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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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Vogt GS, Avendaño-Ortega M, Schneider SC, Goodman WK, Storch EA. Optimizing Obsessive-Compulsive Symptom Measurement With the Yale-Brown Obsessive-Compulsive Scales-Second Edition. J Psychiatr Pract 2022; 28:294-309. [PMID: 35797686 PMCID: PMC9393804 DOI: 10.1097/pra.0000000000000640] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) is a widely used measure for assessing the presence and severity of obsessive-compulsive disorder symptoms. The Yale-Brown Obsessive-Compulsive Scale-Second Edition (Y-BOCS-II) was developed, in part, to more comprehensively evaluate symptom severity, especially in extremely ill patients, and improve consistency in detecting and incorporating avoidance behaviors. We present 3 case studies that demonstrate the enhanced ability of the Y-BOCS-II to: (1) detect fluctuations in symptom severity among extremely ill patients, (2) systematically incorporate avoidance variables for more accurate ratings, and (3) maintain strong convergence with the Y-BOCS in assessing patients presenting with mild to moderate symptoms. In addition, we outline how to obtain both Y-BOCS and Y-BOCS-II scores within 1 administration by adding Y-BOCS item 4 to the Y-BOCS-II assessment, then "back-coding" the Y-BOCS-II ratings to Y-BOCS ratings and using Y-BOCS item 4 in place of Y-BOCS-II item 2. The use of this method allows for more robust data collection while providing comparability across the literature.
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Effectiveness and feasibility of intensive versus regular cognitive behaviour therapy in patients with anxiety and obsessive-compulsive disorders: A meta-analysis. JOURNAL OF AFFECTIVE DISORDERS REPORTS 2021. [DOI: 10.1016/j.jadr.2021.100267] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Balachander S, Bajaj A, Hazari N, Kumar A, Anand N, Manjula M, Sudhir PM, Cherian AV, Narayanaswamy JC, Jaisoorya TS, Math SB, Kandavel T, Arumugham SS, Janardhan Reddy YC. Long-term Outcomes of Intensive Inpatient Care for Severe, Resistant Obsessive-Compulsive Disorder: Résultats à long terme de soins intensifs à des patients hospitalisés pour un trouble obsessionnel-compulsif grave et résistant. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2020; 65:779-789. [PMID: 32452212 PMCID: PMC7564695 DOI: 10.1177/0706743720927830] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
OBJECTIVE A substantial proportion of severely ill patients with obsessive-compulsive disorder (OCD) do not respond to serotonin reuptake inhibitors (SRIs) and are unable to practice cognitive behavioral therapy (CBT) on an out-patient basis. We report the short-term (at discharge) and long-term (up to 2 years) outcome of a multimodal inpatient treatment program that included therapist-assisted intensive CBT with adjunctive pharmacotherapy for severely ill OCD patients who are often resistant to SRIs and are either unresponsive or unable to practice outpatient CBT. METHODS A total of 420 patients, admitted between January 2012 and December 2017 were eligible for the analysis. They were evaluated using the Mini International Neuropsychiatric Interview, the Yale-Brown Obsessive Compulsive Scale (YBOCS), and the Clinical Global Impression (CGI) scale. All patients received 4 to 5 therapist-assisted CBT sessions per week along with standard pharmacotherapy. Naturalistic follow-up information at 3, 6, 12, and 24 months were recorded. RESULTS At baseline, patients were mostly severely ill (YBOCS = 29.9 ± 4.5) and nonresponsive to ≥2 SRIs (83%). Mean duration of inpatient stay was 42.7 ± 25.3 days. At discharge, there was a significant decline in the mean YBOCS score (29.9 ± 4.5 vs. 18.1 ± 7.7, P < .001, Cohen's d = 1.64); 211/420 (50%) were responders (≥35% YBOCS reduction and CGI-I≤2) and an additional 86/420 (21%) were partial responders (25% to 35% YBOCS reduction and CGI-I≤3). Using latent class growth modeling of the follow-up data, 4 distinct classes were identified, which include "remitters" (14.5%), "responders" (36.5%), "minimal responders" (34.7%), and "nonresponders" (14.6%). Shorter duration of illness, better insight, and lesser contamination/washing symptoms predicted better response in both short- and long-term follow-up. CONCLUSION Intensive, inpatient-based care for OCD may be an effective option for patients with severe OCD and should be considered routinely in those who do not respond with outpatient treatment.
