to sick leave due to mental problems: a systematic review and meta-analysis. Int Arch Occup Environ Health 2014; 88:659-67. [PMID: 25380726 DOI: 10.1007/s00420-014-0996-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2014] [Accepted: 10/29/2014] [Indexed: 11/26/2022]
Abstract
PURPOSE The effects of interventions by occupational health services on sick leave prompted by psychiatric disorders were examined with respect to intervention method and the number of sick leave days. METHODS The intervention methods used by occupational health services were systematically reviewed by searching three databases and manual searching. A meta-analysis of the number of sick leave days comparing the intervention group [intervention + care as usual (CAU)] and control group (CAU alone) was performed. In addition, subanalyses were conducted for the duration until sick-listed workers' return to work after sick leave (Subgroup 1) and the number of non-sick-listed workers' total sick leave days (Subgroup 2). RESULTS Ten studies were extracted and integrated, and the subjects were subsequently sorted into the intervention group (n = 434, 322, and 756 in subgroup 1, subgroup 2, and total, respectively) and control group (n = 413, 385, and 798 in subgroup 1, subgroup 2, and total, respectively). All studies employed an intervention method of problem-solving treatment or cognitive behavioral therapy (CBT). There were no significant differences between the intervention and control groups in subgroup 1 or 2. However, the combined intervention group had significantly fewer total sick leave days than the combined control group (mean difference -6.64 days, 95% CI -12.68 to -0.59, I(2) = 0%). CONCLUSIONS The combined study of sick-listed and non-sick-listed workers indicates occupational health services implement problem-solving treatment or CBT interventions, which can shorten total sick leave duration.
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Affiliation(s)
- Shotaro Doki
- Graduate School of Comprehensive Human Sciences, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, Japan
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15
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Hans E, Hiller W. A meta-analysis of nonrandomized effectiveness studies on outpatient cognitive behavioral therapy for adult anxiety disorders. Clin Psychol Rev 2013; 33:954-64. [DOI: 10.1016/j.cpr.2013.07.003] [Citation(s) in RCA: 70] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2012] [Revised: 07/07/2013] [Accepted: 07/09/2013] [Indexed: 10/26/2022]
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16
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Haaland AT, Vogel PA, Launes G, Haaland VØ, Hansen B, Solem S, Himle JA. The role of early maladaptive schemas in predicting exposure and response prevention outcome for obsessive-compulsive disorder. Behav Res Ther 2011; 49:781-8. [DOI: 10.1016/j.brat.2011.08.007] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2011] [Revised: 08/19/2011] [Accepted: 08/30/2011] [Indexed: 10/17/2022]
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