Competitive Memory Training (COMET) for OCD: A Self-treatment Approach to Obsessions

The effectiveness of unguided self-help psychological interventions for obsessive-compulsive disorder: A meta-analysis of randomized controlled trials

BACKGROUND

Evidence-based psychological interventions exist for individuals with obsessive-compulsive disorder (OCD), but many individuals with OCD are unable to access them because of barriers, such as geographical isolation, treatment cost, and stigma etc. Unguided self-help psychological intervention has emerged as a potential solution to this problem. However, there is limited research on its overall effectiveness. This study aimed to address this gap.

METHODS

Comprehensive searches from inception to 1st Jan 2023 were conducted in both international (PubMed, Embase, PsycINFO, International clinical trials registry platform of WHO) and Chinese (China National Knowledge Infrastructure, WeiPu, WanFang, Chinese Clinical Trial Registry) databases. The registered protocol is accessible at https://doi.org/10.17605/OSF.IO/FKB5W. We included randomized controlled trials (RCTs) comparing unguided self-help psychological interventions to control groups for individuals with OCD. The primary outcome was OCD symptom severity, with Hedges' g calculated post-intervention. Heterogeneity was deemed to be low, moderate, and high if the I2 value was quantified 25%, 50%, and 75% respectively. Relative Risks (RRs) was calculated for dropout rates post-intervention. Random-effects models were used for all analyses.

RESULTS

12 RCTs comparing unguided self-help psychological interventions to control groups were identified, with a total of 20 comparisons and 769 OCD patients. Overall, unguided self-help psychological interventions demonstrated a significant moderate effect on reducing OCD symptom severity (g = -0.42; 95% CI [-0.69; -0.14]) compared to control groups, with a moderate heterogeneity (I2 = 59%; 95% CI [22.73; 78.38]). This finding remained significant in sensitivity analyses for the self-rated Yale-Brown Obsessive-Compulsive Scale (Y-BOCS; k = 7, g = -0.46; 95% CI [-0.71; -0.2]) and after removing an outlier (g = -0.37; 95% CI [-0.55; -0.19]), but not for the clinician-rated Y-BOCS (k = 4, g = -0.78; 95% CI [-2.75; 1.19]) and Obsessive Compulsive Inventory-Revised (k = 6, g = -0.26; 95% CI [-0.53; 0]). Subgroup analyses revealed a significant difference in effect size between studies conducting intention-to-treat and completers-only analyses (p = .01). The completers-only analyses demonstrated a moderate significant effect (g = -0.65; 95% CI [-1.08; -0.21]), whereas the effect of the intention-to-treat analyses was not significant (g = -0.18; 95% CI [-0.36; 0]). Participants in the unguided self-help groups exhibited a significantly higher dropout rate (RR = 2.08; 95% CI [1.53; 2.81]) compared to control groups. Furthermore, participants recruited from the community had a higher likelihood of dropping out compared to those recruited from clinical settings (p < .001). Additionally, participants who received cognitive-behavioural therapy intervention were more likely to drop out than those who received other types of intervention (p < .001). Most trials (92%) were rated at a high risk of bias.

CONCLUSION

Unguided self-help psychological interventions demonstrate potential effectiveness in alleviating OCD symptom severity post-intervention. However, caution should be exercised when interpreting the results due to high risk of bias across trials and the relatively small sample size. And the considerable dropout rate might hinder treatment effects. Future studies with strict methodology should investigate the long-term effectiveness of unguided self-help psychological interventions for OCD, explore the reasons for high dropout rates, and improve intervention adherence.

The Lexical Association Technique: A randomized controlled trial with breast cancer patients

Low self-esteem is a vulnerability factor for depressive disorders, and the prevention of psychological disorders is essential in cancer patients. The enhancement of self-esteem in breast cancer patients may therefore be an appropriate clinical target. Previous studies have shown the efficacy of the Lexical Association Technique to enhance self-esteem in healthy subjects. This study aims to test the clinical efficacy and acceptability of the Lexical Association Technique on the self-esteem of cancer patients. A double-blind randomized controlled trial was conducted on 63 breast cancer patients during their radiotherapy treatment. Global self-esteem measures were taken using the Rosenberg Self-Esteem Scale before and after the Lexical Association Technique and 1 month after its end. The results showed a significant improvement in global self-esteem in patients immediately after performing the Lexical Association Technique compared to an active control group. However, the positive effects did not last 1 month. These results confirm the efficacy and suitability of the Lexical Association Technique for cancer patients. Avenues of research are proposed to extend the effects of the technique and increase its transdiagnostic applicability.

