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Gogoi R, Sharma BS. A holistic psychotherapeutic approach for the management of obsessive-compulsive disorder with poor insight. JOURNAL OF MENTAL HEALTH AND HUMAN BEHAVIOUR 2021. [DOI: 10.4103/jmhhb.jmhhb_56_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Abstract
AbstractThe experience of obsessive-compulsive disorder (OCD) symptoms that have a religious theme is common. Recent research has found that religious participants with religious OCD symptoms frequently turn to religious advisors, such as imams or clergy, for help to understand and alleviate their symptoms. As such, the advice provided by imams or clergy may have an important impact on the response of the person seeking help. This study examined the attitudes, beliefs and experiences of 64 Muslim imams with mosque-goers who had religious OCD symptoms, particularly scrupulosity. This study also examined imams’ familiarity with first-line psychological treatments for OCD such as Exposure and Response Prevention (ERP). Sunni imams from Australia and Shia imams from Iran completed an online survey based on the research of Deacon, Vincent, and Zhang (2012), which was conducted with Christian clergy in the United States. Results showed that the majority of imams were unfamiliar with scrupulosity as a possible symptom of a mental health problem, such as OCD, and with ERP as a recognised treatment for OCD. While 37% of participants reported having been approached by mosque-goers for help with scrupulosity, only 9% referred mosque-goers to mental health professionals, and only one imam reported having referred a mosque-goer for ERP. Sunni imams located in Australia were more likely to provide advice inconsistent with the ERP approach and were also significantly less likely than Shia imams located in Iran to recommend referral to a mental health professional who was not affiliated with their own religious denomination. Finally, Sunni imams had significantly higher scores than Shia imams on Thought Action Fusion (TAF) subscales. Results of multiple regression analysis revealed that TAF explained a considerable amount of the variance related to ERP-inconsistent advice. Research implications and limitations are discussed.
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Wu MS, Rozenman M, Peris TS, O'Neill J, Bergman RL, Chang S, Piacentini J. Comparing OCD-affected youth with and without religious symptoms: Clinical profiles and treatment response. Compr Psychiatry 2018; 86:47-53. [PMID: 30077806 PMCID: PMC6245548 DOI: 10.1016/j.comppsych.2018.07.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Revised: 07/14/2018] [Accepted: 07/21/2018] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND Childhood obsessive-compulsive disorder (OCD) is a heterogeneous psychiatric condition, with varied symptom presentations that have been differentially associated with clinical characteristics and treatment response. One OCD symptom cluster of particular interest is religious symptoms, including fears of offending religious figures/objects; patients affected by these symptoms have been characterized as having greater overall OCD severity and poorer treatment response. However, the extant literature primarily examines this symptom subtype within adults, leaving a gap in our understanding of this subtype in youth. METHOD Consequently, this study examined whether presence of religious symptoms in OCD-affected children and adolescents (N = 215) was associated with greater clinical impairments across OCD symptoms and severity, insight, other psychiatric comorbidity, family variables, or worse treatment response. RESULTS Results found that youth with religious OCD symptoms presented with higher OCD symptom severity and exhibited more symptoms in the aggressive, sexual, somatic, and checking symptom cluster, as well as the symmetry, ordering, counting, and repeating cluster. Religious OCD symptoms were also significantly associated with poorer insight and higher family expressiveness. No differences in treatment response were observed in youths with versus without religious OCD symptoms. CONCLUSION Ultimately, youths with religious OCD symptoms only differed from their OCD-affected counterparts without religious symptoms on a minority of clinical variables; this suggests they may be more comparable to youths without religious OCD symptoms than would be expected based on the adult OCD literature and highlights the importance of examining these symptoms within a pediatric OCD sample.