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Affiliation(s)
- Srinivas Balachander
- Obsessive-Compulsive Disorder Clinic, Department of Psychiatry, 29148National Institute of Mental Health and Neuro Science (NIMHANS), Bangalore, India
| | - Aakash Bajaj
- Department of Biostatistics, 29148NIMHANS, Bangalore, India
| | - Nandita Hazari
- Obsessive-Compulsive Disorder Clinic, Department of Psychiatry, 29148National Institute of Mental Health and Neuro Science (NIMHANS), Bangalore, India
| | - Ajay Kumar
- Obsessive-Compulsive Disorder Clinic, Department of Psychiatry, 29148National Institute of Mental Health and Neuro Science (NIMHANS), Bangalore, India.,Department of Clinical Psychology, 29148NIMHANS, Bangalore, India
| | - Nitin Anand
- Obsessive-Compulsive Disorder Clinic, Department of Psychiatry, 29148National Institute of Mental Health and Neuro Science (NIMHANS), Bangalore, India.,Department of Clinical Psychology, 29148NIMHANS, Bangalore, India
| | - M Manjula
- Obsessive-Compulsive Disorder Clinic, Department of Psychiatry, 29148National Institute of Mental Health and Neuro Science (NIMHANS), Bangalore, India.,Department of Clinical Psychology, 29148NIMHANS, Bangalore, India
| | - Paulomi M Sudhir
- Obsessive-Compulsive Disorder Clinic, Department of Psychiatry, 29148National Institute of Mental Health and Neuro Science (NIMHANS), Bangalore, India.,Department of Clinical Psychology, 29148NIMHANS, Bangalore, India
| | - Anish V Cherian
- Department of Psychiatric Social Work, 29148NIMHANS, Bangalore, India
| | - Janardhanan C Narayanaswamy
- Obsessive-Compulsive Disorder Clinic, Department of Psychiatry, 29148National Institute of Mental Health and Neuro Science (NIMHANS), Bangalore, India
| | - T S Jaisoorya
- Obsessive-Compulsive Disorder Clinic, Department of Psychiatry, 29148National Institute of Mental Health and Neuro Science (NIMHANS), Bangalore, India
| | - Suresh Bada Math
- Obsessive-Compulsive Disorder Clinic, Department of Psychiatry, 29148National Institute of Mental Health and Neuro Science (NIMHANS), Bangalore, India
| | | | - Shyam Sundar Arumugham
- Obsessive-Compulsive Disorder Clinic, Department of Psychiatry, 29148National Institute of Mental Health and Neuro Science (NIMHANS), Bangalore, India
| | - Y C Janardhan Reddy
- Obsessive-Compulsive Disorder Clinic, Department of Psychiatry, 29148National Institute of Mental Health and Neuro Science (NIMHANS), Bangalore, India
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Szechtman H, Harvey BH, Woody EZ, Hoffman KL. The Psychopharmacology of Obsessive-Compulsive Disorder: A Preclinical Roadmap. Pharmacol Rev 2020; 72:80-151. [PMID: 31826934 DOI: 10.1124/pr.119.017772] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
This review evaluates current knowledge about obsessive-compulsive disorder (OCD), with the goal of providing a roadmap for future directions in research on the psychopharmacology of the disorder. It first addresses issues in the description and diagnosis of OCD, including the structure, measurement, and appropriate description of the disorder and issues of differential diagnosis. Current pharmacotherapies for OCD are then reviewed, including monotherapy with serotonin reuptake inhibitors and augmentation with antipsychotic medication and with psychologic treatment. Neuromodulatory therapies for OCD are also described, including psychosurgery, deep brain stimulation, and noninvasive brain stimulation. Psychotherapies for OCD are then reviewed, focusing on behavior therapy, including exposure and response prevention and cognitive therapy, and the efficacy of these interventions is discussed, touching on issues such as the timing of sessions, the adjunctive role of pharmacotherapy, and the underlying mechanisms. Next, current research on the neurobiology of OCD is examined, including work probing the role of various neurotransmitters and other endogenous processes and etiology as clues to the neurobiological fault that may underlie OCD. A new perspective on preclinical research is advanced, using the Research Domain Criteria to propose an adaptationist viewpoint that regards OCD as the dysfunction of a normal motivational system. A systems-design approach introduces the security motivation system (SMS) theory of OCD as a framework for research. Finally, a new perspective on psychopharmacological research for OCD is advanced, exploring three approaches: boosting infrastructure facilities of the brain, facilitating psychotherapeutic relearning, and targeting specific pathways of the SMS network to fix deficient SMS shut-down processes. SIGNIFICANCE STATEMENT: A significant proportion of patients with obsessive-compulsive disorder (OCD) do not achieve remission with current treatments, indicating the need for innovations in psychopharmacology for the disorder. OCD may be conceptualized as the dysfunction of a normal, special motivation system that evolved to manage the prospect of potential danger. This perspective, together with a wide-ranging review of the literature, suggests novel directions for psychopharmacological research, including boosting support systems of the brain, facilitating relearning that occurs in psychotherapy, and targeting specific pathways in the brain that provide deficient stopping processes in OCD.
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Affiliation(s)
- Henry Szechtman
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada (H.S.); SAMRC Unit on Risk Resilience in Mental Disorders, Department of Psychiatry, University of Cape Town, and Center of Excellence for Pharmaceutical Sciences, School of Pharmacy, North-West University (Potchefstroom Campus), Potchefstroom, South Africa (B.H.H.); Department of Psychology, University of Waterloo, Waterloo, Ontario, Canada (E.Z.W.); and Centro de Investigación en Reproducción Animal, CINVESTAV-Universidad Autónoma de Tlaxcala, Tlaxcala, Mexico (K.L.H.)
| | - Brian H Harvey
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada (H.S.); SAMRC Unit on Risk Resilience in Mental Disorders, Department of Psychiatry, University of Cape Town, and Center of Excellence for Pharmaceutical Sciences, School of Pharmacy, North-West University (Potchefstroom Campus), Potchefstroom, South Africa (B.H.H.); Department of Psychology, University of Waterloo, Waterloo, Ontario, Canada (E.Z.W.); and Centro de Investigación en Reproducción Animal, CINVESTAV-Universidad Autónoma de Tlaxcala, Tlaxcala, Mexico (K.L.H.)
| | - Erik Z Woody
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada (H.S.); SAMRC Unit on Risk Resilience in Mental Disorders, Department of Psychiatry, University of Cape Town, and Center of Excellence for Pharmaceutical Sciences, School of Pharmacy, North-West University (Potchefstroom Campus), Potchefstroom, South Africa (B.H.H.); Department of Psychology, University of Waterloo, Waterloo, Ontario, Canada (E.Z.W.); and Centro de Investigación en Reproducción Animal, CINVESTAV-Universidad Autónoma de Tlaxcala, Tlaxcala, Mexico (K.L.H.)
| | - Kurt Leroy Hoffman
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada (H.S.); SAMRC Unit on Risk Resilience in Mental Disorders, Department of Psychiatry, University of Cape Town, and Center of Excellence for Pharmaceutical Sciences, School of Pharmacy, North-West University (Potchefstroom Campus), Potchefstroom, South Africa (B.H.H.); Department of Psychology, University of Waterloo, Waterloo, Ontario, Canada (E.Z.W.); and Centro de Investigación en Reproducción Animal, CINVESTAV-Universidad Autónoma de Tlaxcala, Tlaxcala, Mexico (K.L.H.)