Unguided computer-assisted self-help interventions without human contact in patients with obsessive-compulsive disorder: a systematic review and meta-analysis (Preprint)

Background

Computer-assisted treatment may reduce therapist contact and costs and promote client participation. This meta-analysis examined the efficacy and acceptability of an unguided computer-assisted therapy in patients with obsessive-compulsive disorder (OCD) compared with a waiting list or attention placebo.

Objective

This study aimed to evaluate the effectiveness and adherence of computer-assisted self-help treatment without human contact in patients with OCD using a systematic review and meta-analysis approach.

Methods

Randomized controlled trials with participants primarily diagnosed with OCD by health professionals with clinically significant OCD symptoms as measured with validated scales were included. The interventions included self-help treatment through the internet, computers, and smartphones. We excluded interventions that used human contact. We conducted a search on PubMed, Cochrane Central Register of Controlled Trials, EMBASE, World Health Organization International Clinical Trials Registry Platform, and ClinicalTrials.gov, as well as the reference lists of the included studies. The risk of bias was evaluated using version 2 of the Cochrane risk-of-bias tool for randomized trials. We calculated the standardized mean differences for continuous outcomes and risk ratios for dichotomous outcomes. The primary outcomes were short-term improvement of OCD symptoms measured by validated scales and dropout for any reason.

Results

We included 11 randomized controlled trials with a total of 983 participants. The results indicated that unguided computer-assisted self-help therapy was significantly more effective than a waiting list or psychological placebo (standard mean difference −0.47, 95% CI −0.73 to −0.22). Unguided computer-assisted self-help therapy had more dropouts for any reason than waiting list or psychological placebo (risk ratio 1.98, 95% CI 1.21 to 3.23). However, the quality of evidence was very low because of the risk of bias and inconsistent results among the included studies. The subgroup analysis showed that exposure response and prevention and an intervention duration of more than 4 weeks strengthen the efficacy without worsening acceptability. Only a few studies have examined the interaction between participants and systems, and no study has used gamification. Most researchers only used text-based interventions, and no study has used a mobile device. The overall risk of bias of the included studies was high and the heterogeneity of results was moderate to considerable.

Conclusions

Unguided computer-assisted self-help therapy for OCD is effective compared with waiting lists or psychological placebo. An exposure response and prevention component and intervention duration of more than 4 weeks may strengthen the efficacy without worsening the acceptability of the therapy.

Trial Registration

PROSPERO (International Prospective Register of Systematic Reviews) CRD42021264644; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=264644

Low intensity technology-delivered cognitive behavioral therapy for obsessive-compulsive disorder: a meta-analysis

BACKGROUND

Cognitive behavioral therapy (CBT) is a well-established treatment for people suffering from obsessive-compulsive disorder (OCD) and technology-based CBT applications are an emerging treatment option for people with OCD. These applications involve treatment protocols with automated content delivery and relatively low clinical contact. Whilst such CBT applications are promising, however, further investigation is needed to establish the efficacy of this treatment approach for individuals with OCD. The aim of the present study was to review the efficacy of technology-delivered CBT with minimal clinician support for OCD using a meta-analytic approach.

METHODS

Randomized controlled trials (RCT) were identified through PsycINFO, Medline and Scopus resulting in 18 eligible studies (n = 1707). Control conditions comprised both passive (namely no treatment, other treatments and waitlist controls) and active. Measurement of OCD symptoms improvement was the outcome in each study.

RESULTS

Participants in the technology-delivered CBT group scored lower on Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) (g = - 0.59, 95% CI = [- 0.99, - 0.18], p = 0.01), Y-BOCS and Dimensional Obsessive-Compulsive Scale (DOCS) combined (g = - 0.55, 95% CI = [- 0.87, - 0.24], p = 0.003) and Obsessive-Compulsive-Inventory-Revised (OCI-R) (g = - 0.36, 95% CI = [- 0.62, - 0.09], p = 0.02) at post-treatment than passive control groups. There were no significant findings when compared to controls with other treatments.

