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Lisi DM, Hawley LL, McCabe RE, Rowa K, Cameron DH, Richter MA, Rector NA. Online versus in-person delivery of cognitive behaviour therapy for obsessive compulsive disorder: An examination of effectiveness. Clin Psychol Psychother 2023. [PMID: 37699581 DOI: 10.1002/cpp.2908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 06/13/2023] [Accepted: 08/28/2023] [Indexed: 09/14/2023]
Abstract
Cognitive behavioural therapy (CBT) including exposure and response prevention is the first-line psychological treatment for obsessive compulsive disorder (OCD). Given changes in the clinical landscape, there are increasing efforts to evaluate its effectiveness in online contexts. Mirroring the traditional in-person delivery, few studies have assessed the role of therapist-guided, manual-based CBT for OCD delivered in real-time via videoconferencing methods. The present study sought to fill this gap by comparing in-person and online delivery of group-based CBT for the treatment of OCD. A convenience sample of participants with moderate to severe OCD (n = 144) were recruited from a naturalistic database from two large OCD specialty assessment and treatment centres. Patients received group-based CBT that was provided in-person (pre-COVID-19 pandemic; March 2018 to March 2020) or online via videoconferencing (during the COVID-19 pandemic; March 2020 to April 2021). In both delivery methods, treatment consisted of 2-h weekly sessions led by trained clinicians. Analyses revealed that, regardless of treatment modality, both in-person and online groups demonstrated significant, reliable, and statistically equivalent improvements in OCD symptoms post-treatment. Videoconferenced, clinician-led CBT may be a promising alternative to in-person delivery for those with moderate to severe OCD symptoms.
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Affiliation(s)
- Diana M Lisi
- Frederick W. Thompson Anxiety Disorders Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Lance L Hawley
- Frederick W. Thompson Anxiety Disorders Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Randi E McCabe
- Anxiety Treatment and Research Clinic, St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
| | - Karen Rowa
- Anxiety Treatment and Research Clinic, St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
| | - Duncan H Cameron
- Anxiety Treatment and Research Clinic, St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada
| | - Margaret A Richter
- Frederick W. Thompson Anxiety Disorders Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Neil A Rector
- Frederick W. Thompson Anxiety Disorders Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
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Rector NA, Richter MA, Katz D, Leybman M. Does the addition of cognitive therapy to exposure and response prevention for obsessive compulsive disorder enhance clinical efficacy? A randomized controlled trial in a community setting. BRITISH JOURNAL OF CLINICAL PSYCHOLOGY 2018; 58:1-18. [DOI: 10.1111/bjc.12188] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Indexed: 11/26/2022]
Affiliation(s)
- Neil A. Rector
- Frederick W. Thompson Anxiety Disorders Centre; Sunnybrook Health Sciences Centre; Toronto Ontario Canada
- Department of Psychiatry; University of Toronto; Ontario Canada
| | - Margaret A. Richter
- Frederick W. Thompson Anxiety Disorders Centre; Sunnybrook Health Sciences Centre; Toronto Ontario Canada
- Department of Psychiatry; University of Toronto; Ontario Canada
| | - Danielle Katz
- Frederick W. Thompson Anxiety Disorders Centre; Sunnybrook Health Sciences Centre; Toronto Ontario Canada
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Pozza A, Dèttore D. Drop-out and efficacy of group versus individual cognitive behavioural therapy: What works best for Obsessive-Compulsive Disorder? A systematic review and meta-analysis of direct comparisons. Psychiatry Res 2017; 258:24-36. [PMID: 28982038 DOI: 10.1016/j.psychres.2017.09.056] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Revised: 07/18/2017] [Accepted: 09/23/2017] [Indexed: 11/16/2022]
Abstract
Cognitive behavioural therapy (CBT) is the first-line psychological treatment for Obsessive-Compulsive Disorder (OCD). However, a relevant proportion of individuals with OCD remain untreated or inadequately treated. Group cognitive behavioural therapy (GCBT) may be an alternative treatment modality. Little knowledge is available about the efficacy between GCBT versus individual CBT, particularly on long-term secondary outcomes including anxiety and depression. In addition, drop-out rates have not been investigated by previous meta-analyses. The current systematic review and meta-analysis summarized evidence comparing drop-out rates between GCBT and individual CBT and efficacy at post-treatment and follow-up on OCD symptoms, depression and anxiety. A systematic review and meta-analysis according to PRISMA guidelines was conducted. Online databases were searched. Studies were included if using randomized designs comparing GCBT versus individual CBT. Six studies were included (n = 327). No difference was found between GCBT and individual CBT on drop-out rates with a medium non-significant effect. No difference resulted at post-treatment on OCD symptoms, depression, and anxiety. Analyses on a smaller number of studies indicated no difference at follow-up. Findings provided preliminary evidence that GCBT can be as effective as individual CBT. Further trials are required with higher quality and long-term assessments of quality of life.