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Time intensive cognitive behavioural therapy for a specific phobia of vomiting: A single case experimental design. J Behav Ther Exp Psychiatry 2020; 66:101523. [PMID: 31706171 DOI: 10.1016/j.jbtep.2019.101523] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Revised: 07/31/2019] [Accepted: 10/18/2019] [Indexed: 11/20/2022]
Abstract
BACKGROUND AND OBJECTIVES Specific Phobia of Vomiting (SPOV) may be difficult to treat, and to date only one RCT has been published. Specific Phobias can be successfully treated using time intensive treatment formats. Imagery rescripting (ImRs) has also been shown to be a successful component for treating various anxiety disorders. The present study aims to evaluate the effectiveness of time intensive CBT and ImRs at reducing symptoms in SPOV. METHODS A multiple baseline ABCADE single case experimental design (SCED) was used to monitor symptoms across time in eight participants. The Specific Phobia of Vomiting Inventory (SPOVI) was administered to measure SPOV symptoms at each clinical session. Visual analysis of graphed data was used to compare data across treatment phases. Reliable and clinically significant change was also calculated on the SPOVI at 6-month follow up. RESULTS Findings suggest that time intensive CBT is associated with improvements across symptoms of SPOV. There was limited support for ImRs in the current study; however, informal discussion of aversive memories of vomiting, and formulation of the problem may be helpful in its own right in treatment of SPOV. Seven out of eight participants (87.5%) achieved reliable improvement and five (62.5%) achieved clinically significant change on the SPOVI at 6-month follow up. Time intensive treatment was associated with high client satisfaction ratings. LIMITATIONS Limitations include lack of measurement of therapist adherence to protocol, and a short period of daily symptom monitoring in between ImRs and intensive treatment phases. CONCLUSIONS Time intensive CBT including an ImRs component may be an effective and acceptable treatment in reducing SPOV symptomatology. Further research using larger sample sizes in a RCT is needed.
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Maples-Keller JL, Rauch SAM, Jovanovic T, Yasinski CW, Goodnight JM, Sherrill A, Black K, Michopoulos V, Dunlop BW, Rothbaum BO, Norrholm SD. Changes in trauma-potentiated startle, skin conductance, and heart rate within prolonged exposure therapy for PTSD in high and low treatment responders. J Anxiety Disord 2019; 68:102147. [PMID: 31669786 DOI: 10.1016/j.janxdis.2019.102147] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Revised: 09/09/2019] [Accepted: 09/18/2019] [Indexed: 01/29/2023]
Abstract
While exposure-based psychotherapy is recommended as a first-line treatment for posttraumatic stress disorder (PTSD) given strong evidence for its effectiveness, some patients fail to receive full benefit. Psychophysiological data may be important complementary indices for investigating variability in treatment response and changes over the course of treatment. The focus of the present investigation was to examine change in psychophysiological indices pre- to post-treatment and to investigate if changes differed for high versus low PTSD treatment responders. Participants included veterans with primary PTSD diagnoses who received a two-week intensive prolonged exposure (PE) treatment. Psychophysiological assessment included trauma-potentiated startle, heart rate, and skin conductance recordings during presentation of three standard virtual reality (VR)-based, trauma-relevant scenes presented through a head mounted display. Results indicate that 48.6% were classified as high treatment responders (≥50% reduction in PCL-5 from baseline). Trauma-potentiated startle was observed in all patients at pre-treatment, F = 13.58, p < .001, in that startle magnitude was increased during VR stimuli relative to baseline regardless of responder status. However, in high treatment responders, there was an interaction of VR with time, F = 14.10, p = .001; VR scenes did not potentiate startle post-treatment. Specifically, high treatment responders were less reactive to trauma stimuli following PE treatment. There was no effect of time in the low responder group. Heart rate reactivity data revealed a significant main effect of treatment, F = 45.7, p = .035, but no significant interaction with responder status. Skin conductance reactivity did not significantly change from pre to post-treatment. These results suggest that trauma-potentiated startle may represent an objective marker of fear- and anxiety-related symptom reduction that is sensitive to both traditional outpatient as well as intensive treatment approaches.