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Affiliation(s)
- Monica S Wu
- UCLA Semel Institute for Neuroscience and Human Behavior, Los Angeles, CA, USA.
| | - Michelle Rozenman
- UCLA Semel Institute for Neuroscience and Human Behavior, Los Angeles, CA, USA
| | - Tara S Peris
- UCLA Semel Institute for Neuroscience and Human Behavior, Los Angeles, CA, USA
| | - Joseph O'Neill
- UCLA Semel Institute for Neuroscience and Human Behavior, Los Angeles, CA, USA
| | - R Lindsey Bergman
- UCLA Semel Institute for Neuroscience and Human Behavior, Los Angeles, CA, USA
| | - Susanna Chang
- UCLA Semel Institute for Neuroscience and Human Behavior, Los Angeles, CA, USA
| | - John Piacentini
- UCLA Semel Institute for Neuroscience and Human Behavior, Los Angeles, CA, USA
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Andersson E, Ljótsson B, Hedman E, Hesser H, Enander J, Kaldo V, Andersson G, Lindefors N, Rück C. Testing the Mediating Effects of Obsessive Beliefs in Internet-Based Cognitive Behaviour Therapy for Obsessive-Compulsive Disorder: Results from a Randomized Controlled Trial. Clin Psychol Psychother 2014; 22:722-32. [PMID: 25418575 DOI: 10.1002/cpp.1931] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2014] [Revised: 10/21/2014] [Accepted: 10/22/2014] [Indexed: 11/05/2022]
Abstract
UNLABELLED Although cognitive interventions for obsessive-compulsive disorder (OCD) have been tested in randomized trials, there are few trials that have tested the specific mechanisms of cognitive interventions, i.e. how they achieve their effects. In this study, we aimed to investigate the mediating effects of a short cognitive intervention in the treatment of OCD and used data from a recently conducted randomized controlled trial where 101 participants were allocated to either Internet-based CBT (ICBT) or to a control condition. Obsessive beliefs were measured at pre-treatment, at the time they had received the cognitive intervention, and also at post-treatment. Weekly OCD symptoms were measured throughout the 10 weeks of treatment. We hypothesized that (1) the ICBT group would have greater reductions in obsessive beliefs (controlling for change in OCD symptoms) after completing the cognitive intervention, and that (2) this reduction would, in turn, predict greater OCD symptom reduction throughout the rest of the treatment period. Contrary to our expectations, the longitudinal mediation analysis indicated that (1) being randomized to ICBT actually increased the degree of obsessive beliefs after receiving the cognitive intervention at weeks 1-3, and (2) increase in obsessive beliefs predicted better outcome later in treatment. However, when repeating the analysis using cross-sectional data at post-treatment, the results were in line with the initial hypotheses. Results were replicated when the control condition received ICBT. We conclude that, although obsessive beliefs were significantly reduced at post-treatment for the ICBT group, early increase rather than decrease in obsessive beliefs predicted favourable outcome. KEY PRACTITIONER MESSAGE This study investigated the impact of cognitive interventions on obsessive beliefs for patients with obsessive-compulsive disorder. Results showed that a sudden increase in obsessive beliefs is not an indicator of worse treatment response. On the contrary, it is more likely that the patient is better off when having this sudden increase. Clinicians should not be alarmed if the patient has a sudden increase in obsessive beliefs, but we do recommend the clinician to investigate the reasons for this further.