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Affiliation(s)
- Andrea Pozza
- Department of Experimental and Clinical Medicine, University of Florence, largo Brambilla 3, 50134 Florence, Italy.
| | - Davide Dèttore
- Department of Health Sciences, University of Florence, via di San Salvi 12, 50135 Florence, Italy
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Burlingame GM, Jensen JL. Small Group Process and Outcome Research Highlights: A 25-Year Perspective. Int J Group Psychother 2017; 67:S194-S218. [PMID: 38449275 DOI: 10.1080/00207284.2016.1218287] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
We summarize major research findings from the past 25 years within the larger evolution of group psychotherapy. Small group process findings are highlighted from a group-as-a-whole, interpersonal relation, subgroup, individual member characteristics, and leader perspective. Special emphasis is given to cohesion and the significant correlation between cohesion and outcome. We note that group therapy is an empirically well-supported treatment for a large number of psychiatric disorders and describe evidence supporting the outcome of various theoretical orientations. Key studies showing outcome equivalence for group and individual therapy are reviewed, followed by a high-level summary of group therapy's efficacy research for depression, bipolar, social phobia, panic disorder, obsessive compulsive, bulimia nervosa, binge-eating, substance-related, trauma-related, HIV/AIDS, breast cancer, chronic pain, schizophrenia, and borderline personality. We conclude with the promise of recent advances for moving the field forward over the next 25 years.
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Morgiève M, N'Diaye K, Haynes WIA, Granger B, Clair AH, Pelissolo A, Mallet L. Dynamics of psychotherapy-related cerebral haemodynamic changes in obsessive compulsive disorder using a personalized exposure task in functional magnetic resonance imaging. Psychol Med 2014; 44:1461-1473. [PMID: 24001313 DOI: 10.1017/s0033291713002237] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
BACKGROUND Cognitive behavioural therapy (CBT) is a successful treatment of obsessive compulsive disorder (OCD). It is known to induce changes in cerebral metabolism; however, the dynamics of these changes and their relation to clinical change remain largely unknown, precluding the identification of individualized response biomarkers. METHOD In order to study the dynamics of treatment response, we performed systematic clinical and functional magnetic resonance imaging (fMRI) evaluation of 35 OCD patients immediately before a 3-month course of CBT, halfway through and at its end, as well as 6 months after. To sensitize fMRI probing, we used an original exposure task using neutral, generic and personalized obsession-inducing images. RESULTS As expected, CBT produced a significant improvement in OCD. This improvement was continuous over the course of the therapy; therefore, outcome could be predicted by response at mid-therapy (r 2 = 0.67, p < 0.001). Haemodynamic response to the task was located in the anterior cingulate and orbitofrontal cortices and was stronger during exposure to personalized obsession-inducing images. In addition, both the anxiety ratings and the haemodynamic response to the obsession-inducing images in the anterior cingulate and the left but not the right orbitofrontal clusters decreased with symptom improvement. Interestingly, haemodynamic activity continued to decrease after stabilization of clinical symptoms. CONCLUSIONS Using an innovative and highly sensitive exposure paradigm in fMRI, we showed that clinical and haemodynamic phenotypes have similar time courses during CBT. Our results, which suggest that the initial CBT sessions are crucial, prompt us to investigate the anatomo-functional modifications underlying the very first weeks of the therapy.