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Borsari B, Hopkins LB, Manuel JK, Apodaca TR, Mastroleo NR, Jackson KM, Magill M, Norona JC, Carey KB. Improvement in therapist skills over sessions in brief motivational interventions predicts client language and alcohol use outcomes. PSYCHOLOGY OF ADDICTIVE BEHAVIORS 2019; 33:484-494. [PMID: 31144825 DOI: 10.1037/adb0000470] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Brief motivational interventions (BMIs) are widely used and efficacious interventions that address alcohol misuse in mandated college students. Consistent with motivational interviewing (MI; Miller & Rollnick, 2013) theory, within-therapist improvements in MI-consistent (MICO) skills over time-that is, as a therapist gains skill through repeated practice-may be associated with concurrent increases in client change language and subsequent changes in behavior. This study examined how therapist skill changed over time and whether within-therapist improvement in MICO skills impacted in-session client change language and subsequent alcohol-related outcomes. BMI sessions (N = 228) from 2 randomized clinical trials that had led to significant reductions in alcohol use and alcohol-related problems in mandated student drinkers were coded using the Motivational Interviewing Skills Code 2.0 (Miller, Moyers, Ernst, & Amrhein, 2003). In both studies, the BMI consisted of a single 45- to 60-min session. Analyses examined session-by-session changes in therapist MICO skills, client change language, and alcohol use outcomes. Therapist MICO skills improved over time, and there were significant increases in client change language and decreases in client discussion of topics other than personal alcohol use. Among relatively heavy-drinking clients, those treated by a more experienced therapist demonstrated greater reductions in alcohol use; however, this association was not mediated by client change language. Increased experience conducting BMIs improved therapist MICO skills over time, which in turn increased the focus on personal alcohol use during the session. However, it remains unclear how client language predicts behavior change following a BMI. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
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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: 29] [Impact Index Per Article: 4.8] [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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Hansen B, Kvale G, Hagen K, Havnen A, Öst LG. The Bergen 4-day treatment for OCD: four years follow-up of concentrated ERP in a clinical mental health setting. Cogn Behav Ther 2018; 48:89-105. [DOI: 10.1080/16506073.2018.1478447] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Bjarne Hansen
- Haukeland University Hospital, OCD-team, Bergen, Norway
- Department of Clinical Psychology, University of Bergen, Norway
| | - Gerd Kvale
- Haukeland University Hospital, OCD-team, Bergen, Norway
- Department of Clinical Psychology, University of Bergen, Norway
| | - Kristen Hagen
- Haukeland University Hospital, OCD-team, Bergen, Norway
- Department of Psychiatry, Molde Hospital, Molde, Norway
| | - Audun Havnen
- Department of Psychiatry, St. Olav’s University Hospital, Trondheim, Norway
| | - Lars-Göran Öst
- Haukeland University Hospital, OCD-team, Bergen, Norway
- Department of Psychology, Stockholm University, Sweden
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Abstract
SummaryCognitive–behavioural therapy (CBT) is a psychological treatment approach that can be delivered not only on a one-to-one basis but also to groups and in self-help formats. However, the evidence base supporting individual CBT is more extensive than the research regarding group CBT. This is likely to influence the choice of services that develop in the Improving Access to Psychological Therapies (IAPT) programme for the treatment of depression and anxiety disorders in primary care in England. This article outlines the different forms that group CBT takes, the way in which it may benefit people and the current evidence base supporting its use for anxiety and depression. It also outlines the advantages of group or individual CBT and describes those patients who appear to be best suited to a specific delivery.
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Sabetnejad Z, Assarian F, Omidi A, Najarzadegan MR. Effectiveness of cognitive behavioral therapy and fluoxetine on sexual function of women with obsessive compulsive disorder: A double-blind randomized controlled trial. Electron Physician 2016; 8:3156-3163. [PMID: 28070247 PMCID: PMC5217806 DOI: 10.19082/3156] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2016] [Accepted: 07/28/2016] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Obsessive compulsive disorder (OCD) is a mental health concern due to its various negative consequences, especially in sexual function. Therefore, the treatment of sexual dysfunction in women with OCD is important in order to improve the patient's marital function and mental health. OBJECTIVES To compare the sexual behavior and sexual and marital satisfaction in women with obsessive-compulsive disorder (OCD) before and after treatment with fluoxetine and cognitive behavior therapy. METHODS This randomized clinical trial was conducted at psychiatric and psychological counseling centers in Kashan (Iran) from January 2, 2014, to December 29, 2014. Fifty-eight women with OCD were included in the study. In order to compare the effectiveness of pharmacological treatment (fluoxetine) and psychological treatment, cognitive behavior therapy (CBT), 58 female patients with OCD (diagnosed based on DSM-IV-T criteria) were randomized equally to either fluoxetine (at a dose of 60-80 mg daily for 3 months) or CBT (10 45-minute sessions). OCD and sexual behavior status of the patients before and after the intervention was assessed with the Yale-Brown Obsessive Compulsive Scale (Y-BOCS) and Female Sexual Function Index (FSFI) questionnaire, respectively. The data were analyzed using SPSS version 22. To compare changes between the two groups, an independent T-test was used. Finally, the effects of all potential factors on treatment outcome were analyzed using factorial ANCOVA. RESULTS The mean score for OCD in the fluoxetine group was 25.6 ± 4.8 at the beginning of the experiment and 18.79 ± 4.26 at the end of the study, while in the CBT group it was 25.6 ± 4.8 and 18.79 ± 4.26, respectively. No significant differences were found between two groups regarding obsession score changes. These scores in fluoxetine group were 58.1 and 52.8, respectively (p=0.046). There was a significant difference between the two groups in terms of sexual performance (p=0.003). CONCLUSION In this study, our findings demonstrate a significant reduction in symptom severity of OCD after treatment with fluoxetine and CBT, indicating CBT can be an alternative for fluoxetine therapy in such patients. Therefore, both pharmacotherapy and CBT can be used for this purpose in clinical practices, but more studies are needed. CLINICAL TRIAL REGISTRATION The trial was registered at the Iranian Registry of Clinical Trials (http://www.irct.ir) with the Irct ID: IRCT2013091014619N1. FUNDING The authors received no financial support for the research, authorship, and/or publication of this article.