CONCLUSIONS

This meta-analysis suggests that technology-delivered CBT with low personal contact intensity, relative to passive control groups, is an efficacious and promising treatment option for individuals with OCD. Further research is needed to allow for a comparison with control groups with other treatments.

Positive memory intervention techniques: a scoping review

The scoping review examines and summarises the available knowledge base on intervention techniques focused on positive memories. An iterative series of PsycInfo and Medline searches was conducted up to April 2021 following PRISMA-ScR guidelines. Thirty-nine studies, spanning 12 intervention techniques, were selected and described including: (1) theoretical basis; (2) type of study, sample, and measures; (3) intervention protocol; and (4) results of empirical studies if applicable. Results indicated that most techniques have only been tested in one-two studies with modest sample sizes and, when follow-ups are conducted, they are typically short. Results indicate that working with positive memories has the greatest impact on improving positive affect and reducing depressive symptoms, and that these effects are often temporary. This review serves as a quick reference guide to help professionals' access to descriptions and information on empirical evidence of positive memory techniques, improving their therapeutic arsenal to enhance well-being and therapeutic outcomes in their patients.

A Randomized Controlled Trial of Concentrated ERP, Self-Help and Waiting List for Obsessive- Compulsive Disorder: The Bergen 4-Day Treatment

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.

Current understanding of fear learning and memory in humans and animal models and the value of a linguistic approach for analyzing fear learning and memory in humans

Fear is an emotion that serves as a driving factor in how organisms move through the world. In this review, we discuss the current understandings of the subjective experience of fear and the related biological processes involved in fear learning and memory. We first provide an overview of fear learning and memory in humans and animal models, encompassing the neurocircuitry and molecular mechanisms, the influence of genetic and environmental factors, and how fear learning paradigms have contributed to treatments for fear-related disorders, such as posttraumatic stress disorder. Current treatments as well as novel strategies, such as targeting the perisynaptic environment and use of virtual reality, are addressed. We review research on the subjective experience of fear and the role of autobiographical memory in fear-related disorders. We also discuss the gaps in our understanding of fear learning and memory, and the degree of consensus in the field. Lastly, the development of linguistic tools for assessments and treatment of fear learning and memory disorders is discussed.

Autobiographical episodic memory-based training for the treatment of mood, anxiety and stress-related disorders: A systematic review and meta-analysis

We review evidence for training programmes that manipulate autobiographical processing in order to treat mood, anxiety, and stress-related disorders, using the GRADE criteria to judge evidence quality. We also position the current status of this research within the UK Medical Research Council's (2000, 2008) framework for the development of novel interventions. A literature search according to PRISMA guidelines identified 15 studies that compared an autobiographical episodic memory-based training (AET) programme to a control condition, in samples with a clinician-derived diagnosis. Identified AET programmes included Memory Specificity Training (Raes, Williams, & Hermans, 2009), concreteness training (Watkins, Baeyens, & Read, 2009), Competitive Memory Training (Korrelboom, van der Weele, Gjaltema, & Hoogstraten, 2009), imagery-based training of future autobiographical episodes (Blackwell & Holmes, 2010), and life review/reminiscence therapy (Arean et al., 1993). Cohen's d was calculated for between-group differences in symptom change from pre- to post-intervention and to follow-up. We also completed meta-analyses for programmes evaluated across multiple studies, and for the overall effect of AET as a treatment approach. Results demonstrated promising evidence for AET in the treatment of depression (d=0.32), however effect sizes varied substantially (from -0.18 to 1.91) across the different training protocols. Currently, research on AET for the treatment of anxiety and stress-related disorders is not yet at a stage to draw firm conclusions regarding efficacy as there were only a very small number of studies which met inclusion criteria. AET offers a potential avenue through which low-intensity treatment for affective disturbance might be offered.

A systematic review and meta-analysis of self-help therapeutic interventions for obsessive-compulsive disorder: Is therapeutic contact key to overall improvement?

BACKGROUND AND OBJECTIVES

The presence of obsessive-compulsive disorder (OCD) can result in low quality of life, with significant impairments in social and occupational functioning. An increase in the dissemination of self-help programs has been observed in the treatment of OCD, and has provided improved accessibility to treatment. The present study examined the efficacy of self-help interventions for OCD in the context of therapeutic contact.