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Affiliation(s)
- M Morgiève
- Behaviour, Emotion, and Basal Ganglia Team, CNRS UMR 7225, Inserm UMRS 975, Université Pierre et Marie Curie (UPMC), ICM (Brain and Spine Institute), CHU Pitié-Salpêtrière, Paris, France
| | - K N'Diaye
- Behaviour, Emotion, and Basal Ganglia Team, CNRS UMR 7225, Inserm UMRS 975, Université Pierre et Marie Curie (UPMC), ICM (Brain and Spine Institute), CHU Pitié-Salpêtrière, Paris, France
| | - W I A Haynes
- Behaviour, Emotion, and Basal Ganglia Team, CNRS UMR 7225, Inserm UMRS 975, Université Pierre et Marie Curie (UPMC), ICM (Brain and Spine Institute), CHU Pitié-Salpêtrière, Paris, France
| | - B Granger
- Département de Santé Publique, de Biostatistiques et d'Information Médicale (bioSPIM), CHU Pitié-Salpêtrière, Paris, France
| | - A-H Clair
- Behaviour, Emotion, and Basal Ganglia Team, CNRS UMR 7225, Inserm UMRS 975, Université Pierre et Marie Curie (UPMC), ICM (Brain and Spine Institute), CHU Pitié-Salpêtrière, Paris, France
| | | | - L Mallet
- Behaviour, Emotion, and Basal Ganglia Team, CNRS UMR 7225, Inserm UMRS 975, Université Pierre et Marie Curie (UPMC), ICM (Brain and Spine Institute), CHU Pitié-Salpêtrière, Paris, France
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PONNIAH K, MAGIATI I, HOLLON SD. An update on the efficacy of psychological therapies in the treatment of obsessive-compulsive disorder in adults. J Obsessive Compuls Relat Disord 2013; 2:207-218. [PMID: 23888284 PMCID: PMC3718079 DOI: 10.1016/j.jocrd.2013.02.005] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
We conducted a review to provide an update on the efficacy of psychological treatments for OCD in general and with regard to specific symptom presentations. The PubMed and PsycINFO databases were searched for randomized controlled trials (RCTs) published up to mid February 2012. Forty-five such studies were identified. Exposure and response prevention (ERP) and cognitive-behavioral therapy (CBT) were found to be efficacious and specific for OCD. More purely cognitive interventions that did not include ERP or behavioral experiments were found to be possibly efficacious, as were Acceptance and Commitment Therapy, Motivational Interviewing as an adjunct to the established treatments, Eye Movement Desensitization and Reprocessing, and Satiation Therapy. There was little support for Stress Management or Psychodynamic Therapy. Although the majority of the studies recruited mixed or unspecified samples of patients and did not test for moderation, CBT was efficacious for obsessional patients who lacked overt rituals. One more purely cognitive intervention named Danger Ideation Reduction Therapy was found to be possibly efficacious for patients with contamination obsessions and washing compulsions. Although ERP and CBT are the best established psychological treatments for OCD, further research is needed to help elucidate which treatments are most effective for different OCD presentations.
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Affiliation(s)
- Kathryn PONNIAH
- Department of Psychology, National University of Singapore, Singapore
| | - Iliana MAGIATI
- Department of Psychology, National University of Singapore, Singapore
| | - Steven D. HOLLON
- Department of Psychology, Vanderbilt University, Nashville, Tennessee
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Evaluation of an adapted cognitive behavioural therapy (CBT) group programme for people with obsessive compulsive disorder: a case study. COGNITIVE BEHAVIOUR THERAPIST 2012. [DOI: 10.1017/s1754470x13000020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractDespite a strong evidence base for cognitive behavioural therapy (CBT) for obsessive compulsive disorder (OCD), there is limited evidence regarding the effectiveness of group therapy compared to individual therapy. As services struggle to manage high demands, CBT for OCD is often offered in group format. This paper examines the current evidence base for group CBT for OCD considering both clinical outcomes and cost, and describes a group CBT intervention for people with OCD. A CBT group was set up, consistent with NICE guidelines, but slightly adapted from standard group protocols, in line with recommendations from experts in the field. It was evaluated as part of an audit of the service. Statistical analyses demonstrated significant improvements in both measures of depression and the impact of difficulties, and on specific measures of OCD, in clients who attended group CBT (n = 17). The analyses also demonstrated improved effectiveness of therapist hours for group therapy compared to individual therapy. It is concluded that group therapy for OCD should be considered as an alternative to individual therapy when there are significant demands on the service. Recommendations regarding specific adaptations to the standard group CBT format are made.