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Affiliation(s)
- Zahra Sabetnejad
- M.D., Psychiatrist, Department of Psychiatry, Faculty of Medicine, Kashan University of Medical Sciences, Kashan, Iran
| | - Fatemeh Assarian
- M.D., Psychiatrist, Assistant Professor, Department of Psychiatry, Faculty of Medicine, Kashan University of Medical Sciences, Kashan, Iran
| | - Abdollah Omidi
- Ph.D., Psychologist, Associate Professor, Department of Clinical Psychology, Faculty of Medicine, Kashan University of Medical Sciences, Kashan, Iran
| | - Mohammad Reza Najarzadegan
- M.D., Psychiatry Resident, Department of Psychiatry, Faculty of Medicine, Iran University of Medical Sciences, Tehran, Iran
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13
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Individualized Intensive Treatment for Obsessive-Compulsive Disorder: A Team Approach. COGNITIVE AND BEHAVIORAL PRACTICE 2016. [DOI: 10.1016/j.cbpra.2014.09.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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14
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Whiteside SPH, McKay D, De Nadai AS, Tiede MS, Ale CM, Storch EA. A baseline controlled examination of a 5-day intensive treatment for pediatric obsessive-compulsive disorder. Psychiatry Res 2014; 220:441-6. [PMID: 25070176 DOI: 10.1016/j.psychres.2014.07.006] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2013] [Revised: 06/30/2014] [Accepted: 07/06/2014] [Indexed: 01/22/2023]
Abstract
This study extends support for a 5-day intensive exposure and response prevention (ERP) treatment protocol for pediatric obsessive compulsive disorder (OCD). Twenty-two children with OCD received ERP treatment twice daily for 5 days. The treatment also emphasized teaching children and parents how to conduct ERP independently after they returned home. Symptoms were assessed at four time-points: Baseline, 4 weeks later at pre-treatment, one week after the intensive treatment 5-day treatment, and at 3 month follow-up. Changes on the primary outcome measure, clinician severity ratings on the Anxiety Disorders Interview Schedule for Children, and secondary measures, indicated that OCD symptoms remained stable from the evaluation to baseline and improved significantly from baseline to follow-up. Moreover, parental accommodation of OCD decreased significantly from baseline to post-treatment and from post-treatment to follow-up. These data suggest that the 5-day intervention demonstrates efficacy in reducing OCD symptoms and may initiate change in parent accommodation that continues to improve after the family returns home.
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Affiliation(s)
| | - Dean McKay
- Department of Psychology, Fordham University, Bronx, NY, USA
| | - Alessandro S De Nadai
- Departments of Pediatrics and Psychiatry & Behavioral Neurosciences, University of South Florida, St. Petersburg, FL, USA
| | - Michael S Tiede
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA
| | - Chelsea M Ale
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA
| | - Eric A Storch
- Departments of Pediatrics and Psychiatry & Behavioral Neurosciences, University of South Florida, St. Petersburg, FL, USA; Rogers Behavioral Health - Tampa Bay, Tampa, FL, USA; All Children׳s Hospital - Johns Hopkins Medicine, St. Petersburg, FL, USA
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15
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Brennan BP, Lee C, Elias JA, Crosby JM, Mathes BM, Andre MC, Gironda CM, Pope HG, Jenike MA, Fitzmaurice GM, Hudson JI. Intensive residential treatment for severe obsessive-compulsive disorder: characterizing treatment course and predictors of response. J Psychiatr Res 2014; 56:98-105. [PMID: 24909787 PMCID: PMC4112460 DOI: 10.1016/j.jpsychires.2014.05.008] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2014] [Revised: 04/14/2014] [Accepted: 05/13/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND Intensive residential treatment (IRT) is effective for severe, treatment-resistant obsessive-compulsive disorder (OCD). We sought to characterize predictors and course of response to IRT. METHODS Admission, monthly, and discharge data were collected on individuals receiving IRT. We examined the association between baseline characteristics and percent change in OCD symptoms as measured by the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) using linear regression. We compared baseline characteristics of IRT responders (≥35% reduction in Y-BOCS) versus non-responders, and of patients who did versus those who did not achieve wellness (Y-BOCS ≤ 12) using non-parametric tests. To examine the course of OCD severity over time, we used linear mixed-effects models with randomly varying intercepts and slopes. RESULTS We evaluated 281 individuals admitted to an IRT program. Greater baseline Y-BOCS scores were associated with a significantly greater percent reduction in Y-BOCS scores (β = -1.49 ([95% confidence interval: -2.06 to -0.93]; P < .001)). IRT responders showed significantly greater baseline Y-BOCS scores than non-responders (mean (SD) 28 (5.2) vs. 25.6 (5.8); P = .003) and lower past-year alcohol use scores than non-responders (1.4 (1.9) vs. 2.1 (2.2); P = .01). Participants who achieved wellness displayed lower hoarding factor scores than those who did not (5 (4.6) vs. 9.53 (6.3); P = .03). OCD symptoms declined rapidly over the first month but more slowly over the remaining two months. CONCLUSIONS Higher baseline OCD severity, lower past-year alcohol use, and fewer hoarding symptoms predicted better response to IRT. IRT yielded an initial rapid reduction in OCD symptoms, followed by a slower decline after the first month.