METHODS

Randomised controlled trials and quasi-experimental studies were identified through computerised database searches. Self-help format (bibliotherapy, internet-based, computerised), and therapeutic contact were examined for their effect on treatment outcomes.

RESULTS

Eighteen studies targeting self-help for OCD met inclusion criteria with 1570 participants. The average post-treatment effect size (Hedges' g) of self-help interventions on primary outcomes was .51 (95% CI: .41 to 0.61). Subgroup analysis revealed large effect sizes for minimal-contact self-help (g = 0.91, 95% CI: 0.66 to 1.17), moderate effect sizes for predominantly self-help (g = 0.68, 95% CI: 0.40 to 0.96), and small effect sizes for self-administered self-help (g = 0.33, 95% CI: .18 to 0.47).

LIMITATIONS

A large variation of treatment approaches, amount of therapeutic contact, and risk of bias within each study may account for the large magnitude in effect sizes across studies. Additionally, the long-term follow-up effects of treatment approaches were not examined.

CONCLUSIONS

A growing body of literature supporting to the use of self-help treatments for OCD is evident, however, further investigation through use of randomised controlled trials is required, particularly the use of stepped care and long-term effectiveness.

Mindfulness and relaxation treatment reduce depressive symptoms in individuals with psychosis

Introduction

Self-help is increasingly accepted for the treatment of mental disorders, including psychosis, as both a provisional first step and a way to bridge the large treatment gap. Though mindfulness-based interventions do not belong to first line treatment strategies in psychosis and randomized controlled trials are lacking, encouraging preliminary findings speak for the usefulness of this approach. For the present study, we examined whether patients with psychosis benefit from mindfulness bibliotherapy.

Methods

A sample of 90 patients with psychosis (including a subsample with a verified diagnosis of schizophrenia) took part in the study via the Internet. Following baseline assessment, participants were randomized to either a mindfulness group or a Progressive Muscle Relaxation (PMR) control group and received the respective self-help manual including accompanying audio files. Symptom change was measured six weeks after the baseline assessment with self-rating scales including the Paranoia Checklist. The retention rate was 71%. The quality of the online dataset was confirmed by various strategies (e.g., psychosis lie scale; examination of response biases). The trial was registered at the ISRCTN registry (ISRCTN86762253).

Results

No changes across time or between groups were noted for the Paranoia Checklist. Both conditions showed a decline in depressive and obsessive-compulsive symptoms at a medium effect size (per protocol and intention to treat analyses).

Discussion/conclusion

The study provided partial support for the effectiveness of self-help mindfulness and PMR for depression in psychosis. Whether mindfulness delivered by a licensed therapist might lead to improved treatment adherence and a superior outcome relative to PMR remains to be established. The results underscore that bibliotherapy is a worthwhile approach to narrow the large treatment gap seen in psychosis.

Evaluation of Inference-Based Therapy (Doubt Therapy) as a Self-Help Tool for Obsessive-Compulsive Disorder

Introduction: Inference-based therapy (IBT) is a novel therapeutic approach aimed at reducing obsessive-compulsive symptoms. For this study, the original therapist-guided protocol was adapted for self-help administration. Method: Fifty patients with obsessive-compulsive disorder who had been recruited via specialized online fora were randomly allocated to either IBT or a wait-list control condition. At baseline and 4 weeks later, questionnaires tapping into psychopathology, quality of life, and faulty reasoning were administered. Results: The completion rate was acceptable (74%) and not significantly different across groups. Relative to controls, patients in the IBT group showed modest but significant symptom decline on obsessions (Yale-Brown Obsessive-Compulsive Scale [Y-BOCS] self-report and Obsessive–Compulsive Inventory—Revised [OCI-R]) and washing compulsions (OCI-R) across time. No significant differences emerged for depression, quality of life, and inferential confusion. Ratings at the post-assessment suggest that the training was well accepted among patients. Test–retest reliability was high indicating good quality of the data. Discussion: This study confirms prior research suggesting that IBT is effective as a stand-alone technique. Follow-up studies are needed to elucidate the long-term effects of the training and whether positive effects are maintained if IBT is introduced as an add-on to standard treatment (i.e., cognitive behavioral therapy/medication).