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Walsh KH, McDougle CJ. Psychotherapy and medication management strategies for obsessive-compulsive disorder. Neuropsychiatr Dis Treat 2011; 7:485-94. [PMID: 21931490 PMCID: PMC3173031 DOI: 10.2147/ndt.s13205] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Obsessive-compulsive disorder (OCD) is a chronic anxiety disorder. While medication and psychotherapy advances have been very helpful to patients, many patients do not respond adequately to initial trials of serotonergic medication or cognitive-behavioral therapy (CBT) and require multiple treatment trials or combination therapies. Comorbidity may also influence treatment response. The role of streptococcal infections in pediatric OCD has become an area of intense scrutiny and controversy. In this article, current treatment methods for OCD will be reviewed, with special attention to strategies for treating OCD in children and in patients with comorbid tic disorders. Alternative psychotherapy strategies for patients who are highly anxious about starting CBT, such as cognitive therapy or augmentation with D-cycloserine, will be reviewed. Newer issues regarding use of antibiotics, neuroleptics, and glutamate modulators in OCD treatment will also be explored.
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Affiliation(s)
- Kelda H Walsh
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN, USA
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Belloch A, Cabedo E, Carrió C, Fernández-Alvarez H, García F, Larsson C. Group versus individual cognitive treatment for Obsessive-Compulsive Disorder: changes in non-OCD symptoms and cognitions at post-treatment and one-year follow-up. Psychiatry Res 2011; 187:174-9. [PMID: 21075455 DOI: 10.1016/j.psychres.2010.10.015] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2010] [Revised: 08/05/2010] [Accepted: 10/19/2010] [Indexed: 11/24/2022]
Abstract
Current cognitive approaches postulate that obsessions and compulsions are caused and/or maintained by misinterpretations about their meaning. This assumption has led to the development of cognitive therapeutic (CT) procedures designed to challenge the dysfunctional appraisals and beliefs patients have about their obsessions. Nonetheless, few studies have compared the efficacy of individual and group CT in changing the dysfunctional cognitions that hypothetically underlie Obsessive-Compulsive Disorder (OCD). In this study, 44 OCD patients were assigned to individual (n=18) or group (n=24) CT. Sixteen completed the individual CT, and 22 completed the group CT. The effects of the two CT conditions on depression and worry tendencies were comparable. Individual treatment was more effective than group treatment in decreasing scores on dysfunctional beliefs (responsibility, overestimation of threat, and intolerance to uncertainty) and the use of suppression as a thought control strategy. The post-treatment changes were maintained one year later. The correlations between symptom improvement (OCD severity change) and belief changes were moderate: in the individual treatment the greatest associations were with beliefs about thoughts (importance and control), whereas in the group treatment the greatest associations were with beliefs related to anxiety in general (threat overestimation and intolerance to uncertainty).
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Affiliation(s)
- Amparo Belloch
- Departmento de Psicologia de la Personalidad, Universidad de Valencia, Valencia, Spain.
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Jimenez-Murcia S, Aymamí N, Gómez-Peña M, Santamaría JJ, Alvarez-Moya E, Fernández-Aranda F, Granero R, Penelo E, Bueno B, Moragas L, Gunnard K, Menchón JM. Does exposure and response prevention improve the results of group cognitive-behavioural therapy for male slot machine pathological gamblers? BRITISH JOURNAL OF CLINICAL PSYCHOLOGY 2011; 51:54-71. [PMID: 22268541 DOI: 10.1111/j.2044-8260.2011.02012.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Cognitive-behavioural therapy (CBT) seems to offer effective treatment for pathological gambling (PG). However, it has not yet been established which techniques yield the best results, or whether exposure and response prevention (ERP) techniques are of additional use. OBJECTIVES To evaluate clinical and socio-demographic characteristics of a PG sample at baseline, comparing cognitive-behavioural group intervention, with and without exposure, with response prevention (CBT + ERP vs. CBT), to compare the results of therapy and to assess pre-post changes in psychopathology between both groups. DESIGN We applied a quasi-experimental design comprising intervention on the independent variable, but without random assignment. METHODS The sample comprised 502 males with PG, consecutively admitted to a specialist unit, who received standardized outpatient CBT group therapy in 16 weekly sessions. Scores on the Symptom Checklist-Revised (SCL-90-R), the Temperament and Character Inventory-Revised (TCI-R), the South Oaks Gambling Screen (SOGS), and other clinical and psychopathological scales were recorded. RESULTS Pre-post changes did not differ between groups, except for SCL paranoid ideation, being greater in the CBT therapy group. The risk of relapse during treatment was similar in the CBT + ERP and CBT patients. However, compliance with treatment was poorer in the CBT + ERP group, who presented higher drop-out rates during treatment. Drop-out during therapy was associated with shorter disorder duration and higher scores on the TCI-R novelty seeking scale. CONCLUSIONS Although the two CBT programs elicited similar therapy responses, patients receiving CBT alone showed higher adherence to therapy and lower drop-out rates.