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Affiliation(s)
- Brian P. Brennan
- Biological Psychiatry Laboratory, McLean Hospital, Belmont, MA,Obsessive-Compulsive Disorder Institute, McLean Hospital, Belmont, MA,Department of Psychiatry, Harvard Medical School, Boston, MA
| | - Catherine Lee
- Department of Biostatistics, Harvard School of Public Health, Boston, MA
| | - Jason A. Elias
- Obsessive-Compulsive Disorder Institute, McLean Hospital, Belmont, MA,Department of Psychiatry, Harvard Medical School, Boston, MA
| | - Jesse M. Crosby
- Obsessive-Compulsive Disorder Institute, McLean Hospital, Belmont, MA
| | | | - Marie-Christine Andre
- Obsessive-Compulsive Disorder Institute, McLean Hospital, Belmont, MA,Psychology Department, Suffolk University, Boston, MA
| | | | - Harrison G. Pope
- Biological Psychiatry Laboratory, McLean Hospital, Belmont, MA,Department of Psychiatry, Harvard Medical School, Boston, MA
| | - Michael A. Jenike
- Obsessive-Compulsive Disorder Institute, McLean Hospital, Belmont, MA,Department of Psychiatry, Harvard Medical School, Boston, MA
| | - Garrett M. Fitzmaurice
- Department of Biostatistics, Harvard School of Public Health, Boston, MA,Laboratory for Psychiatric Biostatistics, McLean Hospital, Belmont, MA
| | - James I. Hudson
- Biological Psychiatry Laboratory, McLean Hospital, Belmont, MA,Department of Psychiatry, Harvard Medical School, Boston, MA
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16
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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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17
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Kugler BB, Lewin AB, Phares V, Geffken GR, Murphy TK, Storch EA. Quality of life in obsessive-compulsive disorder: the role of mediating variables. Psychiatry Res 2013; 206:43-9. [PMID: 23122558 DOI: 10.1016/j.psychres.2012.10.006] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2012] [Revised: 10/03/2012] [Accepted: 10/10/2012] [Indexed: 11/26/2022]
Abstract
This study examined the association of various clinical features of obsessive-compulsive disorder (OCD) with quality of life (QoL) in 102 adults with a principal diagnosis of OCD. Participants were assessed by trained clinicians using the Anxiety Disorders Interview Schedule 4th edition, the Yale-Brown Obsessive-Compulsive Scale, and an unstructured clinical interview. Subjects completed the MOS-36 Item Short Form Health Survey, and Beck Depression Inventory-II. Obsessive-compulsive symptom severity was negatively correlated with emotional health, social functioning and general health QoL. Depressive symptoms mediated the relationship between obsessive-compulsive symptom severity and emotional health, social functioning and general health QoL. Additionally, interference of obsessive-compulsive symptoms mediated the relationship between obsessive-compulsive symptom severity and emotional health, social functioning and general health QoL. Resistance against obsessive-compulsive symptoms mediated the relationship between obsessive-compulsive symptom severity and social functioning QoL. Diminished QoL is present in persons with OCD and is essential in understanding the complete clinical picture of OCD.
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Affiliation(s)
- Brittany B Kugler
- Department of Psychology, University of South Florida, 4202 E. Fowler Avenue, Tampa, FL 33620, USA
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18
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Andersson E, Enander J, Andrén P, Hedman E, Ljótsson B, Hursti T, Bergström J, Kaldo V, Lindefors N, Andersson G, Rück C. Internet-based cognitive behaviour therapy for obsessive-compulsive disorder: a randomized controlled trial. Psychol Med 2012; 42:2193-2203. [PMID: 22348650 PMCID: PMC3435873 DOI: 10.1017/s0033291712000244] [Citation(s) in RCA: 139] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2011] [Revised: 01/25/2012] [Accepted: 01/26/2012] [Indexed: 11/06/2022]
Abstract
BACKGROUND Cognitive behaviour therapy (CBT) is an effective treatment for obsessive-compulsive disorder (OCD) but access to CBT is limited. Internet-based CBT (ICBT) with therapist support is potentially a more accessible treatment. There are no randomized controlled trials testing ICBT for OCD. The aim of this study was to investigate the efficacy of ICBT for OCD in a randomized controlled trial. METHOD Participants (n=101) diagnosed with OCD were randomized to either 10 weeks of ICBT or to an attention control condition, consisting of online supportive therapy. The primary outcome measure was the Yale-Brown Obsessive Compulsive Scale (YBOCS) administered by blinded assessors. RESULTS Both treatments lead to significant improvements in OCD symptoms, but ICBT resulted in larger improvements than the control condition on the YBOCS, with a significant between-group effect size (Cohen's d) of 1.12 (95% CI 0.69-1.53) at post-treatment. The proportion of participants showing clinically significant improvement was 60% (95% CI 46-72) in the ICBT group compared to 6% (95% CI 1-17) in the control condition. The results were sustained at follow-up. CONCLUSIONS ICBT is an efficacious treatment for OCD that could substantially increase access to CBT for OCD patients. Replication studies are warranted.
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Affiliation(s)
- E Andersson
- Department of Clinical Neuroscience, Division of Psychiatry, Karolinska Institutet, Stockholm, Sweden.
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19
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Gallo KP, Chan PT, Buzzella BA, Whitton SW, Pincus DB. The impact of an 8-day intensive treatment for adolescent panic disorder and agoraphobia on comorbid diagnoses. Behav Ther 2012; 43:153-9. [PMID: 22304887 PMCID: PMC3510263 DOI: 10.1016/j.beth.2011.05.002] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2010] [Revised: 05/15/2011] [Accepted: 05/16/2011] [Indexed: 11/30/2022]
Abstract
Previous research findings have shown positive effects of cognitive-behavioral therapy for primary anxiety disorders as well as for nonprimary, co-occurring anxiety disorders. In this study, we analyzed data from an existing randomized controlled trial of intensive treatment for panic disorder with or without agoraphobia (PDA) to examine the effects of the treatment on comorbid psychiatric diagnoses. The overall frequency and severity of aggregated comorbid diagnoses decreased in a group of adolescents who received an 8-day treatment for PDA. Results suggest that an 8-day treatment for PDA can alleviate the symptoms of some specific comorbid clinical diagnoses; in particular specific phobias, generalized anxiety disorder, and social phobia. These findings suggest that an intensive treatment for PDA is associated with reductions in comorbid symptoms even though disorders other than PDA are not specific treatment targets.
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Affiliation(s)
- Kaitlin P Gallo
- Department of Psychology, Center for Anxiety and Related Disorders, Boston University, 648 Beacon Street, Boston, MA 02215, USA.