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Affiliation(s)
- Erik Andersson
- Department of Clinical Neuroscience, Division of Psychiatry, Karolinska Institutet, Stockholm, Sweden.,Department of Clinical Neuroscience, Division of Psychology, Karolinska Institutet, Stockholm, Sweden
| | - Brjánn Ljótsson
- Department of Clinical Neuroscience, Division of Psychology, Karolinska Institutet, Stockholm, Sweden
| | - Erik Hedman
- Department of Clinical Neuroscience, Division of Psychology, Karolinska Institutet, Stockholm, Sweden.,Osher Center for Integrative Medicine, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Hugo Hesser
- Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden
| | - Jesper Enander
- Department of Clinical Neuroscience, Division of Psychiatry, Karolinska Institutet, Stockholm, Sweden
| | - Viktor Kaldo
- Department of Clinical Neuroscience, Division of Psychiatry, Karolinska Institutet, Stockholm, Sweden
| | - Gerhard Andersson
- Department of Clinical Neuroscience, Division of Psychiatry, Karolinska Institutet, Stockholm, Sweden.,Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden
| | - Nils Lindefors
- Department of Clinical Neuroscience, Division of Psychiatry, Karolinska Institutet, Stockholm, Sweden
| | - Christian Rück
- Department of Clinical Neuroscience, Division of Psychiatry, Karolinska Institutet, Stockholm, Sweden
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Külz AK, Landmann S, Cludius B, Hottenrott B, Rose N, Heidenreich T, Hertenstein E, Voderholzer U, Moritz S. Mindfulness-based cognitive therapy in obsessive-compulsive disorder: protocol of a randomized controlled trial. BMC Psychiatry 2014; 14:314. [PMID: 25403813 PMCID: PMC4239327 DOI: 10.1186/s12888-014-0314-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2014] [Accepted: 10/24/2014] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Obsessive-compulsive disorder (OCD) is a very disabling condition with a chronic course, if left untreated. Though cognitive behavioral treatment (CBT) with or without selective serotonin reuptake inhibitors (SSRI) is the method of choice, up to one third of individuals with obsessive-compulsive disorder (OCD) do not respond to treatment in terms of at least 35% improvement of symptoms. Mindfulness based cognitive therapy (MBCT) is an 8-week group program that could help OCD patients with no or only partial response to CBT to reduce OC symptoms and develop a helpful attitude towards obsessions and compulsive urges. METHODS/DESIGN This study is a prospective, bicentric, assessor-blinded, randomized, actively-controlled clinical trial. 128 patients with primary diagnosis of OCD according to DSM-IV and no or only partial response to CBT will be recruited from in- and outpatient services as well as online forums and the media. Patients will be randomized to either an MBCT intervention group or to a psycho-educative coaching group (OCD-EP) as an active control condition. All participants will undergo eight weekly sessions with a length of 120 minutes each of a structured group program. We hypothesize that MBCT will be superior to OCD-EP in reducing obsessive-compulsive symptoms as measured by the Yale-Brown-Obsessive-Compulsive Scale (Y-BOCS) following the intervention and at 6- and 12-months-follow-up. Secondary outcome measures include depressive symptoms, quality of life, metacognitive beliefs, self-compassion, mindful awareness and approach-avoidance tendencies as measured by an approach avoidance task. DISCUSSION The results of this study will elucidate the benefits of MBCT for OCD patients who did not sufficiently benefit from CBT. To our knowledge, this is the first randomized controlled study assessing the effects of MBCT on symptom severity and associated parameters in OCD. TRIAL REGISTRATION German Clinical Trials Register DRKS00004525 . Registered 19 March 2013.
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Affiliation(s)
- Anne Katrin Külz
- Clinic of Psychiatry and Psychotherapy, University Medical Center Freiburg, Freiburg, Germany.
| | - Sarah Landmann
- Clinic of Psychiatry and Psychotherapy, University Medical Center Freiburg, Freiburg, Germany.
| | - Barbara Cludius
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
| | - Birgit Hottenrott
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
| | - Nina Rose
- Clinic of Psychiatry and Psychotherapy, University Medical Center Freiburg, Freiburg, Germany.
| | | | - Elisabeth Hertenstein
- Clinic of Psychiatry and Psychotherapy, University Medical Center Freiburg, Freiburg, Germany.
| | | | - Steffen Moritz
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
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Besiroglu L, Karaca S, Keskin I. Scrupulosity and obsessive compulsive disorder: the cognitive perspective in Islamic sources. JOURNAL OF RELIGION AND HEALTH 2014; 53:3-12. [PMID: 22395755 DOI: 10.1007/s10943-012-9588-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
A moral/religious subtype of obsessive compulsive disorder has been termed as scrupulosity by mental health professionals. Since ultimate feared consequence in scrupulous individuals is religious or moral in nature, it also presents interesting and difficult issue for religious authorities. This article focuses on various aspects of scrupulosity that have until now been poorly conceptualized in Islamic world and provides a conceptual cognitive framework and analysis of scrupulosity according to Islamic sources.
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Affiliation(s)
- Lutfullah Besiroglu
- Department of Psychiatry, Faculty of Medicine, Yuzuncu Yil University, 65200, Van, Turkey,
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