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Jónsson H, Hougaard E, Bennedsen BE. Randomized comparative study of group versus individual cognitive behavioural therapy for obsessive compulsive disorder. Acta Psychiatr Scand 2011; 123:387-97. [PMID: 20946200 DOI: 10.1111/j.1600-0447.2010.01613.x] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE The primary aim of the study was to compare the effectiveness of group and individual cognitive behaviour therapy (CBT) for obsessive compulsive disorder (OCD). METHOD One hundred and ten out-patients with OCD were randomly assigned to 15 sessions of either group CBT or individual CBT. Outcome measures were administered before and after treatment, as well as at 6- and 12-month follow-ups. The study was supplemented by a meta-analysis of accomplished comparative studies of group vs. individual CBT for OCD. RESULTS Large and stable pre-post effect sizes were found for both treatment conditions in the study (d = 1.06-1.24 on the Yale-Brown Obsessive Compulsive Scale). There were no significant between-group differences in outcome at any data point (ds= -0.13 to 0.15). The meta-analysis of four accomplished comparative studies (including the present one) found a between-group mean effect size of (d= 0.15 favouring individual over group CBT at posttreatment (95% confidence interval, -0.12, 0.42). CONCLUSION The results of this study suggest that OCD can be treated effectively with a group format of CBT, thus sparing some therapist resources, although the four accomplished comparative studies do not rule out the possibility of a small superiority of individually conducted CBT.
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Affiliation(s)
- H Jónsson
- Department of Psychology, Aarhus University, Aarhus Clinic for Obsessive Compulsive Disorder, Aarhus University Hospital, Denmark.
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Group versus individual cognitive treatment for Obsessive-Compulsive Disorder: changes in non-OCD symptoms and cognitions at post-treatment and one-year follow-up. Behav Cogn Psychother 2010; 38:227-32. [PMID: 21075455 DOI: 10.1017/s135246580999066x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Current cognitive approaches postulate that obsessions and compulsions are caused and/or maintained by misinterpretations about their meaning. This assumption has led to the development of cognitive therapeutic (CT) procedures designed to challenge the dysfunctional appraisals and beliefs patients have about their obsessions. Nonetheless, few studies have compared the efficacy of individual and group CT in changing the dysfunctional cognitions that hypothetically underlie Obsessive-Compulsive Disorder (OCD). In this study, 44 OCD patients were assigned to individual (n=18) or group (n=24) CT. Sixteen completed the individual CT, and 22 completed the group CT. The effects of the two CT conditions on depression and worry tendencies were comparable. Individual treatment was more effective than group treatment in decreasing scores on dysfunctional beliefs (responsibility, overestimation of threat, and intolerance to uncertainty) and the use of suppression as a thought control strategy. The post-treatment changes were maintained one year later. The correlations between symptom improvement (OCD severity change) and belief changes were moderate: in the individual treatment the greatest associations were with beliefs about thoughts (importance and control), whereas in the group treatment the greatest associations were with beliefs related to anxiety in general (threat overestimation and intolerance to uncertainty).
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Håland ÅT, Vogel PA, Lie B, Launes G, Pripp AH, Himle JA. Behavioural group therapy for obsessive–compulsive disorder in Norway. An open community-based trial. Behav Res Ther 2010; 48:547-54. [DOI: 10.1016/j.brat.2010.03.005] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2009] [Revised: 03/01/2010] [Accepted: 03/08/2010] [Indexed: 11/25/2022]
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