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20
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Belotto-Silva C, Diniz JB, Malavazzi DM, Valério C, Fossaluza V, Borcato S, Seixas AA, Morelli D, Miguel EC, Shavitt RG. Group cognitive-behavioral therapy versus selective serotonin reuptake inhibitors for obsessive-compulsive disorder: a practical clinical trial. J Anxiety Disord 2012; 26:25-31. [PMID: 21907540 DOI: 10.1016/j.janxdis.2011.08.008] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2011] [Revised: 08/11/2011] [Accepted: 08/12/2011] [Indexed: 11/16/2022]
Abstract
Clinical effectiveness of group cognitive-behavioral therapy (GCBT) versus fluoxetine in obsessive-compulsive disorder outpatients that could present additional psychiatric comorbidities was assessed. Patients (18-65 years; baseline Yale-Brown Obsessive-Compulsive-Scale [Y-BOCS] scores ≥ 16; potentially presenting additional psychiatric comorbidities) were sequentially allocated for treatment with GCBT (n=70) or fluoxetine (n=88). Mean Y-BOCS scores decreased by 23.13% in the GCBT and 21.54% in the SSRI groups (p=0.875). Patients presented a mean of 2.7 psychiatric comorbidities, and 81.4% showed at least one additional disorder. A reduction of at least 35% in baseline Y-BOCS scores and CGI ratings of 1 (much better) or 2 (better) was achieved by 33.3% of GCBT patients and 27.7% in the SSRI group (p=0.463). The Y-BOCS reduction was significantly lower in patients with one or more psychiatric comorbidities (21.15%, and 18.73%, respectively) than in those with pure OCD (34.62%; p=0.034). Being male, having comorbidity of Major Depression, Social Phobia, or Dysthymia predicted a worse response to both treatments. Response rates to both treatments were similar and lower than reported in the literature, probably due to the broad inclusion criteria and the resulting sample more similar to the real world population.
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Affiliation(s)
- Cristina Belotto-Silva
- Department and Institute of Psychiatry, Clinical Hospital, University of São Paulo Medical School, São Paulo, Brazil.
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21
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Speisman BB, Storch EA, Abramowitz JS. Postpartum Obsessive‐Compulsive Disorder. J Obstet Gynecol Neonatal Nurs 2011; 40:680-90. [DOI: 10.1111/j.1552-6909.2011.01294.x] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
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22
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Mancebo MC, Eisen JL, Sibrava NJ, Dyck IR, Rasmussen SA. Patient utilization of cognitive-behavioral therapy for OCD. Behav Ther 2011; 42:399-412. [PMID: 21658523 PMCID: PMC3857709 DOI: 10.1016/j.beth.2010.10.002] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2010] [Revised: 10/27/2010] [Accepted: 10/27/2010] [Indexed: 11/19/2022]
Abstract
The current study examined utilization of cognitive-behavioral therapy (CBT) by individuals receiving treatment for obsessive-compulsive disorder (OCD). Participants were 202 adults with primary DSM-IV OCD who enrolled in a longitudinal, observational study of the course of OCD and completed 2 years of annual follow-up interviews using the Longitudinal Interval Follow-Up Evaluation. One hundred twenty participants reported that a mental health professional recommended CBT for their OCD symptoms at some point during the 2-year follow-up period. One quarter (n = 31) of these participants did not initiate CBT despite receiving a treatment recommendation. Thirty-one percent of the 89 participants who entered CBT endorsed dropping out of CBT prematurely and less than one third received an adequate "dose" of CBT sessions. Self-reported CBT drop-out rates were significantly greater than attrition rates reported in clinical trials using intensive schedules of exposure and ritual prevention (EX/RP). Perceived environmental barriers and fears regarding treatment participation were the most frequently endorsed reasons for not participating or dropping out of CBT. Despite its efficacy for OCD, many individuals with clinically significant symptoms fail to initiate CBT when recommended by a mental health professional, receive treatments that are less intensive than those used in clinical trials, or drop out of treatment prematurely. Financial costs of CBT, difficulty attending sessions, and fears regarding treatment are significant barriers to initiating and completing therapy.
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Affiliation(s)
- Maria C Mancebo
- Butler Hospital, Brown University Medical School, Providence, RI 02906, USA.
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23
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Intensive cognitive-behavioural treatment for women with postnatal obsessive-compulsive disorder: A consecutive case series. Behav Res Ther 2011; 49:422-6. [DOI: 10.1016/j.brat.2011.03.006] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2010] [Revised: 03/16/2011] [Accepted: 03/17/2011] [Indexed: 11/23/2022]
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Lewin AB, De Nadai AS, Park J, Goodman WK, Murphy TK, Storch EA. Refining clinical judgment of treatment outcome in obsessive-compulsive disorder. Psychiatry Res 2011; 185:394-401. [PMID: 20846725 DOI: 10.1016/j.psychres.2010.08.021] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2010] [Revised: 08/17/2010] [Accepted: 08/18/2010] [Indexed: 10/19/2022]
Abstract
This research aimed to provide clinicians and investigators with optimal treatment outcome criteria for accurately predicting response and remission in both research studies and clinical practice. Data from 153 adult OCD outpatients (ages 18-79) who had participated in a treatment outcome study were examined. Signal detection analysis was conducted to compare levels of Yale-Brown Obsessive Compulsive Scale (Y-BOCS) symptom percent reductions and post treatment absolute scores with Clinical Global Impression (CGI) ratings of symptom improvement and severity. Optimal cutoff criteria were based on sensitivity, specificity and efficiency and were assessed via the Quality Receiver Operating Characteristic curve. A Y-BOCS reduction of 45% was observed to be the most efficient for predicting response in research trials, whereas a reduction of 35% may be optimal for clinical use. A 55% Y-BOCS reduction was determined to be the optimal cutoff for predicting remission in both clinical and research settings. A Y-BOCS absolute raw score of 12 or less was optimal for predicting remission in a clinical setting and a raw score of 14 or below was most favorable in research trials. This research provides the first empirical contrast of optimal outcome criteria in OCD based on differing ideals of both research and practice.
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Affiliation(s)
- Adam B Lewin
- Department of Pediatrics, Rothman Center for Neuropsychiatry, University of South Florida College of Medicine, Saint Petersburg, FL, USA.
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Oldfield VB, Salkovskis PM, Taylor T. Time-intensive cognitive behaviour therapy for obsessive-compulsive disorder: A case series and matched comparison group. BRITISH JOURNAL OF CLINICAL PSYCHOLOGY 2011; 50:7-18. [DOI: 10.1348/014466510x490073] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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26
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Price MC, Salsman NL. Exposure and Response Prevention for the Treatment of Late-Onset Obsessive-Compulsive Disorder in an 82-Year-Old Man. Clin Case Stud 2010. [DOI: 10.1177/1534650110387294] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This case study demonstrates an effective course of exposure/response prevention (EX/RP) in an 82-year-old man with late-onset obsessive-compulsive disorder (OCD) with no apparent neurobiological changes. The results indicated significant reductions in time spent on rituals, anxiety associated with obsessions, and depression. Treatment gains were maintained and continued to progress through appropriate aftercare. In this case, a graduate student therapist learned and applied EX/RP after engaging in a training process. Results highlight the importance of life stressors in the development of OCD and that EX/RP can be applied to older adults with certain modifications. The results are promising for the implementation of EX/RP in older adults with OCD; however, future randomized controlled trials are needed.
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Graziano PA, Callueng CM, Geffken GR. Cognitive-Behavioral Treatment of an 11-Year-Old Male Presenting With Emetophobia: A Case Study. Clin Case Stud 2010. [DOI: 10.1177/1534650110384436] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The goal of the current case study was to illustrate an evidence-based assessment and the cognitive-behavioral treatment of an 11-year-old male with emetophobia. A multimodal assessment of the child’s anxiety symptoms was conducted, including a semistructured diagnostic interview (Anxiety Disorders Interview Schedule: Child and Parent Versions), parent report (Behavior Assessment System for Children—Second Edition.), and child self-report (Revised Children’s Manifest Anxiety Scale and Child Depression Inventory). Emetophobia symptoms were assessed via parent and child report of the Emetophobia Questionnaire. Treatment included graduated exposure, cognitive restructuring, and parent training. Improvement was seen within 22 sessions and maintained at a 6 months follow-up. In addition to a reduction in symptoms of emetophobia, discontinuation of medication, and no longer meeting Diagnostic and Statistical Manual of Mental Disorders (4th ed.; DSM-IV) criteria for specific phobia, treatment gains also included a reduction in internalizing and somatization symptoms as well as an increase in the patient’s adaptive skills. This case study illustrates the use of CBT along with parent training as an efficacious treatment for children with emetophobia. It also demonstrates how to incorporate simple, everyday technology (i.e., Internet) to simulate exposures that are otherwise difficult to duplicate in the therapy session.
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An uncontrolled examination of a 5-day intensive treatment for pediatric OCD. Behav Ther 2010; 41:414-22. [PMID: 20569789 DOI: 10.1016/j.beth.2009.11.003] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2009] [Revised: 11/15/2009] [Accepted: 11/16/2009] [Indexed: 11/20/2022]
Abstract
This study examined the feasibility of a 5-day intensive treatment for pediatric obsessive-compulsive disorder (OCD). Fifteen children with OCD received a week-long treatment based on exposure and response prevention (ERP). The intervention also emphasized teaching children and parents how to conduct ERP independently at home. All families completed the week-long treatment and symptoms improved significantly as measured by self- and parent-report forms, as well as the Children's Yale-Brown Obsessive-Compulsive Scale, F(2, 22)=45.67, p<.05. Total CY-BOCS scores decreased significantly from pretreatment (M=28.00, SD=4.24) to posttreatment [M=16.00, SD=6.0, F(1, 11)=34.38, p<.05] and from posttreatment to 5-month follow-up [M=11.5, SD=7.3; F(1, 11)=12.94, p<.05]. This level of improvement was consistent with other intensive treatments for pediatric OCD. The study suggests that the 5-day program is a promising treatment for children with OCD who do not have access to local providers.
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Storch EA, McKay D, Reid JM, Geller DA, Goodman WK, Lewin AB, Murphy TK. D-Cycloserine Augmentation of Cognitive-Behavioral Therapy: Directions for Pilot Research in Pediatric Obsessive-Compulsive Disorder. CHILD & YOUTH CARE FORUM 2010. [DOI: 10.1007/s10566-010-9094-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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30
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Clinical Correlates and Treatment Response of the Yale-Brown Obsessive Compulsive Scale Auxiliary Items. COGNITIVE THERAPY AND RESEARCH 2009. [DOI: 10.1007/s10608-009-9275-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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31
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Ehrenreich JT, Santucci LC. SPECIAL SERIES: Intensive Cognitive-Behavioral Treatments for Child and Adolescent Anxiety Disorders. COGNITIVE AND BEHAVIORAL PRACTICE 2009. [DOI: 10.1016/j.cbpra.2009.04.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Fornaro M, Gabrielli F, Albano C, Fornaro S, Rizzato S, Mattei C, Solano P, Vinciguerra V, Fornaro P. Obsessive-compulsive disorder and related disorders: a comprehensive survey. Ann Gen Psychiatry 2009; 8:13. [PMID: 19450269 PMCID: PMC2686696 DOI: 10.1186/1744-859x-8-13] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2008] [Accepted: 05/18/2009] [Indexed: 12/16/2022] Open
Abstract
Our aim was to present a comprehensive, updated survey on obsessive-compulsive disorder (OCD) and obsessive-compulsive related disorders (OCRDs) and their clinical management via literature review, critical analysis and synthesis. Information on OCD and OCRD current nosography, clinical phenomenology and etiology, may lead to a better comprehension of their management. Clinicians should become familiar with the broad spectrum of OCD disorders, since it is a pivotal issue in current clinical psychiatry.
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Affiliation(s)
- Michele Fornaro
- Dipartimento di Neuroscienze, Oftalmologia e Genetica (DINOG), Sezione di Psichiatria, Università di Genova, Genova, Italy.
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